A Genetically Informed Study of the Covariation Between Childhood Anxiety Dimensions and Social Competence

We investigated the nature of latent shared etiological elements in 398 Italian twin pairs aged 8–17, explaining covariation between high levels of anxiety symptoms and low social competence. We found significant negative correlations between Child Behaviour Checklist/6–18 Social Competence Scale and three (Panic Anxiety, Separation Anxiety, Social Anxiety) out of five Screen for Child Anxiety Related Disorders anxiety subscales. Results from causal analysis seem to exclude the hypothesis that co-occurrence between Anxiety Symptoms and Social Competence could be due to a direct phenotypic effect of one trait upon the other. Multivariate analysis suggested that both genetic and shared environmental components contribute to the phenotypic correlation between Social Competence and Anxiety Subscales, whereas unique environmental factors have a negligible influence. This means that both common genetic and shared environmental causal factors contribute simultaneously to increase risk of having low Social Competence and high Anxiety scores. In particular, covariation with Social Competence seems to be influenced by both genetic and shared environmental causal components in Separation Anxiety and Social Anxiety, whereas environmental factors have an irrelevant influence for covariation with Panic/Somatic Anxiety Subscale. Our results support the adoption of a broader view of the relationships between psychopathology and diminished social competences in childhood for both clinicians and educators.     

Discriminant validity of the Social Phobia and Anxiety Inventory (SPAI), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS)

Three measures commonly used in assessment of social phobia, the Social Phobia and Anxiety Inventory (SPAI [Turner, S. M., Beidel, D. C. & Dancu, C. V. (1996). Social phobia and anxiety inventory: manual. Toronto, Ont.: Multi-Health Systems Inc.), the Social Phobia Scale (SPS [Mattick, R. P. & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470] and the Social Interaction Anxiety Scale (SIAS [Mattick, R. P. & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470], were compared for their ability to discriminate between social phobia and other anxiety disorders (panic disorder with or without agoraphobia). Participants were 117 patients attending a specialized anxiety disorders unit for treatment. While all three measures were able to detect differences between social phobic patients and patients with panic disorder with or without agoraphobia, a logistic regression analysis showed that the SPAI, but not the SPS and SIAS, was a significant predictor of membership of the social phobia group. Receiver operating characteristic (ROC) analysis also showed that the SPAI was the better measure for discriminating between social phobia and panic disorder with and without agoraphobia. Analysis of the sensitivity, specificity and positive and negative predictive power of the measures at the optimum cutoff scores produced by the ROC analysis are presented.     

An Assessment of Social Phobia and Social Anxiety and their Relation to Self-Consciousness

Abstract

The translation of the Social Phobia and Anxiety Inventory (SPAI) into Icelandic was submitted to a psychometric assessment. Two hundred sixty-three university students participated in the study. In addition to the SPAI they filled in Fenigstein, Scheier and Buss' (1975) Self-Consciousness Scale (SCS) as well as Spielberger's (1983) State-Trait Anxiety Inventory (STAI). A principal components analysis of the SPAI yielded as expected an agoraphobia and a social phobia factor. As expected the Social Anxiety Scale of the SCS correlated much more strongly with the Social Phobia than the Agoraphobia Scale. The correlation of the Social Phobia Scale with the Social Anxiety Scale was substantially higher than its correlation with any other anxiety measure. The relationships between the Social Phobia Scale and Public versus Private Self-Consciousness were moreover in accordance with theoretical expectations as well as prior research. Generally the discriminant and convergent validity of the Icelandic translation of the Social Phobia Scale as a measure of social anxiety is supported.     

Perfectionism and Interpersonal Sensitivity in Social Phobia: The Interpersonal Aspects of Perfectionism

We examined perfectionism, interpersonal sensitivity and dysfunctional cognitions in patients with Social Phobia (SP). The sample consisted of a clinical group with a diagnosis of SP (n?=?30) and a non clinical group (n?=?30), matched for age and gender. Both groups were assessed on Frost??s Multidimensional Perfectionism Scale (FMPS), Interpersonal Sensitivity Measure (IPSM), and Dysfunctional Attitudes Scale (DAS). The clinical sample was also assessed on Liebowitz Social Anxiety Scale (LSAS), Beck??s Depression Inventory-II, Eysenck??s Personality Inventory-Neuroticism sub-scale (EPI- N). The two groups were compared on FMPS, IPSM and DAS using t-test. Associations between FMPS, IPSM, DAS and predictors of social anxiety and depression were examined. The clinical group scored higher on perfectionism, interpersonal sensitivity and dysfunctional cognitions. There was no significant association between total scores on FMPS and IPSM. However subscales of IPSM and FMPS were correlated. Doubt about Actions was associated with Separation Anxiety (r?=?0.520) and Timidity (r?=?0.407). Organization was related to Interpersonal Awareness (r?=?0.371) and Separation Anxiety (r?=?0.407). Parental criticism was negatively associated with fragile inner self. DAS was positively correlated with FMPS and IPSM. Interpersonal sensitivity emerged as a significant predictor of social anxiety. Discriminant Functional Analysis indicated that concern over mistakes, organization, fragile inner self, separation anxiety discriminated between the clinical and non-clinical groups.     

Associations of symptoms of anxiety disorders and self-reported behavior problems in normal children

61 children, aged between 14 and 18 years, completed the Screen for Child Anxiety Related Emotional Disorders, a scale of anxiety disorders symptoms, and the Youth Self-report, a measure of internalizing, i.e., emotional, and externalizing, i.e., behavioral, problems. Analysis showed that, with the exception of the Social Phobia and the Specific Phobia subscales, Screen total and subscale scores were significantly related to Internalizing problems (rs between .40 and .77). Thus, the more frequently children reported Anxiety Disorder symptoms, the more often they reported emotional problems. Furthermore, in particular, anxious-depressed problems as measured by the Youth Self-report were significantly associated with scores on Screen scales. These results further support the concurrent validity of the Screen.     

Concurrent validity of the Social Phobia and Anxiety Inventory

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument designed to assess symptoms of social phobia. Although the scale has been shown to have a good test-retest reliability, internal consistency, and construct validity, no studies have examined its concurrent validity with respect to other measures of social anxiety and avoidance. In the present study, the relationship between the SPAI and several self-report measures of social anxiety was examined in a sample of 23 patients meeting DSM-III-R criteria for social phobia. The relationship between the SPAI and other measures of psychopathology, as well as performance during a role play test and an impromptu speech, was also examined. The results strongly support the concurrent validity and the specificity of the SPAI. The Social Phobia subscale may be a better index of social anxiety symptoms than the Difference subscale.This research was supported, in part, by NIMH grants MH 38636 and MH 41577 to the second author.     

Psychometric properties of the Social Phobia and Anxiety Inventory for Children in a Spanish sample

The objectives of the present study were to adapt and analyze the factor structure, reliability, and validity of the Social Phobia and Anxiety Inventory for Children (SPAI-C; Beidel, Turner, & Morris, 1995) in a Spanish population. The SPAI-C was applied to a sample of 1588 children and adolescents with ages ranging from 10 to 17 years. The confirmatory factor analysis (CFA) showed a four-factor structure: Public performance, Assertiveness, Fear and avoidance/escape in social encounters, and Cognitive and psychophysiological interferences. Internal consistency was high (.90) and test-retest reliability was moderate (.56). Significant differences were found in the variables sex and age, although the effect size was small in both variables and their interaction. Overall, the increase of the age value was inversely proportional to that of social anxiety measured with the SPAI-C; in participants of the same age, values were higher for girls than for boys. Results suggest that the Social Phobia and Anxiety Inventory For Children is a valid and reliable instrument to assess social anxiety in Spanish children and adolescents.     

Personality Dimensions as Common and Broadband-Specific Features for Internalizing and Externalizing Disorders

Several researchers have suggested that the nature of the covariation between internalizing and externalizing disorders may be understood better by examining the associations between temperament or personality and these disorders. The present study examined neuroticism as a potential common feature underlying both internalizing and externalizing disorders and novelty seeking as a potential broad-band specific feature influencing externalizing disorders alone. Participants were 12- to 18-year-old twin pairs (635 monozygotic twin pairs and 691 dizygotic twin pairs; 48 % male and 52 % female) recruited from the Colorado Center for Antisocial Drug Dependence. Genetic and nonshared environmental influences shared in common with neuroticism influenced the covariation among distinct internalizing disorders, the covariation among distinct externalizing disorders, and the covariation between internalizing and externalizing disorders. Genetic influences shared in common with novelty seeking influenced the covariation among externalizing disorders and the covariation between major depressive disorder and externalizing disorders, but not the covariation among internalizing disorders or between anxiety disorders and externalizing disorders. Also, after accounting for genetic and environmental influences shared in common with neuroticism and novelty seeking, there were no significant common genetic or environmental influences among the disorders examined, suggesting that the covariance among the disorders is sufficiently explained by neuroticism and novelty seeking. We conclude that neuroticism is a heritable common feature of both internalizing disorders and externalizing disorders, and that novelty seeking is a heritable broad-band specific factor that distinguishes anxiety disorders from externalizing disorders.     

A psychometric reanalysis of the Albany Panic and Phobia Questionnaire

The psychometric properties of the 27-item Albany Panic and Phobia Questionnaire (APPQ) were evaluated in 1930 outpatients with DSM-IV anxiety and mood disorders. Although prior findings of a 3-factor latent structure were upheld in several replications (Social Phobia, Agoraphobia, Interoceptive), three items failed to load on their predicted factor (Interoceptive). Multiple-groups CFAs indicated that the measurement properties of the APPQ were invariant in male and female patients, with the exception of an intercept of one item from the Agoraphobia scale which evidenced bias against females. The three APPQ dimensions were consistently associated with high levels of scale reliability and factor determinacy. Strong evidence of concurrent validity of the Social Phobia and Agoraphobia factors was obtained in relation to interview and questionnaire measures. Although the Interoceptive factor was more strongly related to criterion measures of anxiety sensitivity and fear of panic than Social Phobia, the Agoraphobia factor had the strongest relationships with these validity indices. The results are discussed in regard to psychometric implications for the APPQ and conceptual issues pertaining to the discriminant validity of fear of agoraphobic situations and fear of sensation-producing activities.     

Structure and Etiology of Co-occurring Internalizing and Externalizing Disorders in Adolescents

Several studies suggest that a two-factor model positing internalizing and externalizing factors explains the interrelationships among psychiatric disorders. However, it is unclear whether the covariation between internalizing and externalizing disorders is due to common genetic or environmental influences. We examined whether a model positing two latent factors, internalizing and externalizing, explained the interrelationships among six psychiatric disorders (major depressive disorder, generalized anxiety disorder, separation anxiety disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) in adolescents, and whether there are common genetic and environmental influences on internalizing and externalizing latent factors. Multivariate behavior genetic analyses of data from 1162 twin pairs and 426 siblings ascertained from the general population via the Colorado Center for Antisocial Drug Dependence (CADD) were conducted. We found support for a model positing two latent factors (internalizing and externalizing). These factors were moderately heritable and influenced by significant common genetic and nonshared environmental influences. These findings suggest that co-occurrence of internalizing and externalizing psychopathology in adolescents results from both genetic and environmental influences.     

Stable Genetic Influence on Anxiety-Related Behaviours Across Middle Childhood

We examined the aetiology of anxiety symptoms in an unselected population at ages 7 and 9, a period during which anxiety disorders first begin to develop (mean age at onset is 11 years). Specifically, the aim of the study was to investigate genetic and environmental continuity and change in components of anxiety in middle childhood. Parents of over 3,500 twin pairs completed the Anxiety-Related Behaviours Questionnaire (ARBQ) when twins were 7 and 9 years old. Multivariate-longitudinal analyses were conducted to examine genetic and environmental influences on stability and change in four anxiety scales: Negative Cognition, Negative Affect, Fear and Social Anxiety. We found moderate temporal stability in all four scales from 7 to 9 years (correlations ranging from 0.45 to 0.54) and moderate heritability (average 54%). Both shared and non-shared environmental influences were modest (average 18%–28% respectively). Genetic factors (68%) explained most of the homotypic continuity in anxiety. We show that homotypic continuity of Anxiety-Related Behaviours (i.e. the continuation of one specific type of anxiety over time) was largely driven by genetic factors. In contrast, though more varied, heterotypic continuity between some traits (i.e. the change from one type of anxiety-related behaviour into another over time) was mainly due to shared-environmental factors.     

A Psychometric Analysis of the Revised Child Anxiety and Depression Scale—Parent Version in a Clinical Sample

The Revised Child Anxiety and Depression Scale—Parent Version (RCADS-P) is a 47-item parent-report questionnaire of youth anxiety and depression, with scales corresponding to the DSM-IV categories of Separation Anxiety Disorder, Social Phobia, Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive-Compulsive Disorder, and Major Depressive Disorder (MDD). The RCADS-P is currently the only parent-report questionnaire that concurrently assesses youth symptomatology of individual anxiety disorders as well as depression in accordance with DSM-IV nosology. The present study examined the psychometric properties of the RCADS-P in a large (N = 490), clinic-referred sample of youths. The RCADS-P demonstrated favorable psychometric properties, including high internal consistency, convergent/divergent validity, as well as strong discriminant validity—evidencing an ability to discriminate between anxiety and depressive disorders, as well as between the targeted anxiety disorders. Support for the DSM-related six-factor RCADS-P structure was also evidenced. This structure demonstrated superior fit to a recently suggested alternative to the DSM-IV classification of anxiety and affective disorders—namely, the MDD/GAD “distress” factor.     

What Causes Internalising Traits and Autistic Traits to Co-occur in Adolescence? A Community-Based Twin Study

Autism shows a high degree of comorbidity with anxiety disorders. Adolescence is a time of increased stress and vulnerability to internalising problems. This study addresses for the first time the degree of genetic and environmental overlap between autistic traits (total measure and subscales) and internalising traits in a community-based adolescent twin sample. Parents of 12-14-year-old twins (N?=?3,232 pairs; 3,460 males, 3,004 females) reported on the twins’ internalising and autistic traits. Autistic trait subscales were created using principal component analysis. Bivariate twin model-fitting was conducted. Autistic and internalising traits correlated moderately (r?=?0.30). Genetic influences on individual traits were substantial but genetic overlap between traits was moderate (genetic correlation: males?=?0.30, females?=?0.12). Shared environmental influences were low for internalising traits and moderate for autistic traits, and showed considerable overlap (shared environmental correlation: males?=?0.53, females?=?1). Nonshared environmental influences were moderate for internalising traits and low for autistic traits and showed low overlap. A multiple component solution was found for autistic traits and of the derived subscales, autistic-like ‘Social Unease’ showed the most phenotypic and genetic overlap with internalising traits.     

A Cross-Cultural Comparison of Social Phobia Symptoms

This study examined two forms of social anxiety or phobia, social phobia as defined by DSM-IV and Taijin Kyofusho (TKS, a Japanese form of social anxiety), in relation to their respective culturally prescribed self-construals as independent and interdependent. Japanese university students (N = 124) and U.S. university students (N = 123) were administered the Social Interaction Anxiety Scale, the Social Phobia Scale, the TKS Scale, and the Self-Construal Scale. From the results of a hierarchical regression analysis, TKS symptoms are more likely to be expressed by individuals who are Japanese and individuals who construe themselves low on independence but high on interdependence. In addition, social phobia symptoms are more likely to be expressed by individuals who construe themselves low on independence but high on interdependence irrespective of culture. Implications for therapists from each culture who have clients who present social anxiety or phobia symptoms are discussed.     

Effectiveness of cognitive behavioural group therapy for social phobia in a community clinic: a benchmarking study

This study used a benchmarking strategy to investigate the transportability of cognitive behavioural group therapy (CBGT) for social phobia to a community mental health clinic. The influence of common exclusion criteria on effect sizes was also examined. Patients (N=153) attended seven 4-h sessions of CBGT, which resulted in significant reductions in symptoms of social anxiety and depression. Effect sizes compared favourably to previous efficacy and effectiveness studies of both group and individual treatment. More than half of the treatment completers achieved reliable change. One-third achieved clinically significant change (CSC) on the Social Phobia Scale and the Beck Depression Inventory, but fewer achieved CSC on the Social Interaction and Anxiety Scale. Restricting the sample on the basis of depression symptoms, age above or below 50 years, comorbidity, alcohol problems, or student status did not significantly moderate effect sizes for social anxiety. It is concluded that CBGT is effective within community mental health clinics.     

Validity of the social avoidance and distress and fear of negative evaluation scales

The Social Avoidance and Distress Scale (SAD) and the Fear of Negative Evaluation Scale (FNE), two commonly accepted measures of social anxiety, were administered to a large group of patients diagnosed as having Agoraphobia with Panic Attacks, Agoraphobia without Panic Attacks, Social Phobia, Simple Phobia, Generalized Anxiety Disorder, Panic Disorder and Obsessive-Compulsive Disorder. On the SAD and FNE, social phobies did not differ significantly from the other major anxiety disorders, with the exception of simple phobies. Performance on the SAD and FNE was significantly correlated with measures of anxiety, depression and general emotional distress. The lack of discriminative validity of the SAD and FNE is discussed.     

Psychometric Properties of the Social Phobia and Anxiety Inventory, the Social Anxiety Scale for Adolescents, the Fear of Negative Evaluation Scale, and the Social Avoidance and Distress Scale in an Adolescent Spanish-Speaking Sample

The relationship among several social anxiety measures and a semistructured interview in an adolescent Spanish-speaking sample is examined. Construct validity and test-retest reliability were tested. A principal axis factor analysis was also explored. Results revealed good construct validity and alpha coefficients for the assessment instruments such as the Social Phobia and Anxiety Inventory (SPAI), the Social Anxiety Scale for Adolescents (SAS-A), the Fear of Negative Evaluation Scale (FNES) and the Social Avoidance Distress Scale (SADS). Among these, data strongly support the validity of the Social Phobia and Difference measures of the SPAI and Total SAS-A score as assessment measures in the adolescent population even in non-American cultures and languages. Furthermore, results appear to support the presence of a single higher-order dimension, social anxiety, as measured by the instruments used in this study.     

Understanding the Covariation Among Childhood Externalizing Symptoms: Genetic and Environmental Influences on Conduct Disorder,Attention Deficit Hyperactivity Disorder,and Oppositional Defiant Disorder Symptoms

Conduct disorder (CD), attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are common childhood externalizing disorders that frequently co-occur. However, the causes of their comorbidity are not well understood. To address that question, we analyzed data from > 600 Finnish twin pairs, who completed standardized interviews at age 14. Behavior genetic methods were used to examine how genetic/environmental factors contribute to each disorders symptoms and to their covariation. We found significant genetic effects on each disorder with only modest evidence of shared environmental influences. Our data suggest the comorbidity among CD, ADHD, and ODD is primarily explained by shared genetic influences; however, each disorder was also under unique genetic influence, supporting the distinction of each disorder.     

Short forms of the Social Interaction Anxiety Scale and the Social Phobia Scale

Mattick and Clarke's (1998) Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) are commonly used self-report measures that assess 2 dimensions of social anxiety. Given the need for short, readable measures, this research proposes short forms of both scales. Item-level analyses of readability characteristics of the SIAS and SPS items led to the selection of 6 items from each scale for use in the short forms. The SIAS and SPS short forms had reading levels at approximately the 6th and 5th grade level, respectively. Results using nonclinical (Study 1: N = 469) and clinical (Study 2: N = 145) samples identified these short forms as being factorially sound, possessing adequate internal consistency, and having strong convergence with their full-length counterparts. Moreover, these short forms showed convergence with other measures of social anxiety, showed divergence from measures assessing related constructs, and predicted concurrent interpersonal functioning. Recommendations for the use of these short forms are discussed.     

The social phobia and anxiety inventory: psychometric properties in a Spanish sample

This study is a validation of the Spanish version of the Social Phobia and Anxiety Inventory using a nonclinical sample (198 participants) and a clinical sample (72 participants with social phobia). The factor structure and concurrent validity with Fear of Negative Evaluation and Social Avoidance and Distress scales were analyzed. The Social Phobia and Anxiety Inventory demonstrated good concurrent validity, showing statistically significant relationships with Fear of Negative Evaluation and Social Avoidance and Distress. Results confirmed the rationale for the division of the SPAI into two subscales. Results also demonstrated the utility of the Social Phobia and Anxiety Inventory for differentiating between a nonclinical sample and participants with a social phobia, and its adequate reliability.