Social Anxiety Among Adolescents: Linkages with Peer Relations and Friendships

This study examined the utility of modifying the Social Anxiety Scale for Children—Revised (SASC-R) for use with adolescents, and examined associations between adolescents' social anxiety (SA) and their peer relations, friendships, and social functioning. Boys (n = 101) and girls (n = 149) in the 10th through 12th grades completed the Social Anxiety Scale for Adolescents (SAS-A) and measures of social support, perceived competence, and number and quality of their best friendships. Factor analysis of the SAS-A confirmed a three-factor structure: Fear of Negative Evaluation, Social Avoidance and Distress in General, and Social Avoidance Specific to New Situations or Unfamiliar Peers. Girls reported more SA than boys, and SA was more strongly linked to girls' social functioning than boys'. Specifically, adolescents with higher levels of SA reported poorer social functioning (less support from classmates, less social acceptance), and girls with higher levels of SA reported fewer friendships, and less intimacy, companionship, and support in their close friendships. These findings extend work on the SASC-R to adolescents, and suggest the importance of SA for understanding the social functioning and close friendships of adolescents, especially girls.     

Assessing Peer-Related Impairments Linked to Adolescent Social Anxiety: Strategic Selection of Informants Optimizes Prediction of Clinically Relevant Domains

Socially anxious adolescents commonly experience impaired interpersonal functioning with unfamiliar, same-age peers. Yet, we lack short screening tools for assessing peer-related impairments. Recent work revealed that a parent-reported, three-item screening tool produced scores that uniquely related to social anxiety concerns. However, this tool ought to go beyond linking impairments to service needs (i.e., social anxiety symptoms). This tool should also inform the goals of services, in particular by linking impairments to key domains relevant to therapeutically addressing adolescents’ anxiety-related needs, such as social skills when interacting with unfamiliar peers. This requires an assessment approach that involves strategic selection of informants who vary in their expertise for observing anxiety-related needs, as well as the therapeutic goals for addressing anxiety-related impairments (e.g., social skills within peer interactions). We leveraged parents’ reports to link impairments to social anxiety-related needs. To link impairments to social skills, we leveraged informants (i.e., unfamiliar untrained observers [UUOs]) who observed adolescents within tasks designed to simulate interactions with same-age, unfamiliar peers. We tested this approach using a mixed-clinical/community sample of 134 adolescents, ages 14- to 15 years old. We leveraged multi-informant survey reports to assess adolescent social anxiety, and trained independent observers rated adolescents’ social skills within unfamiliar peer interactions. Parents’ reports performed best when distinguishing adolescents on referral status and predicting survey-reported social anxiety, whereas only UUOs’ reports predicted independent observers’ social skills ratings. These findings inform the strategic selection of informants for assessing impairments that commonly prompt the need for adolescents to access mental health services for social anxiety.     

Marital Quality, Family Patterns, and Children's Fears and Social Anxiety

This study examined relationships among marital quality, family patterns, and children's fears, and social anxiety. Two types of family patterns were studied, adaptability and cohesion. Mothers of children aged 5–6, drawn from kindergartens in northern Israel, completed Hebrew versions of the ENRICH scale (abridged, for marital quality), FACES-III (adaptability and cohesion), the FSSC-R (fears), and the SASC-R (social anxiety). Family cohesion was negatively correlated with marital quality and positively correlated with children's social anxiety. Marital quality and family adaptability were inversely related to specific children's fears. Children's social anxiety was highly correlated with specific fears. These findings suggest that children from rigid, fused families or low quality marriages may be at risk for high levels of fears and social anxiety.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.     

Reactivity to Exclusion Prospectively Predicts Social Anxiety Symptoms in Young Adults

Peer victimization leads to negative outcomes such as increased anxiety and depression. The prospective relationship between peer victimization and social anxiety in children and adolescents is well established, and adults with social anxiety disorder (SAD) are more likely than individuals with other anxiety disorders to report a history of teasing. However, a crucial bridge between these findings (peer victimization in young adults) is missing. We manipulated perceptions of peer exclusion in a young adult sample (N = 108) using the Cyberball Ostracism Task. Reactivity to exclusion prospectively predicted social anxiety symptoms at a 2-month follow-up, whereas self-reported teasing during high school and current relational victimization did not. This research suggests that reactions to peer victimization may be a worthwhile target for clinical interventions in young adults. Targeting how young adults react to stressful social interactions such as exclusion may help prevent the development of SAD. Future research should test if reactivity to exclusion plays a role in the relationship between other disorders (e.g., depression) and peer victimization.     

Development of Social Anxiety: Social Interaction Predictors of Implicit and Explicit Fear of Negative Evaluation

Little is known about how to predict which individuals with known temperament vulnerabilities will go on to develop social anxiety problems. Adolescents (N = 185) were followed from age 13 to 18 to evaluate psychosocial, prospective predictors of social anxiety symptoms and fears of negative evaluation (FNE), after accounting for pre-existing social withdrawal symptoms. Results from structural equation modeling suggest that lack of perceived social acceptance predicts subsequent explicit social anxiety and FNE, whereas the emotional intensity of close peer interactions predicts subsequent implicit FNE. Results are discussed in terms of the importance of peer interaction in the development of social anxiety, and the value of measuring both implicit and explicit FNE.     

Development of the Friendships and Social Skills Test (FASST): A Parent Report Measure

This paper describes the initial development of the Friendships and Social Skills Test (FASST), a clinically oriented 25-item parent report measure of child peer relationships and social skills in a community (N = 423) and clinical sample (N = 159) of elementary school age children. Confirmatory factor analyses supported five factors measuring pro-social skills, negative peer directed behavior, friendship interactions, peer victimization, and the level of concern expressed about a child’s social functioning. Internal consistency and test–retest reliability of the FASST factors predominately ranged from moderate to very good. Validity was supported through higher scores in at-risk and clinical groups compared to children in the community and through correlations with an existing measure of social skills and emotional and behavioral functioning. Cross-informant validity was supported by correlations with teacher-report. Moreover, the scales measuring negative social behaviors and pro-social skills predicted changes in peer victimization and concern expressed about the child over a 1-year duration. By assessing positive and negative aspects of peer-directed behaviors and relationships the FASST has the potential to facilitate the identification and treatment of childhood social deficits in mental health settings.     

Social anxiety disorder in children and youth: A research update on aetiological factors

Social Anxiety Disorder (SAD) is a heterogeneous and distressing problem for many children and youth. This review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent–child interactions (attachment, parenting styles). It is concluded that genetic influences, behavioural inhibition, and parent–child interactions play significant and interactive roles in the development and maintenance of SAD. Other influences such as peer relationships, social skills deficits, and traumatic experiences are also acknowledged. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.     

Social Anxiety and Peer Relations in Early Adolescence: Behavioral and Cognitive Factors

This study investigated factors associated with social anxiety during early adolescence using multiple informants, including self and peer perspectives, teacher ratings, and direct observations. Negative social performance expectations, maladaptive coping strategies, and social skill deficits were examined as correlates of social anxiety and mediators linking social anxiety with poor peer relations. Participants were 84 middle school students (47 girls, 37 boys) over-sampled for elevated social anxiety. Analyses revealed correlations linking social anxiety with decreased peer acceptance and increased peer victimization. Path analysis indicated that negative social performance expectations and social withdrawal-disengagement accounted for the association between social anxiety and decreased peer acceptance. Social anxiety, self-directed coping strategies, and social withdrawal-disengagement were each directly linked with increased peer victimization for boys. The results replicate findings based on clinical samples, extend understanding of cognitive, social, and behavioral factors associated with social anxiety in middle school, and provide new information regarding gender differences in the correlates of social anxiety.     

Treating Childhood Social Anxiety Disorder With Virtual Environments and Serious Games: A Randomized Trial

Disseminating efficacious psychological treatments remains a challenge for researchers and clinicians. In the case of social anxiety disorder (SAD), Social Effectiveness Therapy for Children (SET-C) has been demonstrated as an efficacious intervention, but elements of the protocol, such as peer generalization sessions, remain challenging to conduct in typical clinical settings. To address this need, we developed an artificially intelligent, web-based application, Pegasys-VR™, designed to replace peer generalization sessions and enhance homework compliance. The feasibility of Pegasys-VR™ was tested in a randomized controlled trial in comparison to SET-C. The results indicated that both programs were equally efficacious in decreasing anxiety and improving social skill in social encounters. Sixty-three percent (63%) of children treated with SET-C and 60% treated with Pegasys-VR™ did not meet diagnostic criteria for SAD at posttreatment. Pegasys-VR™ is a feasible, efficacious, and dissemination-friendly element of a comprehensive treatment program for social anxiety disorder in children.     

Social Anxiety and Its Relationship to Functional Impairment in Body Dysmorphic Disorder

Social anxiety appears to be a prominent characteristic of body dysmorphic disorder (BDD). However, few previous studies have examined social anxiety and its facets (i.e., physiological arousal, fear and avoidance of social situations) and their relationship to psychosocial functioning in BDD. The present study aimed to fill these gaps by examining (a) social anxiety and its facets in BDD, and b) cross-sectional and prospective relationships between social anxiety symptoms and functional impairment in BDD. Individuals with DSM-IV BDD without comorbid social phobia (N = 108) completed measures of social anxiety and psychosocial functioning at study intake (T1). Psychosocial functioning was also assessed at a 12-month follow-up interview (T2). Severity of social anxiety (i.e., due to BDD or any other source) was rated with the Social Phobia Inventory (SPIN). In addition, participants were interviewed with the Duke Brief Social Phobia Scale (BSPS) to assess social anxiety independent of BDD. At T1, participants endorsed high levels of social anxiety on the SPIN and subclinical levels of social anxiety on the BSPS. Greater social anxiety was associated with poorer psychosocial functioning in cross-sectional and prospective analyses, particularly fear and avoidance of social situations. These results suggest that certain aspects of social anxiety, especially social fear and avoidance, may be significant contributing factors to functional impairment in individuals with BDD.     

Social Anxiety,Social Skills and Expectancy/ Cost of Negative Social Events

Abstract

The aim of the study was to investigate the relationships between social anxiety, social skills and estimated cost as well as expectancy of negative social/non-social events. One hundred and twenty-six students (half males and half females) filled in the Social Phobia and Anxiety Inventory (SPAI), the Social Skills Inventory (SSI), and measures of expectancy and estimated cost of negative social and non-social events. Social anxiety was negatively correlated with self-reported social skills. Further, social anxiety was strongly related to both expectancy and estimated cost of negative social, as opposed to non-social, events. Social skills were related to expectancy, but not to estimated cost of negative social events. Finally, the correlation between social anxiety and expectancy of negative social events disappeared when social control (measured with a subscale of SSI) was partialized out of the relationship, whereas the correlation between social anxiety and estimated cost of negative social events did not. Potential therapeutic implications are discussed.     

Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation

The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait anxiety, alexithymia and global psychiatric symptom severity. A multivariate analysis of covariance demonstrated that subscales of the Liebowitz Social Anxiety Scale (LSAS) were related to alexithymia and trait anxiety. The “difficulty in describing feelings” (DDF) dimension of alexithymia and trait anxiety appear to be important factors in this relationship between social anxiety and alexithymia. Results of this study suggest that patients with dermatological disorder may benefit from both treatment of social anxiety symptoms and learning how to regulate their affects and emotional expression.     

Social interaction and interpersonal distance in normal and behaviorally disturbed boys

Frequency of social interaction and interpersonal distance of 24 normal and 24 behaviorally disturbed white, preadolescent boys were examined. Each child's behavior was analyzed from videotapes that were recorded during four 60-min sessions, during which time the child played with the same unfamiliar peer, matched for age and emotional functioning. The results indicated that the frequency of global social interactions was a powerful discriminator between normal and disturbed boys at the older but not at the younger age levels. Proximity to peers and adults also was a powerful discriminator at both age levels. These results were discussed in relationship to the development of social skills in preadolescent children, the need to establish criteria for social competence, and the evaluation of social skills training programs from a development perspective.     

Impaired Fear Recognition and Social Anxiety Symptoms in Adolescence

This study represents the first examination of adolescent anxiety in relation to peer emotion recognition, rather than adult emotion recognition. Additionally, we examine potential mechanisms for the development of social anxiety in females. Facial emotion recognition (FER) is important for accurate social cognition, which is impaired in individuals with various disorders, including anxiety disorders. Social anxiety often onsets during adolescence, is observed more commonly in females, and is often associated with FER difficulties. Given the importance of peer interaction during adolescence, and some evidence that FER may differ as a function of the stimuli (adolescent or adult faces), we sought to study FER in relation to social anxiety symptoms using stimuli portraying adolescent faces. Male and female adolescents (N = 64) completed an online survey in which they rated 257 child and adolescent emotional faces and completed a self-report measure of social anxiety symptoms. We examined differences in emotion recognition (e.g., fear, anger, sadness) between individuals with high and low levels of social anxiety symptoms. Adolescents with high social anxiety symptoms were more likely to have problems correctly identifying fearful expressions (90.55 % accuracy) compared to adolescents with low social anxiety symptoms (96.00 % accuracy; t = 2.375, p = .021, d = 0.594), and this effect was observed exclusively in female adolescents. The observed sex difference in accurate identification of fearful faces in relation to social anxiety could suggest a potential mechanism for social anxiety development in adolescent females.     

Peer Perceptions and Liking of Children with Anxiety Disorders

Examined three aspects of childhood anxiety and peer liking: (1) whether or not children can detect anxiety in age-mates, (2) the degree to which peer-reported anxiety, self-reported anxiety, and presence of anxiety disorders are associated with peer liking, and (3) whether or not self-reported anxiety and presence of anxiety disorders are associated with peer liking after controlling for peer-reported anxiety. Peer raters (9.5–12.5 years) rated videotaped speech samples of target children with anxiety disorders (AD; 9.5–13 years) and target children without anxiety disorders (NAD; 9.5–13 years). Peer-rated anxiety was positively correlated with target children’s self-reported anxiety and was higher among children with AD and children with social phobia (SP). Peer liking was inversely related to peer-reported anxiety and was lower for target children with SP. Target children with SP were liked less regardless of how anxious peers perceived them to be. Peer rater and target child demographics did not moderate the relationship between peer-rated anxiety and peer liking.     

The role of emotion knowledge in the links between shyness and children's socio‐emotional functioning at preschool

The present study investigated the potential protective role of components of emotion knowledge (i.e., emotion recognition, situation knowledge) in the links between young children's shyness and indices of socio‐emotional functioning. Participants were n = 163 children (82 boys and 81 girls) aged 23–77 months (M = 53.29, SD = 14.48), recruited from preschools in Italy. Parents provided ratings of child shyness and teachers rated children's socio‐emotional functioning at preschool (i.e., social competence, anxiety‐withdrawal, peer rejection). Children were also interviewed to assess their abilities to recognize facial emotional expressions and identify situations that affect emotions. Among the results, shyness was positively related to anxiety‐withdrawal and peer rejection. In addition, emotion recognition was found to significantly moderate the links between shyness and preschool socio‐emotional functioning, appearing to serve a buffering role. For example, at lower levels of emotion recognition, shyness was positively associated with both anxiety‐withdrawal and rejection by peers, but at higher levels of emotion recognition, these associations were attenuated. Results are discussed in terms of the protective role of emotion recognition in promoting shy children's positive socio‐emotional functioning within the classroom context.     

Health Status and Peer Relationships in Early Adolescence: The Role of Peer Contact, Self-esteem, and Social Anxiety

We examined associations between children’s health status and the quality of their peer relationships, as well as factors that may account for individual variation in the quality of chronically ill and healthy children’s peer relationships. Our sample included 268 children (138 boys; 130 girls) with 149 European-Americans and 119 African-Americans. There were 91 children with a chronic illness; 35 with asthma, 26 with diabetes, and 30 with obesity. Chronically ill children were characterized by teachers as displaying less prosocial behavior, less overt aggression, and less relational aggression with peers than healthy children. Chronically ill children reported lower levels of peer contact and higher levels of social anxiety than healthy children. Among chronically ill children those with high self-esteem were more prosocial and less aggressive than those with low self-esteem. Our findings suggest that chronically ill children are at risk for peer relationship difficulties, but that self-esteem may serve as a protective factor against poor peer relationships for some chronically ill children.     

父母冲突对青少年社交焦虑的影响：序列中介效应分析

采用父母冲突儿童知觉量表(CPIC)、父母关系安全感量表(SIS Scale)和社交焦虑分量表调查480名高中生,运用偏差矫正的百分位Bootstrap方法探索青少年对父母冲突的威胁知觉和情绪不安全感在父母冲突水平与青少年社交焦虑之间的序列中介作用。本研究同时检验认知情境理论和情绪安全感理论,发现青少年对父母冲突的威胁知觉对其情绪不安全感的不同维度存在不同影响,从而更为完善地揭示父母冲突影响青少年社交焦虑的内部机制。具体来说,父母冲突主要通过三条途径影响青少年社交焦虑:通过威胁知觉的中介作用;通过情绪不安全感,特别是消极表征的中介作用;通过依次影响威胁知觉和情绪不安全感(特别是消极表征和情绪失调)而正向预测青少年社交焦虑。     

Depression and Social Anxiety in Children: Differential Links with Coping Strategies

Strategies that children use for coping with stressors are known to be related to emotional adjustment, but not enough is understood about specific links with social anxiety and depression. The present investigation tested differentiated associations of social anxiety and depression with specific types of coping strategies, and evaluated the direction of these associations over time. In Study 1, 404 children aged 8–13 years completed a coping scale modified from Kochendefer-Ladd and Skinner (Developmental Psychology 38:267-278, 2002) in order to evaluate factor structure and subscale internal consistency. In Study 2, 270 8–11-year-old children completed depression and social anxiety scales, a sociometric survey, and the coping scale from Study 1, with a follow-up timepoint 9 months later. In Study 1, factor analysis revealed six internally consistent coping subscales. In Study 2, social anxiety and depression were found to have distinctive longitudinal associations with subsequent coping strategies. Decreased problem-solving, social support-seeking, and distraction were uniquely predicted by depression but not by social anxiety. Internalising coping was a stronger outcome of social anxiety, and increased externalising was uniquely predicted by depression. There was also some evidence for a moderating role of peer relations. However, none of the coping strategies predicted changes in depression or social anxiety over the two timepoints. These results highlight the impact that emotional adjustment may have on children’s coping strategies, and clarify important distinctions between social anxiety and depression in relation to coping.