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Social anxiety disorder in children and adolescents: assessment, maintaining factors, and treatment
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The present dissertation consists of three empirical studies on social anxiety disorder (SAD) in a sample of Swedish children and adolescents. Based on findings made in a large behavior treatment study, the thesis contributes to the field of research on childhood SAD by investigating a factor that maintains the disorder, ways to measure and screen for diagnosis, and the treatment of the disorder. Study I investigated whether giving an educational course to the parents of socially anxious children would lead to a better outcome of a behavior-treatment study consisting of individual and group treatment components such as exposure in-vivo and social skills training, compared to a condition where only children were treated and the parents received no educational course.  Another purpose of Study I was to investigate what influence, if any, co-morbidity has on treatment outcome. The results showed that there was no significant difference between the two treatment groups on any of the primary or secondary outcome measures. Further, the comorbid disorders did not impair the SAD treatment but was rather associated with further improvement, and despite the sole focus on SAD, there was significant improvement in the comorbid disorders. Study II tested the psychometric properties of the Social Phobia and Anxiety Inventory for Children in a sample of children with SAD. The results indicated that the instrument is a both valid and reliable measure. Further, a three-factor solution represented the three areas of SAD commonly found in adult studies, i.e. fear of performance, observation, and interaction situations. Study III explored threat perception and interpretation bias by means of an ambiguous stories task. The results showed that children with SAD deviated significantly from a non-anxious control peer group with regard to their interpretations. Post treatment the threat perception bias was altered in a normal direction, and one year after treatment termination, the SAD sample ratings were comparable to those of the non-anxious children.

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University , 2013. , 88 p.
Keyword [en]
Social anxiety disorder, youth, behavior therapy, parent involvement, assessment
National Category
Medical and Health Sciences
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-93932ISBN: 978-91-7447-764-1 (print)OAI: oai:DiVA.org:su-93932DiVA: diva2:650125
Public defence
2013-10-18, David Magnussonsalen (U31), hus 8, Frescati Hagväg 8, Stockholm, 13:00 (English)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 1: Manuscript.

Available from: 2013-09-26 Created: 2013-09-19 Last updated: 2013-09-20Bibliographically approved
List of papers
1. Behavioral treatment of social phobia in youth: Does parent education training improve the outcome?
Open this publication in new window or tab >>Behavioral treatment of social phobia in youth: Does parent education training improve the outcome?
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Social phobia is one of the most common anxiety disorders in children and adolescents, and it runs a fairly chronic course if left untreated. The goals of the present study were to evaluate if

a parent education course would improve the outcome for the children and if comorbidity at the start of treatment would impair the outcome of the social phobia. A total of 55 children, 8-14 years old, were randomly assigned to one of three conditions: 1) Child is treated, 2) Child is treated and parent participates in the course, or 3) A wait-list for 12 weeks. The treatment consisted of individual exposure and group social skills training based on the Beidel et al. (2000) SET-C. Children and parents were assessed pre-, post-, and at one year follow- up with independent assessor ratings and self-report measures. Results showed that there was no significant difference between the two active treatments and both were better than the wait-list. The treatment effects were maintained or furthered at the follow-up. Comorbidity did not lead to worse outcome of social phobia, but significantly better. Comorbid disorders improved significantly from pre- to post-treatment, and from post- to follow-up assessment without being targeted in therapy. 

Keyword
Social phobia, youth, behavior therapy, parent involvement, comorbidity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:su:diva-93931 (URN)
Available from: 2013-09-19 Created: 2013-09-19 Last updated: 2013-09-20Bibliographically approved
2. Psychometric properties of the Social Phobia and Anxiety Inventory-Child version in a Swedish clinical sample
Open this publication in new window or tab >>Psychometric properties of the Social Phobia and Anxiety Inventory-Child version in a Swedish clinical sample
2013 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 27, no 5, 503-511 p.Article in journal (Refereed) Published
Abstract [en]

The Social Phobia and Anxiety Inventory for Children (SPAI-C) is a 26 item, empirically derived self-report instrument developed for assessing social phobic fears in children. Evidence for satisfactory psychometric properties of the SPAI-C has been found in multiple community studies. Since its development, however, no study has presented an extensive psychometric evaluation of SPAI-C in a sample of carefully diagnosed children with social phobia. The present study sought to replicate and expand previous studies by administrating the SPAI-C to a sample of 59 children that fulfilled DSM-IV criteria for social phobia, and 49 children with no social phobia diagnosis. An exploratory factor analysis resulted in a three factor solution reflecting: (1) fear of social interactions, (2) fear of public performance situations, and (3) physical and cognitive symptoms connected with social phobia. These factors appear to parallel domains of social phobia also evident in adults. The SPAI-C total scale and each factor was found to possess good internal consistency, good test–retest reliability and was generally strongly correlated with both self-report and clinician measures of anxiety and fears. The discriminative properties of the total scale were satisfactory.

Keyword
Social anxiety, Psychometric properties, Social Phobia Anxiety Inventory for Children, Children and adolescents
National Category
Medical and Health Sciences Psychology
Identifiers
urn:nbn:se:su:diva-93930 (URN)10.1016/j.janxdis.2013.06.004 (DOI)000324348600009 ()
Available from: 2013-09-19 Created: 2013-09-19 Last updated: 2017-12-06Bibliographically approved
3. Perception of Threat in Children With Social Phobia: Comparison to Nonsocially Anxious Children Before and After Treatment
Open this publication in new window or tab >>Perception of Threat in Children With Social Phobia: Comparison to Nonsocially Anxious Children Before and After Treatment
2011 (English)In: Journal of clinical child and adolescent psychology (Print), ISSN 1537-4416, E-ISSN 1537-4424, Vol. 40, no 6, 855-863 p.Article in journal (Refereed) Published
Abstract [en]

The present study investigated interpretation bias and reduced evidence for danger (RED) bias in 49 children with social phobia and 49 nonsocially anxious children between the ages of 8 and 14 years, using an ambiguous stories task. A posttreatment and follow-up measure was included for 26 of the socially phobic children to examine whether there would be a change in interpretation and RED bias after a 12-week behavior therapy program. Ambiguous scenarios were presented sentence by sentence. Participants gave interpretations and fear ratings after each sentence, and they rated negative emotions after each complete scenario. Compared to the nonsocially anxious children, children with social phobia displayed both a RED bias and an interpretation bias. After the treatment program, the children with social phobia displayed a reduced tendency to make biased interpretations, but there were no significant posttreatment changes in the RED bias. At 1 year follow-up there was a significant reduction in both interpretation and RED bias and clinical children no longer differed from nonsocially anxious controls.

Keyword
threat, children, social phobia, before and after treatment
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-70451 (URN)10.1080/15374416.2011.618448 (DOI)000299228700009 ()
Funder
Swedish Research Council, 421-2001-4740
Note

This study was supported by grants from the Swedish Council for Working Life and Social Research (F0129/2001) and from the Swedish Research Council (421-2001-4740). We gratefully acknowledge the help from Lisa Alexandersson and Evelina Pärnerud in collecting the normal group data, the valuable comments on the manuscript from Kia Åsberg and Jonas Ramnerö, and the thorough work of the anonymous reviewers.

Available from: 2012-01-20 Created: 2012-01-20 Last updated: 2017-12-08Bibliographically approved

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