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Plovdiv Hall - Marinela

Improving our understanding of social anxiety disorder in children and adolescents: disorder specific psychological factors, maintenance mechanisms and new treatment approaches.

Ron Rapee, Jennie Hudson, Eleanor Leigh Speaker

The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioural mechanisms that occur in adult SAD also apply to SAD among children and adolescents. This symposium brings together researchers from different institutions around the world who are all currently leading research projects on social anxiety disorder in children and adolescents. The symposium will begin by critically examining the different theoretical conceptualizations of the maintenance of SAD in the child/adolescent and adult literature and illustrate how these have typically resulted in different treatment approaches. We will then review research examining how well the adult SAD cognitive models ‘fit’ to younger populations – bringing together hypotheses of mechanisms and psychosocial factors that may be specific to childhood/adolescent SAD. In addition, we will consider how these factors may need to be addressed in treatment. The symposium will then finish with a presentation of a recent study where young people with SAD were treated on the basis of an adapted version of the adult SAD cognitive models. In summary, the symposium will bring attendees up to date on the current literature on SAD in young people with particular emphasis on what psychological factors may maintain the problem and how it is best treated using CBT approaches. As such, it should benefit both researchers and clinicians.

Track Stream: Children and Young People

Convenor and Chair: Dr Brynjar Halldorsso

Presentation 1: Understanding the maintenance mechanisms of childhood social anxiety disorder: Does parental psychopathology play a role?
Dr Brynjar Halldorsson; Anxiety and Depression in Young People Research Unit (AnDY) School of Psychology & Clinical Language Sciences, University of Reading, UK

While the cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, it remains unknown if, or to what extent, the same cognitive and behavioural maintenance mechanisms that occur in adult SAD also apply to childhood SAD. The current talk will first focus on ‘what we currently know about maintenance mechanisms in childhood SAD’. We will then explore whether parental psychopathology may need to be considered specifically when treating socially anxious children building on findings from a recent study examining mothers’ and fathers’ psychopathology across different childhood anxiety disorders. This study set out to examine whether symptoms of social anxiety were more severe amongst mothers of 7-12 year old children presenting for treatment with SAD (n=260) compared to those presenting with other anxiety disorders (n=138). Given the high comorbidity between social anxiety and depression, we also explored associations between child anxiety disorders and maternal depressive symptoms. In an effort to address the neglect in recruiting fathers in research on childhood anxiety we also examined whether fathers of children with SAD report greater symptoms of anxiety and depression than fathers of children with other anxiety disorder. Finally, in order to examine whether elevated levels of parental psychopathology are specifically related to childhood SAD, we compared parental psychopathology among children with SAD and children with other anxiety disorders.

Presentation 2: Understanding the maintenance mechanisms in childhood social anxiety
Professor Jennie Hudson; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.

This study examined aspects of the cognitive model of social anxiety disorders in a treatment seeking sample of 120 pre-adolescent children. Participants aged 7 – 12 were included if they met criteria, as assessed by the ADIS-IV- child and parent, for a diagnosis of social anxiety disorder (n = 60) or a non-social anxiety disorder such as Generalised Anxiety Disorder, Separation Anxiety Disorder, or Specific Phobia (n = 60). Children were assessed before treatment on a range of observational, self-report and parent measures to determine dysfunctional beliefs, safety behaviours, perceived social danger, as well as parenting behaviours.

Presentation 3: Psychosocial factors distinguishing socially anxious pre-teens
Professor Ron Rapee; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.

Adolescence is a critical time for the development of emotional distress and resilience. The teenage years are characterised by several major social and personal changes including pubertal development, increased peer influence, romantic experimentation, individuation from family, changes in sleep patterns and diet, and in today’s society, increased exposure to social media. Understandably, this is a time of general emotional turbulence and “angst” that often does not reach clinical levels, however, it is during adolescence that we see an increase in the onset of several major mental disorders. One of the primary disorders characterising this developmental period is social anxiety disorder, which has a mean age of onset around 13 years. Prevalence of social anxiety disorder in adolescents is around twice that of pre-teen children. The Risks to Adolescent Wellbeing (RAW) project began in 2016 and aims to understand psychosocial factors associated with mental health during the adolescent period. In 2016/17 525 young people, aged mean 11 years, provided baseline assessments comprised of detailed questionnaires, laboratory tasks, and diagnostic interviews. Key measures included social (e.g., social media use, family relationships, peer relationships), psychological (e.g., cognitive biases, perceptual accuracy, rumination), behavioural (e.g., fear extinction, rejection sensitivity, helplessness, attention), and physiological (e.g., pubertal stage, sleep, BMI) factors. The current talk will focus on baseline relationships. Social anxiety was determined on the basis of both structured diagnostic interview and parent and pre-teen self-reported questionnaires. We evaluated differences between socially anxious pre-teens and their non-anxious peers on a range of psycho-social factors. Results have implications for understanding the development of social anxiety, its prevention, and treatment.

Presentation 4: Preliminary tests of the Cognitive Model of Clark & Wells (1995) in social anxiety in adolescents.
Dr Eleanor Leigh; Department of Experimental Psychology, University of Oxford

Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. It has its origins in adolescence; the median age of onset is 13 years and about 95% of cases have occurred by early adulthood. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood, so there is a real need for effective treatments. However, there is limited evidence on the specific efficacy of available therapies. In contrast in adults, randomized controlled trials have shown that individual cognitive therapy (based on the Clark & Wells 1995 model) is highly effective and compares favourably with other treatments (exposure therapy, group CBT, IPT, psychodynamic psychotherapy, SSRI’s, and pill placebo). It might therefore be profitable to investigate whether the Clark and Wells (1995) model applies to adolescent social anxiety as well as the adult condition as a way to improve treatment outcomes. We present findings from a series of linked studies that we have undertaken with a sample of school-based adolescents using correlational and experimental methods to examine whether the processes specified in the model are implicated in adolescent social anxiety.