Faculty Bibliography

OBJECTIVE: To examine the psychometric properties of a newly developed clinician rating scale, the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). METHOD: A total of 154 children and adolescents participated in an assessment consisting of a diagnostic interview, the LSAS-CA, and other measures of psychopathology and impairment. Sixty-one of these children also participated in a second LSAS-CA administration, by a different rater blind to diagnosis, within 7 days of the initial assessment. RESULTS: High internal consistency (alpha =.90-.97 for full sample and.83-.95 for social phobia group) and test-retest reliability (intraclass correlation coefficient = 0.89-0.94) were obtained for LSAS-CA total and subscale scores. LSAS-CA scores had stronger associations with measures of social anxiety and general impairment than with a measure of depression. Subjects with social anxiety disorder had significantly higher LSAS-CA scores than subjects with other anxiety disorders and healthy controls. A LSAS-CA cutoff score of 22.5 represented the best balance of sensitivity and specificity when distinguishing between individuals with social phobia and normal controls, whereas a cutoff of 29.5 was optimal for distinguishing social phobia from other anxiety disorders. CONCLUSION: Initial findings suggest that the LSAS-CA is a reliable and valid instrument for the assessment of social anxiety disorder

OBJECTIVE: This study investigated recall in a sample of depressed, anxious, and normal children followed up as adults. Strengths of this study were that the length of the retest interval was substantial, follow-up information was collected by blind interviewers, and childhood diagnoses were clearly documented. METHOD: The sample consisted of 144 subjects with a childhood diagnosis of depression, 48 with a childhood diagnosis of anxiety, and 128 normal controls. Best-estimate diagnoses assigned at follow-up were compared with childhood primary diagnoses. RESULTS: Reliability and sensitivity were fair for major depressive disorder (mean = 0.46 and 50%, respectively) and any depression (mean = 0.57 and 65%, respectively). Reliability and sensitivity were relatively lower for anxiety (mean = 0.32 and 43%, respectively). Sensitivity for any diagnosis was good (mean = 71%). Specificity was good among all diagnostic categories (range = 73%-100%). Results suggest better diagnostic recall for females than for males. Recall was slightly better for subjects who were older than age 12 during their original episode. Age-of-onset reliability was poor (major depressive disorder = 0.22, any depression = 0.22, and any anxiety = -0.13). CONCLUSIONS: Recall of any childhood disorder is moderately reliable and accurate. Recall of a specific disorder is less accurate. Depression was more likely to be recalled than anxiety. High specificity suggests that participants were not biased to report disorders not present in childhood

We examined the relation of overt and relational victimization to depressive symptoms, fear of negative evaluation (FNE), social avoidance, and loneliness in a sample of Hispanic and African-American children. The Social Experience Questionnaire, Children's Depression Inventory, Social Anxiety Scale for Children-Revised, and Asher Loneliness Scale were administered to 190 children in the fifth and sixth grades of an urban elementary school. Consistent with prior work, overt victimization was positively associated with depressive symptoms, FNE, social avoidance, and loneliness for both boys and girls. Relational victimization was found to be uniquely associated with depressive symptoms, FNE, and social avoidance of general situations for girls only. Prosocial behaviors from peers moderated the effects of relational victimization on loneliness, but no other social-psychological adjustment variables. Implications of our findings for the role of peer victimization and prosocial behaviors in the peer relationships of Hispanic and African-American children are discussed

(from the journal abstract) Social anxiety disorder in children and adolescents is common, debilitating, and may place children at later risk for secondary disorders such as substance abuse and affective disorders. Recognition of the significance of social phobia has led to a surge of research on its assessment and treatment in youth. This paper provides an overview of the recent advances in this area including the development of new assessment instruments and interventions designed specifically for social anxiety disorder. Commonly used child anxiety measures and associated psychometric properties are described. In addition, the advances and limitations of the existing treatment outcome research are highlighted. Directions for continued progress are suggested including additional work on parent and teacher measures and treatment studies with adolescents, investigations of barriers to referral and treatment participation, and transporting interventions to community settings such as schools.

OBJECTIVE: To provide preliminary estimates of feasibility and effectiveness for school-based behavioral treatment in adolescents with social anxiety disorder. METHOD: Six adolescents with social anxiety disorder were treated in a 14-session group treatment program conducted at their school. Assessments were conducted at baseline and after treatment. RESULTS: All participants were classified as treatment responders (markedly or moderately improved). Half of the participants did not meet diagnostic criteria for social phobia after treatment. Clinician severity ratings, as measured by the Anxiety Disorders Interview Schedule for Children for DSM-IV: Child Version and the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA), decreased significantly after intervention, with effect sizes of 2.5 and 1.8, respectively. All LSAS-CA scale scores decreased significantly after treatment. Self-reported social phobia symptoms on the Social Phobia and Anxiety Inventory for Children were not significantly reduced. Fear and avoidance ratings of the 10 most feared situations significantly decreased after treatment, with effect sizes of 1.5 for anxiety and 2.1 for avoidance. CONCLUSIONS: This study provides preliminary support for the promise of school-based behavioral intervention for treating social phobia in adolescents. The school environment may be a rich and innovative setting for implementation of behavioral treatment because this is the setting where adolescents with social phobia endure the most distress

The purpose of the present study was to further clarify the behavioral, physiological, and verbal response of patients with circumscribed social (speech) phobia, generalized social phobia without avoidant personality disorder, and generalized social phobia with avoidant personality disorder. Patients completed a battery of verbal report instruments and participated in two behavioral assessment tests. Measures of avoidance/escape behavior, cardiac response, level of behavioral skill, state anxiety, and positive and negative self-statements during performance were collected. Significant differences across response domains were found between the circumscribed social phobia and the generalized groups. Most of the distinctions were between individuals with circumscribed social phobia and those with both generalized social phobia and avoidant personality disorder, with the former group having less overall psychopathology. In addition, there was substantial overlap of problems between generalized social phobia individuals with and without avoidant personality disorder. Implications for the conceptualization of social phobia are discussed in terms of the differences among social phobia subtypes

Examined the relation of the Social Phobia and Anxiety Inventory for Children (SPAI-C) to the Social Anxiety Scale for Children-Revised (SASC-R). The association between the SPAI-C and the SASC-R was moderate, suggesting that the measures assess overlapping, although not identical, constructs. Initial normative data are reported on the SPAI-C for a community sample of 277 4th-through 6th-grade children. Girls reported higher social anxiety on both measures than did boys. Notably, a substantial proportion of children were found to exceed suggested cut-off scores on both measures for identifying children with high levels of social anxiety, which suggests the importance of screening elementary-age children for social fears