User:Ongmianli/Portfolios/Social phobia

Social Anxiety Disorder

Diagnostic Changes

The essential features of social anxiety disorder (social phobia) (formerly called social phobia) remain the same. The changes in DSM-5 to social anxiety disorder are as follows:

• Deletion of the requirement that individuals over age 18 years must recognize that their fear or anxiety is excessive or unreasonable
• Duration criterion of “typically lasting for 6 months or more” is now required for all ages
• The “generalized” specifier has been deleted and replaced with a “performance only” specifier. The DSM-IV generalized specifier was problematic in that “fears include most social situations” was difficult to operationalize. Individuals who fear only performance situations (i.e., speaking or performing in front of an audience) appear to represent a distinct subset of social anxiety disorder in terms of etiology, age at onset, physiological response, and treatment response.

Demographic Information

Base Rates of Social Phobia in Different Clinical Settings

Setting	Reference	Base Rate	Demography	Diagnostic Method
National Comorbidity Survey Replication (NCS-R). Nationally representative household survey, community sample of adults ages 18+ (n=9282).	Ruscio et al., 2008	12.1% (lifetime) 7.1% (12-month)	All of U.S.A.	WHO-CIDI Clinical Interview
NCS Adolescent Supplement (NCS-A) for ages 13 to 17. Community sample, (n=6243).	Kessler et al., 2012	Females 11.2% Males 6.2% Total 8.6%	All of U.S.A.	WHO-CIDI Clinical Interview, modified to simplify language and use examples relevant to adolescents.
The Great Smoky Mountains Study (GSMS). Longitudinal, community sample of children ages 9 to 16 (n=6674)	Costello, Mustillo, Erkanli, Keeler, Angold, 2003	Females 0.8% Males 0.3% Total 0.5%	Western North Carolina.	CAPA
Teen Health 2000 (TH2K). Community sample in large, metropolitan area, ages 11 to 17 (n=4,175).	Roberts, Roberts, & Xing, 2007	1.6%	Houston, Texas metropolitan area.	DISC-IV
Representative household probability community sample, ages 4 to 17 (n=1886)	Canino et al., 2004	2.8%	Puerto Rico	DISC-IV
Child and Adolescent Anxiety Disorders outpatient research clinic, ages 8 to 13 with anxiety disorder diagnosis (n=199).	Verduin & Kendall, 2003	20%	Children referred to Anxiety Disorders clinic	ADIS-C/P
Meta-analysis of data collected across multiple clinical settings, 1995-2006 (n=15,967)	Rettew et al., 2009	20% (SDI) 6% (unstructured interview)	All of U.S.A. – clinical settings	Structured or Semi-Structure Diagnostic Interviews and unstructured clinical interviews.

Diagnosis

Recommended Diagnostic Interviews

The Anxiety Disorders Interview Schedule for Children (ADIS-C/P) has been used most frequently and accrued a strong evidence base (κ for SOP = 0.92; Silverman et. al, 2001). Hardcopy in assessment file cabinet at Finley. More information at http://www.excellenceforchildandyouth.ca/resource-hub.

Screening Instruments

Area under Curve (AUCs) and Likelihood Ratios for [Social Anxiety Disorder] Potential Screening Measures

Screening Measure	AUC	LR+	LR-	Citation
Multidimensional Anxiety Scale for Children (MASC) (March, Parker, Sullivan, Stallings, & Conners, 1997)	.61 for Males .69 for Females .80 Total for SA Subscale (n=632)	3.4(13.5+)	.46	(Dierker et al., 2001; Anderson et al., 2009)
Revised Children’s Manifest Anxiety Scale (RCMAS) (Reynolds & Richmond, 1985)	.61 for Males .58 for Females (n=632)	5.25 (t >60)	.63	(Dierker et al., 2001; Hodges, 1990)
Social Phobia and Anxiety Inventory for Children (SPAI-C) (Beidel, Turner, & Morris, 1995)	.65 (n=172)	3.55 (18+)	.47	(Inderbitzen-Nolan et al., 2004; Viana et al, 2008)
Screen for Child Anxiety and Related Emotional Disorders (SCARED) (Birmaher et al., 1997, 1999)	.72 (n=119)	1.9 (27+)	.50	(DeSousa et al., 2013)
Brief Fear of Negative Evaluation Scale Revised (BFNE-R) (Leary, 1983)		3.3 (+38)	.45	(Carleton et al., 2011)

Empirically Supported Treatment

• The website www.effectivechildtherapy.com is a website sponsored by Division 53 of the American Psychological Association (APA), or The Society for Child and Adolescent Psychology.
• Using information from a recent meta-analysis by Silverman, Pina, and Viswesvaran (2008), the website outlines Evidence Based Practice (EBP) options for Social Phobia.
• No “Well-Established” treatments have been empirically validated for Social Phobia.
  • However, group Cognitive Behavioral Therapy, or Group CBT, for Anxiety has been identified as “Probably Efficacious” in treating Social Phobia.
• According to Effective Child Therapy, the “Probably Efficacious” distinction marks a treatment as having “strong research support” but lacking the criteria that at least two large-scale randomized controlled trials have been conducted by “independent investigatory teams working at different research settings.”
• This prevents the treatment from moving into the “Well-Established” group.
• Currently, however, CBT is identified as the most promising treatment for childhood and adolescent social phobia.

Effective Child Therapy identifies the following core components of CBT for anxious youth, including those with Social Phobia:

• Emotions Education and Relaxation. Parents and child are taught about the interrelated physiological, cognitive, and behavioral components of anxiety.
  • Activities help demonstrate different emotions, body postures, and cognitive and physiological correlates. Progressive relaxation training helps anxious children develop awareness and control over their own physiological and muscular responses to anxiety.
• Cognitive restructuring. Cognitive restructuring helps children identify and replace distorted cognitions with more adaptive beliefs.
  • Basic cognitive strategies include identifying and reducing negative self-talk, generating positive self-statements, thought stopping, thought challenging (weighing evidence for and against), testing both dysfunctional and adaptive beliefs, and creating a coping plan for feared situations.
• Imaginal and in-vivo exposure. The goals of exposures are to encourage approach behavior by positioning the child in a previously feared or challenging situation.
  • The child attempts to complete tasks in a graded "fear hierarchy" such that the child experiences early success before attempting greater

challenges.

• During individual exposures, a child is encouraged to use any number of coping skills, including relaxation exercises, coping thoughts

(challenging anxious thoughts with more positive, realistic thoughts), concrete problem-solving, or rehearsal of desirable skills.

• Parent Interventions. Parents may have their own preconceptions about the threatening nature of anxiety and they may not know how best to encourage

a child to cope with anxiety.

• CBT provides parents education about the risks of continued avoidance and guidance in managing their own anxiety.
• CBT may also impart basic parenting strategies (e.g., positive/negative reinforcement, planned ignoring, modeling, reward planning) to facilitate the practice of therapy skills in the home.

Sources: Silverman, W. K., Pina, A. A., & Viswesvaran, Chock

Table 3. Clinically Significant Change Benchmarks with Common Instruments and Rating Scales

Measure	Subscale	Cut-off scores			Critical Change (unstandardized scores)
Benchmarks Based on Non-Referred Sample of Adolescents (Anderson et al., 2009)
		A	B	C	95%	90%	SEdifference
MASC (2009)	Total	15.9	63.8	38.9	11.9	10.0	6.1
	Social Anxiety Scale	3.5	19.9	11.8	7.8	6.6	4.0
SPAI-C (2009)	Total	3.3	26.6	15.9	7.5	6.3	3.8
Benchmarks Based on Published Norms
CBCL T-Scores (2001 Norms)	Total	49	70	58	5	4	2.4
	Internalizing	n/a	70	56	9	7	4.5
TRF T-Scores (2001 Norms)	Total	n/a	70	57	5	4	2.3
	Internalizing	n/a	70	55	9	7	4.4
YSR T-Scores (2001 Norms)	Total	n/a	70	54	7	6	3.3
	Internalizing	n/a	70	54	9	8	4.8