NAPNAP's Developmental-Behavioral & Mental Health SIG
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Social Anxiety Disorder (Social Phobia): Screening & Assessment

Screens
  • Liebowitz Social Anxiety Scale - Child Adolescent version (LSAS-CA)
  • Social Phobia and Anxiety Inventory for Children (SPAI-C)
Home presentation can include:
  • Consistent, extreme fear of new situations/people
  • Extreme fear of social and performance situations, preoccupation with embarrassment
  • Accompanying anxiety/panic attacks in attempted social interactions
  • Feeling "paralyzed" and unable to participate or engage with other peers or adults
  • Avoidance of social situations
  • Severe distress in ordinary social situations
  • Resistance or refusal to participate in ordinary activities
  • Helplessness, even depression
School presentation can include:
  • School refusal
  • Difficult transitions to/from home.
  • Resistance or refusal of activities with peers
  • Low self-esteem in social situations and academic projects
  • Difficulty concentrating
  • Learning disorders and cognitive problems

Treatment

PSYCHOLOGIC
  • Individual psychotherapy -- reduce symptoms, help youth address feelings and any sense of failure, embarrassment, etc.
  • Cognitive Behavior Therapy (CBT) -- teach youth the skills to reduce anxiety when interacting with others and help brainstorm alternative strategies for coping.
  • Family therapy and parent skills workshops/classes
  • Group psychotherapy (as age appropriate)
  • School-based counseling -- address any outstanding or pressing issues in the school setting with appropriate people.
PSYCHOPHARM (note: there are no FDA-approved medications specific for social phobia in children at this time)
  • SSRIs -- Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft 
  • Other antidepressants -- Effexor

Take 2-6 weeks for initial improvement; therapeutic dose is usually around 12 weeks. 
HOME INTERVENTION 
  • Encourage rapid return to school, if there is/was refusal.
  • Increase empathy toward disorder by asking parents to understand why/how it exists and is perpetuated, through the lens of child.
  • Help parents address the low self-esteem, anxiety, and depression through active listening, less "do it now" problem-solving.
  • Advise parents to remain collected/calm when child is panicked about a social situation to help model desirable behavior.
  • Remind the youth that he/she survived the last social encounter and will continue to survive the next/present.
  • Plan soothing/routines around transition times (to/from school, etc.) to lessen anxiety.
  • Teach relaxation techniques.
  • Encourage child's participation in routine activities at home.
  • Make easy, attainable steps toward goals, track meticulously to show child that he/she is succeeding. Praise success.

Articles

  • Biederman, Hirshfeld-Becker, Rosenbaum, Hérot, Friedman, Snidman, Kagan & Faraone (2001). Further Evidence of Association Between Behavioral Inhibition and Social Anxiety in Children. Am J Psychiatry, 158, 1673–1679.
  • Bostic, JQ and Bagnell, A. "School Consultation." In Comprehensive Textbook of Psychiatry, 8th Edition. Kaplan, BJ and Sadock, VA. Philadelphia: Lippincott Williams and Wilkins, 2000

Resources

  • DVD -- Selective Mutism and Social Anxiety Disorder: Learning to Socialize and Communicate within the Real World (Shipon-Blum)

Organizations

  • Anxiety Disorders Association of America
  • Childhood Anxiety Network
  • The Child Anxiety Network
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DISCLAIMER: NAPNAP's DBMH SIG site is for informational and educational purposes only. All informational materials and guides on this site are offered "as is" and are NOT a substitute for medical advice, diagnostic analysis, or treatment planning by a licensed provider. Please note that the information found on this site is not a comprehensive review of any condition, drug, or body system; do not use it to replace clinical decision making. By accessing this resource, you agree that neither NAPNAP nor its SIG group editors will be legally held responsible for any clinical, professional or personal actions taken as a result of using this site.
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