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