Evidence-based assessment/Social anxiety disorder (disorder portfolio)/extended version

What is a "portfolio"?

 * For background information on what assessment portfolios are, click the link in the heading above.
 * Is all this information too much? There's an condensed version of this page here.

Diagnostic criteria for phobic anxiety disorders
ICD-11 Diagnostic Criteria for Social Anxiety Disorder
 * Social anxiety disorder is characterized by marked and excessive fear or anxiety that consistently occurs in one or more social situations such as social interactions (e.g., having a conversation), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech). The individual is concerned that he or she will act in a way, or show anxiety symptoms, that will be negatively evaluated by others. The social situations are consistently avoided or else endured with intense fear or anxiety. The symptoms persist for at least several months and are sufficiently severe to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

Changes in DSM-5
 * The diagnostic criteria for simple phobia changed slightly from DSM-IV to DSM-5. Summaries are available here and here.

Base rates of social phobia in different clinical settings
This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of social anxiety disorder they are likely to see in their clinical practice.
 * To see prevalence rates across multiple disorders, click here.

Note: WHO-CIDI = World Health Organization Composite International Diagnostic Interview; NCS-A (lifetime prevalence); CAPA= Children and Adolescent Psychiatric Assessment (3-month prevalence); DISC-IV = Diagnostic Interview Schedule for Children, Version 4 (12-month prevalence); ADIS-C/P=Anxiety Disorders Interview Schedule for Children/Parents; SIDP-IV = Structured Interview for DSM-IV Personality; SCID=Structured Clinical Interview for DSM-IV; SDIs included in Rettew et al. (2009): CIDI, DAWBA, DICA, DISC, DIS, MINI, K-SADS-PL, SCAN-2, SCID, SCID-II.


 * Higher rates of social anxiety disorder are found in females than in males, with more pronounced differences in adolescence. Prevalence rates in children and adolescents are comparable to those in adults. Onset is typically in early adolescence (DSM-5, 2013).

Psychometric properties of screening instruments for social anxiety disorder
The following section contains a list of screening and diagnostic instruments for social anxiety disorder. The section includes administration information, psychometric data, and PDFs or links to the screenings.
 * Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.


 * For a list of more broadly reaching screening instruments, click here.

Note: L= Less than adequate; A= Adequate; G= Good; E= Excellent; U= Unavailable; NA= Not applicable

Likelihood ratios and AUCs of screening measures for social anxiety disorder

 * For a list of the likelihood ratios for more broadly reaching screening instruments, click here.


 * Note: All studies used some version of ADIS-C, K-SADS or CAS administered by trained raters. “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000). AUC guidelines according to Swets and Pickett (1982) : .50 to .70 (low accuracy), .70 to .90 (moderate accuracy), and greater than .90 (high accuracy).


 * Note: Silverman & Ollendick (2005) suggest that the SPAI-C is the better instrument for identifying those children and adolescents who most likely meet DSM-IV criteria for social phobia, but that this measure may miss some adolescents who would meet criteria for social phobia. Child and Adolescent Social Anxiety Disorder Jacqueline Nesi 7 Although the MASC has evidence to support it, the current evidence only applies to screening for GAD in girls and anxiety comorbidities (p.404). Thus, for both of these measures, another assessment method is to be used as well, such as an interview schedule (pp 401-5). The SCARED, MASC, and FSSC-R may be helpful to discriminate between youth with social phobia versus other anxiety disorders (p. 404).

Interpreting social anxiety disorder screening measure scores

 * For information on interpreting screening measure scores, click here.
 * Also see the page on likelihood ratios in diagnostic testing for more information

Gold standard diagnostic interviews

 * For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic interviews for social anxiety disorder
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Severity interviews for social anxiety disorder
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process phase
The following section contains a brief overview of treatment options for social anxiety disorder and list of process and outcome measures for social anxiety disorder. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Outcome and severity measures
This table includes clinically significant benchmarks for social anxiety disorder specific outcome measures


 * Information on how to interpret this table can be found here.
 * Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
 *  For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks,  see here.

 Note:  A = Away from the clinical range; B= Back into the nonclinical range; and C = Closer to the nonclinical than clinical mean.

Treatment
According to Effective Child Therapy, 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.

Cognitive Behavioral Therapy


 * 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: Effective Child Therapy page on Fear, Worry & Anxiety Please refer to the Wikipedia page on Social Anxiety Disorder for more information on available treatment for social anxiety or go to Effective Child Therapy for a curated resource on effective treatments for anxiety disorders.


 * For information on conducting Exposure Therapy for anxiety disordered youth, see www.BravePracticeForKids.com

External resources

 * 1) ICD-10 diagnostic criteria
 * 2) Find-a-Therapist
 * 3) * A curated list of find-a-therapist websites where you can find a provider
 * 4) NIMH
 * 5) * Go to this resource for more information on anxiety disorders
 * 6) OMIM (Online Mendelian Inheritance in Man)
 * 7) * Entry for anxiety
 * 8) Effective Child Therapy page for Fear, Worry, & Anxiety
 * 9) * Effective Child Therapy is website sponsored by Division 53 of the American Psychological Association (APA), or The Society for Clinical Child and Adolescent Psychology (SCCAP), in collaboration with the Association for Behavioral and Cognitive Therapies (ABCT). Use for information on symptoms and available treatments.
 * 10) Society of Clinical Child and Adolescent Psychology
 * 11) Behavioral Health Virtual Resource
 * 12) * This resource has free PDFs of anxiety screenings, as well as information on diagnosing and treating different anxiety disorders
 * 13) www.abctcentral.org
 * 14) * This is a website sponsored by the Association for Behavioral and Cognitive Therapies.
 * 15) * Use the “Find a Therapist” option to search for local therapists using CBT, an effective treatment for Social Anxiety.
 * 16) www.BravePracticeForKids.com
 * 17) *This website, created by Dr. Emily Becker-Haimes at the University of Pennsylvania, has information on conducting Exposure Therapy for anxiety disordered youth.