A Multi-Informant Approach to Assessing Safety Behaviors among Adolescents: Psychometric Properties of the Subtle Avoidance Frequency Examination

  • Noor Qasmieh
  • Bridget A. Makol
  • Tara M. Augenstein
  • Melanie F. Lipton
  • Danielle E. Deros
  • Jeremy N. Karp
  • Lauren M. Keeley
  • Michelle L. Truong
  • Sarah J. Racz
  • Andres De Los Reyes
Original Paper


Safety behaviors are subtle avoidance strategies for minimizing distress within social situations (e.g., avoidance of eye contact). These behaviors factor prominently in the development and maintenance of social anxiety concerns, and when patients use these behaviors within psychosocial treatments for social anxiety, this may impede treatment response. Prior work supports the need to include measures of safety behaviors within evidence-based assessments of social anxiety. Along these lines, researchers developed the Subtle Avoidance Frequency Examination (SAFE) to assess safety behaviors among adults. However, we know relatively little about the SAFE’s psychometric properties when administered to adolescents. We tested the SAFE’s psychometric properties using adolescent self-reports and parallel parent reports in a mixed-clinical/community sample of 96 14 to 15 year-old adolescents and their parents (33 clinic-referred; 63 community control; 59.4% African American). Adolescent and parent SAFE reports displayed moderate correspondence with each other. Both adolescent and parent SAFE reports related positively to well-established measures of adolescent social anxiety and depressive symptoms. Both reports distinguished adolescents on referral status as well as cut scores on well-established measures of adolescent social anxiety. Further, both adolescent and parent SAFE reports displayed incremental validity in relation to survey reports of adolescent social anxiety, over-and-above survey reports of adolescent depressive symptoms, which commonly co-occur with social anxiety. However, adolescent (but not parent) SAFE reports predicted adolescents’ social anxiety and state arousal as displayed within social interactions with unfamiliar peer confederates. These findings have important implications for leveraging multi-informant approaches to assessing safety behaviors among adolescents.


Adolescents Multiple informants Safety behaviors Social anxiety Subtle Avoidance Frequency Examination 



This work was supported, in part, by an internal grant from the University of Maryland at College Park (College of Behavioral and Social Sciences Dean’s Research Initiative) awarded to the last author.

Author Contributions

N.Q.: assisted in executing the study, assisted with data analyses, and wrote the paper. B.A.M.: assisted with data analyses and collaborated in editing the paper. T.M.A. and M.F.L.: collaborated with the design of the study, executed the study, and collaborated in editing the paper. D.E.D., J.N.K., and L.M.K.: assisted in executing the study and collaborated in editing the paper. M.L.T. and S.J.R.: collaborated in editing the paper. A.D.L.R.: designed the study, assisted with data analyses, and wrote the paper.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Maryland at College Park’s Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Noor Qasmieh
    • 1
  • Bridget A. Makol
    • 1
  • Tara M. Augenstein
    • 1
  • Melanie F. Lipton
    • 1
  • Danielle E. Deros
    • 1
  • Jeremy N. Karp
    • 1
  • Lauren M. Keeley
    • 1
  • Michelle L. Truong
    • 1
  • Sarah J. Racz
    • 1
  • Andres De Los Reyes
    • 1
  1. 1.Comprehensive Assessment and Intervention Program, Department of PsychologyUniversity of MarylandCollege ParkUSA

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