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Anxiety and Social Functioning: The Moderating Roles of Family Accommodation and Youth Characteristics


It is well established that anxiety can contribute to social functioning difficulties during childhood and adolescence. It is less clear which anxious youth are most likely to struggle socially, and what types of difficulties they are likely to experience, limiting the extent of identification and intervention efforts. In this study, we aim to improve specification of the linkages between youth anxiety severity and social functioning by examining several potential moderators of these associations. Specifically, we examine whether family accommodation of youth anxiety, in addition to youth age, sex, and the presence of a social anxiety disorder diagnosis, influence associations between anxiety severity and social functioning among youth with anxiety disorders. Youth (N = 158, Mage = 9.99 years, SD = 2.74) and their mothers completed diagnostic interviews and questionnaires assessing anxiety and depression symptoms, family accommodation, and a range of social functioning variables. In a series of hierarchical linear regressions, we found that youth anxiety severity was most strongly associated with social impairment at high levels of family accommodation for adolescents and for youth without social anxiety disorder (mother-report). We also found several direct effects of anxiety severity, family accommodation, and youth age, sex, and diagnosis on different facets of youth social functioning (youth- and/or mother-report). We discuss clinical implications and future research directions focused on specifying the nature of associations between youth anxiety and their social functioning.

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Data are available from first author upon reasonable request.


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This study was supported by National Institute of Mental Health grants R61MH115113 and R01MH119299. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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All authors contributed to the study conception and design. Material preparation and data collection were performed by Eli Lebowitz and Wendy Silverman. Analyses were performed by Rebecca Etkin and Eli Lebowitz. The first draft of the manuscript was written by Rebecca Etkin and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Rebecca G. Etkin.

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This study was approved by the Institutional Review Board.

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Written, informed consent to participate was obtained from legal guardians of participating children (17 years and under). Assent was also obtained from participating children.

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Not applicable.

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The authors have no relevant financial or non-financial interests to disclose.

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Etkin, R.G., Silverman, W.K. & Lebowitz, E.R. Anxiety and Social Functioning: The Moderating Roles of Family Accommodation and Youth Characteristics. Res Child Adolesc Psychopathol 50, 781–794 (2022).

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  • Anxiety
  • Family Accommodation
  • Social Functioning
  • Child
  • Adolescent