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Social Skills Deficits and Self-appraisal Biases in Children with Social Anxiety Disorder

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Abstract

Social Anxiety Disorder is highly prevalent among children and leads to poor long-term outcomes if left untreated. Theoretical models of anxiety differ in whether children with Social Anxiety Disorder experience objective social skills deficits, negative self-interpretation biases, or some combination of the two. This pilot study evaluated evidence in support of the “deficit” and “bias” models. Approval was obtained from the ethics committee of a large private university in Cambridge, MA, USA, and data collection was completed in 2015. We recruited 68 parent-child dyads for a study in which anxious children (with Social Anxiety Disorder) and non-anxious children underwent a child-adapted version of the Trier Social Stress Test. Children were aged 8-14, 67.6% male, and self-identified as 54.4% White, 7.4% Black, 4.4% Latinx, 13.2% Asian, 14.7% multiethnic, and 5.9% “other” or no response. Performance ratings were obtained from children, their parents, and external observers. We found evidence of both specific social skills deficits and self-appraisal biases in anxious children. Anxious children struggled with signs of physical discomfort but not with actual speech content. Although children were generally able to accurately evaluate their social performance, older anxious children were most self-critical. Parents were similarly accurate in appraisals of their children’s social performance. Anxious children responded favorably to positive feedback with improved self-evaluations of performance and decreased anxiety. Findings suggest that a comprehensive “integrated” theoretical model of Social Anxiety Disorder should include both skills deficits and self-appraisal biases.

Highlights

  • This parent-child dyadic study utilized a behavioral paradigm – the Trier Social Stress Test – to examine social skills deficits and self-appraisal biases in anxious children from the perspective of multiple reporters (child, parent, and external observer).

  • We found evidence of both specific social skills deficits and self-appraisal biases in anxious children.

  • Parents of anxious children were not hypercritical or inaccurate in appraisal of their children’s social skills.

  • Our study supports a comprehensive “integrated” theoretical model of anxiety.

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Data Availability

Our data cannot legally or ethically be released as our participants include minors, and they and their parents did not provide consent for data sharing.

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Funding

N.L. is funded as an Implementation Science Scholar through the National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant number: 5K12 HL137940-02).

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Author notes

  1. Unaffiliated: Amanda Yuan

Authors and Affiliations

  1. Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, USA

    Nancy Lau & Abby R. Rosenberg

  2. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

    Nancy Lau

  3. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA

    Nancy Lau & Abby R. Rosenberg

  4. Department of Psychology, The Pennsylvania State University, University Park, PA, USA

    Anna M. Zhou

  5. Department of Psychology, University of Massachusetts Boston, Boston, MA, USA

    Ryan Parigoris

  6. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    Abby R. Rosenberg

  7. Department of Psychology, Harvard University, Cambridge, MA, USA

    John R. Weisz

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Ethics Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Committee on the Use of Human Subjects of Harvard University (IRB No. 24143).

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Appendix 1 Behavioral anchors for the Social Performance Rating Scale (SPRS) (as adapted from the SPRS; Fydrich et al., 1998)

Appendix 1 Behavioral anchors for the Social Performance Rating Scale (SPRS) (as adapted from the SPRS; Fydrich et al., 1998)

1. Gaze

(1) Very poor: participant completely avoids looking at the audience or stares continually and intently at audience member directly in front of him/her in an uncomfortable manner (i.e., no eye contact or stares down audience member). Gaze pattern is very disruptive to performance.

(2) Poor: participant frequently avoids looking at the audience (or stares intently at audience member directly in front of him/her) for majority of time. Gaze pattern is disruptive to performance.

(3) Fair: participant avoids eye contact or tends to look too much (staring intently) at specific audience member. Gaze pattern is mildly disruptive to performance.

(4) Good: participant shifts focus during pauses, but occasionally avoids eye contact or stares at audience members.

(5) Very good: participant keeps eye contact during the speech, does not stare; shifts focus during pauses.

2. Vocal quality

(1) Very poor: (a) participant speaks in a flat, monotonous voice; or (b) speaks at a low volume or mumbles; or (c) speaks overly loudly, or has intrusive tone (harsh or unpleasant voice quality).

(2) Poor: (a) participant demonstrates minimal vocal inflections/nuances, enthusiasm, or interest in verbal expression; or (b) volume somewhat low and speech somewhat unclear; or (c) speaks a little bit too loudly, or tone is somewhat intrusive, unpleasant, or sarcastic.

(3) Fair: (a) participant shows some inflections/nuances in verbal expression but at most times sounds unenthusiastic or uninterested; and (b) speaks in appropriate volume; has clear voice quality; and (c) does not have an intrusive or sarcastic tone.

(4) Good: (a) participant shows moderate inflections/nuances and but inconsistent enthusiasm or interest. Could also be too ‘over the top’ (seems fake or forced); and (b) speaks in appropriate volume; has clear voice quality and (c) does not have an intrusive, unpleasant, or sarcastic tone.

(5) Very good: participant is emphatic and enthusiastic in verbal expression; and (b) speaks in appropriate volume; has clear voice quality and (c) does not have an intrusive, unpleasant, or sarcastic tone.

3. Discomfort

(1) Very high: complete rigidity of arms, legs or whole body. Constant leg movements or fidgeting with hands, hair or clothing. Extremely stiff face or constant facial tics. Frequent nervous throat clearing, swallowing, or stuttering. Frequent inappropriate giggling or laughing. Look of extreme discomfort and desire to flee situation.

(2) High: rigidity or fidgeting for majority of time. Difficulty staying still is somewhat disruptive to conversation. Stiff face or frequent facial tics. Some nervous throat clearing or swallowing. Some inappropriate giggling or laughing. Participant shows signs of discomfort by frequently looking around.

(3) Moderate: no rigidity. Slight movement of legs, fidgeting, throat clearing, or swallowing. Participant shows only brief periods of discomfort.

(4) Low: no rigidity, nervous throat clearing, or swallowing. Minimal fidgeting that is not disruptive to performance. No notable signs of discomfort. At times may appear relaxed and at ease (smiling or gesturing).

(5) Very low: relaxed body posture and natural body movement. Participant laughs and smiles at appropriate times. S/he shows effective gesturing (to be distinguished from fidgeting). Participant does not appear at all uncomfortable and is at ease in situation.

4. Speech flow

(1) Very poor: participant frequently trails off, making few attempts to continue the speech. Participant does not respond appropriately to audience’s prompts, (does not acknowledge prompts and/or does not react to prompts). Even when prompted by the audience, participant cannot maintain the speech.

(2) Poor: participant tries to initiate and continue the speech but is only successful about half the time. The speech does not flow smoothly—participant trails off, participant does not follow up information on topics in a fluid manner or provide relevant examples. Participant sometimes repeats the same factual information during the speech (repeats himself/herself). Participant occasionally responds appropriately to audience’s prompts, (does not acknowledge prompts and/or does not react to prompts).

(3) Fair: for the most part, the participant is able to continue the speech with little to no help/prompts from the audience, although the speech is still somewhat awkward and stalls at times, with participant occasionally trailing off. Participant provides little follow-up information on topics or provide relevant examples. Participant responds appropriately to audience’s prompts.

(4) Good: participant is able to maintain the speech with no help/prompting from the audience. The speech flows smoothly with few awkward pauses. Participant rarely trails off. The participant readily shares information and examples. Shows interest in engaging the audience, and follows up appropriately on participant’s own remarks. No obvious deficits.

(5) Very good: participant easily maintains the speech with minimal pauses and smooth transitions, often following up on previous information provided by making appropriate follow-up remarks and offering additional information on a related topic. Participant introduces new topics fluidly and speaks fluently.

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Lau, N., Zhou, A.M., Yuan, A. et al. Social Skills Deficits and Self-appraisal Biases in Children with Social Anxiety Disorder. J Child Fam Stud 32, 2889–2900 (2023). https://doi.org/10.1007/s10826-021-02194-w

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