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School-Based Intervention for Adolescents with Social Anxiety Disorder: Results of a Controlled Study

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Abstract

Social anxiety disorder, whose onset peaks in adolescence, is associated with significant impairment. Despite the availability of effective treatments, few affected youth receive services. Transporting interventions into schools may circumvent barriers to treatment. The efficacy of a school-based intervention for social anxiety disorder was examined in a randomized wait-list control trial of 35 adolescents (26 females). Independent evaluators, blind to treatment condition, evaluated participants at preintervention, postintervention, and 9 months later. Adolescents in the intervention group demonstrated significantly greater reductions than controls in social anxiety and avoidance, as well as significantly improved overall functioning. In addition, 67% of treated subjects, compared to 6% of wait-list participants, no longer met criteria for social phobia following treatment. Findings support the possible efficacy of school-based intervention for facilitating access to treatment for socially anxious adolescents.

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References

  • Adelman, H. S., Barker, L. A., & Nelson, P. (1993). A study of a school-based clinic: Who uses it and who doesn't? Journal of Clinical Child Psychology, 22, 52–59.

    Google Scholar 

  • Adelman, H. S., & Taylor, L. (1998). Reframing mental health in schools and expanding school reform. Educational Psychologist, 33, 135–152.

    Article  Google Scholar 

  • Adelman, H. S., & Taylor, L. (1999). Mental health in schools and system restructuring. Clinical Psychology Review, 19, 137–163.

    Article  PubMed  Google Scholar 

  • Albano, A. M. (1995). Treatment of social anxiety in adolescents. Cognitive and Behavioral Practice, 2, 271–298.

    Google Scholar 

  • Albano, A. M., Marten, P. A., Holt, C. S., Heimberg, R. G., & Barlow, D. H. (1995). Cognitive-behavioral group treatment for social phobia in adolescents: A preliminary study. The Journal of Nervous and Mental Disease, 183, 649–656.

    PubMed  Google Scholar 

  • Anglin, T. M. (2003). Mental health in schools: Programs of the Federal Government. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 89–105). New York: Kluwer Academic/Plenum.

    Google Scholar 

  • Angold, A., Messer, S. C., Stangl, D., Farmer, E. M., Costello, E. J., & Burns, B. (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health, 88, 75–80.

    Article  PubMed  Google Scholar 

  • Asher, S. R., & Wheeler, V. A. (1985). Children's loneliness: A comparison of rejected and neglected peer status. Journal of Consulting and Clinical Psychology, 53, 500–505.

    Article  PubMed  Google Scholar 

  • Beidel, D. C., Turner, S. M., & Fink, C. M. (1996). Assessment of childhood social phobia: Construct, convergent, and discriminative validity of the Social Phobia and Anxiety Inventory for Children (SPAI-C). Psychological Assessment, 3, 73–79.

    Google Scholar 

  • Beidel, D. C., Turner, S. M., Hamlin, K., & Morris, T. L. (2000). The Social Phobia and Anxiety Inventory for Children (SPAI-C): External and discriminative validity. Behavior Therapy, 31, 75–87.

    Google Scholar 

  • Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess childhood social anxiety and phobia: The Social Phobia and Anxiety Inventory for Children. Psychological Assessment, 7, 73–79.

    Article  Google Scholar 

  • Beidel, D. C., Turner, S. M., & Morris, T. L. (1998). Social effectiveness therapy for children: A treatment manual. Charleston, Medical University of South Carolina.

  • Beidel, D. C., Turner, S. M., & Morris, T. L. (1999). Psychopathology of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 643–650.

    PubMed  Google Scholar 

  • Beidel, D. C., Turner, S. M., & Morris, T. L. (2000). Behavioral treatment of childhood social phobia. Journal of Consulting and Clinical Psychology, 68, 1072–1080.

    Article  PubMed  Google Scholar 

  • Bird, H. R., Canino, G., Rubio-Stipec, M., & Ribera, J. (1987). Further measures of the psychometric properties of the Children's Global Assessment Scale. Archives of General Psychiatry, 44, 821–824.

    PubMed  Google Scholar 

  • Burns, B. J., Costello, E. J., Angold, A., Tweed, D. L., Stangl, D. K., Farmer, E. M. Z., et al. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147–159.

    Article  PubMed  Google Scholar 

  • Burns, B. J., & Hoagwood, K. (2002). Community-based treatment for youth: Evidence-based interventions for severe emotional and behavioral disorders. New York: Oxford University Press.

    Google Scholar 

  • Carlson, G. A., & Cantwell, D. P. (1979). A survey of depressive symptoms in a child and adolescent psychiatric population. Journal of the American Academy of Child Psychiatry, 18, 587–599.

    Article  PubMed  Google Scholar 

  • Catron, T., Harris, V. S., & Weiss, B. (1998). Posttreatment results after 2 years of services in the Vanderbilt School-Based Counseling project. In M. H. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices (pp. 653–656). Austin, TX: PRO-ED.

    Google Scholar 

  • Catron, T., & Weiss, B. (1994). The Vanderbilt School-Based Counseling Program: An interagency, primary-care model of mental health services. Journal of Emotional and Behavioral Disorders, 2, 247–253.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Cohen, P., Kasen, S., Brook, J. S., & Struening, E. L. (1991). Diagnostic predictors of treatment patterns in a cohort of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 989–993.

    PubMed  Google Scholar 

  • Costello, E. J., & Angold, A. (1995). Epidemiology. In J. S. March (Ed.), Anxiety disorders in children and adolescents (pp. 109–124). New York: Guilford.

    Google Scholar 

  • Costello, E. J., & Janiszewski, S. (1990). Who gets treated? Factors associated with referral in children with psychiatric disorders. Acta Psychiatrica Scandinavica, 81, 523–529.

    PubMed  Google Scholar 

  • Craighead, W. E., Smucker, M. R., Craighead, L. W., & Ilardi, S. S. (1998). Factor analysis of the Children's Depression Inventory in a community sample. Psychological Assessment, 10, 156–165.

    Article  Google Scholar 

  • Essau, C. A., Conradt, J., & Petermann, F. (1999). Frequency and comorbidity of social phobia and social fears in adolescents. Behaviour Research and Therapy, 37, 831–843.

    Article  PubMed  Google Scholar 

  • Evans, S. W. (1999). Mental health services in schools: Utilization, effectiveness, and consent. Clinical Psychology Review, 19, 165–178.

    Article  PubMed  Google Scholar 

  • Evans, S. W., Altenderfer, L., Mirarchi, S., & Achre, C. (1996). Examining the cost-effectiveness of schools as a service delivery site for outpatient treatment. In S. Little (Chair), Implementing behavior interventions in the classroom. Symposium conducted at the Annual Meeting of the Association for the Advancement of Behavioral Therapy, New York.

  • Evans, S. W., Langberg, J., & Williams, J. (2003). Achieving generalization in school-based mental health. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 335–348). New York: Kluwer Academic/Plenum.

    Google Scholar 

  • Farmer, E. M. Z., Stangl, D. K., Burns, B. J., Costello, E. J., & Angold, A. (1999). Use, persistence, and intensity: Patterns of care for children's mental health across one year. Community Mental Health Journal, 35, 31–46.

    Article  PubMed  Google Scholar 

  • Gibbons, R. D., Hedeker, D., Elkin, I., Waternaux, C., Kraemer, H. C., Greenhouse, J. B., et al. (1993). Some conceptual and statistical issues in analysis of longitudinal psychiatric data. Archives of General Psychiatry, 50, 739–750.

    PubMed  Google Scholar 

  • Ginsburg, G. S., LaGreca, A. M., & Silverman, W. K. (1998). Social anxiety in children with anxiety disorders: Relation with social and emotional functioning. Journal of Abnormal Child Psychology, 26, 175–185.

    Article  PubMed  Google Scholar 

  • Graczyk, P. A., Domitrovich, C. E., & Zins, J. E. (2003). Facilitating the implementation of evidence-based prevention and mental health promotion efforts in schools. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 301–318). New York: Kluwer Academic/Plenum.

    Google Scholar 

  • Hayward, C., Varady, S., Albano, A. M., Thienemann, M., Henderson, L., & Schatzberg, A. F. (2000). Cognitive-behavioral group therapy for social phobia in female adolescents: Results from a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 721–726.

    PubMed  Google Scholar 

  • Heimburg, R. G., Liebowitz, M. R., Hope, D. A., Scheiner, F. R., Holt, C. S., Welkowitz, L. A., et al. (1998). Cognitive behavioral group therapy vs. phenelzine therapy for social phobia: 12-week outcome. Archives of General Psychiatry, 55, 1133–1141.

    Google Scholar 

  • Hoagwood, K., Burns, B. J., Kiser, L., Ringeisen, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52, 1179–1189.

    Article  PubMed  Google Scholar 

  • Hoagwood, K., & Erwin, H. (1997). Effectiveness of school-based mental health services for children: A 10-year research review. Journal of Child and Family Studies, 6, 435–451.

    Article  Google Scholar 

  • Hoagwood, K., & Olin, S. S. (2002). The NIMH blueprint for change report: Research priorities in child and adolescent mental health. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 760–767.

    Google Scholar 

  • Hoberman, H. (1992). Ethnic minority status and adolescent mental health services utilization. Journal of Mental Health Administration, 19, 246–267.

    PubMed  Google Scholar 

  • Hofmann, S. C., Albano, A. M., Heimberg, R. G., Tracey, S., Chorpita, B. F., & Barlow, D. H. (1999). Subtypes of social phobia in adolescents. Depression and Anxiety, 9, 15–18.

    PubMed  Google Scholar 

  • HoganBruen, K., Clauss-Ehlers, C., Nelson, D., & Faenza, M. M. (2003). Effective advocacy for school-based mental health programs. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 45–59). New York: Kluwer Academic/Plenum.

    Google Scholar 

  • Kashdan, T. B., & Herbert, J. D. (2001). Social anxiety disorder in childhood and adolescence: Current status and future directions. Clinical Child and Family Psychology Review, 4, 37–61.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366–380.

    PubMed  Google Scholar 

  • Klein, R. G., & Pine, D. S. (2002). Anxiety disorders. In M. Rutter & E. Taylor (Eds.), Child and adolescent psychiatry: Modern approaches (pp. 486–509). London: Blackwell Science.

    Google Scholar 

  • Kovacs, M. (1992). The Children's Depression Inventory Manual. Toronto, Ontario, Canada: Multi-Health Systems.

    Google Scholar 

  • Kovacs, M., & Beck, A. T. (1977). An empirical–clinical approach toward a definition of childhood depression. In J. G. Schulterbrandt & A. Raskin (Eds.), Depression in childhood: Diagnosis, treatment, and conceptual models (pp. 1–25). New York: Raven.

    Google Scholar 

  • LaGreca, A. M. (1998). Social anxiety scales for children and adolescents: Manual and instructions for the SASC, SASC-R, SAS-A, and parent versions of the scales. Unpublished manuscript available from the author. University of Miami, Coral Gables, FL.

  • LaGreca, A. M., & Lopez, N. (1998). Social anxiety among adolescents: Linkages with peer relations and friendships. Journal of Abnormal Child Psychology, 26, 83–94.

    Google Scholar 

  • Laitinen-Krispijn, S., van der Ende, J., Wierdsma, A. I., & Verhulst, F. C. (1999). Predicting adolescent mental health service use in a prospective record-linkage study. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1073–1080.

    PubMed  Google Scholar 

  • Leaf, P. J., Alegria, M., Cohen, P., Goodman, S. H., Horowitz, S. M., Hoven, C. W., et al. (1996). Mental health service use in the community and schools: Results from the four-community MECA study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 889–897.

    PubMed  Google Scholar 

  • Leff, S. S., Power, T. J., Manz, P. H., Costigan, T. E., & Nabors, L. A. (2001). School-based aggression prevention programs for young children: Current status and implications for violence prevention. School Psychology Review, 30, 344–362.

    Google Scholar 

  • Liebowitz, M. R., Gorman, J. M., Fryer, A. J., & Klein, D. F. (1985). Social phobia: Review of a neglected anxiety disorder. Archives of General Psychiatry, 42, 729–736.

    PubMed  Google Scholar 

  • Liebowitz, M. R., Scheiner, F., Campeas, R., Hollander, E., Hatterer, J., Fyer, A., et al. (1992). Phenelzine vs. atenolol in social phobia: A placebo-controlled comparison. Archives of General Psychiatry, 49, 290–300.

    PubMed  Google Scholar 

  • March, J. S., Parker, J. D. A., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554–565.

    PubMed  Google Scholar 

  • Masia, C., Beidel, D. C., Albano, A. M., Rapee, R. M., Turner, S. M., Morris, T. L., et al. (1999). Skills for Academic and Social Success. Available from Carrie Masia-Warner, PhD, New York University School of Medicine, Child Study Center, 215 Lexington Avenue, 13th floor, New York 10016.

  • Masia, C. L., Klein, R. G., Storch, E., & Corda, B. (2001). School-based behavioral treatment for social anxiety disorder in adolescents: Results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 780–786.

    PubMed  Google Scholar 

  • Masia-Warner, C., Klein, R. G., & Liebowitz, M. R. (2003). The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). Available from Carrie Masia-Warner, PhD, NYU Child Study Center, 215 Lexington Avenue, 13th floor, New York 10016.

  • Masia-Warner, C., Storch, E. A., Pincus, D. B., Klein, R. G., Heimberg, R. G., & Liebowitz, M. R. (2003). The Liebowitz Social Anxiety Scale for Children and Adolescents: An initial psychometric investigation. Journal of the American Academy of Child and Adolescent Psychiatry, 4, 1076–1084.

    Google Scholar 

  • Pandey, P., Han, S., Fisher, P. H., Ferrante, D., Selinger, A., Cho, L.Y-J., et al. (2003). Barriers to referral of socially anxious students: Teacher perspectives of why they go unnoticed. Poster presented at the 37th Annual Convention of the Association for the Advancement of Behavior Therapy, Boston, MA.

  • Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56–64.

    PubMed  Google Scholar 

  • Power, T. J., Manz, P. H., & Leff, S. S. (2003). Training for effective practice in the schools. In M. D. Weist, S. W. Evans, & N. A. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 257–273). New York: Kluwer Academic/Plenum.

    Google Scholar 

  • Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3, 223–240.

    Article  PubMed  Google Scholar 

  • Schneier, F. R., Johnson, J., Hornig, C. D., Liebowitz, M. R., & Weissman, M. M. (1992). Social phobia: Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49, 282–288.

    PubMed  Google Scholar 

  • Schoenwald, S., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197.

    Article  PubMed  Google Scholar 

  • Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A Children's Global Assessment Scale. Archives of General Psychiatry, 40, 1228–1231.

    PubMed  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions. San Antonio, TX: Graywind, A Division of the Psychological Corporation.

    Google Scholar 

  • Spence, S. H. (1995). Social skills training: Enhancing social competence with children and adolescents. Windsor, UK: NFER-Nelson.

    Google Scholar 

  • Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (1999). Social skills, social outcomes, and cognitive features of childhood social phobia. Journal of Abnormal Psychology, 108, 211–221.

    Article  PubMed  Google Scholar 

  • Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioral intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry, 41, 713–726.

    Article  PubMed  Google Scholar 

  • Staghezza-Jaramillo, B., Bird, H. R., Gould, M. S., & Canino, G. (1995). Mental health service utilization among Puerto Rican children ages 4 through 16. Journal of Child and Family Studies, 4, 399–418.

    Article  Google Scholar 

  • Tarico, V. S., Low, B. P., Trupin, E., & Forsyth-Stephens, A. (1989). Children's mental health services: A parent perspective. Community Mental Health Journal, 25, 313–326.

    Article  PubMed  Google Scholar 

  • Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95, 389–394.

    PubMed  Google Scholar 

  • U.S. Department of Health and Human Services. (1999). Mental Health: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health and National Institute of Mental Health.

  • U.S. Public Health Service. (2000). Report on the Surgeon General's conference on children's mental health: A national action agenda. Washington, DC: Department of Health and Human Services.

  • Verhulst, F. C., & van der Ende, J. (1997). Factors associated with child mental health service use in the community. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 901–909.

    PubMed  Google Scholar 

  • Verhulst, F. C., van der Ende, J., Ferdinand, R. F., & Kasius, M. C. (1997). The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents. Archives of General Psychiatry, 54, 329–336.

    PubMed  Google Scholar 

  • Wampold, B. E. (2001). The great psychotherapy debate. Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Weist, M. D. (1997). Expanded school mental health services: A national movement in progress. In T. H. Ollendick & R. J. Prinz (Eds.), Advances in clinical child psychology (Vol. 19, pp. 319–352). New York: Plenum.

  • Weist, M. D. (1999). Challenges and opportunities in expanded school mental health. Clinical Psychology Review, 19, 131–135.

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 688–701.

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Weiss, B., & Donenberg, G. R. (1992). The lab versus the clinic: Effects of child and adolescent psychotherapy. American Psychologist, 47, 1578–1585.

    Article  PubMed  Google Scholar 

  • Wittchen, H.-U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community sample of adolescents and young adults: Prevalence, risk factors, and comorbidity. Psychological Medicine, 29, 309–323.

    PubMed  Google Scholar 

  • Wu, P., Hoven, C. W., Bird, H. R., Moore, R. E., Cohen, P. C., Alegria, M., et al. (1999). Depressive and disruptive disorders and mental health service utilization in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1081–1090.

    PubMed  Google Scholar 

  • Zahner, G. E. P., & Daskalakis, M. S. (1997). Factors associated with mental health, general health, and school-based service use for child psychopathology. American Journal of Public Health, 87, 1440–1448.

    Article  PubMed  Google Scholar 

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Masia-Warner, C., Klein, R.G., Dent, H.C. et al. School-Based Intervention for Adolescents with Social Anxiety Disorder: Results of a Controlled Study. J Abnorm Child Psychol 33, 707–722 (2005). https://doi.org/10.1007/s10802-005-7649-z

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