Friday, December 28, 2007

Cognitive correlates of social phobia among children and adolescents

Recent prevalence estimates of childhood social phobia indicate that up to 3-4% of children may be affected (Beidel, Turner, & Morris, 1999), placing it among the most adjectives of childhood psychiatric disorders. As such, identification of factor presumed to both underlie and maintain the disorder have become a burgeoning area of research. Although characterized by physiological reaction such as heart palpitations, sweating, and blushing, it also is generally traditional that social phobia is associated with cognitive symptoms. Cognitive models of fully fledged social anxiety (e.g., Clark & Wells, 1995) propose that socially phobic individuals possess biases in the way they process, attend to, and expect to accomplish in social situations. In expert, Clark and Wells' (1995) model poses that within social contexts, attention is shifted away from external social cues and instead is excessively self focused. The socially phobic individual is characterized as individual flooded with distrustful self-images and thoughts of his/her behavior that occupy the individual's primary focus. These negative self-images are purported to organize to the (inaccurate) belief that others see him/her in the same gloomy fashion. Overall, this process is considered to result surrounded by perpetual feelings of excessive anxiety and expectations of decrease social performance over time.


The presence of glum cognitions, irrational beliefs, and low expectations of performance adjectives have support within the adult social phobia literature (e.g., Beidel, Turner, & Dancu, 1985; Foa, Franklin, & Perry, 1996; Rapee & Lim, 1992). In certainty, such findings have organize to the general belief that cognitive factor assist in maintain emotional distress and behavioral avoidance. By comparison, research examining cognitive features of childhood social phobia have only begin to accumulate. Although empirical information continue to emerge (e.g., Bogels & Zigterman, 2000; Chansky & Kendall, 1997; Kendall & Chansky, 1991; Spence, Donovan, & Brechman-Toussaint, 1999), overall results are smaller quantity robust than is commonly found within the fully fledged literature. Specifically, although some child studies have reported the presence of aberrant/dysfunctional cognition among socially phobic youths, other studies own not. Indeed, there are several possible explanations for these divergent findings including differences in methodology and types of breadth, a lack of attention to developmental factor and competing definitions of the residence "cognition" (see Alfano, Beidel, & Turner, 2002 for review of this literature).


Among the available studies, Spence et al. (1999) examined cognitive content in relation to a social-evaluative task. Using a video-mediated call in procedure, socially phobic children and adolescents (ranging from 7 to 14 years of age) reported a significantly greater number of negative cognitions compared to their nonanxious peers. Using a speaking thought-listing procedure, Beidel (1991) also assessed self-talk among socially phobic, overanxious, and normal control children following a social-evaluative favour. All groups reported few thoughts when actually occupied in the duty. Furthermore, there be no significant differences for any type of cognition. Also using a thought-listing procedure, children and adolescents (ages 9 to 15 years) diagnosed with DSM-III-R overanxious disorder, avoidant disorder, and separation anxiety disorder did not report more glum self-evaluative thoughts than normal controls, but they did report more unenthusiastic thoughts overall (Chansky & Kendall, 1997). Taken together, these disparate findings illustrate the lack of clarity about cognitive phenomena and childhood social phobia.


Comparatively, research examining social expectation has produced somewhat more consistent results. Available empirical facts indicate that socially phobic children tend to have poorer expectations of their actions within social contexts than run of the mill control children. For example, socially phobic children expected to perform more poorly on both a role-play and read-aloud obligation than normal control children (Spence et al., 1999). Interestingly, however, after the charge, there be no group difference for self-evaluated performance ratings. Thus, socially phobic children's lower expectations be not confirmed by their perceptions of their gig. Also with good opinion to social expectancies, anxiety-disordered children endorsed significantly higher level of negative expectation within anticipation of a social interaction with a peer compared to control children (Chansky & Kendall, 1997). Unfortunately, because children did not rate their actual favour performance, it is vague how these expectations compare to self-ratings of actual performance. Thus, although available information suggest that anxious children expect to perform smaller number well than their peers within social situations, it is not clear whether socially phobic children perceive their actual performance differently (i.e., poorer) than majority children. Meanwhile, among adult sample of social phobics, such differences have commonly be reported (Alden & Wallace, 1995; Beidel et al., 1985; Rapee & Lim, 1992; Wallace & Alden, 1997).


A related area of study involves the role of excited understanding contained by childhood social phobia. Available data suggest that clinically anxious children may hold a poor meta-cognitive understanding of reaction compared to their nonanxious peers (Southam-Gerow & Kendall, 2000). In particular, socially anxious children may possess difficulties compassionate the linkages between cognition and mood (Banjeree & Henderson, 2001). Although this preliminary research awaits replication, potential deficits within emotional concerned may impact report of negative cognition. Specifically, base on such deficits, socially anxious youths may be more feasible to report emotional responses when asked in the order of their specific thoughts. Currently, however, it remains unclear how potential deficit in excited understanding may affect socially phobic children's detection and report of their own thoughts.


In summary, substantial questions remain in connection with cognitive factors associated beside childhood social phobia. A better understanding of the role of cognition surrounded by the clinical presentation of social phobia among children and adolescents has the potential to inform both clinical and research pains. To better understand these phenomena, this study compared the self-talk, expected observation, self-rated, and observer-rated performance of socially phobic and regular control children in relation to two social tasks. Additionally, base on the suggestion of several researchers (e.g., Alfano et al., 2002; Morris, Hirshfeld-Becker, Henin, & Storch, 2004) who have noted a common lack of attention toward developmental factor in the assessment of childhood anxiety, we categorized socially phobic youths into two groups: younger children (7 to 11 years) and adolescents (12-16 years).


METHOD


Subjects


The tolerant sample consisted of 50 children and adolescents referred for the treatment of social phobia at one of two sites: the Maryland Center for Anxiety Disorders (MCAD) at the University of Maryland contained by College Park, Maryland or Children's Hospital Medical Center (CHMC) in Cincinnati, Ohio. Children be referred by school counselors, physicians, other professionals, or their parents responded to advertisement regarding free treatment for "shy" children. Parents and children be provided with detailed information on the subject of the treatment study, including the behavioral assessment tasks, and signed consent/assent forms prior to their participation. Mean age for adjectives socially phobic youths was 11.94 years (SD = 2.65), near an age range of 7-16 years. Twenty-eight subjects (56%) be male. There be 39 (78%) Caucasian children, 9 (18%) African-American children, 1 (2%) Hispanic child, and 1 (2%) Asian-American child in the forgiving sample (see Table I). All children be of normal intelligence as assessed by the Vocabulary and Block Design subtests of the WISC-III and base on their enrollment in regular classroom settings.


The control indication consisted of 30 children and adolescents recruited at MCAD as role-play confederates and/or "peer-helpers" for one and the same treatment program. All normal control children be recruited through the use of community flyers or local advertisement for "friendly" children/adolescents. Similar to the socially phobic group, consent/assent was obtain from control children and their parents prior to participation contained by the study. Normal control children first participated as a subject within the current study before serving as a confederate or peer-helper. Mean age for adjectives control subjects was 11.87 (SD = 2.16) years (range 7-16 years), and 17 (57%) children be female. There be 15 (50%) Caucasian children and 15 (50%) African-American children in the control example. Of note, although control children be recruited as peer-helpers for a treatment study, this role required just that children assist with the behavioral assessment (described below) and play a part in group social undertakings with other children. Control children be not required to give performances within front of their peers or demonstrate any specific types of social skill. Accordingly, examination of control children's score on a validated standard of childhood social anxiety (SPAIC; Beidel, Turner, & Morris, 1995) indicated social fears considered to be the normative range (M = 7.9, SD = 7.6; see Beidel et al., 1995). As such, a bit than representing a "supernormal" subsample of normal children, control children reported age-appropriate amounts of social anxiety.


For analyses based on age, children below the age of 12 and adolescents 12 years and older comprised two separate groups. For the 32 babyish children in the study, the penny-pinching age was 9.3 years (SD = 1.26) and for 48 adolescents, the be a sign of age was 13.6 years (SD = 1.28).No differences within mean ages between socially phobic youths and majority control children were found.


Assessment


Diagnostic Interview


All children (as very well as their parents) were interviewed by a licensed clinical psychologist, a postdoctoral fellow in clinical psychology or an advanced doctoral student in clinical psychology using the Anxiety Disorders Interview Schedule for Children for DSM-IV (ADIS-C; Silverman & Albano, 1996). The same clinician interviewed the parent (first) and the child (second). For the current investigation, diagnoses be based on information provided by the child and the parent during separate interviews. Twenty-five percent of interviews be videotaped and rate by a second clinician blind to diagnostic status. The resulting kappa coefficient for the diagnosis of social phobia was 0.85. All socially phobic children met criteria for a primary AXIS I diagnosis of social phobia. Also, 28 (56%) socially phobic youths met criteria for at smallest 1 secondary AXIS I diagnosis. Comorbid diagnoses included generalized anxiety disorder (n = 8), specific phobia (n = 8), separation anxiety disorder (n = 5), attention deficit hyperactivity disorder (n = 4), dysthymia (n = 4), selective mutism (n = 4), oppositional badly behaved disorder (n = 1), and depression (n = 1). Anxious children were excluded from participating if they met criteria for a psychotic disorder, bipolar sickness, or severe depression. Children in the control group did not get together diagnostic criteria for any lifetime AXIS I disorder.


Self-Report


All children completed the Social Phobia and Anxiety Inventory for Children (SPAIC; Beidel et al., 1995). The SPAIC assesses a range of potentially fearful social situations, including physiological and behavioral reaction, and is a reliable measure of childhood social phobia (Beidel, Turner, Hamlin, & Morris, 2000; Morris & Masia, 1998). Additionally, the SPAIC contains seven items aimed at measure dysfunction/negative cognitions (self-talk). For example, "When I am with other those ... I think ... doesn`t matter what I say will nouns stupid." Although not specifically validated separate from the inventory itself, we examined children's self-report on these items added to to examining the SPAIC total score. Internal consistency (coefficient alpha) for this indication was [alpha] = .92 for total SPAIC score and [alpha] = .89 for the SPAIC cognitive items.


Procedure


Behavioral Assessment


Social skill and anxiety were evaluated during two tasks. Children be told that the purpose of these tasks was to examine how children interact near other children. Order of task presentation be randomized for all subjects and children be informed that they could discontinue the tasks at any time. Normal controls participated first as subjects, prior to any taking part as a peer. For the social interaction task, five role-play scene requiring interaction with a peer assessed children's wherewithal to (1) carry on a conversation, (2) dispense a compliment, (3) graciously receive another child's proposition for help, (4) receive a compliment, and (5) request that another child devolution their negative behavior. The confederate be a peer of the same age and sexual category. Peer-helpers were prompted to direct two separate statements toward socially phobic youths (using standardized cue cards). Subjects be instructed to respond to the peer as they would if they were in actual fact in that situation (i.e., including instances where on earth they would not respond to their peer). The performance errand required children to read aloud an age-appropriate story (i.e., Jack and the Beanstalk for children below 12 years; The Ransom of Red Chief for adolescents 12 years and older) for 10 min in front of two individuals: the peer used for the role-play project and the adult assessor.


Video-Mediated Recall Procedure


Following the two behavioral tasks and rating of anxiety and ceremonial (see below), peers left the room while subjects view a videotape of him or herself engaged surrounded by the tasks. The videotape was stopped twice during respectively task at which point the children be asked to retrospectively recall their thoughts (self-talk). Specific stop points be chosen arbitrarily but allowed for children to view an ample portion of respectively task prior to recall their specific thoughts. For the current investigation, a videotape shot from the child's perspective was used base on previous research that this perspective assists children in retrospectively recall their thoughts (Lodge, Tripp, & Harte, 2000).


Self-Rated Expectation/Performance


Immediately prior to each behavioral mission (but following task directions), adjectives children completed a four-item questionnaire regarding their implementation expectations including (1) overall performance on the tasks, (2) faculty to hide their anxiety, (3) use of task-specific skills, and (4) peer's evaluation of their working. Each question be rated on a 4-point likert-type extent where 1 = poorly, 2 = somewhat poorly, 3 = somewhat in good health, and 4 = well. Thus, for respectively task a maximum total evaluation of 16 was possible. For the role-play odd job, the expectation questionnaire was administered following a practice scene to ensure that the children unspoken the task's requirements. Immediately following both tasks, children be asked to complete a similar four-item questionnaire regarding how ably they thought they actually perform on the previous task. Items on the implementation questionnaires matched items on the expectation questionnaire but were worded within the past rigid. Although peers were present when questionnaire were completed, they be unable to see the children's ratings. Coefficient alphas for the four running measures were as follows: roleplay expectancy, [alpha] = .89, read-aloud expectancy, [alpha] = .84, read-aloud presentation, [alpha] = .91, and read-aloud performance, [alpha] = .87.


Self-Rated Anxiety


Following respectively task, children be asked to rate their anxiety while engaged surrounded by the actual task. A 5-point likert-type ascend was used, beside 1 reflecting very little to no anxiety and 5 reflecting extreme anxiety. The scramble used pictorial representations of anxiety levels to assist children surrounded by anchoring their feelings. Similar to rating of expectation/performance, anxiety ratings be kept hidden from peers.


Observer-Rated Anxiety/Performance


All behavioral tasks be videotaped and after that rated by independent raters blind to diagnostic status. Independent raters used 4-point likert-type scales and rate anxiety (1 = extremely anxious to 4 = not at all anxious) and working (1 = not at all important to 4 = very effective) for the two tasks. In incorporation, observers rate facial gaze (i.e., appropriate eye contact) and speech latencies during the role-play responsibility. All raters were trained prior to rating videotapes. Twenty-five percent of the videotapes be rated independently by a second rater to ensure interrater reliability. Respectively for the role-play and read-aloud tasks, interrater reliability (kappa) be 0.88/0.85 for anxiety and 0.82/0.84 for performance. For specific social skills, interrater reliability be 0.92 for facial gaze and 0.95 for speech latency.


Coding of Self-Talk


During the video-mediated take out procedure, the children's self-talk (thoughts) was record verbatim. For younger children (under 12 years), a form consisting of a cartoon scene resembling the actual assessment be used to record actual self-talk and children be told that the assessor would be writing down their thoughts in the empty "thought bubbles." Independent magistrates coded each thought into 1 of 10 category (see Table II for category descriptions). Thoughts were coded base on both their valence (negative vs. positive vs. neutral) and their content (performance vs. task vs. emotion). Additionally, thoughts be coded as "Other" if they did not fit into any of the above categories. Twenty-five percent of adjectives cases were rate independently by a second rater to determine interrater reliability.


RESULTS


Site Differences


Chi-square and t-tests revealed no site differences between socially phobic children with the exception of ethnicity. Specifically, here was a significantly better percentage of African-American children among the socially phobic group presenting to MCAD compared to CHMC [[chi square](1, N = 50) = 11.08, p < .05]. However, follow-up ANOVAs examining anxiety, expectation of performance, activities ratings and total thoughts (self-talk) did not reveal any site differences. Therefore, socially phobic children from both clinic sites were combined to represent one group.


Demographics


There be no significant group differences based on age or masculinity. There was a significant difference between the socially phobic (SOC) and commonplace control (NOR) groups in jargon of ethnicity [[chi square](1, N = 80) = 9.78, p < .05], with more African-American children within the control group. Although there is no clear reason to assume a significant relationship between cognitive factors related to social anxiety and ethnicity, a follow-up 2 x 2 (group x ethnicity) MANOVA across adjectives dependent measures did not reveal any significant group differences. Thus, race be not included as a covariate for final analyses.


Self-Report


Anxiety


A 2 x 2 (group x age) MANOVA was conducted for adjectives dependent anxiety measures (SPAIC, cognitive items on the SPAIC, anxiety rating on the role play task, and anxiety rating on the read-aloud task). The overall F be significant [F(1, 79 = 16.16, p < .001]. Follow-up univariate ANOVAs revealed that socially phobic youths scored significantly greater on the SPAIC [F(1, 79) = 4.07, p < .001], role-play ratings of anxiety [F(1, 79) = 33.55, p < .001], and read-aloud ratings of anxiety [F(1, 79) = 9.79, p < .01] compared to control children. No significant main effects emerge for age. However, a significant group x age interaction was detected for the cognitive items on the SPAIC [F(1, 79) = 6.29, p < .05]. In instruct to better understand the specific humour of this difference, data for socially phobic children and adolescents and control children and adolescents be recoded into four separate groups (socially phobic children, socially phobic adolescents, control children, and control adolescents). An ANOVA and follow-up Tukey's test revealed that both socially phobic adolescents (M = 6.6) and socially phobic younger children (M = 4.6) score higher on these items than control adolescents (M = 1.2).


Expectation of Performance


A 2 x 2 (group x age) MANOVA examining score on the role-play expectation questionnaire revealed that socially phobic youths expected to perform smaller number well than the control group on the role-play assignment [F(1, 79) = 4.05, p < .01; see Table III]. Follow-up univariate ANOVAs revealed that compared to the control children, socially phobic youths believed they would be less competent to hide their anxiety [F(1, 79) = 7.07, p < .01] and that the peer would referee their performance to be worse [F(1, 79) = 9.65, p < .01]. There be no significant main effect for age. However, near was a significant group x age interaction for children's expectation in relation to their ability to "give attention to of things to say" to the peer during the role-plays [F(1, 79) = 4.65, p < .05]. A follow-up ANOVA and Tukey's test examining score across all four groups revealed that socially phobic adolescents (M = 2.4) expected to carry out worse than control adolescents (M = 3.6) on this particular aspect of the duty.


A 2 x 2 (group x age) MANOVA examining scores on the read-aloud expectation questionnaire revealed that overall, socially phobic children did not expect to make less economically than the control group on this task [F(1, 79) = 2.24, p = .07]. No significant major effect for age or group x age interactions was found.


Performance


Results of a 2 x 2 (group x age) MANOVA examining score on the role-play performance questionnaire revealed that socially phobic youths believed that they perform less capably than the control group [F(1, 79) = 5.55, p < .001]. Follow-up univariate ANOVAs revealed that compared to control children, socially phobic youths believed that they were smaller amount able to store their anxiety [F(1, 79) = 19.09, p < .001] and that the peer judged their recitation to be worse [F(1, 79) = 4.07, p < .05]. No significant main effect emerge for age. However, a significant group x age interaction was found in relation to children's self-rated ability to generate conversation topics during the role-plays [F(1, 79) = 5.06, p <.05].Afollowup Tukey's experiment revealed that both younger socially phobic children (M = 2.6) and socially phobic adolescents (M = 2.3) believed that they were smaller amount able to believe of things to say than control adolescents (M = 3.6).


A 2 x 2 (group x age) MANOVA examining score on the read-aloud performance questionnaire revealed that overall, socially phobic youths did not differ from control children surrounded by terms of their ratings of their enactment on this task. No significant largest effect for age or group x age interactions was found.


Expectation Versus Perceived Performance


A 2 x 2 x 2 (evaluation extent x group x age) repeated measures MANOVA was conducted using total expectation and actions scores across both tasks to examine change in self-ratings from pre- to post-task. Interestingly, adjectives children (i.e., both the socially phobic and control groups) rated their actual manners to be poorer than their initial expectations on the read-aloud task [F(1, 79) = 5.37, p < .05]. On the role-play chore, however, when compared to the control group (Mexp = 14.0, Mperf = 13.9), only socially phobic youths (Mexp = 11.1, Mperf = 10.7) believed that they have performed smaller amount well compared to their initial expectation of their concert [F(1, 79) = 6.55, p < .05]. No significant main effect for age or interaction jargon emerged.


Independent Observer-Ratings


Anxiety


Results of a 2 x 2 (group x age) ANOVA examining observer-rated anxiety during the role-play odd job revealed that socially phobic youths exhibited significantly higher level of anxiety than control children [F(1, 79) = 34.54, p < .001]. There was neither amain effect for age nor for the interaction occupancy. A similar ANOVA examining observer-rated anxiety during the read-aloud task also revealed that the socially phobic youths exhibited significantly greater levels of anxiety during the job than control children [F(1, 79) = 12.72, p < .001]. Again, no significant main effect for age or interaction lingo emerged.


Performance


Two separate 2 x 2 (group x age) ANOVAs be used to examine overall observer-rated performance during the two tasks. For the role-play task, socially phobic youths be judged to be smaller number socially effective than the control group of children [F(1, 79) = 66.68, p < .001]. Similar results emerge for the read-aloud task, where on earth reading performance among socially phobic youths be rated as smaller quantity effective than the control children [F(1, 79) = 18.05, p < .01]. For both tasks, no significant most important effect for age or interaction terms emerge. For facial gaze, in attendance were no primary effects for group or age. For speech latencies, main effects for both group [F(1, 79) = 28.82, p < .001] and age [F(1, 79) = 4.16, p < .05] be detected. Compared to the control group, socially phobic youths had significantly longer speech latencies during the role-play responsibility. In terms of age, younger children have significantly longer speech latencies during the role-play task compared to adolescents aged 12 and elder. Results of this ANOVA also revealed a significant group x age interaction. A follow-up of Tukey's test revealed that socially phobic children required a significantly longer term of time to respond to the peer than the other three groups, including socially phobic adolescents, control children, and control adolescents. Means and standard deviations for all observer-rated measures across groups are presented in Table IV.


Self-Talk


Data Reduction


Few or no children reported thoughts coded as positive performance, positive favour, positive emotion, nonpartisan emotion, or other thoughts. Thus, to increase statistical power for subsequent analyses, these category were delete, resulting in a total of five self-talk categories (including distrustful performance thoughts, indeterminate performance thoughts, cynical task thoughts, indeterminate task thoughts, and refusal emotions). Means and standard deviations for each category are provided surrounded by Table V. Interrater reliability (kappa coefficients) was as follows: denial performance = 0.91, colourless performance = 0.87, distrustful task = 0.80, dull task = 0.98, and unenthusiastic emotions = 0.95.


Video-Mediated Recall of Self-Talk


A 2 x 2 (group x age) ANOVA conducted for total number of thoughts across the two tasks revealed no primary effect for group. However, there be a main effect for age. Adolescents reported significantly sophisticated frequencies of self-talk (M = 5.5) than young children [M = 3.8; F(1, 79) = 5.03, p < .05]. To control for the effect that overall frequency of thoughts may exert on the specific types of thoughts reported, number of thoughts be entered as a covariate for adjectives subsequent analyses.


Role-Play Task


A 2 x 2 (group x age) multivariate analysis of covariance (MANCOVA) for thoughts during the roleplay task revealed a significant prime effect for group [F(1, 79) = 2.29, p < .05]. Specifically, socially phobic youths (M = 0.26) reported a greater number of negative rite thoughts than the control group [M = 0.03; F(1, 79) = 4.42, p < .05]. In contrast, control children (M = 1.4) reported a greater number of neutral duty thoughts than the socially phobic group [M = .74; F(1, 79) = 10.12, p < .01]. A significant main effect be also detected for age [F(1, 79) = 3.27, p < .05]. Univariate tests revealed that younger children (M = 0.50) (regardless of group) reported a greater number of gloomy emotions than adolescents [M = 0.10; F(1, 79) = 8.94, p < .01]. Additionally, adolescents (M = 1.29) reported a greater number of indeterminate task thoughts compared to younger children [M = 0.56; F(1, 79) = 4.36, p < 0.05]. No significant interaction expressions were found for types of cognitions reported during the role-play responsibility.


Read-Aloud Task


A similar MANCOVA for thoughts reported during the read-aloud task did not reveal significant most important effects for either group or age. Further, no significant group x age interactions be found.


Correlations Between Self-Talk and Self-Rated Performance


Partial correlations controlling for total number of thoughts (n = 80) revealed a moderate and significant negative correlation between gloomy performance thoughts during the read-aloud project and self-rated perceptions of their concert during the task (r = -.33, p < .05). Role-play rite self-ratings were not significantly correlated near any specific type of cognition/emotion reported by children during the role-play task. Additionally, indistinct task thoughts reported during the read-aloud favour were significantly negatively correlated beside both negative actions thoughts (r = -.37, p < .001) and negative emotion (r = -.41, p < .001) during the same odd job. Similar significant negative correlations be found for neutral assignment thoughts reported during the role-play task and both unenthusiastic performance thoughts (r = -.39, p<.001) and distrustful emotions (r = -.37, p < .001). See Table VI for correlation matrix.


Correlations Across All Variables


Table VII depicts the correlations across demographic and dependent variables included in the current study. As expected, here were significant relationships between social phobia severity (as measured by the SPAIC) and most cognitive measures including children's expectations and their perceived actions on both behavioral tasks.


DISCUSSION


This study examined the relationship between different cognitive phenomena and childhood social phobia. The results of this investigation indicate that in anticipation of and following a social interaction, children and adolescents with social phobia be more likely to expect to achieve poorly and to evaluate their performance as inferior to those of peers beside no psychiatric disorder. Interestingly, although their evaluations were more cynical, they were nonetheless accurate, as independent evaluators, blinded to group assignment, rate the youths with social phobia as significantly smaller quantity skilled than their normal control counterparts. However, single socially phobic adolescents reported the presence of negative self-talk during a social interaction and even among this subgroup, simply 20% of adolescents reported the presence of such self-talk.


The results are consistent with previous reports but bring to the fore interesting questions almost the role of cognition, and especially self-talk, in the presentation of the disorder among youths. First, and consistent near others (Spence et al., 1999; Chan sky & Kendall, 1997), the results indicated that socially phobic youths reported significantly greater self-talk (more negative recital thoughts) during a social interaction. However, the clinical significance of this finding is unclear as the niggardly number of negative recitation thoughts reported by the anxious group was approximately one quarter of one thought per subject. In reality, only 20% of the socially phobic youths reported the presence of any glum performance self-talk and adjectives negative thoughts be reported by adolescents. The fact that cynical performance thoughts be infrequently reported by socially phobic adolescents and were largely absent among young-looking socially phobic children has implication for both childhood models of the disorder and its treatment. We discuss these implications below.


The presence of gloomy self-thoughts only among adolescents beside social phobia highlights the importance of considering developmental factor in the assessment of cognition. For example, one fundamental interrogate addressed surrounded by the current study is whether younger anxious children experience difficulty in differentiating self-talk (thoughts) from sentiment, particularly during period of increased anxiety. However, the current results do not support the hypothesis that confusing thoughts with violent responses is specific to socially phobic youths. Rather, younger children, regardless of diagnostic status, more commonly reported emotions when question about their self-talk, possible reflecting a developmentally appropriate deficit in meta-cognitive skill. Although these results provide support for the use of developmentally sensitive methods of assessment among children, further research examining discrete domains of emotional compassion (as in Banjeree & Henderson, 2001) is needed.


The scarcity of negative ceremonial thoughts reported by young children beside social phobia raises central conceptual questions beside regard to how gloomy self-talk relates to the etiology of this disorder. Although 20% of adolescents with social phobia reported glum performance thoughts during the role-play assignment, their absence among the other 80% of socially phobic adolescents (and all immature children with social phobia) suggests that unenthusiastic self-thoughts may be a potential epiphenomenon or consequence of the disorder rather than a specific contributing factor. One possible explanation for their presence among only 20% of adolescents may be the inherently adjustable range of social experiences during this term. More specifically, negative self-thoughts may be more probable to develop following a multitude of previous social interactions where the young perceives their performance as smaller amount than adequate. Over time, a growing number of (negative) social experiences may create an thrilling state in which glum self-talk is most likely to emerge, resulting in their presentation among some adolescents and tons adults with this disorder.


Of course, alternative explanations also exist. First, the presence of glum self-talk may be related to symptom severity. Specifically, a more severe form of the disorder among adolescents may directly moderate the relationship between such thoughts and level of nouns. However, there be no differences in denial thoughts based on age group (children vs. adolescents). Further evaluations of this relationship should use a broader age scope and determine the relations between anxious severity and negative thoughts as a function of age. Another possibility is that the presence and severity of cynical self-talk may directly relate to the assessment method used in the current study. As reviewed previously by the current authors (Alfano et al., 2002), different methods of assessment hold produced somewhat variable frequencies of self-talk. Although a video-mediated recollect procedure was preferred based on previous research (Lodge et al., 2000; Spence et al., 1999), other methods might enjoy yielded different results. Further, because video stop points be chosen arbitrarily, it is not clear whether allowing children to view longer (or shorter) segment of their performance might produce dissimilar rates of self-talk.


Another possible explanation is that immature socially phobic children may have have difficulty articulating negative self-talk related to their celebration on the role-play task (i.e., despite their presence), probably highlighting basic developmental limitations contained by meta-cognitive skill. In fact, some of the self-talk may own actually be expressed as negative emotion. Although this remains a possibility, it should be noted that many younger children (both socially phobic and controls) reported at smallest one negative acting out thought during the read-aloud task. Thus, because they be able to report the presence of cynical self-talk during the read-aloud task, it appears unlikely that their absenteeism during the social interaction task resulted from restricted meta-cognitive skill. Alternatively, the greater complexity of the social interaction task (i.e., requiring flexible attention and greater cognitive resources) as compared to the read-aloud project may explain these differences in self-talk. Although completely untangling these alternative hypotheses are beyond the scope of this investigation, overall, the current notes suggest that developmental differences in denial self-talk cannot be attributed to differences in level of anxiety or meta-cognitive skill.


In contrast to the data for self-talk, decrease expectation of social performance appears more consistently within the disorder's clinical presentation. Regardless of age, socially phobic youths had significantly lower expectations of their conduct during the social interaction task and rate their performance to be worse than their peers. These distrustful expectations and lower performance ratings be confirmed by blinded independent observers, who rate socially phobic youths as less skilled during the social interaction errand compared to their nonanxious peers. Interestingly, with good opinion to the specific ability to generate conversation topics, individual socially phobic adolescents expected to perform worse than controls. Despite the certainty that they later rate their actual ability to "expect of things to say" similarly (i.e., poorly) to their adolescent counterparts, younger socially phobic children did not differ from controls on this consider of expectation. This finding is particularly surprising considering the certainty that blinded observers judge socially phobic children to exhibit the longest speech latencies compared to the other three groups. Again, a mounting number of negative social experiences may hold played a role in directly shaping adolescents' expectations of this specific skill. Although adjectives youths with social phobia may verbs about their skill to generate conversation, expectations of decreased production may become exaggerated and more specific over time, even in the presence of increased social skill. Such preemptive glum thoughts and expectations likely assist surrounded by maintaining anxious symptoms and behavioral avoidance over time.


Despite the reality that blinded observers rate the reading performance of socially phobic youths to be poorer than controls, no group differences for expectation, implementation, or self-talk emerged. In reality, overall rates of self-talk differed considerably across the two tasks, with both the socially phobic and the control groups reporting significantly more cynical self-talk during the read-aloud task. Additionally, a sophisticated frequency of negative ceremony self-talk during the reading task be associated with lower self-ratings of ceremonial, consistent with Spence et al. (1999). Although it might appear difficult to interpret these findings, it should be noted that the read-aloud duty is conceptualized as an analogue public speaking task for use near children. In this light, the denial of group differences and higher rate of gloomy performance self-talk, indicating greater concern roughly speaking performance, is more graspable. Speaking in front of a group represents one of the most adjectives fears reported by adolescents (Poulton et al., 1997), and it is likely that this chore, which involved performance surrounded by front of a group, elicited some distress for adjectives youths. In fact, while socially phobic youths reported similar level of anxiety across both tasks, control children endorsed higher rates of anxiety for the reading mission. Thus, for the current study, the social interaction task appeared to be a more successful discriminator of social phobia.


Several limitations of the current investigation should be noted. Specifically, in the absence of an developed comparison group, conclusions about the nouns of cognitive aberrations over time are somewhat speculative. Additionally, for analyses base on both group and age, cell sizes in the current study be somewhat small, which inevitably resulted in a lack of statistical power. Future research utilizing larger sample of children and adolescents may reveal different findings. It should also be noted that since the current investigation was concerned near self-talk during actual anxiety-provoking situations, thoughts experienced prior to beginning the tasks be not assessed. Some previous research indicates an increase in negative self-talk during this time of year (Kendall & Chansky, 1991). Thus, examination of whether anticipatory self-talk may directly impact expectations of rite is needed. Finally, it will be important for adjectives investigations to examine different diagnostic groups of anxious children to discern whether cognitive correlates vary within accordance with specific childhood anxiety diagnoses.


Overall, the current background indicate that negative self-talk during social interactions is exceptional among young children next to social phobia, though they may be found among adolescents with this disorder. In contrast, unenthusiastic beliefs regarding one's potential to perform inwardly social situations appear to be more consistently associated with social phobia within children of all ages. Although some researchers hold suggested that such beliefs do not necessarily reflect convincing estimations of children's social abilities (Cartwright-Hatton, Hodges, & Porter, 2003), findings from the current study do not support this tract. Rather, consistent with their self-ratings of actions, socially phobic youths were judge by blinded observers to exhibit poorer performances than their nonanxious peers. This finding is consistent near other investigations where social skill deficit have be reported (Beidel et al., 1999; Ginsburg, LaGreca, & Silverman, 1998; Spence et al., 1999) and where significant improvements contained by overall functioning have resulted base on the inclusion of a social skills treatment component (Beidel, Turner, & Morris, 2000).


By comparison, the absence of glum self-talk among a majority of youths with social phobia appears to provide smaller quantity support for treatment efforts attempting to stamp out or alter this aspect of negative cognition, although such interventions may be adjectives for those who do report their presence and perhaps may serve as a preventative strategy to prevent reoccurrence at a next date. In fact, to some extent than qualitative (i.e., positive vs. negative) thoughts regarding dramatization, data indicate that indistinct on-task thoughts may be important marker of social anxiety and self-rated performance. For example, control children be most likely to report thoughts that be observational in quality (e.g., "I was thinking that if that really happen, I would offer to help"), apparently indicating that these children be focused on the interaction itself. Together with a significant glum correlation for neutral job self-talk and anxiety during the interaction task, findings from the current study indicate that high-ranking levels of anxiety may directly interfere beside children's overall cognitive processing of social situations. However, because it remains unclear at the current time how self-talk may play a role contained by the onset and keeping of social phobia in children and adolescents, adjectives research based on the use of developmentally sensitive assessment methods is needed.

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