Social fear and social phobia types among community youth: differential clinical features and vulnerability factors

Prospective Associations Between Fears of Negative Evaluation, Fears of Positive Evaluation, and Social Anxiety Symptoms in Adolescence

Fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are independently associated with social anxiety symptoms in adolescence, though no study has tested these relations longitudinally. The current study examined longitudinal relations between FNE, FPE, and social anxiety symptoms using a multi-informant design, in addition to testing adolescent gender as a moderator. Adolescents (N = 113; Mage = 12.39; Girls = 44.2%) and parents completed measures of FNE, FPE, and two ratings of social anxiety approximately 6 months apart. FNE and FPE demonstrated significant stability over time, but neither predicted change in the other construct. Adolescent and parent-reported FNE, but not FPE, predicted increased social anxiety symptoms. Adolescent report of social anxiety symptoms predicted increased FPE over time, whereas parent report of social anxiety symptoms predicted increased FNE. Contrary to hypothesis, gender did not moderate any of the pathways in the model. Findings provide the first evidence that FNE may function as a risk factor for increased social anxiety in adolescence.

Long-term outcome of selective mutism: factors influencing the feeling of being cured

Some long-term outcomes for participants with selective mutism (SM) are elevated rates of phobic disorders, particularly social phobia, persistent communicative problems, and reduced self-esteem. However, data on the long-term outcomes of SM are scarce. In this study, by analyzing interpersonal anxiety, communication skills, and self-esteem among those who experienced SM and felt cured (SM-C-group: 30 females, 6 males, mean age 28.0, SD = 7.42, range 19-47 years), those who experienced SM and did not feel cured (SM-NC-group: 37 females, 4 males, mean age 27.4, SD = 7.24, age range 19-50 years), and those who had not experienced SM (Non-SM-group: 30 females, 30 males, mean age 26.4, SD = 7.62, age range: 20-48 years), we examined the long-term outcomes of SM and the factors that influence the feeling of being cured of SM. Results showed that the SM-C-group and SM-NC-groups had significantly higher interpersonal anxiety and significantly lower communication skills than the Non-SM-group. Moreover, the SM-C-group showed significantly lower interpersonal anxiety and significantly higher communication skills than the SM-NC-group. However, while there was no significant difference in self-esteem between the SM-C and SM-NCgroups, there was a significant difference between the SM-NC and Non-SM groups. The SM-C and SM-NC groups did not differ on the retrospective symptom load (SMQ-J), but did on the Current level of difficulty with speaking. The results of the logistic regression analysis predicted that communication skills and self-esteem did not influence the feeling of being cured of SM, but interpersonal anxiety and Current level of difficulty to speak did. Therefore, it is speculated that the intensity of this interpersonal anxiety and whether people with SM still felt difficulty in talking to others may have affected the feeling of being cured from SM.

School-based cognitive-behavioural therapy for children and adolescents with social anxiety disorder and social anxiety symptoms: A systematic review

BACKGROUND

Social anxiety disorder (SAD) is prevalent among children and adolescents. Cognitive-behavioural therapy (CBT) has been used as the first-line treatment. However, evaluation of CBT conducted in a school setting has been scarce.

OBJECTIVES

This study aims to review the CBT and its effectiveness in the school setting for children and adolescents with SAD or social anxiety symptoms. Quality assessment on individual studies was conducted.

METHODS

Studies were identified through the search in PsycINFO, ERIC, PubMed and Medline targeting CBT conducted in a school setting with an aim to treat children and adolescents with SAD or social anxiety symptoms. Randomised controlled trials and quasi-experimental studies were selected.

RESULTS

A total of 7 studies met the inclusion criteria. Five studies were randomised controlled trials, and two were quasi-experimental studies with 2558 participants aged 6-16 years from 138 primary schools and 20 secondary schools. There were minor effects to reduce social anxiety symptoms for children and adolescents at post-intervention in 86% of the selected studies. Friend for Life (FRIENDS), Super Skills for Life (SSL) and Skills for Academic and Social Success (SASS) conducted in school were more effective than the control conditions.

CONCLUSIONS

There is a lack of quality of the evidence for FRIENDS, SSL and SASS, due to inconsistencies on the outcome assessments, statistical analyses, and the fidelity measures adopted in individual studies. Insufficient school funding and workforce with relevant health background, and the low level of parental involvement in the intervention would be the major challenges in school-based CBT for children and adolescents with SAD or social anxiety symptoms.

Measuring social phobia symptoms in a community sample of adolescents: An examination of the psychometric properties of the SPAI-23

A number of studies to date examine dimensions of social phobia and anxiety in adolescents. A variety of tools has been developed, along with their abbreviated versions, that are used to assess Social Anxiety (SA) but little research has been devoted to the types of fears they each assess. Due to differences in the content of the multitude of instruments, different aspects of SA are addressed and this leads to confusion when the relationship between SA and other constructs is being investigated. The aim of the present study was to examine the psychometric properties of the abbreviated Social Phobia and Anxiety Inventory SPAI-23 in Greek-Cypriot community adolescents and describe dimensions of social fears at that age. Seven hundred twenty-one adolescent students from Cyprus, (Mean Age: 15.5, Range: 13-19, SD: 1.12, 64% female) participated in the study. Participants completed, among others, an abbreviated version of the Social Phobia and Anxiety Inventory (SPAI-23). Exploratory Factor Analysis on the SPAI-23 revealed a quite similar structure to the original questionnaire (SPAI). Three Social Phobia factors, describing distinct socially fearful situations, were identified (Performance, Interaction, and Presence in a social context) and one Agoraphobia factor after the evaluation of alternative solutions. Findings were verified by means of Confirmatory Factor Analysis, testing alternative models. Overall, findings were in line with recent evidence on youth samples, and contribute to significant insights towards more sophisticated and personalized assessments.

Social anxiety in adolescents and young adults from the general population: an epidemiological characterization of fear and avoidance in different social situations

Social Anxiety Disorder (SAD) and, more generally, social fears are common in young people. Although avoidance behaviors are known to be an important maintaining factor of social anxiety, little is known about the severity and occurrence of avoidance behaviors in young people from the general population, hampering approaches for early identification and intervention. Symptoms, syndromes, and diagnoses of DSM-5 mental disorders including SAD were assessed in a random population-based sample of 14-21-year-olds (n = 1,180) from Dresden, Germany, in 2015/2016 using a standardized diagnostic interview (DIA-X-5/D-CIDI). An adapted version of the Liebowitz Social Anxiety Scale was used to ascertain the extent of social fears and avoidance. Diagnostic criteria for lifetime SAD were met by n = 82 participants, resulting in a weighted lifetime prevalence of 6.6%. Social anxiety was predominantly reported for test situations and when speaking or performing in front of others. Avoidance was most prevalent in the latter situations. On average, anxiety and avoidance first occurred at ages 11 and 12, respectively, with avoidance occurring in most cases either at about the same age as anxiety or slightly later. In the total sample, lifetime prevalence for most DSM-5 disorders increased with the severity of social anxiety and avoidance. Results underline the need for preventive or early intervention efforts especially regarding test anxiety and fear and avoidance of speaking in front of others. These situations are particularly relevant in youth. Avoidance behaviors may also be discussed as diagnostic marker for early case identification.

Please Don’t Compliment Me! Fear of Positive Evaluation and Emotion Regulation—Implications for Adolescents’ Social Anxiety

In recent years, fear of positive evaluation has emerged as one of the key aspects of social anxiety, alongside fear of negative evaluation. Fears of evaluation intensify during adolescence, a time when individuals are expected to navigate new, emotionally challenging situations. The purpose of this study was to examine the associations between social anxiety, fear of positive and negative evaluation, and three emotion regulation strategies relevant to social anxiety, i.e., suppression, acceptance, and rumination. To this end, data were collected from 647 adolescents via an online survey and analyzed using structural equation modeling. We found that fear of negative evaluation was significantly related to rumination, whereas fear of positive evaluation was significantly and negatively related to acceptance. We further found an indirect effect of social anxiety on suppression via fear of positive evaluation and acceptance in a serial mediation and an indirect effect of social anxiety on rumination via fear of negative evaluation. Not only do fears of positive and negative evaluation appear to be distinct constructs, but they are also differentially associated with three emotion regulation strategies pertinent to social anxiety. Fear of evaluation and its associations with emotion regulation deficits might hinder the therapeutic process by acting as a deterrent to positive reinforcement or potentially impeding the development of a successful therapeutic alliance.

The Prevalence of Adolescent Social Fears and Social Anxiety Disorder in School Contexts

Social fears arise when fearing to be judged in social events. When these fears are intense, persistent, and debilitating, the individual may suffer from social anxiety disorder (SAD), which has its most frequent onset during adolescence and tends to be chronic. Still, evidence on the prevalence of social fears and SAD in adolescence is scarce. This study analyzed the prevalence of social fears and of SAD in Portuguese adolescents. Of the initial sample (n = 1495), 26% presented with intense self-reported social fears. Of those, 53.9% accepted to be further assessed for diagnosis, resulting in a point-estimate prevalence of adolescent SAD of 9.4%; this is slightly higher than previously found. Social performance was the most feared social event. Of the adolescents with SAD, 12.9% were receiving psychological intervention, 12.1% refused intervention, and 92 (65.7%) accepted intervention. Findings confirm SAD as a highly prevalent mental disorder among adolescents, particularly girls, and additionally, that most of these adolescents did not seek treatment but are willing to receive help if made available. Hence, schools should be invested not only in identifying vulnerable adolescents but also in providing diverse intervention options, tailored to their needs, and directing them to successful developmental trajectories.

Prevalence of social anxiety disorder and symptoms among Chinese children, adolescents and young adults: A systematic review and meta-analysis

The objective of the study is to provide a reliable estimate of the pooled prevalence of social anxiety disorder (SAD) and social anxiety symptoms (SAS) among children, adolescents, and young adults (CAYA) in China. Meta-analysis is used to provide pooled-prevalence rate of SAD and SAS. Literature searches were conducted in both English and Chinese databases from the database's inception to April 2019. Eleven studies were identified for SAD, and 17 were included for SAS. The results revealed a pooled prevalence of SAD of 2.1% (95% CI: 1.2-3.8%) with high between-studies heterogeneity (Q = 1,055.2, I 2 = 99.1%, p < 0.001). The pooled prevalence estimate of SAS was 23.5% (95% CI: 18.6-29.3%), also with significant heterogeneity (Q = 1,019.3, I 2 = 98.4%, p < 0.001). Different diagnostic tools or self-report scales reported significant different prevalence of SAD or SAS. Further analysis stratified by gender, age, sampling methods, economic status, and risk of bias were performed. Limitations include the high level of heterogeneity between studies, inadequate number of the studies, and significant differences in prevalence caused by measurements.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020149591, identifier: PROSPERO CRD42020149591.

Social anxiety disorder in adolescents: Prevalence and subtypes in the Young-HUNT3 study

BACKGROUND

Few studies have examined the prevalence of social anxiety disorder (SAD) among adolescents and the associated sex-specific fears. No previous studies have reported variance in SAD prevalence among adolescents based on a stepwise diagnostic approach.

METHODS

Using various diagnostic thresholds from the Anxiety Disorders Interview Schedule child version, and the diagnostic criteria from both the 4th and 5th editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), we explored the point prevalence of SAD among a population-based sample of 8216 adolescents aged 13-19 years.

RESULTS

Overall, 2.6% of adolescents met the SAD diagnostic criteria. The prevalence varied from 2.0% to 5.7% depending on the criteria-set. Twice as many females met the overall SAD criteria. The DSM-IV generalized SAD subtype was assigned to 86.5% of the sample, while 3.5% met the DSM-5 performance-only subtype. Compared with males aged 16-19 years, significantly more of those aged 13-15 years met the SAD criteria; no significant age group differences were found among females.

CONCLUSIONS

This is the first study to demonstrate variance in SAD prevalence among adolescents based on the diagnostic threshold method. Depending on the threshold applied, SAD prevalence among adolescents varied from 2.0% to 5.7%. Age and sex differences in social fear experiences highlight the importance of considering developmental heterogeneity in SAD, especially for adapting prevention and treatment interventions.

Assessing metacognitive beliefs in test anxiety: Psychometric properties of the metacognitions questionnaire, 30 (MCQ-30) among university students

The Metacognitions Questionnaire-30 (MCQ-30) measures maladaptive metacognitive beliefs considered central to the metacognitive model of psychopathology. However, the psychometric properties of the MCQ-30 in test anxiety (TA) among university students are unknown. This study examined the MCQ-30 factor structure and concurrent validity in both trait and state TA. Confirmatory and exploratory factor analyses support the previously established five-factor structure of the MCQ-30 in both state and trait TA, with factors having good internal consistency. Structural equation modeling of the relationships between MCQ-30 subscales and TA found ‘Negative beliefs about uncontrollability and danger of worry’ to have the strongest association. The MCQ-30 appears a robust measure of metacognitive beliefs in TA and provides a basis for further testing of the validity of the metacognitive model in TA. Extending the reach of metacognitive therapy, which is based upon the metacognitive model, to TA could help to improve both student wellbeing and academic performance.

Cognitive Variables in Social Anxiety Disorder in Children and Adolescents: A Network Analysis

Clark and Wells' prominent model of social anxiety disorder (SAD) assumes that cognitive variables such as negative expectations or dysfunctional cognitions play a central role in the symptomatology of SAD. In contrast to adults, it is less clear how well the cognitive model can be applied to children and adolescents. A network analysis with seven nodes was conducted to explore the importance of cognitive variables and their interaction with symptoms of SAD based on N = 205 children and adolescents (8-18 years, M = 11.54 years). Cognitive variables had a high but differential impact within the positively connected network of SAD. Dysfunctional cognitions were most strongly connected within the network. Dysfunctional cognitions, as predicted by Clark and Wells' model, seem to act as a hub affecting several symptoms. The association between negative expectations and avoidance indicates that negative expectations may particularly contribute to the maintenance of SAD.

An exploration of the nomological network of trypophobia

BACKGROUND

Trypophobia is characterised by an aversion to or even revulsion for patterns of holes or visual stimuli featuring such patterns. Past research has shown that trypophobic stimuli trigger emotional and physiological reactions, but relatively little is known about the antecedents, prodromes, or simply covariates of trypophobia.

AIM

The goals of this study were (a) to draw the contours of the nomological network of trypophobia by assessing the associations of symptoms of trypophobia with several constructs that were deemed relevant from past research on anxiety disorders and specific phobias, (b) to compare such associations with those found for symptoms of spider phobia and blood and injection phobia (alternative dependent variables), and (c) to investigate the main effect of gender on symptoms of trypophobia and replicate the association of gender with symptoms of spider phobia and blood and injection phobia (higher scores for women).

METHODS

Participants (N = 1,134, 53% men) in this cross-sectional study completed an online questionnaire assessing the constructs of interest.

RESULTS

Most assessed constructs typically associated with anxiety disorders (neuroticism, conscientiousness, anxiety sensitivity, trait anxiety, disgust sensitivity, and disgust propensity) were also associated with trypophobia in the predicted direction. All of these constructs were also associated with spider phobia and blood and injection phobia. Behavioral inhibition was negatively associated with trypophobia and spider phobia-contrary to what was expected, but positively with blood and injection phobia. We found no gender difference in trypophobia, whereas women scored higher on spider phobia and blood and injection phobia.

DISCUSSION

Although some differences were observed, the nomological network of trypophobia was largely similar to that of spider phobia and blood and injection phobia. Further studies are needed to clarify similarities and dissimilarities between trypophobia and specific phobia.

Sequential multiple mediation of cognitive fusion and experiential avoidance in the relationship between rumination and social anxiety among Chinese adolescents

BACKGROUND AND OBJECTIVES

The potential mechanism by which rumination influences social anxiety through cognitive fusion and experiential avoidance proposed by the Acceptance and Commitment Therapy model has not been well-documented. This study, therefore, aimed to examine the sequential multiple mediation of the two processes.

DESIGN

A cross-sectional survey was conducted.

METHOD

A total of 233 Chinese adolescents (42.06% girls) completed a set of printed self-report questionnaires measuring rumination, cognitive fusion, experiential avoidance, and social anxiety. The SPSS macro PROCESS (model 6) was used to test a sequential mediating model. A 95% confidence interval (CI) was calculated with 5000 bootstrapping re-samples.

RESULTS

Bootstrap analyses indicated that there were indirect effects of rumination on social anxiety mediated by cognitive fusion together with experiential avoidance (B = 0.098, BootSE = 0.032, CI = 0.045 to 0.170), or solely by experiential avoidance (B = 0.048, BootSE = 0.020, CI = 0.014 to 0.093). The mediation of cognitive fusion alone was not significant (B = 0.065, BootSE = 0.038, CI = -0.006 to 0.144).

CONCLUSIONS

The results indicated the sequential mediating role of cognitive fusion and experiential avoidance, and the relative prominence of the latter in the association between rumination and social anxiety.

A Multi-Method, Multi-Informant Test of Maternal Emotion Socialization in Relation to Adolescent Fears of Social Evaluation

Fears of negative and positive social evaluation are considered potential transdiagnostic mechanisms underpinning multiple internalizing disorders and impairments in adolescence. Although emotion socialization processes have been associated with adolescents' internalizing symptoms, the socialization of distinct fears of social evaluation has not been studied. Thus, the goal of the current study was to test whether mother's emotion expression, direct messages, responses to emotions, and parenting behaviors interact with adolescents' gender and temperamental shyness in relation to fears of negative and positive evaluation. A community sample of 107 adolescents ages 11 to 14 (M = 12.39; Girls = 45.8%) and their mothers completed survey measures of emotion socialization, temperament, and fears of social evaluation, in addition to participating in a speech preparation task used to code observed behaviors. For shy adolescents, adolescent-reported maternal cautious messages about social evaluation were associated with greater fears of positive evaluation, while encouraging messages were linked to less fears of positive evaluation. Further, maternal self-reported warmth was associated with fewer fears of negative and positive for shy adolescents, while supportive responses to emotions were linked to higher fears of positive evaluation for boys. Among girls, maternal ratings of encouraging messages were associated with higher fears of social evaluation, while cautious messages were linked to lower fears of negative evaluation. These findings are the first to consider several features of emotion socialization in relation to two distinct valences of adolescents' socio-evaluative fear, and highlight the importance of assessing emotion socialization behaviors via multiple informants and methods.

The Test Anxiety Measure for College Students-Short Form: Development and Examination of Its Psychometric Properties

A short form of the 43-item Test Anxiety Measure for College Students (TAM-C) was developed in the present study. The TAM-C consists of six (social concerns, cognitive interference, worry, physiological hyperarousal, task irrelevant behaviors, and facilitating anxiety) scales. Twenty-four items from the TAM-C were selected for the short form. Single-group confirmatory factor analyses (CFAs) and correlational analyses were conducted with the responses of 728 U.S. college students to the TAM-C Short Form. Results of the single-group CFAs supported a six-factor model for the TAM-C Short Form. Concurrent and convergent validity evidence was found for the TAM-C Short Form scores. Overall, the findings suggest the TAM-C Short Form is an economical measure with unique features to assess test and facilitating anxiety in the college student population.

The heterogeneity of social anxiety symptoms among Chinese adolescents: Results of latent profile analysis

BACKGROUND

The main objective of the current study was to investigate the symptoms of social anxiety in Chinese adolescents by conducting latent profile analysis (LPA), a person-centered statistical approach, with items from the Social Anxiety Scale for Adolescents (SAS-A).

METHOD

In total, a sample of 2,755 adolescents aged 11‒19 years were recruited from six urban public schools in the Beijing District and Sichuan Province, China. Latent profile analysis, regression mixture modelling, and multinomial logistical regression were adopted to investigate the latent profiles and profiles validity.

RESULTS

A four-profile model was suggested as the optimum: low group with diffuse social anxiety, moderate group with difficulties in new situations, moderate group with cognitive disturbance, and high group with diffuse social anxiety. With regression mixture modelling, results showed a greater possibility for older adolescents and girls fall into the high group with diffuse social anxiety. Finally, to examine the validity and interpretability of the social anxiety profiles, two cognitive factors-post-event rumination and self-focused attention-were adopted for their potential to significantly predict the moderate and high group social anxiety profiles.

CONCLUSIONS

The current study, which was the first effort to investigate the features of social anxiety among Chinese adolescents with LPA, supports an innovative model of social anxiety symptoms in a large, non-Western sample. Limitations and clinical implications are included.

Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities

BACKGROUND

Social anxiety disorder is a frequent psychiatric disorder. We aimed to estimate the life-time prevalence, socio-demographic characteristics, risk factors and co-morbidities of this condition among children and adolescents.

METHODS

This was a cross sectional national survey conducted in Iranian individuals aged 6 to 18 years. Face-to-face household interviews were performed by trained clinical psychologists. The Farsi version of the kiddie schedule for affective disorders and schizophrenia for school-age children/present and lifetime version (K-SADS-PL) was administered to estimate the SAD prevalence. Parental personality traits and their psychopathologies were also obtained using Millon clinical multiaxial inventory, third edition (MCMI-III) to find the possible risk factors.

RESULTS

From 29,878 participants, 585 individuals were diagnosed with SAD and weighted lifetime prevalence of 1.8% was observed. The odds of this condition was significantly higher among older adolescents (odds ratio (OR):1.47; 95% confidence interval(CI): 1.11-1.95) and individuals with paternal history of psychiatric hospitalization (OR: 2.96; 95%CI: 1.29-6.79). Higher means of persistent depression disorder (OR: 1.009; 95%CI: 1.000-1.018) and melancholic personality trait (OR: 1.007; 95%CI: 1.001-1.014) in mothers as well as schizophrenia spectrum (OR: 1.014; 95%CI: 1.001-1.027) and anxiety (OR: 1.010; 95%CI: 1.010-1.021) in fathers were statistically associated with higher odds of SAD in their children. Other anxiety disorders and behavioral disorders were the most prevalent co-morbidities.

LIMITATIONS

The cross-sectional analysis does not enable analyses of possible causal associations. Lacking control group and follow-up periods were other major limitations that should be resolved in future studies.

CONCLUSION

Clinicians and researchers need to continue studying this condition at all levels and in all developmental periods.

Examining the Relation Between Adolescent Social Anxiety and Positive Affect Regulation: Self-Report vs. Observation

Social anxiety symptomatology is associated with disruptions in positive affect, though no study has examined deficits in responses to positive affect related to adolescent social anxiety symptoms. The present study tested whether adolescents' self-reported and observed social anxiety symptoms were uniquely associated with specific responses to positive affect. Moreover, we examined whether adolescent gender moderated these relations. Ninety adolescents (ages 11 to 18, M_age = 14.26, SD = 2.03; girls = 62%; white = 79%) completed self-report measures, participated in a social stressor task, and engaged in two positively-valenced interaction tasks with their female caregivers. Adolescent self-reported social anxiety symptoms were not uniquely associated with responses to positive affect. However, observed social anxiety symptoms were uniquely related to greater self-reported inhibiting positive affect responses and fewer observed positive affect maximizing behaviors. These findings highlight the need to examine self-reported and observed social anxiety symptoms in understanding associated disruptions in positive affect regulation.

Fears and fear-related cognitions in children with selective mutism

Selective mutism (SM) is classified under the category of anxiety disorders in DSM-5 [1], although concrete fears that underlie the condition are not specified contrary to all other anxiety disorders. Given the lack of studies systematically investigating fears in SM, content and frequency of concrete fears as well as related cognitions have remained unclear so far. One hundred and twenty-four participants [M = 13.25 years (SD = 3.24), range 8-18 years] with SM (n = 65), social phobia (SP n = 18) or with typical development (TD n = 51) took part in an online survey. Participants with SM (n = 65) answered an open-ended question concerning fears that might cause the consistent failure to speak in select situations. Additionally, participants with SM, SP and TD completed a survey containing 34 fear-related cognitions that might occur in speech-demanding situations. Open text answers were systematically evaluated by extracting higher-order categories using a Qualitative Content Analysis. Single item scores of the survey were compared between the three groups. 59% of all spontaneously reported fears were assigned to the cluster of social fears. Other reported fears represented the categories fear of mistakes (28%), language-related fears (8%) and voice-related fears (5%). The SM- and SP group only differed regarding the cognition that one's own voice might sound funny (SM > SP). Social fears and the fear of mistakes account for the majority of fears in SM. Therefore, future interventions should consider specifically targeting these types of fears.

The efficacy of interventions for test-anxious university students: A meta-analysis of randomized controlled trials

Test anxiety (TA) is highly distressing and can significantly undermine academic performance. Many randomized controlled trials (RCTs) of interventions for university students with TA have been conducted, but there has been no systematic review of their efficacy. This meta-analysis examines the efficacy of interventions for test-anxious university students in: (i) reducing TA, and (ii) improving academic performance. We searched for RCTs published in English language peer-reviewed journals. Forty-four RCTs met our eligibility criteria (n = 2,209). Interventions were superior to control conditions at post-treatment for reducing TA (g = -0.76) and improving academic performance (g = 0.37). Interventions were superior to control conditions at follow-up. Subgroups analyses found most support for behaviour therapy. Cognitive-behavioural therapy, study skills training, and combined psychological and study skills training interventions show promise but lack evidence for their longer-term efficacy, and results are based upon a small number of studies. Evidence of publication bias was found and poor quality of reporting meant that confidence in results should be moderated. Future RCTs should be conducted and reported with greater rigour, have larger samples, and examine newer interventions.

Navigating the social world: The role of social competence, peer victimisation and friendship quality in the development of social anxiety in childhood

Social and communication (SC) difficulties predict increased social anxiety (SA) symptoms in childhood. Peer victimisation and friendship quality are commonly associated with both SC difficulties and SA. Based on this, we tested for a cascade effect of early SC difficulties, peer victimisation and friendship quality on SA in late childhood, using a population-based sample of 8028 children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Parent-reported data were collected on SC difficulties at age 7 and SA at age 7, 10 and 13. Child-reported data on peer victimisation and friendship quality were collected at age 8. Our results revealed that SC difficulties predict increased negative friendship qualities and peer victimisation. Relational victimisation predicted increased SA symptoms at 13 years old. Neither overt nor relational victimisation mediated the developmental relationship between SC difficulties and SA. Furthermore, friendship quality did not moderate the developmental relationship between SC difficulties and SA. In addition, no sex differences were observed. The evidence demonstrates that peer victimisation and friendship quality do not explain why some children with SC difficulties go on to develop SA. Future research clarifying the complex etiological pathways contributing towards the development of SA in childhood and adolescence is warranted.

I Like Them…Will They Like Me? Evidence for the Role of the Ventrolateral Prefrontal Cortex During Mismatched Social Appraisals in Anxious Youth

OBJECTIVE

Socially anxious adolescents report distress during social decision-making, wherein their favorable view of peers directly conflicts with their expectation to be viewed negatively by peers; a phenomenon we refer to as "mismatch bias." The present study utilizes a novel paradigm with dynamic social stimuli to explore the correlates of mismatch biases in anxious and healthy youth.

METHOD

The behavioral and neural correlates of mismatch biases were assessed in healthy (N = 17) and anxious (N = 14) youth during functional MRI. Participants completed a novel task where they viewed silent videos of unknown peers. After viewing each video, participants appraised the social desirability of the peer ("How much do you think you would like them [if you met them]") or predicted how socially desirable the peer would find them ("How much do you think they would like you [if you met them]"). Each participant's mismatch bias was calculated as the difference between their appraisal of peers and their prediction of peers' appraisal of them.

RESULTS

We found that anxious youth exhibited mismatch bias: they rated unknown peers as more desirable than they predicted peers would rate them. This effect was not present in the healthy group. Mismatch biases were associated with increased engagement of the ventrolateral prefrontal cortex (vlPFC), a region broadly involved in flexible cognitions and behavioral selection. In addition, greater mismatch biases and vlPFC activation during mismatch biases were associated with more severe anxiety symptoms.

CONCLUSIONS

The findings highlight the importance of understanding mismatch biases to inform treatments that target distress elicited by discrepant social appraisals in anxious youth.

The Role of Family for Youth Friendships: Examining a Social Anxiety Mechanism

The quality of family relationships and youth friendships are intricately linked. Previous studies have examined different mechanisms of family-peer linkage, but few have examined social anxiety. The present study examined whether parental rejection and family climate predicted changes in youth social anxiety, which in turn predicted changes in friendship quality and loneliness. Possible bidirectional associations also were examined. Data for mothers, fathers, and youth (M _age at Time 1 = 11.27; 52.3% were female) from 687 two-parent households over three time points are presented. Results from autoregressive, cross-lagged analyses revealed that father rejection (not mother rejection or family climate) at Time 1 (Fall of 6th Grade) predicted increased youth social anxiety at Time 2 (Spring of 7th Grade), which in turn, predicted increased loneliness at Time 3 (Spring of 8th Grade). The indirect effect of father rejection on loneliness was statistically significant. Mother rejection, father rejection, and a poor family climate were associated with decreased friendship quality and increased loneliness over time. Finally, there was some evidence of transactional associations between father rejection and youth social anxiety as well as between social anxiety and loneliness. This study's findings underscore the important role of fathers in youth social anxiety and subsequent social adjustment.

Social anxiety in pre-adolescent children: What do we know about maintenance?

The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioral maintenance mechanisms that occur in adult SAD also apply to SAD among pre-adolescent children. In contrast to the adult literature, current models of SAD in children mostly account for etiology and maintenance processes are given limited attention. Consequently, their clinical utility for the treatment of SAD in children may be limited. This narrative review, first, critically examines the different theoretical conceptualizations of the maintenance of social anxiety in the child and adult literature and illustrates how these have resulted in different treatment approaches and clinical understanding. Second, it reviews the available evidence relating to hypotheses about the maintenance of SAD in children as derived from adult cognitive and etiological models. Third, it highlights the need to attend directly to child specific maintenance mechanisms in SAD, to draw on cognitive theory, and to account for the influence of childhood-specific contextual (e.g. family and school-based interactions) and developmental factors on children's social experiences.

Test Anxiety and the Americans With Disabilities Act

Test anxiety leads to requests for accommodations under the Americans With Disabilities Act (ADA), but many testing entities have expressed skepticism about whether test anxiety qualifies as a disability. This article addresses three legal issues raised by the inclusion of test anxiety under ADA: whether test anxiety is a mental impairment, whether test-taking is a major life activity, and whether test anxiety substantially limits test-taking. The article then turns to questions of policy: How should ADA claims for test anxiety be handled by educational institutions, independent testing agencies, and employers? A review of scientific research and legal authorities are used to answer these questions. Most individuals with high test anxiety levels will not qualify as disabled under ADA, although there will be exceptions to that general rule, and testing entities should always conduct an individualized inquiry into each claim.

Subtyping social anxiety in youth

Few empirical studies have examined subtypes of social anxiety disorder (SAD) in youth, and limited consensus resides on the nature of potential subtypes. Identifying subtypes, based on both fear and avoidance patterns, can help improve assessment and treatment of SAD. Subtypes of fear and avoidance were examined in a sample comprising 131 youth (age 8-15 years) diagnosed with SAD using the Anxiety Disorders Interview Schedule for children and parents (ADIS-C/P). Exploratory factor analysis of fear responses revealed three factors, defining fear subtypes linked to: (1) performance, (2) observation, and (3) interaction situations, respectively. Exploratory factor analysis of avoidance responses showed these were best represented by one avoidance factor. Few youth qualified exclusively for either of the fear subtypes, thus calling into question the clinical utility of these subtypes. Nevertheless, the findings indicate distinct contributions of fear and avoidance in SAD presentation. This finding might help clinicians target and improve treatment of the disorder.

The Age of Onset of Anxiety Disorders

OBJECTIVE

The objective was to estimate the age of onset (AOO) for all anxiety disorders and for specific subtypes. Gender differences in the AOO of anxiety disorders were examined, as were the influence of study characteristics on reported AOOs.

METHODS

Seven electronic databases were searched up to October 2014, with keywords representing anxiety disorder subtypes, AOO, and study design. The inclusion criteria were studies using a general population sample that provided data on the AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV, or ICD-10 criteria.

RESULTS

There were 1028 titles examined, which yielded 24 studies meeting the inclusion criteria. Eight studies reported the AOO and gender. Meta-analysis found a mean AOO of all anxiety disorders of 21.3 years (95% CI 17.46 to 25.07). Separation anxiety disorder, specific phobia, and social phobia had their mean onset before the age of 15 years, whereas the AOO of agoraphobia, obsessive-compulsive disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder began, on average, between 21.1 and 34.9 years. Meta-analysis revealed no difference in the AOO between genders. A prospective study design and higher developmental level of the study country were associated with an earlier AOO.

CONCLUSIONS

Results from this meta-analysis indicate that anxiety disorder subtypes differ in the mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards factors associated with the development of anxiety disorder subtypes in the age groups with the greatest vulnerability for developing those disorders.

Unterschiede in der Mutter-Kind-Bindung bei Frauen mit und ohne Soziale Phobie

Zusammenfassung. Fragestellung: Untersuchung der Bedeutung von mütterlicher Sozialer Phobie für die Entwicklung der Mutter-Kind-Beziehung in einer prospektiv-longitudinalen Studie. Methodik: Eine Teilstichprobe von 46 Frauen mit vs. ohne Lebenszeitdiagnose einer Sozialen Phobie und deren Kindern wurde analysiert. Soziale Phobien der Mütter wurden mit dem Composite International Diagnostic Interview für Frauen (CIDI-V) erhoben. Die Mütter wurden zum ante- und postnatalen Bonding befragt (MAAS, MPAS) und die Kinder wurden 16 Monate nach der Geburt mit dem Fremde-Situations-Test beobachtet. Ergebnisse: Kinder von sozialphobischen Müttern waren in der Verhaltensbeobachtung prozentual häufiger unsicher gebunden (45.4 % vs. 33.3 %) und brauchten signifikant länger, um den Kontakt zur Mutter in der Wiedervereinigungsphase wiederherzustellen (U = 160.0, p = .019). In Bezug auf das ante- (t = -.151, p = .881) und postnatale (t = .408, p = .685) Bonding der Mutter an das Kind sowie im widerstehenden (U = 262.5, p = .969), vermeidenden (U = 311.5, p = .258) und kontakterhaltenden (U = 224.0, p = .373) Verhalten des Kindes in der Fremden Situation zeigten beide Gruppen vergleichbare Werte. Schlussfolgerungen: Möglicherweise haben Mütter mit Sozialer Phobie eine gehemmte Verhaltensdisposition weitergegeben oder ihre Kinder weniger zur sozialen Interaktion ermutigt als Mütter ohne Soziale Phobie. Wenn Kinder von sozialphobischen Müttern Interaktionsängste zeigen, sollte eine Aufklärung über verschiedene Therapiemöglichkeiten sowie über mögliche Konsequenzen des eigenen (Vermeidungs-)Verhaltens für die kindliche Entwicklung erfolgen.

Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar

Behavioral inhibition (BI) is a suspected precursor of selective mutism. However, investigations on early behavioral inhibition of children with selective mutism are lacking. Children aged 3-18 with lifetime selective mutism (n = 109), social phobia (n = 61), internalizing behavior (n = 46) and healthy controls (n = 118) were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire. Analyses showed that children with lifetime selective mutism and social phobia were more inhibited as infants and toddlers than children of the internalizing and healthy control groups, who displayed similar low levels of behavioral inhibition. Moreover, behavioral inhibition was higher in infants with lifetime selective mutism than in participants with social phobia according to the Total BI score (p = 0.012) and the Shyness subscale (p < 0.001). Infant behavioral inhibition, particularly towards social stimuli, is a temperamental feature associated with a lifetime diagnosis of selective mutism. Results yield first evidence of the recently hypothesized temperamental origin of selective mutism. Children at risk should be screened for this debilitating child psychiatric condition.

Oral but not written test anxiety is related to social anxiety

AIM

To examine the associations of test anxiety (TA) in written vs oral exam situations with social anxiety (SA).

METHODS

A convenience sample of 204 students was recruited at the Technische Universität Dresden (TU Dresden, Germany) and contacted via e-mail asking to complete a cross-sectional online survey based on established questionnaires. The study protocol was approved by the ethics committee of the TU Dresden. Full data of n = 96 students were available for dependent t-tests and correlation analyses on the associations of SA and TA respectively with trigger events, cognitions, safety behaviors, physical symptoms and depersonalization. Analyses were run using SPSS.

RESULTS

Levels of TA were higher for fear in oral exams than for fear in written exams (M = 48.1, SD = 11.5 vs M = 43.7, SD = 10.1 P < 0.001). Oral TA and SA were positively correlated (Spearman’s r = 0.343, P < 0.001; Pearson’s r = 0.38, P < 0.001) contrasting written TA and SA (Spearman’s r = 0.17, P > 0.05; Pearson’s r = 0.223, P > 0.05). Compared to written TA, trigger events were more often reported for oral TA (18.2% vs 30.3%, P = 0.007); which was also accompanied more often by test-anxious cognitions (7.9% vs 8.5%, P = 0.001), safety behavior (8.9% vs 10.3%, P < 0.001) and physical symptoms (for all, P < 0.001).

CONCLUSION

Written, but not oral TA emerged being unrelated to SA and may rather not be considered as a typical facet of SA disorder.

Recent Insight Into the Subtypes of Social Anxiety Disorder

Systems for subtyping individuals with social anxiety disorder have been the focus of much research attention as a means to improve assessment and treatment of the disorder. This article highlights recent revisions to social anxiety disorder (SAD) subtypes from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to DSM-V, reviewing empirical evidence that served as the impetus for the revisions. Recent research examining the validity of the DSM-V system and alternative subtyping systems is reviewed. Overall, there appears to be greater empirical support for a dimensional subtyping system. Concerns therefore remain with the DSM-V system, which retained a categorical system but replaced the previous subtypes with a subtype of individuals fearing only performance situations. Recommendations for future research are discussed, as well as alternate options for capturing the variability in SAD presentations, including the possibility of eliminating subtyping altogether.

Social Phobia Is Associated with Delayed Onset of Chickenpox, Measles, and Mumps Infections

OBJECTIVE

Evidence showing that infectious diseases in childhood play an important role in the etiopathogenesis of neurodevelopmental and other mental disorders is growing. The aim of this study was to explore the timing of common childhood diseases in early-onset anxiety disorders.

MATERIALS AND METHODS

We analyzed data from PsyCoLaus, a large Swiss Population Cohort Study (N = 3720). In this study, we regressed overanxious disorder, separation anxiety disorder, social phobia, and specific phobias on the age of onset of several childhood diseases, always adjusting for the other anxiety disorders listed above and for sex.

RESULTS

The timing of viral childhood diseases (chickenpox, measles, and mumps) was consistently delayed in social phobia, notably both in men and women. We found no evidence for a reversed sequence of onset of phobia symptoms before that of the infections included.

CONCLUSION

Social phobia was the only early anxiety disorder to show an association with a delayed onset of common viral childhood diseases.

Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review

In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.

The 'Early Developmental Stages of Psychopathology (EDSP) study': a 20-year review of methods and findings

PURPOSE

The "Early Developmental Stages of Psychopathology (EDSP)" study is a prospective-longitudinal study program in a community sample (Munich, Germany) of adolescents and young adults. The program was launched in 1994 to study the prevalence and incidence of psychopathological syndromes and mental disorders, to describe the natural course and to identify vulnerability and risk factors for onset and progression as well as psychosocial consequences. This paper reviews methods and core outcomes of this study program.

METHODS

The EDSP is based on an age-stratified random community sample of originally N = 3021 subjects aged 14-24 years at baseline, followed up over 10 years with up to 3 follow-up waves. The program includes a family genetic supplement and nested cohorts with lab assessments including blood samples for genetic analyses. Psychopathology was assessed with the DSM-IV/M-CIDI; embedded dimensional scales and instruments assessed vulnerability and risk factors.

RESULTS

Beyond the provision of age-specific prevalence and incidence rates for a wide range of mental disorders, analyses of their patterns of onset, course and interrelationships, the program identified common and diagnosis-specific distal and proximal vulnerability and risk factors including critical interactions.

CONCLUSIONS

The EDSP study advanced our knowledge on the developmental pathways and trajectories, symptom progression and unfolding of disorder comorbidity, highlighting the dynamic nature of many disorders and their determinants. The results have been instrumental for defining more appropriate diagnostic thresholds, led to the derivation of symptom progression models and were helpful to identify promising targets for prevention and intervention.

Factors Predicting Youth Anxiety Severity: Preliminary Support for a Standardized Behavioral Assessment of Parental and Youth Avoidance Behaviors

Anxiety severity in youth is associated with a host of negative outcomes including poor response to treatment. Thus, a better understanding of factors that contribute to anxiety severity is needed. Such factors may include parental anxiety as well as anxiety-related approach and avoidance behaviors in both children and parents. In this study, we examined automatic behavioral tendencies as a method of quantifying anxiety-related approach and avoidance behaviors in children and their parents. Clinically anxious youth (N = 19) with mixed anxiety diagnoses and their parents completed an approach-avoidance task (AAT) comprising different emotional expressions. Our results suggest that in addition to parent report of youth anxiety, both youth and parent automatic avoidance biases predict clinician-rated youth anxiety severity accounting for 62% of the variance in clinician-rated youth anxiety. These results suggest that the AAT may be a useful measure of automatic behavioral tendencies in clinically anxious youth and their parents and that these factors may be relevant to youth anxiety severity.

Developmental pathways of social avoidance across adolescence: the role of social anxiety and negative cognition

It is argued that the adolescent onset of social anxiety disorder (SAD) may be partly attributable to an increase in avoidance of social situations across this period. The current cohort-sequential study investigated developmental pathways of social avoidance in adolescence and examined the explanatory role of social anxiety and negative cognitive processes. A community sample of youth (9-21 years, N=331) participated in a four-wave study. Trajectory analyses revealed two pathways: an increased avoidance pathway and a low avoidance pathway. The pathways were hardly distinguishable at age 9 and they steadily diverged across adolescence. Logistic regression analyses showed that social anxiety and post-event rumination were significantly related to the increased avoidance pathway; anticipatory processing and self-focused attention were not. The findings suggest that adolescence is a key developmental period for the progression of social avoidance among youth who show relatively high levels of social anxiety and post-event rumination.

Impact of Item Orientation on the Structural Validity of Self-Report Measures

Although test anxiety (TA) has been shown to be prevalent among Australian university students, the 17-item German Test Anxiety Inventory (TAI-G) has only recently been shown to be a valid measure for use with Australian university students. However, contention exists within the literature as to whether the Lack of Confidence subscale is better conceptualized as a correlate of TA as opposed to a constituent factor because it has been found to have the weakest subscale intercorrelation. It has been suggested that this may be due to the positive item wording of this subscale, which is in contrast to wording of the other subscales. To test this, the Lack of Confidence subscale items were worded negatively for this study and previously established 30-item, 20-item, and 17-item models of the TAI-G were tested using confirmatory factor analysis (CFA) with 473 Australian university students. In line with expectations, the 17-item TAI-G provided the best fit to the data. Furthermore, in contrast to previous findings, there was no notable difference between models conceptualizing the reworded Lack of Confidence subscale as a correlate of TA and models incorporating it as a factor of TA. Moreover, the reworded Lack of Confidence subscale was found to have the strongest subscale intercorrelations. It was concluded that the 17-item TAI-G with the negatively worded Lack of Confidence subscale provided the most valid measure of TA, with semantically opposed items being detrimental to validity. Implications of these findings are discussed.

Differentiating the subtypes of social anxiety disorder

Since the inclusion of subtypes of social anxiety disorder (SAD) in the DSM-III-R, the most studied have been generalized versus specific subtypes. Previous research indicated that the generalized subtype was associated with greater severity, comorbidity and functional impairment compared to the specific subtype, but more recent evidence supports a dimensional conceptualization of SAD. Earlier studies also possessed limitations, such as heterogeneity in definitions of generalized SAD. Based on the more recent findings and the limitations of the earlier studies, the DSM-5 eliminated the generalized specifier. However, it also retained a categorical system by including a performance-based fear specifier, thus leaving an open debate on whether or not a dimensional or categorical system best describes SAD. Future research could examine other, more recent concepts as potential subtypes (e.g., attentional biases), or perhaps the larger question of the overall utility in subtyping SAD.

Social anxiety disorder in DSM-5

With the publication of DSM-5, the diagnostic criteria for social anxiety disorder (SAD, also known as social phobia) have undergone several changes, which have important conceptual and clinical implications. In this paper, we first provide a brief history of the diagnosis. We then review a number of these changes, including (1) the primary name of the disorder, (2) the increased emphasis on fear of negative evaluation, (3) the importance of sociocultural context in determining whether an anxious response to a social situation is out of proportion to the actual threat, (4) the diagnosis of SAD in the context of a medical condition, and (5) the way in which we think about variations in the presentation of SAD (the specifier issue). We then consider the clinical implications of changes in DSM-5 related to these issues.

Evaluation of the proposed social anxiety disorder specifier change for DSM-5 in a treatment-seeking sample of anxious youth

BACKGROUND

The current proposal for the DSM-5 definition of social anxiety disorder (SAD) is to replace the DSM-IV generalized subtype specifier with one that specifies fears in performance situations only. Relevant evaluations to support this change in youth samples are sparse.

METHODS

The present study examined rates and correlates of the DSM-IV and proposed DSM-5 specifiers in a sample of treatment-seeking children and adolescents with SAD (N = 204).

RESULTS

When applying DSM-IV subtypes, 64.2% of the sample was classified as having a generalized subtype of SAD, with the remaining 35.2% classifying as having a nongeneralized subtype SAD. Youth with generalized SAD, relative to those with nongeneralized SAD, were older, had more clinically severe SAD, showed greater depressive symptoms, and were more likely to have a comorbid depressive disorder. No children in the current sample endorsed discrete fear in performance situations only in the absence of fear in other social situations.

CONCLUSIONS

The present findings call into question the meaningfulness of the proposed changes in treatment-seeking youth with SAD.

Metacognitions, worry and attentional control in predicting OSCE performance test anxiety

OBJECTIVES

This study investigated the applicability of the self-regulatory executive functioning (S-REF) model to performance test anxiety (PTA) in objective structured clinical examinations (OSCEs). Specifically, it examined the relative contributions of metacognitive beliefs, trait worry and attentional control to PTA.

METHODS

A cross-sectional design was used. Immediately prior to their formative Communication for Clinical Practice OSCE, 240 Year 1 medical students completed the following self-report questionnaires: the Metacognitions Questionnaire-30 (MCQ-30); the Penn State Worry Questionnaire (PSWQ); the Attentional Control Scale (ACS), and the Performance Test Anxiety questionnaire (PTA).

RESULTS

Univariate analysis indicated that female students scored significantly more highly than male students on the MCQ-30 subscale for negative beliefs about the uncontrollability and danger of worry, the MCQ-30 subscale for cognitive confidence and the PSWQ subscale for trait worry. Partial correlations (controlling for gender) showed that metacognitions, worry and attentional control were significantly correlated with PTA. Multiple regression analyses showed that worry and negative beliefs about the uncontrollability and danger of worry were independent predictors of PTA in both male and female students, whereas attention focus was an independent predictor only in male students.

CONCLUSIONS

The findings support predictions derived from the S-REF model that metacognitive beliefs, trait worry and attentional control processes underlie the onset and maintenance of PTA.

Does the Revised Child Anxiety and Depression Scale (RCADS) measure anxiety symptoms consistently across adolescence? The TRAILS study

We assessed if the Revised Child Anxiety and Depression Scale (RCADS) measures anxiety symptoms similarly across age groups within adolescence. This is crucial for valid comparison of anxiety levels between different age groups. Anxiety symptoms were assessed biennially in a representative population sample (n = 2226) at three time points (age range 10-17 years) using the RCADS anxiety subscales (generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD], panic disorder [PD], separation anxiety [SA], social phobia [SP]). We examined longitudinal measurement invariance of the RCADS, using longitudinal confirmatory factor analysis, by examining the factor structure (configural invariance), factor loadings (metric invariance) and thresholds (strong invariance). We found that all anxiety subtypes were configural invariant. Metric invariance held for items on the GAD, OCD, PD and SA subscales; yet, for the SP subscale three items showed modest longitudinal variation at age 10-12. Model fit decreased modestly when enforcing additional constraints across time; however, model fit for these models was still adequate to excellent. We conclude that the RCADS measures anxiety symptoms similarly across time in a general population sample of adolescents; hence, measured changes in anxiety symptoms very likely reflect true changes in anxiety levels. We consider the instrument suitable to assess anxiety levels across adolescence.

Ages of Onset of Mood and Anxiety Disorders in Fragile X Premutation Carriers

OBJECTIVE

FMR1 premutation carriers of both genders have a high lifetime prevalence of anxiety and depressive disorders, however little is known regarding the onset ages of these conditions. This study compared onset ages of mood and anxiety disorders in premutation carriers with typical onset ages of the same disorders in the general population.

METHODS

Eighty-one premutation carriers (42% men; average age 62, SD 10) with and without FXTAS completed the Structured Clinical Interview for DSM-IV-TR. Onset ages of mood and anxiety disorders were compared to the corresponding typical population onset ages using the signed rank test.

RESULTS

Overall median onset ages of MDD (46 years old, p < 0.0001), panic disorder (40 years old, p = 0.0067), and specific phobia (11.5 years old, p = 0.0003) were significantly higher in premutation carriers compared to the general population. Median MDD onset ages in male carriers (52 years old) and those with FXTAS (49.5 years old) were significantly higher relative to the general population (median 32, both p < 0.0001). Tremor and ataxia emerged significantly later than MDD and the anxiety disorders studied.

CONCLUSION

Depressive and anxiety disorders in premutation carriers have a later onset compared to the general population, but precede the onset of motor symptoms. This may be due to progressive mRNA toxicity in the limbic system, white matter changes leading to neuronal dysconnectivity, and interaction with environmental factors. Psychosocial factors may be protective. Further research is needed to understand the full spectrum of psychiatric phenotypes in FMR1 premutation carriers.