Social anxiety disorder (SAD) in children can be difficult to treat, as evidenced by the varied outcomes reported post-treatment.1,2 Although childhood treatments for SAD commonly involve at least some social skills training,3 it isn’t clear whether children with SAD have particular difficulties with social skills. There is therefore a need to better establish whether social skills are an effective target for treating SAD.
Samantha Pearcey and colleagues have been working to address this knowledge gap and published their latest findings earlier this year as a Research Review in the Journal of Child Psychology and Psychiatry. “The presentation of SAD and social skills difficulties can look very similar, creating problems for observational studies”, explains Pearcey. “We thus performed a systematic review and meta-analysis to establish whether or not there is a relationship between social anxiety and the cognitions that underlie social skills (e.g. Theory of Mind) as well as disorders typically associated with social cognition deficits (i.e. autism spectrum disorder, ASD)”.
The researchers identified 50 studies from which they could calculate an effect size to measure the relationship between social anxiety and social cognition. Together, these studies included data from >15,000 children and adolescents. Overall, they found a significant, moderate effect to support an association between increased social anxiety and lower social cognitive ability. However, this association appeared largely accounted for by elevated social anxiety among children with ASD, and those with difficulties in specific aspects of Theory of Mind, but not broader social skills such as emotion recognition.
Based on these findings, Pearcey et al. consider that treatments for SAD in neurotypical children may benefit from focusing on particular aspects of Theory of Mind rather than emotion recognition and other broad social skills. “Research into what other targets might best facilitate improved treatment outcomes for children with SAD is needed,” says Pearcey. “At this point it is worth carefully considering whether social skills training is really applicable in treatment plans for children with SAD”.
Pearcey, S., Gordon, K., Chakrabarti, B., Dodd, H., Halldorsson, B. & Creswell, C. (2020), . J. Child Psychol. Psychiatr. doi: 10.1111/jcpp.13310.
1Beidel, D.C. et al. (2000), Behavioral treatment of childhood social phobia. J. Consult. Clin. Pscyhol. 68, 1072–1080. doi: 10.1037/0022-006X.68.6.1072.
2Spence, S.H. et al. (2000), The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. J. Child Psychol. Psychiatr, 41, 713–726. doi: 10.1111/1469-7610.00659.
3National Institute for Health and Care Excellence (2013). Social anxiety disorder: Recognition, assessment and treatment (NICE Quality Standard, CG159).
Social anxiety disorder: Fear of negative evaluation by others in particular social situations, leading to marked anxiety and distress or avoidance of these social situations.
Theory of mind: The ability to identify and understand how someone else is thinking or feeling.