New research published in Behavioural and Cognitive Psychotherapy offers evidence that the maintenance of social anxiety in children is not unlike that in adults. The study found that children with social anxiety disorder displayed a cognitive bias characterized by heightened negative automatic thoughts concerning social threats.
Social anxiety disorder (SAD) is marked by an unrelenting fear of being judged by other people, which hinders a person’s social experiences. Most studies exploring the features of SAD have used adult samples, and much less is known about how the disorder is maintained in children. Study authors Barbara Hoff Esbjørn and associates aimed to add to a recent train of research that is focused on exploring whether the current understanding of the maintenance of SAD can be applied to children.
The researchers recruited 122 children between the ages of 7 and 13 from a specialized clinic. All the children had clinical anxiety, and 33 met criteria for SAD. Separate interviews were conducted among the children and their parents to assess the children’s frequency of positive automatic thoughts (PATs), negative automatic thoughts (NATs), and repetitive negative thinking (RNT). The interview also assessed the presence of maladaptive metacognitions — dysfunctional thoughts about one’s way of thinking.
The researchers’ analysis found strong evidence that children with greater SAD symptoms hold more negative automatic thoughts to do with social threat (e.g., “I look like an idiot.”). Moreover, when considering all other variables, NATs about social threat were the most strongly linked to SAD symptoms, accounting for about one-third of the variance in SAD symptoms. Importantly, children with SAD had more of these negative thoughts than children who had anxiety without SAD, suggesting that these thoughts are disorder-specific and key to the maintenance of SAD.
Children with elevated SAD symptoms also showed greater repetitive negative thinking, greater negative metacognitions, and fewer positive automatic thoughts — although all of these associations were small. These small effects, Esbjørn and team say, suggest that none of these aspects are pivotal to the maintenance of social anxiety.
Overall, the findings point to what researchers call a “social threat perception bias” as a key mechanism through which social anxiety is maintained in children. “Perceived social danger, expressed as social threat NATs, emerged as a particularly central and disorder-specific mechanism in the present study. This corroborates previous studies suggesting that this element of main cognitive maintenance models of SAD in adults may apply to children,” the authors say.
The researchers address that the study was limited since it relied partly on child reports, even though efforts were made to include parental reports as well. They suggest that future longitudinal research should explore whether negative anticipatory processing (mental preparation before a social event) and post-event processing (rumination following a social event) are relevant factors in the maintenance of SAD in children.
The study, “Social anxiety disorder in children: investigating the relative contribution of automatic thoughts, repetitive negative thinking and metacognitions”, was authored by Barbara Hoff Esbjørn, Anette Falch, Monika Anna Walczak, Nicoline Normann, and Sonja Breinholst.