Social Anxiety Scale for Adolescents: Factorial invariance and latent mean differences across gender and age in Spanish adolescents

Little is known about the factorial invariance across gender and age for self-report measures of social anxiety in adolescence. This study examined the factorial invariance and latent mean differences of the Social Anxiety Scale for Adolescents (SAS-A) across gender and age groups in 1570 Spanish adolescents (54% girls), ranging in age from 14 to 17 years. Equality of factor structures was compared using multi-group confirmatory factor analyses. Measurement invariance for the correlated three-factor model of the SAS-A was found across gender and age samples. Analyses of latent mean differences revealed that girls exhibited higher means than boys on two SAS-A subscales, Fear of Negative Evaluation and Social Avoidance and Distress-New (SAD-New). In addition, on the SAD-New subscale, the structured means significantly diminished from 14-year olds to 16- and 17-year olds and from 15-year olds to 17-year olds. Findings are discussed in terms of the use of the SAS-A with Spanish adolescents.     

Reliability and Validity of the Chinese Version of the Social Anxiety Scale for Adolescents

This study evaluated the psychometric properties of the Chinese version of the Social Anxiety Scale for Adolescents (SAS-A) in a sample of 296 adolescents (49% boys) in Grades 7, 8, 9, 10, and 12 with a mean age of 15.52 years. Confirmatory factor analysis replicated the three-factor structure of the SAS-A in the Chinese sample: Fear of Negative Evaluation (FNE), Social Avoidance and Distress in New Situations (SAD-New), and Social Avoidance and Distress-General (SAD-General). Internal consistency and test-retest reliability were appropriate. The results also revealed a clear and predictable pattern of relationships between the SAS-A and the Questionnaire about Interpersonal Difficulties for Adolescents and the International Personality Item Pool. Chinese boys reported greater SAD-General than Chinese girls, and this difference increased with grade. The SAS-A scores were compared to previously collected data from the USA and Spain, revealing that Chinese adolescents scored significantly higher in social anxiety than American and Spanish adolescents.     

Social Anxiety Scale for Adolescents (SAS-A): Measuring Social Anxiety Among Finnish Adolescents

The aim of this study was to investigate symptoms of social anxiety and the psychometric properties of the Social Anxiety Scale for Adolescents (SAS-A) among Finnish adolescents, 13–16 years of age. Study 1 (n = 867) examined the distribution of SAS-A scores according to gender and age, and the internal consistency and factor structure of the SAS-A. In a subsample (n = 563; Study 2) concurrent and discriminant validity of the SAS-A were examined relative to the Social Phobia Inventory and the Beck Depression Inventory. Test–retest stability was examined over a 30-month period by repeated measures every 6 months in another subsample (n = 377; Study 3). Results mostly revealed no gender differences in social anxiety, except that boys reported more general social avoidance and distress than girls. Older adolescents (14–16-year-olds) reported higher social anxiety than younger adolescents (12–13-year-olds). Internal consistency for the SAS-A was acceptable for both genders and for all three SAS-A subscales. Confirmatory factor analysis replicated the original 18-item three-factor structure of the SAS-A, accounting for 61% of the variance between items. Evidence for concurrent and discriminant validity was found. Test–retest stability over 6 months was satisfactory. Results support the reliability and validity of the Finnish adaptation of the SAS-A, and further indicate that gender differences in adolescents’ social anxiety may vary across Western countries.     

Psychometric evaluation of the Social Anxiety Scale for Adolescents and the Social Phobia and Anxiety Inventory for Children: construct validity and normative data

This study evaluated the psychometric properties of the Social Anxiety Scale for Adolescents (SAS-A) and Social Phobia and Anxiety Inventory for Children (SPAI-C) in a sample of 1147 adolescents aged 13-17 years. The fit indices of confirmatory factor analyses were comparable to those obtained in prior studies and supported the hypothesized models of the SAS-A and SPAI-C. The internal consistency was good and 12-month test-retest reliability modest for both measures. A significant, positive correlation was found between the SAS-A and SPAI-C, showing that these measures assess related, but relatively independent constructs of social anxiety and phobia. These findings support the use of the SAS-A and SPAI-C with adolescents.     

Social phobia in Swedish adolescents

Background  The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Methods  Students in grades 6–8 (aged 12–14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Results  Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5–5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. “Speaking in front of class” and “calling someone unfamiliar on the phone” were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. Conclusion  Social phobia is a common psychiatric condition in Swedish adolescents, especially in girls. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.     

Cross validation of the Social Anxiety Scale for Adolescents in a high school sample

Social anxiety disorder in adolescents is increasingly recognized as a common condition that may precede onset of other mental health problems. However, few measures are currently available to screen for adolescent social anxiety, and little is known about their psychometric characteristics in school-based samples. To this end, the present study was undertaken as a psychometric cross validation of the Social Anxiety Scale for Adolescents (SAS-A). Exploratory and Confirmatory Factor Analyses (CFA) supported the original 3-factor structure of the SAS-A but retained fewer items than in the original scale. The revised scales demonstrated good internal consistency as well as criterion and concurrent validity. Despite including fewer items, psychometric characteristics of the revised scales were equivalent to or stronger than those reported in previous studies of the measure. As such, the present study provides initial support for the utility of the revised SAS-A as a measure of social anxiety in adolescent school samples.     

The Liebowitz social anxiety scale for children and adolescents: an initial psychometric investigation

OBJECTIVE: To examine the psychometric properties of a newly developed clinician rating scale, the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). METHOD: A total of 154 children and adolescents participated in an assessment consisting of a diagnostic interview, the LSAS-CA, and other measures of psychopathology and impairment. Sixty-one of these children also participated in a second LSAS-CA administration, by a different rater blind to diagnosis, within 7 days of the initial assessment. RESULTS: High internal consistency (alpha =.90-.97 for full sample and.83-.95 for social phobia group) and test-retest reliability (intraclass correlation coefficient = 0.89-0.94) were obtained for LSAS-CA total and subscale scores. LSAS-CA scores had stronger associations with measures of social anxiety and general impairment than with a measure of depression. Subjects with social anxiety disorder had significantly higher LSAS-CA scores than subjects with other anxiety disorders and healthy controls. A LSAS-CA cutoff score of 22.5 represented the best balance of sensitivity and specificity when distinguishing between individuals with social phobia and normal controls, whereas a cutoff of 29.5 was optimal for distinguishing social phobia from other anxiety disorders. CONCLUSION: Initial findings suggest that the LSAS-CA is a reliable and valid instrument for the assessment of social anxiety disorder.     

Self-reported social anxiety symptoms and correlates in a clinical (CAP) and a community (Young-HUNT) adolescent sample

Purpose

The frequencies of social anxiety symptoms in a mental health clinical and a community sample of adolescents are compared. Also, we explore if adolescents can be classified in subgroups based on social anxiety symptoms. Associations between social anxiety symptoms and coexisting problems and sociodemographic characteristics are examined.

Methods

Adolescent participants, aged 13–18, in two large Norwegian studies, consisting of a clinical (n = 694, 42.1 % participation rate, 55 % girls, mean age = 15.6) and a community (n = 7,694, 73.1 % participation rate, 51 % girls, mean age = 15.8) sample completed identical self-report questionnaires measuring social anxiety and related variables.

Results

Median sum scores (interquartile range) of social anxiety symptoms were higher among girls than boys and in the clinical [girls = 16 (12–22); boys = 12 (9–16)] compared to the community sample [girls = 12 (9–15); boys = 10 (7–12)] (p < 0.001). Latent profile analysis revealed two classes of adolescents based on social anxiety profiles. Adolescents scoring high on social anxiety symptoms, which ranged from 16 % (boys in community sample) to 40 % (girls in clinical sample), had significantly more coexisting problems than those scoring low. Social anxiety symptoms were associated with academic school problems, bullying, eating problems, acne, and general anxiety and depression in both samples.

Conclusion

Social anxiety symptoms were commonly reported by adolescents, in both clinical and community settings. These symptoms were associated with a broad spectrum of coexisting problems, which can be used to detect adolescents struggling with social anxiety. Adolescent, family, peer, school, and community interventions targeting these associated problems may contribute to prevent and alleviate social anxiety symptoms.     

School-based behavioral treatment for social anxiety disorder in adolescents: results of a pilot study.

OBJECTIVE: To provide preliminary estimates of feasibility and effectiveness for school-based behavioral treatment in adolescents with social anxiety disorder. METHOD: Six adolescents with social anxiety disorder were treated in a 14-session group treatment program conducted at their school. Assessments were conducted at baseline and after treatment. RESULTS: All participants were classified as treatment responders (markedly or moderately improved). Half of the participants did not meet diagnostic criteria for social phobia after treatment. Clinician severity ratings, as measured by the Anxiety Disorders Interview Schedule for Children for DSM-IV: Child Version and the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA), decreased significantly after intervention, with effect sizes of 2.5 and 1.8, respectively. All LSAS-CA scale scores decreased significantly after treatment. Self-reported social phobia symptoms on the Social Phobia and Anxiety Inventory for Children were not significantly reduced. Fear and avoidance ratings of the 10 most feared situations significantly decreased after treatment, with effect sizes of 1.5 for anxiety and 2.1 for avoidance. CONCLUSIONS: This study provides preliminary support for the promise of school-based behavioral intervention for treating social phobia in adolescents. The school environment may be a rich and innovative setting for implementation of behavioral treatment because this is the setting where adolescents with social phobia endure the most distress.     

Investigating the construct validity of the SPAI-C: comparing the sensitivity and specificity of the SPAI-C and the SAS-A

Investigates the construct validity of the Social Phobia and Anxiety Inventory for Children (SPAI-C) by comparing its sensitivity and specificity with another self-report measure of social anxiety, the Social Anxiety Scale for Adolescents (SAS-A). Participants were 252 adolescents (124 males and 128 females) 13-17 years old. Adolescents completed the SPAI-C and the SAS-A and were interviewed using the Anxiety Disorders Interview Schedule for DSM-IV: Child Version (ADIS-IV:C). Parents were also interviewed and composite diagnoses were formed. Youth were classified as socially phobic or non-anxious based on these composite diagnoses. By comparing clinical cutoff scores with diagnostic group classification, the sensitivity and the specificity of the SPAI-C and SAS-A were compared. Results indicated that the SPAI-C was a more sensitive measure than the SAS-A (61.5% vs. 43.6%) providing evidence of the scale's construct validity. The two measures were similar with regard to specificity (82.7% for both). Implications of these results for assessment and research are discussed.     

Age and gender differences in social anxiety symptoms during adolescence: the Social Phobia Inventory (SPIN) as a measure

The aim of the present study was to examine age and gender differences in social anxiety symptoms during adolescence, and to investigate the psychometrics of the Social Phobia Inventory (SPIN) among adolescents. The SPIN was administered to a large general population sample (n=5252) of Finnish adolescents aged 12-16 years. Age and gender trends in scores and internal consistency and factorial composition of the SPIN were examined in this sample. The test-retest reliability of the SPIN was examined in a smaller sample of adolescents (n=802). Results showed that girls scored higher than boys on the SPIN full scale and three subscales across the whole age range. Eighth graders (14- to 15-year-olds) scored higher than seventh and ninth graders on the full scale, for boys the differences were significant. Good test-retest reliability (r=0.81), and internal consistency (alpha=0.89) were found for the SPIN. An exploratory factor analysis (EFA) performed on a random half (n=2625) of the population sample yielded a one-factor model accounting for 38% of the variance between items. This one-factor model, plus an alternative three-factor model, were examined in the holdout half of the population sample (n=2627) by means of a confirmatory factor analysis (CFA). Some support was gained for both factor structures. Our results indicate that symptoms of social phobia may increase in mid-adolescence. The SPIN appears to be a reliable self-report instrument among adolescents.     

Association study of monoamine oxidase-A gene promoter polymorphism (MAOA-uVNTR) with self-reported anxiety and other psychopathological symptoms in a community sample of early adolescents

The polymorphism upstream of the gene for monoamine oxidase A (MAOA-uVNTR) is reported to be an important enzyme involved in human physiology and behavior. With a sample of 228 early-adolescents from a community sample (143 girls) and adjusting for environmental variables, we examined the influence of MAOA-uVNTR alleles on the scores obtained in the Screen for Childhood Anxiety and Related Emotional Disorders and in the Child Symptom Inventory-4. Our results showed that girls with the high-activity MAOA allele had higher scores for generalized and total anxiety than their low-activity peers, whereas boys with the low-activity allele had higher social phobia scores than boys with the high-activity allele. Results for conduct disorder symptoms did not show a significant relationship between the MAOA alleles and the presence of these symptoms. Our findings support a possible association, depending on gender, between the MAOA-uVNTR polymorphism and psychopathological disorders such as anxiety, which affects high rates of children and adolescents.     

Prevalence and some psychosocial characteristics of social anxiety disorder in an urban population of Turkish children and adolescents

PurposeTo define the prevalence and some of the psychosocial characteristics of social anxiety disorder (SAD) in an urban population of Turkish children and adolescents.Subjects and methodsThis was a two-stage cross-sectional urban-based study conducted in Fatih, Istanbul, Turkey. The initial sample included 1,482 students between the 4th and 8th grades. The first stage involved screening using the Social Anxiety Scale for Children-Revised (SASC-R) and the Capa Social Phobia Scale for Children and Adolescents (CSPSCA). According to the test results, 324 children were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) in the second stage.ResultsThe SAD prevalence rate was 3.9%. According to the multiple regression analysis, low paternal education and trait anxiety were associated with SASC-R scores, whereas female gender and trait anxiety were associated with CSPSCA scores. According to logistic regression analysis, the anxiety subscale of the self-concept scale and trait anxiety were associated with SAD.ConclusionSAD is a relatively common disorder that is associated with lower self-concept in children and adolescents. Low paternal education, trait anxiety, and low self-concept may be the intervention targets for SAD prevention and treatment.     

A new proposal for the subtypes of social phobia in a sample of Spanish adolescents

The present study aimed to analyze validity of a new proposal of delimitation and operationalization of the social phobia subtypes in the adolescence. The sample consisted of 971 Spanish adolescents ranged between 14 and 18 years, attending 59 high schools in rural and urban areas of the south-east of Spain. Principal component and cluster analyses were conducted. Results indicated that the principal components analysis revealed two factors, which could be categorized as interaction and performance anxiety, whereas the cluster analysis delimited four subtypes: specific social phobia, mild generalized social phobia, moderate generalized social phobia and severe generalized social phobia. Subsequently, comparisons in psychopathological and demographic variables showed statistically significant differences among the four subtypes. The emerging multidimensional structure was consistent with the differential psychopathological and demographic features of each group. The current study establishes preliminary support for a new proposal of subdivision and operationalization of the construct social phobia in adolescence.     

Risk factors for poor health-related quality of life in adolescents with epilepsy

PURPOSE: To examine potential risk factors for poor health-related quality of life (HRQOL) among adolescents with epilepsy by using the newly developed QOLIE-AD-48. Risk factors were derived from sociodemographic, social, academic, and epilepsy- and health-related domains. METHODS: The QOLIE-AD-48 was administered to 197 English-speaking adolescents (age 11-17 years from >20 sites in the United States and in Canada). The self-report instrument yields an overall HRQOL score and eight subscale scores. Other data were obtained from family interviews, physician reports, and health records. Multiple regression analyses were conducted to study risk factors for impairment of HRQOL. RESULTS: Older adolescents (age 14-17 years), those with more severe epilepsy and more symptoms of neurotoxicity, and those living in households with lower socioeconomic status were more likely to report poor overall HRQOL. Risk factors in the eight HRQOL domains were found as follows: (a) Epilepsy Impact: older age in adolescence, more severe epilepsy and neurotoxicity, more hospitalizations during the past year, and fewer hours of extracurricular activities; (b) Memory and Concentration: longer duration of epilepsy, special education classes, and history of repeating a grade in school; (c) Attitude Toward Illness: older age, female gender, and more severe epilepsy and neurotoxicity; (d) Social Support: younger age, male gender, and fewer hospitalizations in the last year; (e) Stigma: lower socioeconomic status and special-education classes; and (f) Health Perceptions: older age, female gender, and lower socioeconomic status. None of the factors examined was significantly associated with HRQOL in (g) Physical Functioning or (h) School Behavior subscales. CONCLUSIONS: We identified several risk factors for poor HRQOL outcomes in adolescents with epilepsy. Age, increased seizure severity, and neurotoxicity were most consistently associated with poor HRQOL across domains. Older adolescents, independent of epilepsy severity, reported worse overall HRQOL than did their younger counterparts. Older adolescents also were more likely to perceive a greater negative impact on life and general health, and had more negative attitudes toward epilepsy. Adolescent boys and girls may show different sensitivities to various quality-of-life domains.     

Mediators and Moderators of Outcome in the Behavioral Treatment of Childhood Social Phobia

ObjectiveThe current study examined mediators and moderators of treatment response among children and adolescents (ages 7–17 years) with a primary diagnosis of social phobia.MethodParticipants were 88 youths participating in one of two randomized controlled treatment trials of Social Effectiveness Therapy for Children. Potential mediators included changes in observer-rated social skill and child-reported loneliness after 12 weeks of Social Effectiveness Therapy for Children. Age and depressive symptoms were examined as potential moderators.ResultsLoneliness scores and social effectiveness during a role-play task predicted changes in social anxiety and overall functioning at posttreatment. Changes in social anxiety were mediated by child-reported loneliness. Outcomes were not moderated by age or depressive symptoms.ConclusionsFindings support the role of loneliness as an important mechanism of change during treatment for childhood social phobia.     

Gender differences in Childhood Anxiety Sensitivity Index (CASI) dimensions

We examined the hierarchical structure of the Childhood Anxiety Sensitivity Index (CASI) as a function of gender and examined the occurrence of gender differences in anxiety sensitivity (AS) dimensions in a large nonclinical sample of children and adolescents (N = 1698). Separate principal components analyses (PCAs) on the 18 CASI items for the total sample, boys, and girls revealed similar lower-order three-factor structures for all groups. The three factors reflected Physical, Social/Control, and Psychological Concerns. PCAs on the lower-order factor scores revealed similar unidimensional higher-order solutions for all groups. Girls scored higher than boys on the Physical and, to a lesser extent, Social/Control Concerns factors; girls scored higher on the Physical Concerns factor relative to their scores on the Social/Control and Psychological Concerns factors; and boys scored higher on the Social/Control and Psychological Concerns factors relative to their scores on the Physical Concerns factor. Girls also scored higher than boys on the higher-order factor representing the Global AS construct. The present study provides additional support for the theoretical hierarchical structure of AS and suggests that there is a difference in the manifestation of AS between girls and boys.     

The Social Anxiety Scale for Adolescents: Measurement Invariance and Psychometric Properties Among a School Sample of Portuguese Youths

Over the last decades there has been an increased interest in assessing social anxiety in adolescents. This study aims to validate the Social Anxiety Scale for Adolescents (SAS-A) to Portuguese youth, and to examine its invariance across gender as well as its psychometric properties. The participants were 782 Portuguese youths (371 males, 411 females), with an average age of 15.87 years (SD = 1.72). The results support the original three-factor structure of the SAS-A, with measurement invariance being found across gender, with females scoring higher than males on two subscales. High levels of internal consistency were found. Positive associations with empathy demonstrated that high socially anxious adolescents have elevated empathy tendencies. Mostly null or low negative associations were found with measures of psychopathic traits, callous-unemotional traits and aggression. Study findings provide evidence that the SAS-A is a psychometrically sound instrument that shows measurement invariance between genders, good reliability and positive correlations with empathy.     

Effects of autistic traits on social and school adjustment in children and adolescents: The moderating roles of age and gender

This study examined the associations between children's and adolescents’ autistic-like social deficits and school and social adjustment as well as the moderating roles of age and gender in these associations. The sample consisted of 1321 students (48.7% boys) in Grade 1 to Grade 8 from northern Taiwan. Children's and adolescents’ autistic-like social deficits were assessed using the Social Responsiveness Scale (SRS), and their school and social adjustment (i.e., academic performance, negative attitudes toward schoolwork/teachers/classmates, behavioral problems at schools, negative peer relationships, and problems with peers) were assessed using the Social Adjustment Inventory for Children and Adolescents (SAICA). Both measures were completed by the mothers of the participants. Results from the linear mixed models demonstrated that autistic-like social deficits were associated with poor academic performance, negative attitudes toward schoolwork, teachers, and classmates, behavioral problems at schools, negative peer relationships, and problematic peer interactions. Moreover, gender and/or age moderated the associations between autistic-like social deficits and school and social adjustment problems. For example, autistic-like social deficits were more strongly related to negative school attitude, school social problems, and negative peer relationships in boys than in girls. Further, autistic-like social deficits were more strongly related to problems with peers in older girls than in older boys or younger children (regardless of gender). In conclusion, the present study suggests that autistic-like social deficits may place children and adolescents at increased risk for social and school maladjustment and that the extent of maladjustment may vary with the child's age and gender and the domains of adjustment under discussion.     

Normative data for the Multidimensional Anxiety Scale for Children (MASC) in Swedish adolescents

The Swedish translation of a new scale developed for childhood and adolescent anxiety, the Multidimensional Anxiety Scale for Children (MASC), was studied regarding reliability and convergent validity and to obtain norms in a general population. Four hundred and five adolescents, reasonably representative of Swedish adolescents, were asked to rate their anxiety symptoms on the MASC. In order to study the convergent validity, they also rated their depressive symptoms on the Children's Depression Inventory (CDI), their attitude to their body on the Body Esteem Scale for Adolescents and Adults (BESAA) and filled in demographical data on themselves. The MASC showed adequate internal consistency both for the whole scale (alpha = 0.87) and for subscales (range 0.64-0.84). The scale showed convergent validity through a moderate correlation with the CDI (r=0.400, P=0.0001) and the BESAA (r= - 0.29, P=0001). Girls scored higher (mean = 38.9) than boys (mean = 31.9) on the MASC total score (t(385) = 5.14, P=0.0001) and on the subscales, except Harm avoidance. Using the MASC as a general screen for anxiety, scores of 48 for boys and 56 for girls using MASC total scores, or scores of 15 for boys and 17 for girls using the Anxiety Disorders Index could be employed (both representing the 90th percentiles). The MASC appears to be a reliable and valid scale both on the global and on the subscale level.