Environmental influences on childhood social anxiety Flashcards
why should psychologists study anxiety disorders
- Some fear and anxiety in childhood is normal, but a significant minority of children experience fear/anxiety that persists and affects daily functioning.
- 1 in 14 people around the world at any given time has an anxiety disorder.
- The median global current prevalence of all anxiety disorders in 3-17 years olds is ~6% [95% CI: 3.7-9.3%] (Baxter, Scott, Vos & Whiteford, 2012).
- Start early in development with mean age of onset of ~11 years (Kessler et al., 2005).
- Chronic, debilitating course:
- Lifelong impact on wellbeing and daily functioning.
- Raise risk for other psychological disorders.
- Large societal cost.
abnormal fears and anxiety
· A significant proportion of childhood fears and anxiety reflect clinical anxiety disorders, especially phobias (Muris, Merckelbach, Mayer & Prins, 2000).
· Childhood phobias and anxiety diagnoses may reflect radicalisations of normal fear and anxiety.
· Both genetic and environmental vulnerability factors implicated in risk for development of childhood anxiety disorders.
social anxiety disorder - DSM-5 criteria
- a persistent fear of social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. Fear that they will act in a way which will be embarrassing and humiliating.
- exposure to the feared situation almost invariably provokes anxiety
- the person recognises that this fear is unreasonable or exercise
- the feared situations are avoided or endured with intense anxiety and distress.
- the avoidance, anxious anticipation, or interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships.
- the fear, anxiety, or avoidance is persistent, typically lasting 6+ months.
- not due to physiological effects of a substance, general medical condition or another mental disorder
genetic factors
· Social anxiety runs in families
· ~30% heritable but estimates vary depending on population studied (Eley, Collier and McGuffin, 2002; Gregory and Eley, 2007)
· Beginning to identify actual genetic variants using genome-wide association scans (GWAS) (Trzaskowski et al, 2013, Meier et al, 2019)
· Polygenic - many genes of very small effect
environmental factors
· Relative contribution of genes and environment to etiology of anxiety is poorly understood.
· Support for direct environmental transmission of anxiety via e.g. verbal information, vicarious learning (Eley et al., 2015).
· And for (non-shared) environment factors* playing a larger role than genetic factors (Scaini, Belotti & Ogliari, 2014).
- *this is defined as the environmental influences that are not shared (e.g. different friends/teachers) and that make children growing up in the same family different, rather than similar.
assumptions
· Risk factors interact
· Equifinality: different pathways and combinations of factors can result in SAD
· Multifinality: any one risk factor can lead to multiple outcomes, not just SAD
· Reciprocal risk factors – social anxiety in young person influences probability of experiencing a risk factor, which in turn magnifies young person’s risk for SAD
- e.g. fearful temperament at age 2 elicits overprotective parenting, which in turn predicts social withdrawal 3 years later (Kiel & Buss, 2011)
- e.g. social anxiety symptoms increase risk for peer victimisation, which in turn predicts further aversive social outcomes
aversive social outcomes
· Aversive social learning experiences with peers play a role in the development and maintenance of SAD (Blote, Miers, Heyne et al., 2015):
- Excessive teasing.
- Criticism.
- Bullying and Victimisation.
- Rejection.
- Ridicule.
- Humiliation.
- Exclusion by significant others.
why is it that socially anxious young people experience adverse social outcomes?
-> poorer performance on social tasks
-> adverse social outcomes/less positive response from peers
-> heightened anxiety/expectations response from peers
-> avoidance of future social situations
-> reduced opportunity to acquire social skills
Blote, Miers and Westenberg (2015)
· Examined impact of social anxiety and social performance on the way children are judged by their peers.
· N = 20 HSA and N = 20 LSA 13-17 years old recorded giving a speech to a pre-recorded audience.
· N = 534 observers rated HSA and LSA speakers on:
- Rejection using Desire for Future Interaction Scale e.g. Would you like to have this speaker sit next to you in class?
- Attractiveness (not at all good looking – very good looking).
- Performance using Skills Rating Scale for Peers e.g. content, facial expression, body posture and movement, way of speaking.
· Additional adult ratings of social skills performance.
- e.g. how friendly did the speaker look?
peer influences
· Cross-sectional studies show socially anxious children are more likely to experience peer victimisation (Crawford & Manassis, 2011; LaGreca & Harrison, 2005; Ranta et al., 2009).
· Prospective longitudinal studies suggest a causal role for victimisation in increasing future risk for social anxiety (Dempsey et al., 2009; Hamilton et al., 2016).
· Social anxiety not just a consequence of victimisation – may also increase chances of being victimised (Ranta et al., 2013; Siegel et al., 2009).
· Direct/overt victimisation - physical and verbal bullying aimed at causing harm.
· Relational victimisation - harms social standing and reputation. Withdrawal of friendships and attention, exclusion from activities, spreading of gossip and rumours.
Storch et al (2005)
· Prospective study looking at the relationships between overt & relational victimisation and social anxiety symptoms.
· 144 13-15 year olds completed baseline and 1 year assessment, 64% identified as female.
· Overt and relational victimisation measured using Social Experience Questionnaire.
· Social anxiety symptoms measured using Social Phobia and Anxiety Inventory for Children.
- T1 relational victimisation predicted T2 social phobia symptoms
- no significant association with overt vicitmisation
quality of evidence?
· How generalisable are the results?
- White middle class sample, high attrition – generalisability?
- Unequal distribution of people identifying as females/male – may have obscured gender effects.
- Only a small number of participants scoring at higher end of social anxiety symptoms.
· Were the methods optimal?
- Self-report measures are susceptible to shared method variance effects.
- Limited range of outcomes – multifinality: what about depression, loneliness etc?
· What about the breadth of evidence?
- Other types of bullying? e.g. cyberbullying (see Fisher et al., 2016).
- Moderators? e.g. presence of a close friend, warm parenting?
- Lots of other studies, not all showing same pattern of effects (see Siegel, LaGreca & Harrison, 2009; Loukas & Pasch, 2013; Ranta et al., 2013; Reijntes et al., 2010).
trauma and life events
· Adverse/stressful life events and trauma during childhood increases risk of developing SAD.
- Rates of social anxiety twice as likely in a trauma exposed vs. non-exposed group in a community sample (Copeland et al., 2007).
· Mainly retrospective or cross-sectional research.
· Why do some children who experience adversity develop SAD whereas others do not?
Gren-Landell et al (2011)
· 3211 Swedish adolescents, nationally representative.
· Social Phobia Screening Questionnaire for Children provided diagnostic assessment of SAD.
· Juvenile Victimisation Questionnaire – prior year and lifetime:
- Conventional crime.
- Maltreatment.
- Peer or siblings victimisation.
- Sexual victimisation.
- Witnessing victimisation.
· 10.6% prevalence rate for SAD overall, higher in those who identified as female (14.9%) than male (6.2%) so analyses split by gender.
quality of evidence 2:
· What can the study design tell us?
- Focus on adolescence as vulnerable period of development.
- Retrospective report.
- Unable to determine causality – would need prospective longitudinal design.
- Begin to unpick effects of specific types of trauma.
· Were the methods optimal?
- Well validated measures.
- Captured different types of trauma and victimisation.
- All self-report data.
- No assessment of other outcomes of adversity.
