The Nature and Treatment of Childhood Social Phobia

NYU Child Study Center Grand Rounds Summary, October 20, 2000

What was the main issue or question being addressed?

The speaker discussed the nature of childhood social phobia and the aspects of the disorder that are specific to children. The incidence of the disorder varies and Dr. Beidel suggests that between 3–5% of children have social phobia. She also described a particular group intervention program that is being used to successfully treat children with the disorder.

What are the main findings or conclusions?

Although there is a list of specific observable criteria for diagnosing social phobia, children themsleves report very particular problems. Children with social phobia who are 8 to 12-years-old will admit to a lack of friendships and the situations they fear most are, in order of most to least feared include: speaking in public, eating in public, writing, going to parties and meetings. This list differs from that endorsed by adults due to their different experiences, for example, children do not attend meetings. In Dr. Beidel's research, to obtain a baseline understanding of a children's problems they are asked to keep a daily diary of feared situations. Sixty percent of the situations occur in school, this is expected due to the large amount of time spent in school each day. In school, the feared situations included peer interactions, public performance, taking tests, and getting tests returned. While not necessarily rejected by peers they are rated by peers as shy. Children with social phobia may not learn necessary social skills to feel more comfortable and in turn can have a low self esteem and a poor self concept. School refusal, depression, alcohol abuse, conduct problems and selective mutism can all be related to social phobia.

Dr. Beidel has successfully treated children with social phobia in a 12 week, twice a week group program. Based on the specific problems exhibited by pre-adolescent children with social phobia, Dr. Beidel developed a three component treatment program called Social Effectiveness Therapy for Children. According to her research the main components of an effective program include:

1. Social skills training: Children learn particular skills and techniques for interacting with others to help them feel comfortable and in control. This might include teaching children how to start or join a conversation.
2. Peer generalization experiences: Having children with social phobia practice their newly learned skills with non phobic peers increases their ability to use their new skills outside the treatment setting. For example, a group of children with and without social phobia go bowling together.
3. Individualized exposure sessions: The children are exposed to situations in which they are fearful and have a more positive experience in order to decrease their fear and change their behavior. A child with a particular fear of talking on the phone is coached to call a particular store and ask pre-determined questions.