Labelled the neglected anxiety disorder in the eighties, social anxiety disorder (SAD) a major cause of school refusal in children and adolescents is still poorly recognized and treated and will be explored. Raised for discussion are five key considerations in support. What is SAD? Its prevalence; manifestations; co-morbidities and current state of treatment.
Conclusion
These considerations call for renewed attention and redefinition of SAD in the DSM to reverse the neglect.
CreswellCWaitePHudsonJ. Practitioner review: Anxiety disorders in children and young people, assessment and treatment. JCPP (J Child Psychol Psychiatry)2020; 61(6): 638–643. https://doi.org/10.1111/jcpp.13186
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5- TR) Arlington. A.P.A, 2022, pp. 206–209.
3.
LydiardB. When does shyness become a disorder?Psychiatr Times2002; 19(3): 8–11.
4.
KesslerRCBerglundPDemlerO, et al.Lifetime prevalence and age of onset distribution of DSM-1V disorders in the national co-morbidity survey, replication. Arch Gen Psychiatry2005; 62(6): 593–602. https://doi.org/10.1001/archpsyc.62.6.593
5.
LawrenceDHafekostJJohnsonS, et al.Key findings from the second Australian child & adolescent survey of mental health and well-being. Aust N Z J Psychiatr2016; 50(9): 876–886. https://doi.org/10.1177/0004867415617836
MeiserNATurnerSMBeidelDC. Shyness: relationship to social phobia and other psychiatric disorders. Behav Res Ther2003; 41: 209–221.
8.
BenoitLPengECSFlouriotJ, et al.Trajectories of school refusal: sequence analysis using retrospective parent report. Eur J Child Adolesc Psychiatr2024; 33: 3849–3859.
9.
O’Neil RodriquesKAKendallPC. Suicidal ideation in anxiety-disordered youth: identifying predictors of risk. J Clin Child Adolesc Psychol2014; 43: 51–62.
AcquahEOTopekPZWilsonML, et al.Adolescent loneliness and social anxiety as predictors of bullying victimization. Int J Adolesc Youth2016; 21(3): 320–331.
13.
JadambaaAB, DPacellaR, et al.The economic cost of child and adolescent bullying in Australia. JAACAP2021; 60(3): 357–375.
14.
KesslerRCStangPWittchenHU, et al.Lifetime comorbidities between social phobia and mood disorders in the US. National comorbidity survey. Psychol Med1999; 29: 556–557. https://doi.org/10.1017/s0033291799008375
15.
PohlmanKDobellSLofflerS, et al.Social Phobia-the blind spot infrequently diagnosed, highly complex and a predictor of unfavourable therapy outcomes. Journal of Psychosomatic Medicine and Psychotherapy2009; 55(2): 180–188.
16.
KernsCMRumpKWorleyJ, et al.The differential diagnosis of anxiety disorders in cognitively able youth with autism. Cognit Behav Pract2016; 23(4): 530–547. https://doi.org/10.1016/j.cbpra.2015.11.004
17.
PallisterEWalkerG. Anxiety in the eating disorders, understanding the overlap. Clin Psychol Rev2008; 28: 366–396.
18.
FangAHoffmanSG. Relationship between social anxiety disorder and body dysmorphic disorder. Clin Psychol Rev2010; 30(8): 1040–1048. https://doi.org/10.1016/j.cpr.2010.08.001
19.
KrygsmanAVaillancourtT. Elevated social anxiety symptoms across childhood and adolescence predict adult mental health disorders and cannabis use. Compr Psychiatry2022; 115: 152–162.
20.
KeyesKMMcLaughlinKAVoT, et al.Anxious and aggressive: the co-occurrence of intermittent explosive disorder with anxiety disorders. Depress Anxiety2016; 33(2): 101–111. https://doi.org/10.1002/da.22428
21.
LiechsenringFLewekeF. Social anxiety disorder. N Engl J Med2017; 376(23): 2255–2264.
22.
IsolanLPheulaGSalumGA, et al.An open-label trial of escitalopram in children and adolescents with social anxiety disorder. J Child Adolesc Psychopharmacol2008; 17: 751–760. https://doi.org/10.1089/cap.2007.0007
23.
KyranMJJohnsonAHyettM, et al.Current & prospective association between negative social-evaluative beliefs, safety behaviours and symptoms during and following cognitive behaviour group therapy for SAD. Behav Res Ther2023; 161: 1–12.
24.
CarltonCNSullivan-TookHStregeMV, et al.Mindfulness-based intervention for adolescent social anxiety: a unique conversion of factors. Front Psychol2020; 11: 01783.
25.
YeganehRBeidelDCTurnerSM. Selective mutism: more than social anxiety?Depress Anxiety2006; 23: 117–123. https://doi.org/10.1002/da.20139