اضطراب اجتماعی در کودکان: نقص مهارت های اجتماعی، یا اعوجاج شناختی؟

Background. Treatments for childhood social anxiety have traditionally employed social skills training, based on the assumption that effected children have social skills deficits. Recent conceptualisations of social anxiety in adults have questioned this assumption, and have suggested that socially anxious individuals merely believe that they have skill deficits. A recent study using children provided preliminary confirmation of this for younger populations, and also suggested that beliefs about appearing nervous are of particular importance. Methods. Two groups of children, aged 10–11 years (analogue high social anxiety/low social anxiety), participated in a conversation with an unfamiliar adult. They then rated their performance in a number of domains, after which independent observers also rated their performances. Results. Independent observers were unable to distinguish between the low and high social anxiety groups. However, high socially anxious children rated themselves as appearing significantly less skilled than their low socially anxious counterparts. Notably, high socially anxious children rated themselves particularly poorly in terms of how nervous they looked. Conclusions. Socially anxious children may not necessarily display social skill deficits. However, they may believe that they appear nervous during social encounters. Clinicians should consider using CBT techniques to address these concerns, rather than relying on social skill remediation.

Bijstra and Jackson, 1999, Hayward, Varady, Albano, Thienemann, Henderson and Schatzberg, 2000 and Spence, Donovan and Brechman-Toussaint, 2000). This approach has met with some success, which has often been interpreted as giving support to the social skills deficit theory. However, more recently, these assumptions have been questioned. Recent cognitive models of social anxiety (derived mainly for adult clients) have proposed that sufferers do not generally lack adequate social skills. They do, however, believe that they lack social skills—a belief that may seriously undermine their confidence in social situations (e.g. Clark and Wells, 1995 and Rapee and Heimberg, 1997). Cognitive interventions designed to modify these deleterious beliefs about social skills deficits have met with early success (e.g. Wells & Papageorgiou, 2001). In addition, there is now direct evidence that the socially anxious do not necessarily lack social skills. Several studies have reported that individuals with social anxiety (or non-clinical participants with high levels of reported social anxiety) do not lack social skills compared to their low socially anxious counterparts (e.g. Rapee and Lim, 1992 and Strahan and Conger, 1998). A number of studies, however, have reported social skill deficits in the socially anxious, (e.g. Beidel, Turner and Dancu, 1985, Segrin and Flora, 2000 and Spence, Donovan and Brechman-Toussaint, 1999), but it is possible that there is a simple explanation for some of the discrepant results reported by these studies. In particular, most of the studies that reported deficits had asked participants to self-report on their own social skills. In two studies where both objective and subjective reports of social skills were taken, it was only on the subjective reports that any deficits were apparent. ( Segrin, 1999 and Segrin and Kinney, 1995). This indicates that self-reporting of social skills may produce biased results—and supports the new conceptualisations of social anxiety as a deficit in confidence in social skills, rather than a deficit in social skills per se. In several studies where small observable differences were apparent in socially anxious adults, these were substantially magnified by self-reports of performance, when compared with observer ratings (e.g. Norton & Hope, 2001). Futhermore, most studies recognise that there is considerable overlap in the performance of the socially anxious and non-socially anxious groups, such that some socially anxious participants receive very good performance ratings from observers. These facts suggest that impaired social skills cannot be the major cause of social anxiety in all cases. To date, little work has examined the role of social skills in the development of social anxiety in children. However, examination of social skills in the early stages of social anxiety is crucial to the understanding not only of child anxiety, but to the understanding of any deficits that may be apparent in adults with long-standing disorders. It is quite possible that any deficits in social skill that are apparent in adults may not be the cause of their anxiety, but arise as a consequence. Many adults with severe social anxiety avoid social encounters, and report having done so for many years. It is quite possible that the consequent lack of social activity could result in under-rehearsed social skills. If this theory is correct, we may hypothesise that socially anxious children, who have had less opportunity to engage in social avoidance, will not yet show rusty or diminished social skills. In order to test this hypothesis, Cartwright-Hatton, Hodges, and Porter (2003) invited school children aged between 8 and 11 years, to take part in a public speaking task. Participants were asked to rate their own performance in a number of domains. Videotapes of their performance were then rated by objective observers. In particular, the authors were interested in examining the effect of self-reported symptoms of social anxiety on micro-social skills (eye gaze, clarity/loudness of voice, smiling); global performance (how well they did generally, how clever and how friendly they appeared); and nervous behaviour (stuttering and generally looking nervous). The results of this study showed that trait social anxiety was associated with scoring highly on both the objective and subjective measures of nervous behaviours only. A measure of state social anxiety was associated with poorer self-reports on all aspects of performance, but was not significantly correlated with any of the objective performance ratings. The authors concluded that although there was little evidence of any actual social skill deficits, socially anxious children were concerned with their levels of social skills. In particular, they were very concerned with appearing nervous. These results echo those reported by Baker and Edelmann (2002), who found slight observable differences between their socially anxious and non-anxious adult participants, but only in behaviours that could be interpreted as signs of nervousness or as safety behaviours. The present study aimed to replicate and extend the results of Cartwright-Hatton et al. (2003). Two groups of children were recruited. The first were an analogue socially anxious group, the second were a group of children who scored below average on a measure of childhood social anxiety. In the present study, children were asked to engage in a conversation with an adult confederate—rather than a public speaking task as used previously. It was felt that this would represent a more commonplace social situation for the children, and we were interested to see whether the results of the previous study would generalise to this potentially less anxiety provoking setting. Performance was rated by the children and by independent adult observers. It was hypothesised that there would be an interaction between social anxiety level (high/low) and rater (observer/self) on reported levels of social skills, with socially anxious children rating themselves as displaying poorer skills than their less anxious peers, and with the observers detecting no significant differences between the groups. In order to examine the relationship between social anxiety and separate domains of social skill behaviours, analyses were repeated for ratings of micro-social skills, global performance, and nervous behaviours.