Safety behaviors, self-focused attention and negative thinking in children with social anxiety disorder, socially anxious and non-anxious children

Abstract Background and objectives Cognitive behavioral models of social anxiety disorder (SAD) in adults suggest several mechanisms that maintain social anxiety. So far, little is known about the role of these processes in childhood social anxiety. Methods In this study, 21 children with SAD, 21 children with high social anxiety and 21 non-anxious controls (age between 8 and 13 years) were asked about their use of safety behavior in anxiety producing situations. Furthermore, children were asked to indicate their levels of anxiety, self-focused attention and frequency of positive and negative cognitions while engaging in a performance task in front of two adults. Results As expected, a significant group effect was found for all dependent variables, with children suffering from SAD reporting the most frequent use of safety behavior and highest levels of anxiety, self-focused attention and negative cognitions during the task, followed by socially anxious children and controls. Unexpectedly, only self-focused attention mediated the relationship between general social anxiety and state anxiety in response to the task. Limitations We assessed only the general use of safety behavior in social threatening situations and not with respect to the performance task. Conclusions The results provide important preliminary evidence for differences between clinical and non-clinical groups in childhood anxiety in maintaining variables as proposed from cognitive models in adults. In particular, self-focused attention seems to be relevant. Targeting the change of inappropriate attentional focus could be promising for treatment improvement in childhood social anxiety.