Testing theoretical processes that maintain paediatric social anxiety: A comparison between children and adolescents with social anxiety disorder, other mental disorders, and non-clinical controls

Paediatric social anxiety disorder (SoAD) responds poorly to treatment. Improved understanding of potential psychological maintaining processes may indicate fruitful directions to improve treatment outcomes. The current study compared self-reported psychological processes and state anxiety in response to two social tasks experienced by children and adolescents with SoAD against comparison samples. 641 children and adolescents aged 6–17 years (Mage = 9.45 yr; 47.6% girls) engaged in a brief, impromptu speech and a social discussion with a confederate. Participants included 307 with SoAD, 285 with other mental disorders, and 49 non-clinical controls. Participants who completed each task self-reported their anticipated probability and cost of negative evaluation, self-focused attention, personal evaluation of social performance, and engagement in post-event rumination (assessed 1 h later). Independent raters also scored their social performance. Relationships between the variables were tested through path analysis. Participants with SoAD were more likely to avoid and reported significantly greater state anxiety than both comparison groups. They also reported higher levels of each of the putative maintaining processes than either comparison group. In contrast, independent observers did not discriminate between groups on their overt social performance. Path analyses demonstrated good fit of a priori models to the data for both social tasks. Paediatric SoAD is associated with strong expectation of the probability and cost of negative evaluation, excess self-focused attention, and more negative evaluation of one's own social performance. In turn, these putative processes are strong predictors of state anxiety and post-event processing in response to both a speech and social interaction. •Social anxiety disorder (SoAD) in children and adolescents is difficult to treat.•Youth with SoAD avoid social tasks more than other children and adolescents.•Anxiety during social tasks among paediatric SoAD is indirectly predicted by anticipated negative evaluation.•Anxiety during social tasks among paediatric SoAD is indirectly predicted by self-focus and poor performance evaluation.•Post-event rumination is also indirectly predicted by these variables.