# Evidence-based assessment/Social anxiety disorder (disorder portfolio)

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* Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

## What is a "portfolio"?

* For background information on what assessment portfolios are, click the link in the heading above.
* Want even 'more' information about this topic? There's an extended version of this page here.

## Preparation phase
### Diagnostic criteria for phobic anxiety disorders

   ICD-11 Diagnostic Criteria for Social Anxiety Disorder
   * Social anxiety disorder is characterized by marked and excessive fear or anxiety that consistently occurs in one or more social situations such as social interactions (e.g., having a conversation), being observed (e.g., eating or drinking), or performing in front of others (e.g., giving a speech). The individual is concerned that he or she will act in a way, or show anxiety symptoms, that will be negatively evaluated by others. The social situations are consistently avoided or else endured with intense fear or anxiety. The symptoms persist for at least several months and are sufficiently severe to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
   Changes in DSM-5
   * The diagnostic criteria for simple phobia changed slightly from DSM-IV to DSM-5. Summaries are available here and here.

### Base rates of social phobia in different clinical settings

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of social anxiety disorder they are likely to see in their clinical practice.
* To see prevalence rates across multiple disorders, click here.
| Demography | Setting | Base Rate | Diagnostic Method |
| Rhode Island | The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. Psychiatric outpatient practice sample (N=859) | 27.8% | SIDP-IV |
| Oakland, California | Representative probability within primary care group sample ages 18-70 (N=1001) | 3% | SCID |
| All of U.S.A. | National Comorbidity Survey Replication (NCS-R). Nationally representative household survey, community sample of adults ages 18+ (N=9282) | 12.1% (lifetime) 7.1% (12-month) | WHO-CIDI Clinical Interview |
| All of U.S.A. | NCS Adolescent Supplement (NCS-A) for ages 13 to 17. Community sample, (N=6243). | Females 11.2% Males 6.2% Total 8.6% | WHO-CIDI Clinical Interview, modified to simplify language and use examples relevant to adolescents. |
| Western North Carolina. | The Great Smoky Mountains Study (GSMS). Longitudinal, community sample of children ages 9 to 16 (N=6674) | Females 0.8% Males 0.3% Total 0.5% | CAPA |
| Houston, Texas metropolitan area. | Teen Health 2000 (TH2K). Community sample in large, metropolitan area, ages 11 to 17 (N=4,175) | 1.6% | DISC-IV |
| Puerto Rico | Representative household probability community sample, ages 4 to 17 (N=1886). | 2.8% | DISC-IV |
| Children referred to Anxiety Disorders clinic. | Child and Adolescent Anxiety Disorders outpatient research clinic, ages 8 to 13 with anxiety disorder diagnosis (N=199) | 20% | ADIS-C/P |
| All of U.S.A. – clinical settings | Meta-analysis of data collected across multiple clinical settings, 1995-2006 (N=15,967) | 20% (SDI) 6% (unstructured interview) | Structured or Semi-Structure Diagnostic Interviews and unstructured clinical interviews. |
| Metanalysis of outpatient clinics | Outpatient clinic | 6% Diagnosis as Usual (DAU) | |
| Metanalysis of outpatient clinics) | Outpatient clinic | 20% Structured Diagnostic Interviews (SDI) | |
| Intended to apply to the entire United States | General Population | 9% | |
Note: WHO-CIDI = World Health Organization Composite International Diagnostic Interview; NCS-A (lifetime prevalence); CAPA= Children and Adolescent Psychiatric Assessment (3-month prevalence); DISC-IV = Diagnostic Interview Schedule for Children, Version 4 (12-month prevalence); ADIS-C/P=Anxiety Disorders Interview Schedule for Children/Parents; SIDP-IV = Structured Interview for DSM-IV Personality; SCID=Structured Clinical Interview for DSM-IV; SDIs included in Rettew et al. (2009): CIDI, DAWBA, DICA, DISC, DIS, MINI, K-SADS-PL, SCAN-2, SCID, SCID-II.
* Higher rates of social anxiety disorder are found in females than in males, with more pronounced differences in adolescence. Prevalence rates in children and adolescents are comparable to those in adults. Onset is typically in early adolescence (DSM-5, 2013).

## Prediction phase
### Psychometric properties of screening instruments for social anxiety disorder

The following section contains a list of screening and diagnostic instruments for social anxiety disorder. The section includes administration information, psychometric data, and PDFs or links to the screenings.
* Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
* For a list of more broadly reaching screening instruments, click here.
| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Where to Access |
| Liebowitz Social Anxiety Scale (LSAS) | Questionnaire (clinician administered, self-report) | 7 years-adult | 15 minutes | Online questionnaire with scoring Printable PDF |
| Social Phobia Inventory (SPIN) | Questionnaire (self-report) | 12 years-adult | 5-10 minutes | Online questionnaire with scoring Printable PDF |
| Social Phobia and Anxiety Inventory (SPAI) *not free | Questionnaire (self-report) | 14 years-adult | 20-30 minutes | Purchase here |
| For Children and Adolescents Specifically |||||
| Revised Children’s Anxiety and Depression Scale (RCADS) | Questionnaire (Child) | 6-18 years | 12 minutes | RCADS homepage Assessment Center Online Child Self Report Version Assessment Center Online Child Parent Report Version PDFs for RCADS RCADS Child Self-reported (6-18 years) RCADS Parent-reported Child Scoring Aid Parent Scoring Aid Subscales Social Anxiety Self-reported Social Anxiety Parent-reported Translations User Guide |
| Social Phobia and Anxiety Inventory for Children (SPAIC) *not free | Questionnaire | 8-14 years | 20-30 minutes | Purchase here |
Note: Reliability and validity are included in the extended version here. This table includes measures with Good or Excellent ratings.

### Likelihood ratios and AUCs of screening measures for social anxiety disorder

* For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
| Screening Measure (Primary Reference) | AUC (Sample Size) | DiLR+ (Score) | DiLR- (Score) | Clinical Generalizability | Where to Access |
| Liebowitz Social Anxiety Scale (LSAS) and | 0.94 - differentiating from subclinical patients 0.98 - differentiating from healthy controls | Not reported | Not reported | | Printable PDF |
| Overall Anxiety Severity And Impairment Scale (OASIS) | .87 | 3.07 (> or = cut score 8) Cut-score of ≥ 8 to be optimal given that it successfully classified 87% of the sample with the most favorable balance of sensitivity (89%) and specificity (71%) | Not reported | Unknown | Printable PDF |
| Social Phobia and Anxiety Inventory for Children (SPAI-C) (Beidel, Turner, & Morris, 1995) and | .65 (N=172) | 3.55 (18+) | .47 | | Purchase here |
| Screen for Child Anxiety and Related Emotional Disorders (SCARED) | .72 (N=119) | 1.9 (27+) | .50 | | Printable PDF |

### Interpreting social anxiety disorder screening measure scores

* For information on interpreting screening measure scores, click here.
* Also see the page on likelihood ratios in diagnostic testing for more information

## Prescription phase
### Gold standard diagnostic interviews

* For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

### Recommended diagnostic interviews for social anxiety disorder

Diagnostic instruments for social anxiety disorder :
| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Where to Access |
| Anxiety Disorders Interview Schedule (ADIS) | Interview (clinician) | 7 years-adult | 90 minutes | Purchase here |
| Structured Clinical Interview for DSM (SCID) | Semi-structured Interview | Adults (Ages 18+) | 1-2 hours | Available for purchase from APA Publishing (Note: Not free) |
Note: Reliability and validity are included in the extended version here. This table includes measures with Good or Excellent ratings.

## Process phase

The following section contains a brief overview of treatment options for social anxiety disorder and list of process and outcome measures for social anxiety disorder. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

### Outcome and severity measures

This table includes clinically significant benchmarks for social anxiety disorder specific outcome measures
* Information on how to interpret this table can be found here.
* Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
* For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Benchmarks Based on Non-Referred Sample of Adolescents (Anderson et al., 2009) :
| Measure | Subscale | Cut-off scores | Cut-off scores | Cut-off scores | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) |
| Measure | Subscale | A | B | C | 95% | 90% | SE$_{difference}$ |
| MASC (2009) | Total | 15.9 | 63.8 | 38.9 | 11.9 | 10.0 | 6.1 |
| MASC (2009) | Social Anxiety Scale | 3.5 | 19.9 | 11.8 | 7.8 | 6.6 | 4.0 |
| SPAI-C (2009) | Total | 3.3 | 26.6 | 15.9 | 7.5 | 6.3 | 3.8 |
Benchmarks Based on Published Norms :
| Measure | Subscale | Cut-off scores | Cut-off scores | Cut-off scores | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) |
| Measure | Subscale | A | B | C | 95% | 90% | SE$_{difference}$ |
| CBCL T-Scores (2001 Norms) | Total | 49 | 70 | 58 | 5 | 4 | 2.4 |
| CBCL T-Scores (2001 Norms) | Internalizing | n/a | 70 | 56 | 9 | 7 | 4.5 |
| TRF T-Scores (2001 Norms) | Total | n/a | 70 | 57 | 5 | 4 | 2.3 |
| TRF T-Scores (2001 Norms) | Internalizing | n/a | 70 | 55 | 9 | 7 | 4.4 |
| YSR T-Scores (2001 Norms) | Total | n/a | 70 | 54 | 7 | 6 | 3.3 |
| YSR T-Scores (2001 Norms) | Internalizing | n/a | 70 | 54 | 9 | 8 | 4.8 |
Note: A = Away from the clinical range; B= Back into the nonclinical range; and C = Closer to the nonclinical than clinical mean.

### Treatment

The resources below concentrate on child and adolescent populations.
Please refer to the Wikipedia page on Social Anxiety Disorder for more information on available treatment for social anxiety or go to Effective Child Therapy for a curated resource on effective treatments for anxiety disorders.
* For information on conducting Exposure Therapy for anxiety disordered youth, see www.BravePracticeForKids.com

## External resources

* ICD-10 diagnostic criteria
* Find-a-Therapist
** A curated list of find-a-therapist websites where you can find a provider
* NIMH
** Go to this resource for more information on anxiety disorders
* OMIM (Online Mendelian Inheritance in Man)
** Entry for anxiety
* Effective Child Therapy page for Fear, Worry, & Anxiety
** Effective Child Therapy is website sponsored by Division 53 of the American Psychological Association (APA), or The Society for Clinical Child and Adolescent Psychology (SCCAP), in collaboration with the Association for Behavioral and Cognitive Therapies (ABCT). Use for information on symptoms and available treatments.
* Society of Clinical Child and Adolescent Psychology
* Behavioral Health Virtual Resource
** This resource has free PDFs of anxiety screenings, as well as information on diagnosing and treating different anxiety disorders
* www.abctcentral.org
** This is a website sponsored by the Association for Behavioral and Cognitive Therapies.
** Use the “Find a Therapist” option to search for local therapists using CBT, an effective treatment for Social Anxiety.
* www.BravePracticeForKids.com
** This website, created by Dr. Emily Becker-Haimes at the University of Pennsylvania, has information on conducting Exposure Therapy for anxiety disordered youth.