Anxiety Disorders: Turner SM

Frueh BC, Buckley TC, Cusack KJ, Kimble MO, Grubaugh AL, Turner SM, Keane TM. · Medical University of South Carolina and Veterans Affairs Medical Center, Charleston 29401-5799, USA. · J Psychiatr Pract. · Pubmed #15334985 No free full text.

Abstract: The lifetime prevalence of posttraumatic stress disorder (PTSD) is about 8%-14% in the general population, and trauma victimization (51%-98%) and PTSD (up to 42%) are even more prevalent among persons treated within public-sector mental health clinics. Despite this, individuals with PTSD and severe mental illness (SMI) who are treated within the public sector tend to receive inadequate mental health services. In addition, treatments for PTSD for this population remain undeveloped, with virtually no available empirical treatment outcome data to guide clinicians. We propose a model for a comprehensive, multicomponent cognitive-behavioral treatment program for this target population that includes elements of consumer education, anxiety management training, social skills training, exposure therapy, "homework" assignments, and long-term follow-up care. Special considerations for public-sector consumers with PTSD and SMI are addressed, as are directions for future research.

Alfano CA, Beidel DC, Turner SM. · Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park, MD 20742, USA. · Clin Psychol Rev. · Pubmed #12436811 No free full text.

Abstract: Anxiety disorders are one of the most common psychiatric disorders in the general child population and can have significant impact on immediate and long-term functioning. Despite the common use of cognitive-behavioral interventions that target specific, negative thoughts in anxious children, it is unclear that the extant literature clearly documents cognitive aberrations among these children. In this review, conceptual and methodological issues related to the assessment of cognition in anxious children are highlighted and empirical data addressing these areas are evaluated. Furthermore, data addressing cognitive change as a function of treatment outcome is examined, and the impact of cognitive development as a moderating variable is discussed. Finally, areas for future research are presented.

Liebowitz MR, Turner SM, Piacentini J, Beidel DC, Clarvit SR, Davies SO, Graae F, Jaffer M, Lin SH, Sallee FR, Schmidt AB, Simpson HB. · New York State Psychiatric Institute, Department of Psychiatry, Columbia University, New York 10032, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12447029 No free full text.

Abstract: OBJECTIVE: To examine the safety and efficacy of fluoxetine in child and adolescent obsessive-compulsive disorder (OCD). METHOD: Between 1991 and 1998, 43 patients were randomly assigned to fluoxetine or placebo for 8 weeks. Dosing was fixed for the first 6 weeks (up to 60 mg/day) and then could be increased to 80 mg/day. Responders entered an 8-week maintenance phase. The primary outcome measures were the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Clinical Global Impression-Improvement (CGI-I) scale. Analyses were done on the intent-to-treat sample. RESULTS: Fluoxetine patients (n = 21) had significantly lower CY-BOCS scores than placebo patients (n = 22) after 16 (but not 8) weeks. Fluoxetine responders (n = 11) had significantly lower CY-BOCS scores than placebo responders (n = 7) after an additional 8 weeks of treatment. After 16 weeks, 57% of fluoxetine (versus 27% of placebo) patients were much or very much improved on the CGI-I scale (p <.05). No patient terminated the study because of adverse medication effects. CONCLUSION: Fluoxetine was well tolerated and effective for the treatment of child and adolescent OCD, but fluoxetine's full effect took more than 8 weeks to develop.

Beidel DC, Turner SM, Morris TL. · Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park 20742, USA. · J Consult Clin Psychol. · Pubmed #11142541 No free full text.

Abstract: Sixty-seven children (ages 8 and 12) with social phobia were randomized to either a behavioral treatment program designed to enhance social skills and decrease social anxiety (Social Effectiveness Therapy for Children, SET-C) or an active, but nonspecific intervention (Testbusters). Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced social skill, reduced social fear and anxiety, decreased associated psychopathology, and increased social interaction. Furthermore, 67% of the SET-C group participants did not meet diagnostic criteria for social phobia at posttreatment compared with 5% of those in the Testbusters group. Treatment gains were maintained at 6-month follow-up. The results are discussed in terms of treatment of preadolescent children with social phobia and the durability of treatment effects.

Heiser NA, Turner SM, Beidel DC, Roberson-Nay R. · Department of Psychology, Maryland Center for Anxiety Disorders, University of Maryland, College Park, MD 20742, USA. · J Anxiety Disord. · Pubmed #19028075 No free full text.

Abstract: To clarify the relationship between social phobia and shyness, this study examined the characteristics of highly shy persons with social phobia, highly shy persons without social phobia, and non-shy persons. Those with social phobia reported more symptomatology, more functional impairment, and a lower quality of life than those without social phobia. About one-third of the highly shy without social phobia reported no social fears, highlighting heterogeneity of the shy. The social phobia group reported similar levels of anxiety as the shy without social phobia during analogue conversation tasks, but they reported more anxiety during a speech task. The social phobia group performed less effectively across tasks than those without social phobia. All groups' perceptions of anxiety and effectiveness during behavioral tasks were consistent with ratings of independent observers. None of the groups differed on psychophysiological measures. Results are discussed in the context of theoretical models of social phobia.

Alfano CA, Beidel DC, Turner SM. · Department of Psychiatry and Psychology, Children's National Medical Center, George Washington School of Medicine, USA. · J Clin Child Adolesc Psychol. · Pubmed #18470770 No free full text.

Abstract: Based on findings from the adult literature, this study examined the role of negative self-images (NSI) in social phobia during adolescence. NSI was manipulated among 21 nonphobic (IMAG) adolescents (M age = 14.05 years, SD = 1.56) during two social tasks. Self and observer-rated anxiety and performance as well as co-occurring cognition were compared to 21 adolescents with social phobia (SOC) and 21 control adolescents not instructed to use self-imagery. Few differences in observer-rated anxiety or performance were found between the IMAG and control groups, whereas SOC adolescents were consistently rated as more anxious and poorer social performers. Nonsignificantly higher rates of anxiety were reported by the IMAG group compared to controls, but anxiety was not associated with decrements in performance or social skill. A significantly fewer number of on-task thoughts reported by IMAG adolescents suggests that inability to attend to the interaction itself, rather the presence of NSI, served to increase anxiety.

Beidel DC, Turner SM, Sallee FR, Ammerman RT, Crosby LA, Pathak S. · Department of Psychology, University of Central Florida, Orlando, FL32186, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #18030084 No free full text.

Abstract: OBJECTIVE: To determine the efficacy of fluoxetine, pill placebo, and Social Effectiveness Therapy for Children (SET-C) for children and adolescents with social phobia. METHOD: Youths ages 7 to 17 were randomly assigned to one of the treatment conditions. Outcome was evaluated using self-reports, parent ratings, independent evaluator ratings, and behavioral assessment. RESULTS: Both fluoxetine and SET-C were more efficacious than placebo in reducing social distress and behavioral avoidance and increasing general functioning. SET-C was superior to fluoxetine on each of these measures and was the only treatment superior to placebo in terms of improving social skills, decreasing anxiety in specific social interactions, and enhancing ratings of social competence. Furthermore, whereas fluoxetine appears to exert maximum effect by 8 weeks, SET-C provides continued improvement through week 12. CONCLUSIONS: Both fluoxetine and SET-C are efficacious for social phobia, although SET-C appears to provide added benefit by enhancing social skills.

Roberson-Nay R, Strong DR, Nay WT, Beidel DC, Turner SM. · Virginia Commonwealth University, Department of Psychiatry, Richmond, VA 23298-0489, USA. · Psychol Assess. · Pubmed #17371128 No free full text.

Abstract: An abbreviated version of the Social Phobia and Anxiety Inventory (SPAI) was developed using methods based in nonparametric item response theory. Participants included a nonclinical sample of 1,482 undergraduates (52% female, mean age = 19.4 years) as well as a clinical sample of 105 individuals (56% female, mean age = 36.4 years) diagnosed with either generalized (73%) or specific social phobia (27%). Twenty-three of the 45 SPAI items demonstrated good discrimination along the social anxiety continuum. In addition, option characteristic curves (OCCs) indicated that the SPAI's 7-point scale may generate errors in ranking individuals. Thus, options were collapsed to improve item performance. No gender differences emerged between any of the items' OCCs, suggesting that items function similarly among men and women. The abbreviated version also correlated highly with the original 45-item SPAI and exhibited similar patterns of correlations with measures of social anxiety. The SPAI-23 has considerable practical benefits, including a screening of both social and agoraphobic anxiety as well as decreased assessment and scoring time.

Beidel DC, Turner SM, Young BJ. · Penn State College of Medicine, Hershey, PA 17033, USA. · Behav Ther. · Pubmed #17071218 No free full text.

Abstract: Social Effectiveness Therapy for Children (SET-C) is a comprehensive behavioral treatment combining social skills training, peer generalization experiences, and individualized in vivo exposure for the treatment of social phobia in youth. SET-C results in positive treatment outcome and its effects are maintained at least 3 years later. In this investigation, maintenance of treatment gains 3, 4, and 5 years later was examined using a multidimensional assessment strategy consisting of self-report, parental report, clinician ratings, and direct behavioral assessment. Furthermore, the overall functioning of adolescents treated with SET-C 5 years earlier was compared with that of a group of adolescents who never suffered from psychological disorders. All posttreatment gains were maintained 5 years later, and the general functioning of SET-C treatment responders was not significantly different from those who never had a disorder. The data indicate that SET-C results in long-term positive effects for youth suffering from social phobia.

Rao PA, Beidel DC, Turner SM, Ammerman RT, Crosby LE, Sallee FR. · Penn State Hershey College of Medicine<> · Behav Res Ther. · Pubmed #17007813 No free full text.

Abstract: Although the presentation of social anxiety disorder (SAD) in adults is well documented, less is known about its clinical manifestation in children and adolescents. To date, most studies have included combined samples of children and adolescents despite the fact that this age range represents an extensive period of growth and development. This study compares and contrasts the clinical presentation of SAD among children (ages 7-12) and adolescents (ages 13-17). One hundred and fifty children (n=74) and adolescents (n=76) with a primary diagnosis of SAD participated in the study. The assessment battery included clinical ratings and behavioral observation as well as parental and self-report. The results indicate that, although the symptom presentation of children and adolescents with primary SAD shares many features, children tend to present with a broader pattern of general psychopathology, while adolescents have a more pervasive pattern of social dysfunction and may be more functionally impaired as a result of their disorder. These findings suggest that interventions for SAD need to carefully consider clinical presentation of the disorder as it manifests in childhood and adolescence.

Alfano CA, Beidel DC, Turner SM, Lewin DS. · Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street/CMSC 346, Baltimore, MD 21287, USA. · Sleep Med. · Pubmed #16931154 No free full text.

Abstract: BACKGROUND AND PURPOSE: Clinical observation suggests that sleep complaints are common among youth with anxiety disorders though empirical data documenting this co-occurrence of symptoms are generally unavailable. PATIENTS AND METHODS: Based on retrospective chart reviews, the current study examined rates of several types of parent-reported sleep complaints among a sample of (n=35) purely anxious children and adolescents (ANX). Sleep complaints were examined in terms of age (children versus adolescents) and type of anxiety diagnosis (generalized anxiety versus other anxious diagnoses). Rates of sleep complaints among anxious youth also were compared to those among (n=38) healthy control children and (n=33) children referred for sleep problems. RESULTS: The presence of at least one intermittent sleep complaint was reported by 83% of parents of ANX, with almost half reporting at least one frequent sleep complaint. Rates of sleep complaints among anxious children versus adolescents were similar. Children with generalized anxiety disorder (GAD) had a significantly greater number of sleep complaints than children with other types of anxiety disorders, though rates for specific items varied. Although parents of sleep-referred children reported the highest rates of sleep complaints overall, the frequency of several specific types of sleep complaints was highly similar among ANX and sleep-referred children. CONCLUSIONS: Findings indicate that certain sleep complaints are common among ANX. The need for appropriate assessment practices is discussed.

Young BJ, Beidel DC, Turner SM, Ammerman RT, McGraw K, Coaston SC. · Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park, MD, USA. · J Anxiety Disord. · Pubmed #16635559 No free full text.

Abstract: Pretreatment attrition, the systematic self-exclusion of potential participants during the recruitment phase of a study, poses a significant threat to the external validity of randomized clinical trials. Very little is known about the factors that contribute to pretreatment attrition, especially among families seeking treatment for a child. The current study assessed pretreatment attrition in a randomized clinical trial of behavior therapy, fluoxetine, and placebo for child and adolescent social phobia. Reluctance toward medication treatment accounted for 44.7% of study refusals and was disproportionately common among ethnic minority families. Parents were particularly worried about the potential for side effects or physical/psychological dependency upon the medication. Results are discussed in terms of the implications for external validity in future psychopharmacological clinical trials.

Alfano CA, Beidel DC, Turner SM. · Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · J Abnorm Child Psychol. · Pubmed #16514553 No free full text.

Abstract: We examined different cognitive phenomena in relation to social phobia among children (aged 7 to 11) and adolescents (aged 12-16) separately. Fifty socially phobic youths were compared to 30 normal control children on measures of social anxiety, social expectation as well as self- and observer-rated performance during two social tasks involving a same-aged peer. Additionally, a video-mediated recall procedure was conducted immediately following the two behavioral tasks to examine specific types of self-talk. Results indicated that socially phobic youths had lower expectations of their performance and rated their actual performance worse than controls during a social interaction task, but not a read-aloud task. Self-ratings of decreased performance among socially phobic youths were corroborated by blind observers. Although differences in specific types of self-talk were found between the two groups, these findings were generally moderated by age. Furthermore, certain cognitive symptoms associated with the disorder were more commonly found among older socially phobic youths. The current findings highlight the importance of considering developmental factors in the presentation and treatment of social phobia in youths.

Yeganeh R, Beidel DC, Turner SM. · Maryland Center for Anxiety Disorders, University of Maryland-College Park, USA. · Depress Anxiety. · Pubmed #16421889 No free full text.

Abstract: This study investigated the relationship between selective mutism (SM), social phobia (SP), oppositionality, and parenting styles. Twenty-one children with SP, 21 children with SM and SP, and 21 normal children ages 7-15, and the mother of each child, participated in an assessment of psychopathological factors potentially related to SM. Children with SM did not endorse higher levels of social anxiety than did children with SP, although clinicians gave higher severity ratings to those who had both disorders. In addition, although a dimensional measure of oppositionality (Eyberg Child Behavior Inventory) did not reveal group differences, there were significantly more diagnoses of oppositional defiant disorder among children with SM (29%) in comparison to children with SP alone (5%). With respect to parenting styles, there were no significant differences among parents of children with SM and the other groups, except that children with SP reported significantly less warmth/acceptance from parents than normal children. These data replicate previous findings that children with SM do not report greater social anxiety than other children with a SP diagnosis. Furthermore, they suggest that oppositional behaviors may be part of the clinical presentation of a subset of children with SM.

Beidel DC, Turner SM, Young B, Paulson A. · Maryland Center for Anxiety Disorders, University of Maryland, College Park, 20742, USA. · J Consult Clin Psychol. · Pubmed #16173859 No free full text.

Abstract: This study reports the results of a 3-year follow-up assessment of children and adolescents diagnosed with social anxiety disorder (social phobia) and treated with Social Effectiveness Therapy for Children (SET-C), a comprehensive behavioral treatment program combining social skills training, peer generalization, and individualized exposure. Among 32 children initially treated with the protocol, 29 completed the follow-up assessment and were evaluated with a multidimensional assessment strategy, including self-report, parental report, clinician ratings, and behavioral assessment. Results indicated that the majority of posttreatment gains were maintained at 3-year follow-up, and 72% of treated children continued to be free of a social phobia diagnosis 3 years later. These findings support the long-term efficacy of SET-C for children and adolescents suffering from social phobia.

Turner SM, Beidel DC, Roberson-Nay R. · Department of Psychology, Maryland Center for Anxiety Disorders, University of Maryland, College Park, MD 20742, USA. · Behav Res Ther. · Pubmed #16086980 No free full text.

Abstract: Reactivity and habituation patterns were examined in the offspring of anxious and non-anxious parents. Although no differences emerged for magnitude of response to either fear-relevant visual or auditory stimuli, offspring of anxious parents displayed significantly more electrodermal activity during resting baseline and during the inter-trial intervals of these stimulus presentations. Differences also were observed for the number of children per group achieving habituation to the fear-relevant visual and auditory stimuli, where offspring of anxious parents were less likely to habituate to either stimuli. The same pattern of group differences emerged after excluding children diagnosed with an anxiety disorder, indicating that even offspring of anxious parents who did not have an anxiety disorder differ from offspring of normal controls with respect to their pattern of psychophysiological reactivity. It is hypothesized that these features might serve as an indication of anxiety proneness and risk for the development of anxiety disorders.

Picon P, Gauer GJ, Hirakata VN, Haggsträm LM, Beidel DC, Turner SM, Manfro GG. · Post-graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. · Rev Bras Psiquiatr. · Pubmed #15962137 links to  free full text

Abstract: OBJECTIVE: To evaluate internal consistency and temporal stability trough test re-test reliability of the Portuguese version of the Social Phobia and Anxiety Inventory (SPAI) in a heterogeneous Brazilian sample. METHODS: After informed consent, the translated and adapted version of the SPAI Portuguese was tested and re-tested at a 14-day interval in a sample of 225 university students, both genders, from 4 different undergraduate courses. After double data entry, statistical analysis included Cronbach's alphas, Pearson and intra-class correlation coefficients. RESULTS: The studied sample consisted of 213 students from 4 sub-samples: 95 law students, 31 social communication students, 54 civil engineering students and 33 dental medicine students. The mean age was 23 (+/-6) years and 110 (51.6%) were female. The Cronbach' alpha was 0.96, no difference for both genders. The differential (total) score of the SPAI Portuguese showed Pearson coefficient 0.83 (95% CI 0.78-0.87) and Intra-class coefficient 0.83 (95% CI 0.78-0.86). There was no statistical difference in Pearson coefficients between genders (p = 0.121) and the 4 sub-samples (p = 0.258). CONCLUSION: The results do not ensure validity, however, the SPAI Portuguese version presented a good content homogeneity with satisfactory level of internal consistency. The temporal stability evaluated was substantial. The results showed that the Portuguese SPAI presents perfectly acceptable reliability for both genders and suggest that it can be used in Brazilian populations.

Gauer GJ, Picon P, Vasconcellos SJ, Turner SM, Beidel DC. · Departamento de Psiquiatria, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil. · Braz J Med Biol Res. · Pubmed #15917963 links to  free full text

Abstract: The purpose of the present study was to examine the factor structure and psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C), an instrument developed in the United States and applied to a sample of Brazilian schoolchildren. The process included the translation of the original material from English into Portuguese by two bilingual psychiatrists and a back translation by a bilingual physician. Both the front and back translations were revised by a bilingual child psychiatrist. The study was performed using a cross-sectional design and the Portuguese version of the SPAI-C was applied to a sample of 1954 children enrolled in 3rd to 8th grade attending 2 private and 11 public schools. Eighty-one subjects were excluded due to an incomplete questionnaire and 2 children refused to participate. The final sample consisted of 1871 children, 938 girls (50.1%) and 933 boys (49.8%), ranging in age from 9 to 14 years. The majority of the students were Caucasian (89.0%) and the remainder were African-Brazilian (11.0%). The Pearson product-moment correlation showed that the two-week test-retest reliability coefficient was r = 0.780 and Cronbach's alpha was 0.946. The factor structure was almost similar to that reported in previous studies. The results regarding the internal consistency, the test-retest reliability and the factor structure were similar to the findings obtained in studies performed on English speaking children. The present study showed that the Portuguese language version of SPAI-C is a reliable and valid measure of social anxiety for Brazilian children.

Turner SM, Beidel DC, Frueh BC. · Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park, MD 20742-4411, USA. · Behav Modif. · Pubmed #15557478 No free full text.

Abstract: Posttraumatic stress disorder(PTSD) is a severe and chronic mental disorder that is highly prevalent within Veterans Affairs (VA) Medical Centers. A severe psychiatric disorder, combat-related PTSD is typically accompanied by multiple comorbid psychiatric disorders, symptom chronicity, and extreme social maladjustment. Thus, PTSD is a complex psychiatric disorder resulting in considerable emotional distress and impaired social functioning and often constitutes a significant treatment challenge. Although a range of psychotherapeutic strategies for chronic PTSD have been advanced, behavioral treatments emphasizing various methods of exposure therapy have been the most carefully studied and show the most promise. However, chronic PTSD exposure alone does not appear to have a significant effect on the negative symptoms of PTSD (e.g., avoidance, interpersonal difficulties) or anger control. This may be because exposure is more focused on anxiety and fear reduction and does not address basic skill deficits, help reestablish impaired relationships, or teach anger control. Therefore, we developed a multicomponent treatment program to complement exposure by targeting those areas of the clinical syndrome (e.g., social skills) not found to be helped by exposure alone. This treatment program, trauma management therapy (TMT), has showed good preliminary results in an open trial. In this article, we describe the treatment program, including elements of education, individually administered exposure therapy, programmed practice (i.e., homework), and group-administered social and emotional skills training. The appendix includes a detailed description of how to implement the social and emotional skills training components on a session-by-session basis; the full TMT treatment manual is available on request.

Ferrell CB, Beidel DC, Turner SM. · Maryland Center for Anxiety Disorders, University of Maryland, College Park, MD 20742, USA. · J Clin Child Adolesc Psychol. · Pubmed #15136189 No free full text.

Abstract: In this study we examined the psychopathology and behavioral treatment of White and African American preadolescent children with social phobia. The comprehensive assessment strategy, including semistructured diagnostic interviews, clinician ratings of impairment, behavioral observations, parental ratings, and self-report inventories, did not reveal differences in symptomatic presentation between African American and White children. Whereas all children improved from pre- to posttreatment, there were no significant differences based on race. The results are discussed in terms of the applicability of models 0of social phobia and treatment outcome across these 2 ethnic groups.

Turner SM, Johnson MR, Beidel DC, Heiser NA, Lydiard RB. · Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park, Maryland 20742-4411, USA. · Psychol Assess. · Pubmed #14593839 No free full text.

Abstract: Development and initial psychometric features of a new inventory to assess cognitions associated with social phobia are described. The Social Thoughts and Beliefs Scale (STABS) is designed to assess cognitions in individuals with social phobia. In the 1st study, an initial pool of 45 items was reduced to 21. In the 2nd study, psychometric features of the scale were examined in a sample of individuals with social phobia, other anxiety disorders, and no psychiatric disorder. Total scores and two factor scores significantly differentiated individuals with social phobia from those in the other groups and were found to have adequate test-retest reliability and internal consistency. Potential usefulness of the STABS for assessing cognitions associated with social phobia is discussed.

Yeganeh R, Beidel DC, Turner SM, Pina AA, Silverman WK. · Department of Psychiatry, University of Maryland, College Park, MD 20742, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12960706 No free full text.

Abstract: OBJECTIVE: To investigate the hypothesis that children with selective mutism are more socially anxious than children with social anxiety disorder but who are not selectively mute. METHOD: Twenty-three children with comorbid selective mutism and social phobia and 23 age-matched controls with social phobia alone and their parents participated in a comprehensive assessment of social anxiety and related aspects of psychopathology. RESULTS: The results do not uniformly support previous suggestions that children with selective mutism refuse speech because they are "frozen with fear." Although clinician and observer ratings for children with selective mutism revealed higher ratings of social distress than for children with social phobia alone, self-report data do not support this conclusion. Furthermore, although there were no group differences on measures of trait anxiety, general fears, or scores on the Child Behavior Checklist broadband Internalizing or Externalizing scales, children with selective mutism scored higher than children with social phobia alone on the Child Behavior Checklist Delinquency subscale, suggesting the presence of a broader clinical syndrome. CONCLUSION: It remains unclear whether children with selective mutism have extreme levels of social anxiety. Potential areas that might shed further light on this interesting disorder are discussed.

Turner SM, Beidel DC, Roberson-Nay R, Tervo K. · Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park, MD 20742, USA. · Behav Res Ther. · Pubmed #12711263 No free full text.

Abstract: Anxiety disorders are familial, and although considerable evidence supports the role of genetic/biological parameters in their development, these alone do not entirely explain their etiology. In this study, the role of parenting behavior as a possible factor in the transmission of anxiety from parent to child was examined. Using interview, self-report, and direct behavioral observation, behaviors of parents with an anxiety disorder were compared to those of parents without an anxiety disorder on a number of dimensions, but particularly with respect to whether anxious parents actively inhibited their children from engaging in normal age appropriate activities. These behaviors were assessed during routine activities and in a structured non-conflictual play task. Although anxious parents did not overtly restrict their child's behavior in either type of activity, they reported higher levels of distress when their children were engaged in these activities. Similarly, the "emotional climate" in families with an anxious parent differed significantly from families without an anxious parent. The results are discussed in terms of how parenting behaviors might influence the development of maladaptive anxiety via social learning and information transfer, and their heuristic implications.

Heiser NA, Turner SM, Beidel DC. · Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park, MD 20742, USA. · Behav Res Ther. · Pubmed #12547381 No free full text.

Abstract: The relationship between shyness, social phobia and other psychiatric disorders was examined. The prevalence of social phobia was significantly higher among shy persons (18%) compared with non-shy persons (3%). However, the majority of shy individuals (82%) were not socially phobic. A significant and positive correlation was found between the severity of shyness and the presence of social phobia, but the data suggest that social phobia is not merely severe shyness. Social phobia was also positively and moderately correlated with introversion and neuroticism. Thus, shy persons with social phobia were shyer, more introverted, and more neurotic than other shy people, but none of these factors was sufficient to distinguish shy persons with social phobia from those without social phobia. The proportion of the shy group with psychiatric diagnoses other than social phobia was significantly higher than among the non-shy group, indicating that various diagnostic categories are prominent among the shy. The results are discussed in terms of the overlap in shyness and social phobia and the relationship of shyness to other psychiatric diagnoses and personality dimensions.

Frueh BC, Hamner MB, Bernat JA, Turner SM, Keane TM, Arana GW. · Medical University of South Carolina, Veterans Affairs Medical Center Charleston, South Carolina 29401-5799, USA. · Depress Anxiety. · Pubmed #12497647 No free full text.

Abstract: We tested the hypothesis that race may influence clinical presentation and symptomatology in combat veterans with posttraumatic stress disorder (PTSD). African-American and Caucasian veterans were administered the Psychotic Screen Module of the Structured Clinical Interview for DSM, Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and other psychometric measures at a Veterans Affairs outpatient PTSD clinic. Subjects were consecutive referrals who were not matched for level of combat trauma or preexisting trauma; however, there were no group differences in other relevant demographic or diagnostic variables. Significant racial differences, with modest effect sizes, were found on clinician ratings of psychotic symptoms, MMPI-2 scale 6 ("paranoia"), and a measure of dissociation. No significant differences were found for the MMPI-2 scale 8 ("schizophrenia"), or on measures that might suggest comorbid depression or anxiety. African-Americans with PTSD endorsed more items suggesting positive symptoms of psychosis, without higher rates of primary psychosis, depression, or anxiety than Caucasians.