SCCAP/Miami International Child & Adolescent Mental Health (MICAMH) Conference/2018/Day 2/Multi-Modal Assessment of Adolescent Social Anxiety Notes

1.) Learn how to administer behavioral tasks in the clinic to assess adolescent clients' social anxiety with unfamiliar peers (De Los Reyes Workshop Slides Handout, pages 1-8).

• Multi-modal assessment from parents, adolescents and teachers are used to express concerns that clinicians aren't familiar with or observe in the scope of the clinic. Evidence-based assessments should serve the purpose of filling the gap between understanding concerns and facilitating treatment.
• Issue: Adolescents with social anxiety fear positive evaluation such as being center of attention and appraisal but clinicians tend to just focus on the adolescent’s fear of negative evaluation. These are factors that make clinicians question the accuracy and truth of the adolescent’s self report of social anxiety.
• Solution: Compare reports of the parent and the adolescent to see if social anxiety is great enough to need to provide care. One issue is that discrepancies between the informants reports are common.
• Sometimes discrepancies can cause uncertainty such as debating if the child has ADHD or social anxiety but based on parents you think ADHD but you need more information to make a decisions.
• Informant discrepancies may be caused by a manipulated mood causing a changed behavior before interactions.
• Discrepancies between reports might mean you are missing something when assessing social anxiety.
• Who else do you ask after receiving an informant discrepancy? You need to obtain reliable and valid information about adolescents’ concerns specifically in interactions with unfamiliar peers
• You need to get more information to confirm what adolescent said about peer interactions but you can’t ask friend because they're familiar to them.
• Some might suggest sending out a single item measure asking who is shy with a list of names of classmates on it but it is impractical to ask the whole school what they think about them.
• Naturalistic observation is one suggestion some may give to avoid confidentiality issues when it comes to gathering information about the patient’s interactions with unfamiliar peers instead of recruiting them for reports. The problem with naturalistic observation is that it is hard to standardize for each person and the dilemma of where to go observe them because adolescents interaction for different spaces varies.
• All of these issues have lead to the idea of making confederate peers.
• This study is important because social anxiety predicts externalizing behavior like substance use dependence and disorder. Adolescents as adults are at risk for self medicating with alcohol for “liquid of courage” in social settings. Social anxiety might have been precursor for risky behaviors and so treating social anxiety will prevent or buffer negative behavior as an adult. This is all theory and speculation and no longitudinal research has been done yet to back it.

2.) Learn how to administer survey measures to multiple informants to assess adolescent clients' social anxiety

• For the  peer evaluation report it was the same one parent’s and adolescent’s filled out except “I” and “My child” on free assessment was changed to “The participant”.
• The research study’s task of recreating interactions with unfamiliar peers, was a mix of varying situations. The structure should vary in battery of tasks, to see if the adolescent could grasp normal and clear social rules in a situation, and then ambiguous social rules conditions.
• Collection for physiological data about the person's stress level had also been collected in some studies with polar electro, heart rate, flexibility and level of arousal to see which condition stressed the participant out more.
• The recruitment of socially anxious clients was a developmental extension off of Dr. Deborah Beidel's social anxiety studies on children.
• The plan to get unfamiliar peers for this study while getting the International Research Board to approve it was to train young looking undergraduates to be peer adolescent and to complete the same parent assessments to get thin slice judgements.
• Participants were never directly informed that the confederates were participants but if they asked the confederates if they were participants then the confederates were told to just say they were here for a part of a study. This kept the set up under the radar.
• This "unfamiliar peer" the study created is like the referee between the parent or teacher or adolescent's report on the adolescent's social anxiety. Their score on the report helps determine if the adolescent or parent's score is correct.
• Most confederates have no experience before enrolling as a volunteer in the study. In order to get them to look like a adolescent they dress them down just like a Narc or an actor playing a adolescent on a TV show or movie.
• These confederates come in with experience from working at hotlines, hospitals, clinics etc.
• Confederates are unpaid volunteers.
• Most confederates do it for next steps in a career in psychology and to learn how administer the task.
• To train confederates, the research lab uses the trainer-trainer approach by getting confederates to help and practice with other confederates on how to act in the set up scenarios.
• The unpaid volunteers do all of the one on one assessing and take multiple refresher courses to make sure they stay robust and ready.
• The confederate must learn word for word lines but they have no training with measures and how to fill out the survey because parents don't get trained on how to fill out the measure either.
• When parents and confederates say they do not know how to answer a particular question on the measure they are told that there is no right or wrong answer and that the study just wants to know what they think.
• Confederates on average work 10-12 hours per week.
• To maintain high retention rates for unfamiliar peers Dr. De Los Reyes writes them letters of recommendation and vouches for them for jobs/favors.
• About 300 confederate interns have contributed to this research study.
• The unfamiliar peers are trained to stay cool and neutral when faced with nonverbal awkward moments and uncertainty from the participants.

3.) Learn how to score and interpret freely available survey measures of adolescent social anxiety

• When a participant comes in they take a baseline and quick physical assessment before being exposed to a condition. This is done to create a reference point for anxiety rating so they can infer points in between the beginning and after being exposed to the social conditions.
• Participants that were recruited from their parents seeing a flyer about free clinical shyness evaluation only know they are coming in for that shyness evaluation and that is it.
• This study is assessing using a source never used before, a created unfamiliar peer.
• Participants are informed to fill out the surveys after each social interaction set up based on feelings during interaction not the feelings they are having at that moment after finishing.
• The study tested for clustering effects with confederates and nothing significant was found.
• It was hypothesized that gender match up for the participant and confederate would scrub out confounding variables but they did not account for sexual orientation and so this might have a role in interaction.
• This study also had a flyer that did not say anything about shyness evaluation but just that a study was looking for adolescent volunteers in order to get a sample of adolescents who are not shy or adolescents who's parents aren't bringing them in because of a concern with their introvertedness.
• "Wranglers" in this study are graduate students in the lab who gave out the surveys, read out the scenarios and helped conduct the interactions.
• Confederates nor Wranglers had any idea beforehand if the participant was a recruited shy teen or regular teen.
• The word "shy" was used in advertising flyer because the research study wanted to recruit a wide enough net of teens to see if they could differentiate.
• There is a high confidence in reliability of scoring.
• The scores relates really well to behavior, closely approximated and cut offs are not the same for Social Interaction Anxiety Scale (SIAS) and SPAIC.
• Teen participants usually rate in 20s and unfamiliar peers usually rate in the 30s.
• Most sensitive point: that hits that cut off… too sensitive or too specific, 0-1 and consists of 2 curves.
• The values of scores and elevation of adolescent and parent evaluations were looked at to see if confederate peer pick up on blind spots between the parent and adolescent.