The diagnosis of social phobia in Aspergers (high functioning autistic) kids emphasizes the following:
- A youngster with social phobia must show the capacity for age-appropriate social relationships with familiar people, and his/her anxiety must occur in peer contexts, not just with grown-ups.
- Due to limitations of cognitive and perceptual skills, Aspergers kids with social phobia need not recognize that their fear in social situations is excessive or unreasonable.
- The anxiety brought on by social situations may be evidenced by crying, tantrums, meltdowns, freezing, shutdowns, or shrinking from social situations with unfamiliar people.
- There must be evidence of the social fears existing for a minimum of six months.
Developmental Pathways to Social Phobia—
1. Genetic factors: Taken as a whole, studies using twins to determine whether genetics play a significant part in the development of social phobia are inconclusive. Some twin studies have examined the heritability of shyness and social fears rather than the clinical disorder social phobia. Overall, these studies suggest that genetics play a modest to moderate role in the development of symptoms and temperamental traits associated with social phobia.
Studies examining the rates of social phobia in the offspring or in other first-degree relatives of socially phobic people show that social phobia rates in relatives are higher than in the relatives of people with other anxiety disorders or no disorder. Overall, these studies suggest that social phobia is at least moderately familial and possibly specific in its transmission. However, family studies cannot specifically sort-out the relative contributions of genetic influences and family environmental influences on the development of a disorder. Thus, the mechanisms behind this familial connection in social phobia still need clarification.
2. Normative developmental factors: Kids as young as 6 months through 3 years of age commonly show anxiety in the forms of stranger and separation anxiety. Some young kids, when confronted with a new social situation, throw tantrums, cling to a familiar person, avoid contact, refuse to take part in group play, and become overly vigilant. By late childhood and early adolescence, kid's fears of social evaluation of academic and social performance are forefront. Although at some point during their adolescence all youth will experience some level of anxiety about being judged in school or social situations, obviously not everyone goes on to develop pathological levels of social anxiety (i.e., social phobia).
3. Parenting/family environment factors: Research indicates that parent characteristics and family environment (through such mechanisms as modeling of avoidant responses and restricted exposure to social situations) are likely to have at least a moderate effect on the development of social phobia in kids and adolescents. It appears likely that if the parent's own anxiety is communicated to the youngster, a cycle is established in which parent and youngster reinforce each other's anxiety.
Controlling/overprotecting and less affectionate parenting styles have been found to be associated with social phobia in adult offspring, although the cause and effect relationship between these characteristics and social phobia is unclear. A major gap in this area is research that uses kids with social phobia or kids at high risk for social phobia, and this needs to be filled before the developmental impact of parental and family factors can be specified.
4. Physiological factors: Researchers have just begun to explore the physiology of social phobia, and studies have been primarily conducted with grown-ups. When facing phobic situations, socially phobic people commonly experience such symptoms as blushing, racing heart, sweating, and increased respiration, all of which are reactions associated with the autonomic nervous system (ANS). However, the few studies that have examined ANS functioning in socially phobic people have provided mixed results.
Other research has examined the function of the amygdala, a small region in the forebrain involved in the output of conditioned fear responses, e.g., freezing up behavior, blood pressure changes, stress hormone release, and the startle reflex. Hypersensitivity in the neural circuitry that centers on the amygdala may be responsible for behavioral inhibition in kids. The application of currently developing neuroimaging technologies to kids and adolescents may prove to be especially useful in elucidating the continuities and differences between social phobia in youngsters and in grown-ups.
5. Temperamental factors: A predisposition to timidity and nervousness has been believed to be a matter of inborn temperament. The majority of recent research in the role of temperamental factors in the development of social phobia focuses upon behavioral inhibition (BI). BI refers to a temperamental style that is characterized by reluctance to interact with and withdrawal from unfamiliar settings, people or objects. In infants, BI is typically manifest as irritability, in toddlers as shyness and fearfulness, and in school age kids as cautiousness, reticence and introversion. BI includes reactions that can be seen in behavior, such as interrupting of ongoing behavior, ceasing vocalization, comfort seeking from familiar persons, and retreat from and avoidance of unfamiliarity.
BI also includes reactions that are physiological, such as stable high heart rate, acceleration of heart rate to mild stress, pupillary dilation, and increased salivary cortisol. Overall, evidence to date suggests that a behaviorally inhibited temperament may predispose a youngster to the development of high social anxiety, although BI has yet to be definitively identified as a necessary precursor to the development of the clinical syndrome social phobia.
Treatment of Social Phobia—
1. Cognitive Behavioral Treatment (CBT): Treatment from the cognitive-behavioral perspective assumes that social anxiety is a normal and expected emotion. Social anxiety becomes problematic when it exceeds expected developmental levels and results in significant distress and impairment at home, school, and in social contexts. Anxiety is assumed to be comprised of physiological, cognitive, and behavioral components.
Cognitive behavioral treatment involves specific psycho-education, skills training, exposure methods, and relapse prevention plans for addressing the nature of anxiety and its components. Psycho-education provides corrective information about anxiety and feared stimuli; somatic management techniques target autonomic arousal and related physiological responses; developmentally appropriate cognitive restructuring skills are focused on identifying maladaptive thoughts and teaching realistic, coping-focused thinking; exposure techniques involve graduated, systematic, and controlled exposure to feared situations and stimuli; and, relapse prevention methods focus on consolidating and generalizing treatment gains over the long term.
2. Social Effectiveness Therapy for Children (SET-C): This treatment is appropriate for youth ages 8 through 12 and involves 24 treatment sessions held over a 12-week period. Each youngster participates in one group social skills training session and one individual exposure session each week, with structured homework assignments serving to promote generalization of the within session experience to the youngster's real life.
The Aspergers Comprehensive Handbook