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The present study evaluated the utility of parent- and child-reported social fears for reaching a diagnosis of social phobia in youth. The diagnostic utility of (a) the number of fears and (b) specific feared social situations was examined. The sample included 140 youth and their parents: youth diagnosed with social phobia (n = 50), youth diagnosed with generalized anxiety disorder or separation anxiety disorder but not social phobia (n = 49), and youth without an anxiety disorder (n = 41). Youth and their parents were interviewed separately using the Anxiety Disorders Interview Schedule for Children and Parents. Analyses indicate that a cut score of 4 parent-endorsed social fears optimally distinguished youth with and without social phobia. Analyses of child-reported fears did not identify a meaningful cut score. Conditional probability and odds ratio analyses indicated that several specific social fears have high diagnostic efficiency, and others were found to have limited diagnostic efficiency. Results are discussed with regard to informing diagnostic interviews and diagnostic systems for social phobia in youth.

The research literature suggests that children and adolescents suffering from anxiety disorders experience cognitive distortions that magnify their perceived level of threat in the environment. Of these distortions, an attentional bias toward threat-related information has received the most theoretical and empirical consideration. A large volume of research suggests that anxiety-disordered youth selectively allocate their attention toward threat-related information. The present review critically examines this research and highlights several issues relevant to the study of threat-related attentional bias in youth, including the influences of temperament, trait anxiety, and state anxiety on threat-related attentional bias. It furthermore identifies the need for developmental and methodological considerations and recommends directions for research.

The study examined the shape of therapeutic alliance using latent growth curve modeling and data from multiple informants (therapist, child, mother, father). Children (n = 86) with anxiety disorders were randomized to family-based cognitive-behavioral treatment (FCBT; N = 47) with exposure tasks or to family education, support, and attention (FESA; N = 39). Children in FCBT engaged in exposure tasks in Sessions 9-16, whereas FESA participants did not. Alliance growth curves of FCBT and FESA youths were compared to examine the impact of exposure tasks on the shape of the alliance (between-subjects). Within FCBT, the shape of alliance prior to exposure tasks was compared with the shape of alliance following exposure tasks (within-subjects). Therapist, child, mother, and father alliance ratings indicated significant growth in the alliance across treatment sessions. Initial alliance growth was steep and subsequently slowed over time, regardless of the use of exposure tasks. Data did not indicate a rapture in the therapeutic alliance following the introduction of in-session exposures. Results are discussed in relation to the processes, mediators, and ingredients of efficacious interventions as well as in terms of the dissemination of empirically supported treatments. Keywords: alliance, cognitive-behavioral therapy (CBT), anxiety disorders, child, growth curve modeling