July 19, 2022

Dear Colleagues,

The National Social Anxiety Center (NSAC) provides information about relevant and current research in service of disseminating and promoting evidence-based treatment. This month’s summary is written by NSAC Associate Taylor Wilmer, PhD. The article, When Adolescents Experience Co-Occurring Social Anxiety and ADHD Symptoms: Links with Social Skills When Interacting with Unfamiliar Peer Confederates, focuses on the impact of co-occurring social anxiety (SA) and attention deficit hyperactivity disorder (ADHD) on adolescent social effectiveness using a multi-informant, multi-modal approach.

Although 25-40% of adolescents with social anxiety disorder (SAD) also meet criteria for ADHD, little research has investigated the nature of their co-morbidity on functional impairment. Greenberg and De Los Reyes (2022) sought to understand the impact of co-occurring SAD and ADHD on social functioning in adolescence. Their study was strengthened by the use of a mixed clinical/community sample, restricting the sample age range to a specific developmental period (i.e., ages 14-15), data collection from multiple informants (i.e., adolescents and their parents), and inclusion of a live social interaction task with an unfamiliar peer.

Adolescents (N=134) and their parents completed an assessment battery that included measures of social anxiety (SA), ADHD, and psychosocial functioning. Adolescents also completed the Unfamiliar Peer Paradigm (Cannon et al., 2020), in which they engaged in three social tasks (i.e., role-playing scenes, an unstructured conversation, and an impromptu speech) with trained confederates who presented as same-age, unfamiliar peers. Trained independent observers rated adolescents’ social skills within each of the three tasks. For data analyses, adolescents were categorized into one of four groups: 1) Low SA/Low ADHD, 2) Low SA/High ADHD, 3) High SA, Low ADHD, and 4) High SA/High ADHD. Results indicated that adolescents in the High SA/High ADHD group were rated as significantly less socially effective in the Unfamiliar Peer Paradigm tasks compared to the other three groups. Participant- and parent-reported ratings of psychosocial functioning in general were also significantly lower for adolescents in the High SA/High ADHD group compared to their peers.

This study demonstrated that adolescents with co-occurring social anxiety and ADHD experienced greater impairments in peer interactions and psychosocial functioning than their peers with lower levels of social anxiety, ADHD, or both. The authors posited that the combination of avoidance of social situations due to SAD and socially-aversive impulsive behaviors and inattention to nonverbal social cues due to ADHD may have a compounding effect on the development of adolescent social skills. The authors recommend that therapists working with adolescents with this combined clinical presentation assess for peer-related impairments and the factors implicated in their development and maintenance. They also recommend, when possible, incorporating exposures in treatment that simulate social interaction partners and situations that adolescent clients are most likely to encounter in their day-to-day social environment.

How do you address social skill building for adolescents with social anxiety disorder and ADHD? How have you gotten creative with exposures for practicing structured and unstructured peer interactions?

Greenberg, A., and De Los Reyes, A. (2022). When adolescents experience co-occurring social anxiety and ADHD symptoms: Links with social skills when interacting with unfamiliar peer confederates. Behavior Therapy. May 2, 2022.

Taylor Wilmer, PhD
NSAC Associate, Massachusetts