Understanding the social difficulties and the distribution of other putative maintenance mechanisms of childhood anxiety disorders.

Anxiety disorders are common in childhood and have a significant negative effect on functioning. Although cognitive behavioural therapy (CBT) is an effective treatment for many children with anxiety disorders, a significant number of children retain a diagnosis after treatment. Furthermore, children with social anxiety disorder (SAD) have worse outcomes from generic forms of CBT than children with other anxiety disorders. This is likely to be at least partly because the putative maintenance mechanisms that are targeted in CBT are not yet well understood in the context of childhood anxiety disorders in general and SAD in particular. Notably, better outcomes are found for child SAD when treatment includes social skills training, despite mixed evidence for the presence of social skills deficits in socially anxious children. However, this literature is difficult to interpret given measurement issues caused by an overlap in the observable behaviours of social skills deficits and social anxiety. This thesis aims to first establish whether there are subgroups of children with anxiety disorders characterised by particular profiles of the mechanisms targeted in generic CBT programmes (including social skills deficits) within a sample of children who have been diagnosed with a clinical anxiety disorder. The second aim is to explore the relationship between social anxiety and social skills difficulties in more depth. This will be achieved by investigating the relationship between social anxiety and the social cognitions that underlie social skills in order to overcome limitations of previous research which confounded measurements of social anxiety and social skills themselves. The findings suggest that clinically anxious children cluster into three groups according to the putative maintenance mechanisms of childhood anxiety disorders, but that these do not neatly align with existing diagnostic categories. In addition, the findings suggest that social skills difficulties may be present in only a small proportion of children with SAD, but that underlying difficulties in specific aspects of complex Theory of Mind (ToM; i.e. identifying the intentions of others in complex interactions) may be related to SAD more broadly. These findings have implications for the use of specific treatments for children with SAD, targeting their understanding of complex social interactions, rather than general social skills. In addition, these findings identify key variables that warrant further examination to improve understanding of the maintenance of anxiety disorders in children