Social phobia affects 3-5% of children, and prevalence rises with age. Youth with social phobia fear public speaking, reading or writing in public, going to parties, interacting with authority figures, using public restrooms and interacting informally with others. Clinical correlates include headaches or stomachaches, panic, avoidance, general anxiety, dysphoria, loneliness, and a very restricted range of social relationships. In extreme cases, school refusal or other behavior problems result. Deficiencies in social skills necessary for social development are common. Other disorders frequently co-occur, most often generalized anxiety disorder, separation anxiety disorder, and specific phobia. There are few treatment studies of this debilitating, chronic, and highly prevalent disorder. Recent findings indicate a new psychosocial treatment (Social Effectiveness Therapy for Children; SET-C) is efficacious for ages 8-11, resulting in reduced emotional distress and improved social functioning. Treatment effects have been maintained for up to 6 months. Because the prevalence of social phobia increases with age at least through adolescence, treatments for adolescents are needed. The study proposed here will be a two-site study extending the study of SET-C to a larger sample, and extending the age range to age 15. Because available data suggest that fluoxetine is a promising pharmacological treatment, SET-C will be compared to fluoxetine in a double-blind randomized placebo control design. Fluoxetine has yet to be compared to pill placebo in a controlled design using a representative sample of childhood social phobics. Thus, the study will allow continued evaluation of SET-C's efficacy using an expanded age range, and comparing it to fluoxetine. Furthermore, the study will provide data on the efficacy of fluoxetine compared to pill placebo. Finally, durability of treatment will be monitored over a 1-year follow-up period. The sample will be sufficiently large to provide confidence in the clinical meaningfulness of the findings and to conduct initial studies examining predictors and moderators of treatment clinicians. Similarly, critical data on the efficacy of fluoxetine will be available.
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