Effects of interventions for social anxiety and shyness in school-aged children: A systematic review and meta-analysis

The effects of interactive video games combined with LEGO game therapy on social anxiety in rural left-behind children

Background

China has a significant population of left-behind children, defined as those whose parents have migrated away from their home for at least six months. This situation arises when one or both parents leave to seek work in urban areas. Among the various challenges faced by left-behind children, social anxiety has emerged as one of the most pressing issues.

Objective

This study aims to deeply explore the impact of interactive video games and LEGO games on the social anxiety of rural left-behind children, with the aim of providing a more comprehensive and effective solution to the mental health problems they encounter.

Methods

Eighty-four rural left-behind children were randomly assigned to four groups: interactive video game group, LEGO game group, combined intervention group, and the control group, using a single-blind randomized controlled experiment. All participants underwent the intervention three times a week for 12 weeks. Social anxiety levels were assessed at three points: before the intervention (T0), immediately after the intervention (T1), and 6 weeks post-intervention (T2).

Results

The effects of different intervention strategies on the social anxiety of left-behind children showed significant group-time interaction effects. As the intervention progressed, the total score of social anxiety and the scores of various dimensions among participants in different intervention groups showed a gradual decreasing trend. The combined intervention group scored significantly lower at T1 and T2 than both the interactive video game group and the LEGO group.

Conclusion

Our findings indicate that social anxiety in left-behind children can be significantly mitigated through both LEGO therapy and interactive video games, with a combined approach yielding the most pronounced effects. These results underscore the importance of a multifaceted intervention strategy that addresses the unique social needs of this vulnerable population. Importantly, our study suggests that effective interventions should not only focus on symptom reduction but also foster environments that enhance social skills and build confidence. Future research should investigate the scalability of these interventions across diverse contexts and their potential integration into existing mental health services to better support left-behind children.

Behavioral Inhibition and Social Competence Through the Eyes of Parent and Teacher Informants

The centrality of social competence to children's well-being has sparked interest in documenting its correlates and precursors. Behavioral Inhibition (BI) is studied extensively as an early appearing, biologically based, temperamental disposition that places children at increased risk for maladaptive social functioning. Children with BI are characterized by the tendency to react to unfamiliarity or uncertainty with fear and to respond with avoidance or withdrawal, eventuating in missed opportunities to gain social competence (SC). Early interventions that aim to interrupt this negative cycle often rely on parents or teachers to observe BI, but they often disagree in their ratings, raising understudied but basic questions about how to translate the research findings into effective interventions. In this study, parents and teachers rated kindergarteners' (N = 174) disposition toward fear and shyness, underpinnings of BI and SC. As expected, we found modest overlap in the classification of children into relatively High, Average, and Low BI groups based on parent and teacher ratings. Whereas about 40 percent were classified similarly, about 33 percent were discrepant in their classification by more than one category. Yet, the High BI group was at a social disadvantage (lower SC) compared to the Low BI group, even when the comparison groups only included children whose classification was discrepant. In line with the Realistic Accuracy Model of person perception, we describe a context/informant-specific conceptualization of the BI-SC connection with implications for intervention.

Is shyness related to depression and suicide risk?

INTRODUCTION

Suicidal behavior is an important health issue, representing a leading cause of mortality, particularly among young adults. Depression was found to be predictive of suicide risk and predicted by shyness. Consequently, we tested a model wherein shyness leads to depression, which in turn leads to suicide risk. Moreover, we expected gender to moderate the effect of shyness on depression and suicide risk.

METHODS

A convenience sample of 478 first-year college students (51% women, Age: M = 25.42, SD = 3.61) completed online self-report questionnaires assessing suicide risk, depression, shyness, and demographic variables.

RESULTS

As expected, shyness was significantly correlated with depression (r = 0.40) and suicide risk (r = 0.24), and depression and suicide risk were also correlated with each other (r = 0.57). Depression statistically mediated the relationship between shyness and suicide risk (indirect effect for women = 0.92, SE = 0.16; for men = 0.72, SE = 0.17). Gender did not moderate the mediation effect. However, a direct link between shyness and suicide risk was found only among men (direct effect = 0.52, SE = 0.21).

CONCLUSIONS

The results suggest that shyness may be a significant factor in the development of depression and suicide risk, potentially serving as a valuable marker for identifying at-risk individuals. Moreover, clinicians should be aware of these associations, particularly among men, in order to maintain and support mental health as well as reduce suicidality.

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Psychological interventions for children with emotional and behavioral difficulties aged 5-12 years: An evidence review

In low- and middle-income countries (LMICs), children and families face a multitude of risk factors for mental health and well-being. These risks are even further exacerbated in humanitarian emergencies. However, access to effective mental health services in such settings is severely limited, leading to a large mental health treatment gap. Middle childhood (5-12 years) is a crucial period for human development during which symptoms of emotional distress often emerge, with one in three mental disorders developing prior to age 14. However, there is little evidence of effective psychological interventions for children in this developmental stage, and suitable for implementation within LMICs and humanitarian emergencies. We conducted this evidence review to inform the development of a new intervention package based on existing best practice for this age group, drawing insights from both global and LMIC resources. Our review synthesizes the findings of 52 intervention studies from LMICs and humanitarian settings; 53 existing systematic reviews and meta-analyses covering both LMICs and high-income countries, and 15 technical guidelines. Overall, there is limited high-quality evidence from which to draw recommendations for this age group; however, some promising intervention approaches were identified for children experiencing externalizing and internalizing symptoms, traumatic stress and a combination of difficulties. Several effective interventions utilize cognitive-behavioral techniques for children, in either group or individual format, and incorporate caregiver skills training into treatment, although the findings are mixed. Most evaluated interventions use specialists as delivery agents and are lengthy, which poses challenges for scale-up in settings where financial and human resources are scarce. These findings will inform the development of new psychological interventions for children in this age group with emotional and behavioral difficulties.

Addressing School Connectedness, Belonging, and Culturally Appropriate Care for Newly Immigrated Students and Families

School connectedness is the degree to which students experience acceptance, inclusion, and care by school personnel and peers. A sense of belonging incorporates an emotional connection to the community. School connectedness and belonging are protective factors that promote student engagement, accomplishment, and community performance. Despite the rise in students from immigrant families in the United States, belonging and connectedness for youth from diverse cultural and linguistic experiences are understudied. School-based nurses, our term, is inclusive of advanced practice pediatric, family, and psychiatric nurse practitioners, are well-positioned to support school connectedness for youth who may encounter hurdles to health care because of cultural and linguistic differences. We present practice suggestions for language, culture, and inclusion using three health conditions experienced by youth: anxiety, asthma, and obesity. School-based nurses and other school personnel who provide linguistic and culturally appropriate care can support students in feeling connected and included in their school communities.

Effects of smartphone-based hypnotic intervention for undergraduate students' shyness during the COVID-19 pandemic: A randomized controlled trial

BACKGROUND

Since the outbreak of the COVID-19 pandemic, university students have been exposed to a heightened vulnerability towards developing psychological issues, such as psychological distress and shyness. Internet-based interventions offer a convenient avenue for scalability, thus prompting the development of a smartphone-based hypnotic intervention aimed at addressing shyness among university students.

OBJECTIVE

We devised an innovative smartphone-based hypnotic intervention called mHypnosis to examine its impact on shyness among undergraduate students. Furthermore, we aimed to investigate whether the apprehension of negative evaluations before treatment could serve as a predictor for the effectiveness of the intervention on shyness.

METHODS

Eighty students with high shyness scores were randomly assigned to the experimental group and the control group. Another 40 participants with low shyness score were selected as the baseline group. The Shyness Scale (SS), Fear of Negative evaluation scale (FNE), Self-Acceptance Questionnaire (SAQ), and Self-Esteem Scale (SES) were used to evaluate the effect of hypnotic intervention.

RESULTS

Before the intervention, the scores of the experimental and control groups on the SS, FNE, SAQ, and SES were higher than those in the baseline group (p < 0.05). There was no significant difference in scores between the experimental and control group (p > 0.05). After the intervention, the scores of the SS, FNE, SAQ, and SES were significantly lower in the experimental group than those in the control group (p < 0.05). The pretest score of FNE could predict the shyness score after hypnotic intervention (B = 0.35, p < 0.05).

CONCLUSION

Smartphone-based hypnotic intervention had a significant effect on ameliorating shyness during the COVID-19 pandemic; fear of negative evaluation can be a target for treating shyness.

Relations between social withdrawal subtypes and socio-emotional adjustment among Chinese children and early adolescents

The aim of the present study was to compare the relations between subtypes of social withdrawal and socio-emotional adjustment in Chinese children and early adolescents. Participants included 571 children (Mage  = 9.62 years) and 345 adolescents Mage  = 12.12 years) in mainland China. Social withdrawal subtypes (i.e., shyness, unsociability, social avoidance) and indices of socio-emotional adjustment were assessed via self-reports, peer nominations, and teacher ratings. Shyness tended to be more strongly associated with emotional maladjustment in early adolescence, whereas unsociability was more strongly associated with socio-emotional difficulties in childhood. For social avoidance, associations with indices of negative adjustment (i.e., social anxiety, emotional symptoms, peer problems) were stronger in childhood, however, associations with indices of positive adjustment (i.e., life satisfaction, well-being) were stronger in early adolescence.

Prenatal exposure to air pollution and childhood internalizing problems: roles of shyness and anterior cingulate cortex activity

BACKGROUND

Prenatal exposure to air pollution increases the risk for psychiatric disorders characterized by internalizing problems. In this study, we examined the roles of shyness and anterior cingulate cortex (ACC) activity in the association between prenatal exposure to polycyclic aromatic hydrocarbons (PAH) and children's internalizing problems at 7-9 years old.

METHODS

Participants include 53 children (31 girls, 22 boys). Personal air monitoring was conducted over 48 continuous hours during the third trimester of pregnancy to measure 8 PAHs. Mothers reported children's shyness (Emotionality Activity Sociability Temperament Survey) at age 5 and internalizing problems (Child Behavior Checklist) at ages 7-9. ACC activity was measured by fMRI during the Simon Spatial Incompatibility task at ages 7-9.

RESULTS

Shyness mediated the association between prenatal PAH exposure and internalizing problems. Higher prenatal PAH exposure predicted increased shyness, which in turn predicted greater internalizing problems. Moreover, left ACC activity during the Simon task moderated the association between prenatal PAH exposure and internalizing problems. Prenatal PAH exposure predicted increased risk for internalizing problems only when children showed heightened left ACC activity during the resolution of cognitive conflict.

CONCLUSIONS

Our study innovatively synthesizes the fields of developmental psychology and environmental health science to offer new insights into the risk factors for anxiety disorders. Facilitating the development of healthy reactive and regulatory processes may improve the developmental outcomes for children highly exposed to air pollution.

The Effectiveness of Anxiety Interventions for Young Children: A Meta-Analytic Review

Anxiety symptoms and disorders are prevalent and impairing in young children and these symptoms often persist and worsen over time, indicating the need for efficacious interventions for this age group. The purpose of this study was to evaluate the effectiveness of psychosocial interventions targeting anxiety in younger children and to assess the potential moderators of outcome. The effect sizes from 24 trials were assessed based on a random effect model. The mean weighted effect size was found to be significant and moderate in magnitude. Moderators, including level of intervention, intervention approach, rater, and level of training of the provider/program facilitator, are assessed and discussed. Overall, the findings indicate that anxiety interventions are effective in reducing anxiety in young children, and targeted trials show particularly strong promise.

Maternal Western-style diet reduces social engagement and increases idiosyncratic behavior in Japanese macaque offspring

Recent evidence in humans and animals indicates an association between maternal obesity and offspring behavioral outcomes. In humans, increased maternal body mass index has been linked to an increased risk of children receiving a diagnosis of early-emerging neurodevelopmental disorders such as Attention Deficit/Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD). However, a limited number of preclinical studies have examined associations between maternal Western-Style Diet (mWSD) exposure and offspring social behavior. To our knowledge, this is the first study to investigate relationships between mWSD exposure and social behavior in non-human primates. Since aberrant social behavior is a diagnostic criterion for several neurodevelopmental disorders, the current study focuses on examining the influence of maternal nutrition and metabolic state on offspring social behavior in Japanese macaques (Macaca fuscata). We found that mWSD offspring initiated less affiliative social behaviors as well as proximity to a peer. Using path analysis, we found that the association between mWSD consumption and reduced offspring social engagement was statistically mediated by increased maternal interleukin (IL)-12 during the third trimester of pregnancy. Additionally, mWSD offspring displayed increased idiosyncratic behavior, which was related to alterations in maternal adiposity and leptin in the third trimester. Together, these results suggest that NHP offspring exposed to mWSD exhibit behavioral phenotypes similar to what is described in some early-emerging neurodevelopmental disorders. These results provide evidence that mWSD exposure during gestation may be linked to increased risk of neurodevelopmental disorders and provides targets for prevention and intervention efforts.