When Adolescents Experience Co-Occurring Social Anxiety and ADHD Symptoms: Links With Social Skills When Interacting With Unfamiliar Peer Confederates

Adolescents with elevated social anxiety commonly experi-ence peer-related impairments - particularly with same -age, unfamiliar peers - stemming from their avoidant behaviors. Yet, peer-related impairments are not unique to social anxiety. For example, adolescents who experience social anxiety may also experience symptoms of attention deficit/hyperactivity disorder (ADHD), which also increase risk for peer-related impairments. Relative to social anxi-ety, peer-related impairments linked to ADHD symptoms more likely stem from hyperactivity (i.e., approach behav-iors). These distinct pathways point to adolescents with elevated social anxiety and ADHD symptoms (i.e., social anxiety + ADHD) experiencing particularly high peer -related impairments, which commonly manifest as behav-ioral displays of low social skills when interacting with unfamiliar peers. We tested this notion in a mixed-clinical/community sample of 134 14-to 15-year-old ado-lescents and their parents. Adolescents participated in a series of social interaction tasks designed to simulate how adolescents interact with same-age, unfamiliar peers. Trained observers independently rated adolescents on observed social skills within these interactions. Both par-ents and adolescents completed parallel surveys of social anxiety and ADHD symptoms, which we used to identify social anxiety + ADHD adolescents as well as other combi-nations of social anxiety and ADHD symptoms (i.e., nei-ther, elevated on one but not the other). Adolescents with social anxiety + ADHD displayed significantly lower social skills, relative to all other groups. Among adolescents, social anxiety + ADHD may have a compounding effect on social skills. As such, therapists working with social anxiety + ADHD adolescents should probe for peer -related impairments and factors implicated in the develop-ment and maintenance of these impairments.