Download Social Anxiety Disorder among Children at Gofermeda Sub City

ADDIS ABABA UNIVERSITY
COLLEGE OF EDUCATION AND BEHAVIORAL STUDIES
SCHOOL OF PSYCHOLOGY
Social Anxiety Disorder among Children at Gofermeda Sub City, Hosanna
Town: Prevalence and Associated Factors
By: Andualem Gebremicheal
June 2016
Addis Ababa, Ethiopia
ADDIS ABABA UNIVERSITY
COLLEGE OF EDUCATION AND BEHAVIORAL STUDIES
SCHOOL OF PSYCHOLOGY
Social Anxiety Disorder among Children at Gofermeda Sub City, Hosanna
Town: Prevalence and Associated Factors
A THESIS SUBMITTED TO THE SCHOOL OF PSYCHOLOGY OF
ADDIS ABABA UNIVERSITY IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN HEALTH
PSYCHOLOGY
By: Andualem Gebremicheal
Adviser: Kassahun Habtamu
June 2016
Addis Ababa, Ethiopia
ADDIS ABABA UNIVERSITY
COLLEGE OF EDUCATION AND BEHAVIORAL STUDIES
SCHOOL OF PSYCHOLOGY
Social Anxiety Disorder among Children at Gofermeda Sub City, Hosanna
Town: Prevalence and Associated Factors
By: Andualem Gebremicheal
Approval by Board of Examiners
_____________________________
Chair person, Department
Graduate Committee
_______________________
Signature
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Advisor (Name)
___________________
Signature
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Internal Examiner (Name)
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External Examiner (Name)
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Acknowledgements
I would first like to express my deepest gratitude to my advisor Mr. Kassahun Habtamu, for his
invaluable comments and advices. He has been a dedicated mentor to me since from beginning to
completion of the study. He has served as a voice of support when I needed encouragement, and
a voice of experience when I was limited by my own knowledge. He shared his time, talents, and
knowledge with me from beginning to completion of this study.
I would also like to thank school of psychology for extending their knowledge, providing me
with support, and helping me grows as a health psychologist and social worker. I would
particularly like to extend my appreciation to those psychology department instructors who
thought me from beginning to completion of this study. I thank them for readily sharing their
time and talents.
Finally, I would like to express my deepest feeling to my family as a whole for their concern and
understanding during the entire period of study and their support and encouragement throughout
my study.
i
TABLE OF CONTENTS
Contents
Page
Acknowledgements ............................................................................................................................... i
TABLE OF CONTENTS ..................................................................................................................... ii
LIST OF TABLES .............................................................................................................................. vi
ABBREVATIONS ............................................................................................................................. vii
ABSTRACT ..................................................................................................................................... viii
CHAPTER ONE .................................................................................................................................. 1
INTRDUCTION .................................................................................................................................. 1
1.1 Background of the Study ............................................................................................................ 1
1.2. Statement of the Problem .......................................................................................................... 5
1.3. Objectives of the Study ............................................................................................................. 7
1.3.1 General Objective ...................................................................................................................... 7
1.3.2 Specific Objectives .................................................................................................................... 7
1.4 Significance of the Study ........................................................................................................... 7
1.5 Delimitation (scope) of the Study .............................................................................................. 8
1.6 Limitation of the Study .............................................................................................................. 8
1.7 Operational Definitions of Terms .............................................................................................. 9
CHAPTER TWO ............................................................................................................................... 11
REVIEW OF RELATED LITERATURE ......................................................................................... 11
2.1 An over View of Social Anxiety Disorder ............................................................................... 11
2.2 Diagnostic Criteria and Characterizing Psychopathology of SAD among Children ............... 12
2.3 Clinical Pictures of Social Anxiety Disorder among Children ................................................ 14
ii
2.4 Theoretical Modes of Social Anxiety Disorder among Children ............................................. 14
2.4.1 Cognitive aspects of Social Phobia........................................................................................ 14
2.4.2 Behavioral aspects of Social Phobia ...................................................................................... 15
2.4.3 Physiological aspects Social Phobia ...................................................................................... 16
2.4.4 Cognitive Behavioral Models ................................................................................................. 16
2.4.5 Interpersonal Models ............................................................................................................... 17
2.5 Prevalence of Mental Disorder in General and Social Anxiety Disorder in Particular............ 17
2.6 Gender Differences in Social Anxiety Disorder ...................................................................... 20
2.7 Age of Onset of Social Anxiety Disorder ................................................................................ 21
2.8 Co morbidity of SAD with another Anxiety Disorder and Depression ................................... 21
2.9 Determinants and Correlates of Social Anxiety Disorders among Children ........................... 22
2.9.1 Victimization ............................................................................................................................ 22
Peer Victimization ............................................................................................................................. 22
2.9.2 Demographic Variables ........................................................................................................... 22
2.9.3 Genetic Factors ......................................................................................................................... 23
2.9.4 Temperamental Factors ........................................................................................................... 24
2.9.5 Attachment ................................................................................................................................ 24
2.9.6 Parenting Style.......................................................................................................................... 25
2.10 Impact of Social Anxiety Disorder during Childhood and Adulthood .................................. 25
2.11 Assessment of Social Anxiety Disorder ................................................................................. 26
2.11.1 Family Observations .............................................................................................................. 27
2.11.2 School and Peer Observation ............................................................................................... 27
2.12 Measures of Social Anxiety Disorder .................................................................................... 28
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CHAPTER THREE ........................................................................................................................... 30
RESEARCH METHODS .................................................................................................................. 30
3.1 Study Setting ............................................................................................................................ 30
3.2 Study Design ............................................................................................................................ 31
3.3 Types of Variables ................................................................................................................... 31
3.3.1 Dependent Variable ................................................................................................................. 31
3.3.2 Independent Variables ............................................................................................................. 31
3.4 Sample Size Determination ...................................................................................................... 32
3.5 Sampling Procedures ................................................................................................................ 32
3.6 Data Collection Procedures ...................................................................................................... 33
3.7 Instruments of Data Collection ................................................................................................ 33
3.7.1 Questionnaire ............................................................................................................................ 34
3.7.1.1 The Screen for Child Anxiety Related Emotion Disorders (SCARED) .................... 34
3.7.1.2 The Juvenile Victimization Questionnaire (JVQ) .................................................... 36
3.7.1.3 Socio-Demographic Questionnaires ........................................................................ 36
3.8 Data Analysis ........................................................................................................................... 37
3.9 Ethical Considerations.............................................................................................................. 37
CHAPTER FOUR .............................................................................................................................. 39
RESULTS .......................................................................................................................................... 39
4.1 Association between Social Anxiety Disorders with Socio-demographic Characteristics of
Respondents ........................................................................................................................... 39
4.2 Association between Social Anxiety Disorder and Socio-economic Status of Respondents .. 41
4.3 The Prevalence of Social Anxiety Disorder among Children .................................................. 42
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4.4 The Factors Contributed for Social Anxiety Disorder among Children .................................. 43
CHAPTER FIVE ............................................................................................................................... 45
DISCUSSION .................................................................................................................................... 45
5.1 Prevalence of Social Anxiety Disorder among Children ......................................................... 45
5.2 Socio-Demographic and Socio-Economic Variables and Social Anxiety Disorder ................ 46
5.3 Victimization and Social Anxiety Disorder ............................................................................. 48
CHAPTER SIX .................................................................................................................................. 51
SUMMARY, CONCLUTION AND RECOMMENDATIONS........................................................ 51
6.1 Summary and Conclusions ....................................................................................................... 51
6.2 Recommendations .................................................................................................................... 52
References
Appendix
v
LIST OF TABLES
Table 1 Socio- demographic Characteristics of the children respondents ................................39
Table 2 Socioeconomic Status of the parents of the Sample Children ..............................41
Table 3 The Prevalence of social anxiety disorder on children .........................................42
Table 4 The predictors of social anxiety disorder in children .......................................... 43
vi
ABBREVATIONS
APA
American Psychiatric Association
CSA
Central Statistical Agency
DSM
Diagnostic and Statistical Manual of Mental Disorders
DSM-III
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition
DSM-III-R
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised
DSM-IV
Diagnostic and Statistical Manual of Mental Disorders, 4
EPHA
Ethiopian Public Health Association
ECA
Epidemiologic Catchment Area Research Program
HFEDB
Hadiya Zone Finance and Economic Development Bureau
ICD
International Classification Diseases
JVQ
Juvenile Victimization Questionnaire
LR
Likelihood Ratio
RQC
Reported Questionnaire for Children
SAD
Social Anxiety Disorder
SCARED
Screen for Child and Anxiety Related Emotional Disorders
SP
Social Phobia
UNICEF
United Nation‟s International Child Economic Forum
WHO
World Health Organization
th
vii
edition
ABSTRACT
Social anxiety disorder is a disabling anxiety disorder characterized by an extreme fear of
unconstructive estimation in public situations. Human beings are social creatures. Accordingly,
fear of social situations can be severely disabling. This study explored the prevalence and
factors associated with social anxiety disorder in children. Data was collected from samples,
using cross‐sectional design. In the study (n=300), psychometric screening questionnaire was
conducted
with
children and their parents and the association between social anxiety
disorder with selected socio-demographic variables and victimization in children (aged 12-17)
was investigated. Self‐reported social anxiety disorder was found 63%. From total sample
respondents about 26.3% is < 15 years old and 34.8% > 15 years old. This indicates that age of
children increases also the prevalence of social anxiety disorder increases. And the higher
prevalence of social anxiety disorder was found to be among > 15 years old. Females reported
social anxiety disorder to a significantly higher degree than males in all age groups.
Experiences of peer victimization, maltreatment and sexual victimization were significantly more
common in that reporting social anxiety disorder. Social anxiety was increases with age of
children increases. In conclusion, social anxiety disorder was associated with female gender,
low educational status, low income level of parent, experiences of peer victimization,
maltreatment and sexual victimization.
Keywords: Social anxiety disorder, children, prevalence, victimization, socio-demographic
characteristics.
viii
CHAPTER ONE
INTRDUCTION
1.1 Background of the Study
According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV), social anxiety disorder is defined as a “marked and constant fear of one or more
social and performance situations in which the individual is exposed to unfamiliar people. Thus,
the central characteristic of social anxiety disorder is an intense fear of being observed by
unfamiliar persons (APA, 2013).
It is also defined as a persistent fear of one or more situations involving scrutiny by others
because of the possibility of doing something embarrassing or humiliating. Exposure to the
social or performance situation almost invariably provokes an immediate anxiety response, and
these situations are most commonly avoided, or endured with dread. The anxiety interferes
significantly with the child‟s daily routine, academic or social functioning, or other important
areas of functioning like communicating ideas with peers at school and the symptoms must have
persisted for at least 6 months (APA, 2013).
As the DSM-IV classification defines social anxiety disorder among children and adolescents in
much the same way as it is defined among adults, the core symptom is being persistent and
intensive fear and distress experienced in one or more social situations. So the main fear is of
being negatively evaluated, the individual fears that one will do something that is embarrassing
or that one is showing symptoms of anxiety (Watson and Friend 1969). The most notable is that
the anxiety should occur in peer settings, not just in interactions with adults (APA 2013).
1
The phobic children typically reacts with anxiety symptoms such as nervousness, palpitations,
sweating, blushing, catastrophic thinking when they exposed to phobic situations, or in
anticipation thereof and the symptoms arise even though they realizes that the reactions are
exaggerated and unreasonable and if the individual is under age 18, the DSM-IV criteria require
a minimum duration of at least six months (APA, 2013).
Social anxiety disorder
is an enormously impairing disorder because children with social
anxiety disorder is afraid of many everyday situations, such as eating and drinking in public,
writing when someone is watching become near not possible challenges for the phobic children
and or being in the centre of attention can be anxiety inducing for them (Esau, Conrad, &
Peterman, 1999).
The Examples of what a socially phobic children experienced are feeling of painful, being
judged as weak, being judged as being crazy, getting a panic attack, feeling confused, feeling
ashamed of oneself, feeling that they have to vomit, feeling nervousness, and fearing that they
will feel embarrassed (Esau, Conrad, & Peterman, 1999).
Social anxiety disorder in children is associated with low levels of adaptive functioning such as,
emotional over responsiveness and loneliness, impairments in adaptive functioning,
peer
relations, self esteem, school performance, social behavior and psychosocial impairment
(Strauss, Frame, & Forehand, 1987).
As the social phobia literature which had been done indicated that phobic children are suffered
from performance fear, such as speaking in front of peers, do eating, drinking, writing, acting,
playing an instrument, and urinating in front of others. Also they suffered from interactional
2
fears which occur in settings such as parties, peer gatherings, and face-to- face conversations
with strangers (Hazen & Stein, 1995).
Lots of areas of their life are affected for those who suffer from social anxiety disorder like wide
use of alcohol and drugs in their future, as well as they suffer from marriage and employment
difficulties in their future life, and academic underachievement (Amies, Gilder, & Shaw, 1983).
Also some of them are incapable to work, are at higher risk to be without a job, cannot work at
their full ability, and lack career advancement in their later life (Kessler, 2003).
According to Turner, Beidel and Borden (1991), in a study group of people who seeking
treatment for their social anxiety, 91 % reported that lack of academic advancement due to social
phobic fears. Some persons with social anxiety disorder are also at higher risk to be dependent
on financial support and suffer from severe social limitation (Kessler, 2003).
Esau et al., (1999), social anxiety disorder is highly impairing not only children but also
adolescents and adults. Their study indicated that exposure to social fears associated with
avoidance; 17 % of the youth with any social fears reported that they frequently or always
avoided public situations and the children who reported that avoiding at all the numbers
increased to 61.6% of children with any social fear, that means four out of ten children with any
social fear found their fear or their avoidance excessive or unreasonable.
In a study where 3211 Swedish high school students were screened for social anxiety disorder,
self-reported social anxiety disorder was associated with early time victimization to a
significantly higher degree, than it was in children who did not fulfill criteria for social anxiety
disorder (Anderson & Svedin, 2011). Also another study which was done in Swedish high school
students indicated that a sample of 784 children with social anxiety disorder, two thirds (68 %)
3
reported to have been bullied or victimized by their peer (Ranta, Kaltiala-Heino, Rantanen
&Marttunen, 2009).
Although the etiology of social anxiety disorder in children is most likely multi-factorial, peer
influences on the maintenance or even on onset of social anxiety disorder are likely to contribute
(Parker et al. 2006), considering, for example, the accounts of adults with clinical SAD of their
early social traumas (Ost and Hugdahlk 1981; Stumberger et al. 1995), and consistent
associations between self-reported high SAD and being bullied among children (Vern berg et al.
1992; Juvonen et al. 2003; Storch et al. 2005).
There are a variety of predictors of social anxiety disorders in children. These include various
indices of social disadvantage such as low socioeconomic status, low educational status, family
disruptions, parental non-employment, father‟s criminality, increased family size, overcrowding,
and school disadvantage (Thabet & Vostanis, 1998).
Again, most of the research which had been done on prevalence and predictors of social anxiety
disorder among children has been undertaken in the West, with only a few exceptions (Muris,
Schmidt, Engelbrecht and Per old, 2002).There is some evidence that social anxiety disorders in
non-western countries have the same patterns as elsewhere, and may have similar predictors
including age, gender, educational level and income level (Tadesse, Kebede, Tegegne & Alem,
1999). This paper aimed to assess the prevalence and factors associated with social anxiety
disorder among children in Gofermeda sub city, Hosanna town.
4
1.2. Statement of the Problem
Anxiety disorders, such as social anxiety disorder (SAD) in children are a pervasive and allencompassing issue affecting approximately 20% of the population and children with social
anxiety disorder often have symptoms of more than one type of anxiety, and there is a strong
likelihood that without proper intervention its symptoms will persist through adolescence and
adulthood(Langley et al., 2002). Children with social anxiety disorder also have an increased
chance of developing more serious symptoms such as depression, substance abuse, and suicidal
ideation when left untreated (Beidel, Fink & Turner, 1996).
In spite of the importance given to mental health by the world health organization it has so far
received relatively inadequate attention, especially in developing countries like Ethiopia (APA,
1989).
Although children constitute the majority of Ethiopian population, they do not get proper mental
health care and of receiving proper attention from mental health care workers or other social
sector is minimal (UNICEF, 1989). Also Poverty, economic crisis, child labor, life on street and
migration to urban areas may predispose children not only to physical illness, but also to
emotional disorders such as social anxiety disorder and depression in the developing world
(UNICEF, 1989). Moreover, there are evidences which indicate that child maltreatment and child
labor are increasing among children (UNICEF, 1989).All the above circumstances predispose
children to a higher risk of developing psychiatric problems such as social anxiety disorder.
According to Alem, Desta, and Araya(1995), the low level of children mental health care in
Ethiopia is evidenced by: a) insufficient or lacking of mental health services available for
children, b) inadequate treatment of the subject in curricula of health professionals training
program, c) the few number of community based studies about the extent and determinants of
5
mental disorders, such as social anxiety disorder and d) the negative attitude towards the
mentally ill among community in general and the low priority given to child mental health care
by policy makers in particular.
This research report has also described poor access of research that had been done regarding to
the prevalence and factors associated with social anxiety disorder, poor access to mental health
treatment services and shortage of mental health professionals in the country as main causes for
poor mental health of children.
There is one gap to conduct this study. In Ethiopia, there are few community based studies
conducted on the prevalence of mental disorders. Previous studies have also focused on general
mental disorders; no studies have attempted to estimate or assess the prevalence and associated
factors of specific types of mental disorders, such as social anxiety disorder. Thus, this study is
intended to find out the prevalence and associated factors of social anxiety disorder among
children. Hence, it was tried to answer the following research questions.

What is the prevalence of social anxiety disorder among children at Gofermeda sub city,
Hosanna town?

Is there any significant association between social anxiety disorder and sociodemographic characteristics of children?

Is there any significant association between social anxiety disorder and child
victimization?
6
1.3. Objectives of the Study
1.3.1 General Objective
To investigate the prevalence and factors associated with social anxiety disorder among children
at Gofermeda sub city, Hosanna town.
1.3.2 Specific Objectives

To explore the prevalence of social anxiety disorder in children.

To assess the association between social anxiety disorder and socio- demographic
characteristics of children.

To examine the association between social anxiety disorder and victimization.
1.4 Significance of the Study
Investigating the prevalence of social anxiety disorder in children has practical importance for
different vital purposes. First, it is required for scientific understanding of the disorder which
enables us to describe what factors associated with social anxiety disorder among children,
which means this study provides common understanding on some factors associated with the
origins of social anxiety disorder in children like victimization and socio demographic factors.
Second, prevalence data provides an indication of extent of social anxiety disorder among
children and may have implication to the provision of mental health services. Thus, it is
supposed that the present study will provide important empirical evidence regarding the extent of
social anxiety disorder among children, in so doing enabling concerned bodies like children,
parents, teachers, health care providers and policy makers to be aware of the conditions and take
necessary measures to reduce social anxiety disorder.
7
Third, it has also vital importance in creating understanding about the effects and contribution of
socio-demographic characteristics such as gender, educational level, income level of house hold
for social anxiety disorder and it creates understanding on effects of victimization such as
maltreatment, peer victimization/ bullying, sexual victimization and witnessing victimization
for social anxiety disorder.
Fourth, it indicates the specific areas of the problem of social anxiety disorder which call for a
policy intervention and strategy to the problem of social anxiety disorder. Moreover, the finding
of this study will have a remarkable significance in the area of mental health delivery and
development of mental health policy, as well as it may offer some important direction for
conducting further research in the area and knowledge building. Finally this study revealed the
mental health service use experiences of those children with social anxiety disorder who
underwent through prolonged psychiatric treatment.
1.5 Delimitation (scope) of the Study
This study is delimited to Hadiya zone, Hosanna town, Goferemeda Sub City. Also the study was
restricted selected independent factors like socio-demographic factors such as age, sex,
educational status of respondents, socio-economic status of respondents, and victimization like
sexual victimization, peer victimization, maltreatment and witness victimization to assess their
contribution to dependent variable (SAD).
1.6 Limitation of the Study
One of the challenges the researcher faced while conducting the study during my data collection
period was similar to child psychiatric research conducted in Africa. That is done in a setting
where public awareness about child mental health, is lacking. So this is one obstacle of the study.
Most respondents most probably are unaware of the items of the questionnaires that they were
8
asked to report about themselves and their children. This condition was one obstacle which limits
the quality of the data.
The length of each interview session was dependent on the degree of stability of the participants
to stay focused and out of stress to answer questions, most of children are not focused on
questions and most of them are stressed to answer the questions. As a result of this to avoid
unwanted impacts great efforts have been made to minimize and normalize the limitation by
arranging time of interview based on the participant‟s preference. But, at least hundred
participants cannot give responses of questionnaires properly. Participants may hide some
personal information and tell me socially acceptable information. They also may not clearly
recall some their past experience before last six months. These and other related problems were
the main obstacle which was limits the quality data.
1.7 Operational Definitions of Terms
In this study, the following terms are defined as follows.
Child: In this paper the term “child” or “children” is used to mean anyone under age of 18,
entitled to the rights proclaimed in the UN convention on the rights of child, including the right
to get any access (UNICEF, 2005).
th
Social Anxiety Disorder: social anxiety disorder is according to the current 10 revision
the International Classification of Diseases and Related Health Problems (ICD-10; World
Health Organization, 1993) i n comparison to DSM-IV. ICD-10 stipulates that the fear of
scrutiny involves small groups of people which is unfamiliar, rather than crowds, and gives
emphasis to specific stress-related physical symptoms such as blushing, hand tremor,
nervousness, nausea, a feeling confused, feeling ashamed of oneself.
9
Socio-Demographic Characteristics: A socio-demographic characteristic is used to mean and
gives emphasis to social situations such as age, sex, education, socioeconomic status,
employment etc (Thabet and Vostanis, 1998).
Victimization can be defined as “harm or damage that comes to individuals because other
human actors have behaved in ways that violate social norms” (Finkelhor, 2008). Events
included in what is considered victimization in children are maltreatment, peer victimization,
sexual victimization and witness victimization (Finkelhor, 2008).
10
CHAPTER TWO
REVIEW OF RELATED LITERATURE
Review of literature is a key step in research process. Review of literature is the reading and
organizing of previously written materials relevant to the specific problems to be investigated:
framework and methods appropriate to perform the study.
2.1 An over View of Social Anxiety Disorder
The term social anxiety disorder or social phobia has its origins in the Greek word Phobos
(terror) or fear. In ancient times the god Phobos was supposed to call onward fear and terror
in the enemies of the Greek (Davey, 1997). Large numbers of fears have been named by adding
“phobia” to a Latin or Greek prefix. Some examples of relevance to social anxiety are fear of
being
observed
(scopophobia),
fear
of
strangers(
xenophobia),
and
fear
of
people(antrophophobia).The early concept formation of social phobia has been described by
several authors ( Fallen, Heckerman & Schneider, 1995).
What we call social anxiety disorder today is mentioned in the first literature could be from 400
before Christ: A person who loves darkness as life and thinks every man observes him
(Hippocrates, 400 B.C. in Marks, 1965). In 1985, psychiatrist Michael Liebowitz and clinical
psychologist Richard Holmberg drew attention to the lack of research on social phobia and
encouraged colleagues to take the challenge and initiate empirical and experimental studies
(Liebowitz, Gorman, Fyer, & Klein, 1985).
11
Up to this point research on social anxiety disorder had been most limited, rendering it the
nickname “the neglected anxiety disorder.” Further, it was in the third edition of the Diagnostic
and Statistical Manual for Psychiatric Disorders that childhood anxiety got more extensive
recognition, and a diagnostic nomenclature of its own (Last, Perrin, Herzden, & Kazdin, 1996).
The term “social anxiety disorder” was introduced as an alternative to the term “social phobia”,
to emphasize the severity and impairment of the fears associated with the disorder (APA, 1994).
2.2 Diagnostic Criteria and Characterizing Psychopathology of SAD among Children
The diagnosis of social anxiety disorder is based on a categorical classification and found in the
section on anxiety disorders in diagnostic and statistical manuals of mental disorders, 4th edition
and 4th edition text revision (DSM-IV; DSM-TR; American Psychiatric Association, 1994,
2000). Based on the sources following are the diagnostic criteria for social anxiety disorder.
A) A marked and persistent fear of one or more social or performance situations, in which
the person is exposed to unfamiliar people or to possible scrutiny by others.
The individual fears that he or she will act in a way (or show anxiety symptoms) that will be
humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age
appropriate social relationships with familiar people and the anxiety must occur in peer settings,
not just in interactions with adults.
B) Exposure to the feared social situation almost invariably provokes anxiety, which may
take the form of a situational bound or situational predisposed panic attack. Note: In
children, the anxiety may be expressed by traumas, adverse life events, shrinking from
social situations with unfamiliar people.
C) The person recognizes that the fear is excessive or unreasonable. Note that in children
these feature absent.
12
D) The feared social or performance situations are avoided or else are endured with intense
anxiety or distress.
E) The avoidance, anxious anticipation, or distress in the feared social or performance
situation(s) interferes significantly with the person‟s normal routine, occupational
(academic) functioning or social activities and relationships, or there is a marked distress
about having the phobia.
F) In individuals under the age of 18 years, the duration is at least 6 months.
G) The fear or avoidance is not due to the direct physiological effects of a substance (e.g. a
drug abuse, a medication) or a general medical condition and is not better accounted for
by another mental disorder.
H) If a general medical condition or another mental disorder is present the fear of criterion A
is unrelated to it. Specify if: Generalized: if the fears include most social situations (also
consider the additional diagnosis of avoidant personality disorder)
As stated in DSM-IV, children with social anxiety disorder fear and avoid situations in which
they risk negative evaluation, mainly by unfamiliar people. Virtually all situations in which the
person is being observed by others or gets in the focus of attention can become
problematic. Public speaking, however, is the most prevalent social fear (Kessler, Stein, &
Berglund, 1998).
As the social anxiety literature which had been done indicated, performance situation are
commonly distinguished from interactional situations. Public speaking involves a performance
in front of other people, as do eating, drinking, writing, acting, playing an instrument, and
urinating in front of others. Fear arising in such situations may thus be classified as
performance fears (Hazen & Stein, 1995). Interactional fears; on the other hand, may occur in
13
settings such as parties, social gatherings, meetings, and face-to- face conversations with
strangers or authorities. Such fears may also arise in situations that involve ambiguous or
novel roles.
2.3 Clinical Pictures of Social Anxiety Disorder among Children
In wide-ranging, children with social anxiety disorder are characterized by anxiety that is not age
appropriate, that is excessive, that has a long duration, and that interferes with peer interaction
and academic achievements. These children tend to avoid confrontation with the feared situation,
or endure the situations with great anxiety. Worried children experience a broad range of somatic
symptoms, commonly including cardiac and respiratory distress, trembling, flushing or chills,
feeling faint, sweating, nausea, headaches, choking, and dizziness (Beidel, Christ, & Long,
1991).
2.4 Theoretical Modes of Social Anxiety Disorder among Children
Theoretical models of several childhood disorders tend to be downward extensions of models of
adult psychopathology. However, models on development and maintenance of SAD in children
can be seen as exploratory, describing pathways and specific contributing factors within the
psychiatric, clinical, developmental and social psychology field. Cognitive behavioral theory,
as the most influential contemporary model was described and interpersonal theory, related to
variables studied in the present thesis.
2.4.1 Cognitive aspects of Social Phobia
Almost all cognitive models of social anxiety disorder gives emphasis to that social phobic‟s are
excessively concerned with how they are being perceived and evaluated by others. In the
14
cognitive perspective, social anxiety may emerge from an excess of negative thoughts,
perceived personal short comings, excessively high standards for one‟s own performance,
and/or unrealistic beliefs about the standards people ordinarily use to evaluate others (Beck,
Emery, & Greenberg, 1985).
Prior to a problematic social situation, social phobic‟s frequently review in detail what they
think might happen and how they can deal with the various difficulties arising. These
ruminations may sensitize the individual so that he or she enters the situation in a pre-activated
self-focused processing mode (Wells & Clark, 1997).
2.4.2 Behavioral aspects of Social Phobia
According to the principles of operant conditioning socially anxious are thought to be
maintained by escape and avoidance behaviors. However, while these strategies reduce
anxiety in the short perspective, the phobic individual never gets a chance to learn more
adequate and no distressing ways to deal with the phobic situation. That is why exposure to
feared events is an essential feature in behavioral treatments of phobias. Escape and avoidance
are prominent also in social phobia, even though social situations are perhaps more difficult to
avoid completely, and to flee from, compared with photogenic situations in specific phobia and
agoraphobia (Skinner, 1974).
The issue of social skills should also be mentioned among the behavioral aspects of social
phobia. It could be suspected that social phobic‟s lack the proper skills (verbal or non-verbal)
necessary to master social interactions or performance situations (Rupee, 1995). Even though
social phobic‟s appear to have inadequate abilities in some studies, this might reflect inhibition
rather than actual lack of skills. It is also possible that such social abilities are inhibited only
during states of high anxiety in phobic situations (Rupee, 1995).
15
2.4.3 Physiological aspects Social Phobia
Socially anxious children
show signs of basically the same somatic symptoms during (or in
anticipation of) antigenic exposure as observed in other anxiety disorders (Rapee, 1995),
i.e. Palpitations, sweating, tremors, hot flushes, nervousness, etc. These arousal symptoms stem
from exaggerated activity in the sympathetic division of the autonomic nervous system and
are characteristic features of the “fight-or-flight” response (Cannon, 1927).
Autonomic arousal is also accompanied by increased blood pressure and increased secretion of
stress hormones initiated by the hypothalamus-pituitary gland-adrenocortical axis. However,
facial blushing and somatic symptoms of embarrassment, which are common in social phobia,
might not be simply mediated by increased sympathetic activity (Stein & Bower, 1997).
2.4.4 Cognitive Behavioral Models
According to cognitive behavioral theory, SAD is developed through a combination of
biological vulnerability and learning experiences that result in maladaptive beliefs and
assumptions about social events. These beliefs can be activated by social cues and once
activated lead to selective attention and biased interpretation of social events that maintain
social anxiety (Rupee & Heimberg, 1997).
Research on cognitive processes in children and adolescents with anxiety disorders is
emerging and for example support for attention bias and interpretation bias has been found
(Hadwin, Garner, & Perez‐Olives, 2006). Several concepts that are related to a social cognitive
model have been studied. It should be emphasized though that cognitive processes that have
been studied, mainly accounts for maintenance of SAD and not onset of SAD.
16
2.4.5 Interpersonal Models
According to interpersonal model SAD is characterized by disruptions in the interpersonal
functioning and thus theories that take into account how social processes form interpersonal
behavior patterns may be useful for explaining SAD. Still, interpersonal theory has been less
widely applied in the research field of SAD in children and adolescents. Basically, models built
on this theory postulates that social behavior is interactive, i.e. a certain behavior evokes a
response from others that further reinforces and maintains underlying beliefs about one self in
relation to others (Alden, Taylor, Laposa, & Millings, 2006).
Within the interpersonal theory, the self‐representational model deals with how one wants to be
and how one perceives oneself. According to this model, social anxiety is triggered by a
perception of having failed to make the desired impression on others and Parental disapproval or
disapproval from peers (for example, peer victimization) may contribute to the development
of SAD (Schlenker & Leary, 1982).
2.5 Prevalence of Mental Disorder in General and Social Anxiety Disorder in Particular
According to the criteria of the DSM-III (APA, 1980). DSM-III-R (American Psychiatric
Association, 1987) and DSM-IV (American Psychiatric Association, 1994), the lifetime
prevalence rates of social anxiety disorder, vary greatly from 3.9 to 13.1%. It is concluded that
social anxiety disorder is the third most common psychiatric disorder in adult samples (Kessler et
al., 1994). In one study a community sample of children aged 13 years, a six months prevalence
rate of 9.2% was found and social anxiety disorder was among the most common disorders in
that study (Verhulst, Van der Ende, Ferdinand, & Kasius, 1997).
17
In a critical overview of over 23 prevalence studies, investigate the prevalence of social anxiety
disorder as measured by “modern diagnostic criteria” (DSM-III and DSM-IV) (Fehm, Pelissolo,
Fur mark, and Wittchen, 2005). They conclude that the median lifetime prevalence of social
anxiety disorder in Europe is 6.6 %, and the 12-month prevalence is 2-3 %. In the US, numbers
are reported to be higher; 12.1 % estimated lifetime prevalence, and 7.1 % estimated 12-month
prevalence.
In a more recent study, n=3021, 14-24 year olds, in Germany found that 6.6 % of total sample
fulfilled the criteria for DSM-IV social anxiety disorder, and 43.3 % at least one social fear
(Knappe, Beesdo-Baum, Fehm, Stein, Lieb, and Wittchen, 2011). In the total sample, 20.2 % had
one fear, 11.6 % 2 fears, and 11.7 % 3 or more. According to one study of Finland with n = 784
found that 3.2 % met criteria for DSM-IV social anxiety disorder and 4.6 % criteria for
subclinical social anxiety disorder (Ranta, Kaltiala-Heino, Rantanen, and Marttunen, 2009). A
cross-sectional study was conducted on 3211 Swedish high-school students and the prevalence
rate of self-reported social anxiety disorder was 10.6% (Gren- Land ell, Aho, Anderson, &
Svedin, 2011).
There is a relatively large difference between prevalence rates in the US and Europe. The largest
gap in prevalence rates of social anxiety disorder, the authors note, is between the US and Asian
countries. They suggest that individualistic versus collectivistic orientation in society, an
individual‟s perception of social norms, how the image of „self‟ is construed, gender roles, and
gender role identification, are factors that contribute to this difference (Hofmann, Asnaani, &
Hinton, 2010).
18
A world collaborative team conducted a study to measure the prevalence of mental disorder
including social anxiety disorder in 952 children attending primary health care in four
developing countries. It was reported that the prevalence rate of mental disorders was 12% in
Sudan, 15% in Philippines, 24% in India, and 24% in Colombia (Dearango and Clement, 1981).
As one study conducted in rural Senegal in 1985, among 545 children between 5-15 years
attending primary health clinic, found that 17% were suffering from some form of emotional or
neuropsychiatric disorders (Dipo, Collingon, Gueye, and Harding, 1985)
In Ethiopia very few community based studies had been reported. Although earlier studies done
to estimate prevalence of mental disorder in general and social anxiety disorder in particular, in
developing countries were few, recent studies have consistently shown a prevalence rate as high
as those of the developed. However, there is little information to be found about the prevalence
of specific mental disorder in developing countries and Ethiopia is no exception (Rashid, 1993).
Mulatu, using reported questionnaire for children (RQC) and child mental and psychological
questionnaire (CBPQ) on 860 children age 3-12 years, reported a prevalence of psychiatric
disorder of 24 %( Mulatu, 1995). The study revealed that males were more affected than females
as far as maladjustment is concerned, while neurosis was higher in females. These were a higher
prevalence of anxiety disorder between late childhood and early adolescence.
A study in Ambo, Western Ethiopia, surveyed 1400 mothers and care takers to enquire about
the mental health status of 3,001 children. Over 17.7 % of children had at least one of the 10
symptoms of reported questionnaire for children (RQC). Mental disorders were found to be more
common in males than in females and the prevalence increased with age (Tadesse, Kebede,
Tegen & Alem, 1999).
19
In summary, from what has been reported in studies done in the country and from worldwide
statistics, the Ethiopian public Health Association (EPHA) expert group in its report on mental
health in Ethiopia (2006) conservatively estimated that 12% Ethiopians suffer from mental
disorders. That is out of a population of 73 million, 8,760,000 currently have some sort of
psychiatric disturbance. Of these 1,460,000 or 2% of total population are suffering from the
severest form of mental illness or psychosis where as 7,300,000 or 10% are suffering from
milder disorder or neurotic conditions. The average prevalence of mental disorders including
social anxiety disorder in Ethiopia is 15% for adults and 11% for children (WHO, 2007).
As it is indicated in the introduction part of this study, In Ethiopia, there are few community
based studies conducted on the prevalence of mental disorders. Previous studies have also
focused on general prevalence of mental disorders; no studies have attempted to estimate or
assess the prevalence and associated factors of specific types of mental disorders, such as social
anxiety disorder. So, this study is intended to find out the prevalence and associated factors of
social anxiety disorder among children.
2.6 Gender Differences in Social Anxiety Disorder
Differences between males and females may be limited to fear of certain social situations. For
example, when investigating sex differences closer it was found that only fear of “doing
something in front of others” was more common in females than in males (Essau et al., 1999).
However, in a study by Wittchen and colleagues (1999) higher rates were found in females on all
measured social fear situations. The development of self-consciousncess is suggested to be one
condition related to the onset of SAD and self-consciousness is reported to be more pronounced
20
in girls. In this way, concern about physical appearance and others‟ opinions, may explain the
greater fear in females of doing something in front of others (La Greca & Lopez, 1998).
2.7 Age of Onset of Social Anxiety Disorder
According to a number of retrospective studies, social phobia typically begins between late
childhood and early adolescence and it may have after a traumatic experience (Amines, Gilder,
& Shaw, 1983). From a developmental perspective it has been argued that concerns about
negative evaluation from other people or self-consciousness typically emerge around 8 years of
age. Consequently, social phobia should be rare in younger children (Hudson & Rupee, 2000).
2.8 Co morbidity of SAD with another Anxiety Disorder and Depression
In a study of 71 patients with SAD, generalized anxiety was the most common co morbid
disorder, affecting 33 % of the sample. Specific (simple) phobia was found in 11 %. Altogether,
43 % of the sample suffered from one or more secondary diagnosis (Turner, Beidel, Borden,
Stanley, & Jacob, 1991).
Suffering from SAD with an additional anxiety diagnosis is significantly associated with greater
anxiety and even depression as measured with both self-report scales and clinician ratings, than
patients suffering from SAD alone (Turner, Beidel, Borden, Stanley, & Jacob, 1991).
Investigated a sample of 350 persons with social anxiety disorder and in 41 % of the cases, co
morbidity with another anxiety disorder was found, and in 41 % cases co morbidity with mood
disorders (depression) (Ranta, Rantanen, & Marttunen, 2009).
21
2.9 Determinants and Correlates of Social Anxiety Disorders among Children
2.9.1 Victimization
Victimization defined as “harm, hurt or damage that comes to individuals because other human
actors have behaved in ways that violate social norms” (Finkelhor, 2008; p. 23). Events included
in what is considered victimization in children are maltreatment, sexual victimization, peer
victimization and witness victimization (Finkelhor, 2008).
Peer Victimization
Theoretically, peer victimization may be of special interest in studies on social anxiety disorder
due to the interpersonal characteristics. Experiences of peer victimization, also called bullying,
are common in children (La Greca & Harrison, 2005).
During late childhood and early adolescent years there is an emphasis on being part of a group
and the risk of being excluded from the social group can be perceived as particularly distressing
during this period and presumably be related to an outcome of social anxiety disorder
(Bokhorst, Westerberg, & Hayne,
23 2008). Cross sectional studies on children show that peer
victimization is related to social anxiety (Storch, Crisp, & Klein 2005).
2.9.2 Demographic Variables
Sex
Female sex consistently emerges as a risk factor for the development of anxiety disorders.
Females are about twice as likely as males to develop each of the anxiety disorders (Costello,
Mustillo, Erkanli, et al 2003). Sex differences in prevalence, if any, are small in childhood but
they increase with age (Craske, 2003).
22
Education
Most epidemiological studies find higher rates of anxiety disorders among subjects with lower
education in comparison with subjects with a higher education (Wittchen, Nelson and Lachner
1998). It remains unclear to which degree the lower educational performance is a predictor,
correlate, or consequence of anxiety. Two adult studies found associations for anxiety disorders
(Kringlen, Jorgensen and Cramer, 2001)
Financial situation
With few exceptions studies consistently find associations between low household income or
unsatisfactory financial situations and anxiety disorders (Wittchen, Nelson and Lachner 1998).
However, results from a quasi-experimental study suggest that these associations may not
emerge through a risk factor-disorder association; other more complex relationships may explain
the associations seen in cross-sectional research (Costello, Compton, Keeler, et al 2003).
2.9.3 Genetic Factors
As male twin study indicated there seems to be a genetic component that is unique to social
anxiety disorder (SAD); 13 % of the variance in social fears was accounted for by genetic
factors, while only 5 % of the genetic factors common across all fear types was accounted for by
the variance in social fears (Kindler, Myers, Prescott, & Neale, 2001). This study suggests that
other than the genetic predisposal for anxiety in general, individuals with SAD share a unique
genetic encumbrance that predisposes them for social fears specifically. This studies suggest that
a moderate but significant genetic component in the development of SAD.
23
2.9.4 Temperamental Factors
Temperament refers to innate biases towards certain moods and emotional reaction styles
(Mussen, Conger, Kalgan, & Huston, 1990). Jerome Kalgan and coworkers have depicted two
temperamental styles of children called inhibited and uninhibited. Inhibited children are
characterized by withdrawal and increased autonomic arousal in situations of uncertainty, in
contrast to uninhibited children who tend to react with spontaneity and approach in these
situations (Kalgan et al., 1988).
About 10-15% of American (Caucasian) children fit in to each category. Longitudinal studies
suggest that children with a stable pattern of behavioral inhibition have an increased risk for
developing phobic disorders, particularly social phobia. And an increased risk of social phobia
has also been observed in the parents of inhibited children (Rosenbaum et al., 1991).
2.9.5 Attachment
As attachment theory and the research which had been done in the area, indicated that the
formation of a bond between the parent and offspring started from early life (Bowlby, 1978).
Providing the child with an environment where there is absence of threat and presence of safety
is an important aspect of parenting. Also a child with a parent who is abusive or aggressive
(presence of threat), and also emotionally distant or withdrawn (absence of safety) will offer a
foundation for less favorable attachment bonds (Bowl by, 1973). Those children from parents of
presence of threat and absence of safety were suffered from social anxiety disorder.
According to attachment research, four types of attachment styles can be found in infants. These
are “secure”, “avoidant”, “ambivalent/resistant”, and “disorganized”. The three latter are
commonly denominated “insecure” Out of these, the secure attachment style is characterized by
24
a child who is certain that their parent is available to the child emotionally and physically, and
who grants the child and encourages the child autonomy. These children are more prone than
their insecure peers to act proactively, curiously, and independently in new situations and all
these behaviors are counter to social anxiety development (Ainsworth, et al. 1989).
2.9.6 Parenting Style
As one study summarizes two parenting styles frequently associated with social anxiety disorder
in offspring, with the terms Rejection and Control. Both styles can be described on a continuum.
Rejection stretches from Parental warmth and acceptance on one end, and rejection, emotional
withdrawal, and criticism on the other end. Control continuum is described as overengagement/overprotection on one end, and promotion of autonomy on the other (Rupee, 1997).
Overprotection is a parenting style where parents are overly keen on keeping control of their
child‟s behavior, a rearing style characterized of for example constant questioning and decisions
being made for the child. Such a rearing style might make the child unable to attain both
competence in handling social anxiety provoking situations, and give a feeling of lacking control
over one‟s own life, in other words, a rearing style that hinders “transfer of control” from the
parent to the child ( Bar mish & Kendall, 2005). So those children who are emotionally rejected
by their family and over controlled by their family were prone to develop social anxiety disorder.
2.10 Impact of Social Anxiety Disorder during Childhood and Adulthood
Social anxiety disorder in children is associated with low levels of adaptive functioning.
Compared to non anxious children, children with social anxiety disorder show impairments in
peer relations, self-esteem, school performance and social behavior (Strauss, Frame, &Forehand,
1987).
25
They have more negative social expectations, report lower social self competence, and their
parents and teachers rate them as more socially maladjusted or disturbed (Chan sky & Kendall,
1997). Also, many social anxiety disordered children report psychosocial impairment (Esau,
Conrad, & Peterman, 2000).
Children with anxiety disorders were 2.9 times more likely than children without any disorder to
fail to complete secondary school and may thus be at risk for less adult economic success, and
greater instability at home and at work (Vander-Stoop, Beresford, & Cohen, 2002).
In social anxiety disorder, children showed a high level of general emotional overresponsiveness and loneliness, had significantly poorer social skills and reported lower levels of
social functioning and lower self esteem (Ginsburg, La Greca, & Silverman, 1998).
Social anxiety disorder in childhood may have impact on later development: 50% of anxiety
disordered adults reported anxiety disorders in childhood (Pollack, Otto, Sabatini, & Majcher,
1996). Prospectively, clinically referred children with anxiety disorders seem to be at risk for
development of new mental disorders later in life (Last, Perrin, Hessen, & Kazdin, 1996).
Epidemiological research has shown that in 80% of the young adult cases, social phobia in
adolescence preceded depression, substance misuse, or other anxiety disorders (Wittchen, Stein,
& Kessler, 1999).
2.11 Assessment of Social Anxiety Disorder
When assessing for social anxiety disorder in children, it is important to be aware of
developmental factors that exist within the family unit. Choosing the appropriate methods, such
as types of observations, interviews, questionnaire and inventories for intervention should be
customized for the individual dynamics present within each family (e.g., ages of children,
psychological effects of early life experiences, parental psychopathology, blended-families, etc.).
26
2.11.1 Family Observations
Family observations are indicated for the proper assessment and corresponding treatment for
childhood social anxiety disorder. Types of family observations include coding parent-child
dynamics with emphasis on restrictive or controlling behaviors. In a study conducted by Greco
and Morris (2002) fathers who were parenting socially anxious children displayed higher levels
of overt physical control such as completing tasks for children. This was in opposition to fathers
of children who exhibited low social anxiety.
Similar outcomes were observed in a study by Krohne and Hock (1991), in which mothers of
socially anxious girls were more likely to be physically intrusive during tasks set up by
researchers, as opposed to mothers of daughters with little to no social anxiety. Assessment is an
ongoing process, and family observations can and need to be conducted throughout the
assessment and treatment processes to gauge the effectiveness of interventions.
2.11.2 School and Peer Observation
Anxiety Disorder is frequently presented during social situations with peers and during school
hours. Observing children in these settings will lead to a more comprehensive assessment. It will
also help to determine if symptoms of anxiety are generalized beyond the family environment.
Similar to family observations, school and peer observations can be formal or informal. Coding
sheets can be developed to assess for symptoms of anxiety for classroom or playground
observations.
27
2.12 Measures of Social Anxiety Disorder
Self and parent, report questionnaires are measures used to assess social anxiety disorder in
children. These scales and inventories provide global measures to detect symptoms of social
anxiety but do not give syndrome specific diagnoses (Kendall & Marris-Garcia, 1999).
Example of commonly used inventories include and the Screen for Child and Anxiety Related
Emotional Disorders (Muris, Mayer, Bartends, Tierney & Bogie, 2001), the Revised Children‟s
Manifest Anxiety Scale (RCMAS) (Reynolds & Richmond, 1978) Anxiety Disorder Interview
Schedule for DSM-IV-C/P (ADIS-IV-C/P) (Silverman & Albano, 1996), Multidimensional
Anxiety Scale for Children (child and parent version) (MASC) (March, Parker, Sullivan,
Stallings & Parker, 1997), Child Behavior Checklist (CBL) (Achenbach & Edelbrok, 1991),
State-Trait Anxiety Inventory for Children (STAI-C) (Steinberger, 1978), Spence Children‟s
Anxiety Scale (SCAS) (Spence, 1998), and Coping Questionnaire: child and parent versions
(CQ-C/P) (Kendall & Marrs-Garcia, 1999). Based on the above information the Screen for Child
and Anxiety Related Emotional Disorders (SCARED) was chosen for this study.
SCARED consists 8 diagnostic questions to screen social anxiety disorder. First the respondent
rates
perceived
social
fear
in
8 potentially phobic situations on a three point scale
corresponding to with 0 = 'not true or hardly ever true' 1 = 'sometimes true', and 2 = 'true or
often true' which means no fear, some fear and marked fear (Muris, Mayer, Bartelds, Tierney &
Bogie, 2001). Eight diagnostic questions follow, assessing if the individual meet the DSM-IV
social phobia criteria for one or more of the phobic situations.
Item inventory rated on a 3 point Likert-type scale. It comes in two versions; one asks questions
to parents about their child and the other asks these same questions to the child directly. The
28
purpose of the instrument is to screen for signs of social anxiety disorder among children. The
items of the SCARED consist of short, simple statements and each item will be scored on a scale
from 0 to 2, with 0 = 'not true or hardly ever true', 1 = 'sometimes true', and 2 = 'true or often
true'(Muris, Mayer, Bartelds, Tierney & Bogie, 2001)
29
CHAPTER THREE
RESEARCH METHODS
The procedures of selecting subjects, the methods of data collection and analysis are presented in
this section.
3.1 Study Setting
This study was conducted in Hadiya zone Hosanna town, Gofermeda sub city. Hosanna town is
located south west of the capital Addis Ababa about 232km distance. It is also located 168 km
away from Hawasa (the capital of SNNPR) via Halaba- Angecha. The absolute geographic
location of Hosanna is 7015‟00” North latitude and 37050‟30” East longitude. It is found at the
southern edge of western edge of western plateau of physiographic region (HFEDB, 2010).
According to HFEDB its location on a topographically high place makes the town serve as a
divide for the Ghibe-Omo and rift valley lakes drainage basins. The elevation with in the town
ranges from 2,400m near Hosanna Hospital, currently called Queen Eleni Hospital, and 2,200m
at Tekelehaimanot church above sea level. The average elevation is 2,300m from the mean level
(HFEDB, 2010).
The administrative area of Hosanna town is 10,414.3 hectares, from these area 4,585.48 hectares
of the town has been well master planned (HFEDB, 2010).
It is one of the towns in Hadiya
Zone and administrative capital of Hadiya Zone. It was established as municipality in
1942(HCAMO, 2010). Being the administrative capital of Hadiya Zone, it provides many public
and private institutions that operate in the town.
Since May 2008, the town is led under town administration with four sub-cities and eight Kebles
(HFEDB, 2010). Also the town clustered in to four sub-cities (Adise Ketema, Sechedunna,
Gofermeda and Betel) and each sub-city clustered in to two kebeles (HFEDB, 2010).
30
The total population of Hosanna was 13,467 and 31,701 in 1984 and 1994 respectively (CSA;
1984, 1994). With ten years, the population becomes more than double and reached
69,957(CSA; 2007).
Based on CSA 2007 the population census result, current population of the town is projected to
reach 89,251 at the end of 2010 out of which 45,307(50.8%) and 43,944(49.2%) are estimated to
be male and female respectively (CSA; 2007). Based on the above information about the study
setting Gofermeda sub city, and two kebeles under this sub city (Lecha and Melbera kebeles)
was selected for this study to obtain relevant information required for the study.
3.2 Study Design
This study was used across-sectional design to explore the prevalence of social anxiety disorder
and its association with socio-demographic, socio-economic characteristics and victimization.
The data was collected between February1, 2015 to March 30, 2015 from children and parents in
Gofermeda sub city, Hosanna town.
3.3 Types of Variables
3.3.1 Dependent Variable
The dependent variable in this study is social anxiety disorder. It is a marked and persistent fear
of one or more social or performance situations in which the person is exposed to unfamiliar
people or possible scrutiny by others.
3.3.2 Independent Variables
The independent variables are selected socio-demographic characteristics such as age, gender,
and educational level, income level of house hold, and victimization such as maltreatment, peer
victimization / bullying, sexual victimization and witnessing victimization.
31
3.4 Sample Size Determination
A total of 403 children in the age group 12 to17 and their parents were included in the study.

Considering the absence of studies on the study population and to obtain substantial size
of samples, the prevalence of social anxiety disorder among children is estimated to be
50%; and

95 percent confidence interval and 0.05 (5%) error margins
The sample size is determined using the formula proposed by Gordon (1994).
That is:
Sample size (n) = p (1-p) z²+5% non response rate
Where P= 0.5(50%) of population who has ever had anxiety disorders
1-P= proportion of population who has never had anxiety disorders
Z= 1.96
T= error margins= 0.05(5%)
3.5 Sampling Procedures
For each data collection, c h i l d r e n and their parents were provided information about the
study and participation. The children and their parents were also orally informed that
participation was voluntary. Questionnaires were administered by trained third year nursing
students and were completed in their house.
32
This study is a community based study of urban population. Households were the sampling unit
for this study. In order to identify the eligible population aged 12-17 years, lists of households
was obtained from selected Keble was as a sampling procedure for the selection of the specific
households included in the study. At the first stage, selection of Kebles were made and thus, the
investigator has decided to take two kebeles from eight kebeles and then the households were
selected by using simple random sampling method (lottery system). If the selected household
does not have eligible person, the first immediate household was taken. Interviewers were
selected from college students and they were given one-day training by the investigator.
3.6 Data Collection Procedures
The questionnaire was administered by third year nursing college students. Four interviewers
(3males and 1 female) were recruited to serve as interviewers using a number of criteria believed
to be relevant for interview (WHO, 1990). Information was collected through face-to-face
interviews with respondents after obtaining informed consent and questionnaires was
administered in private. The average administration time was about 30-45 minutes. After
completion, questionnaires were edited for completeness and accuracy.
3.7 Instruments of Data Collection
The main focus of the study is to investigate the prevalence and associated factors of social
anxiety disorder in children. In order to asses factors associated with social anxiety disorder in
children, quantitative data collection tools were applied. So together data about the sociodemographic characteristics like age, gender, educational level, income level of house hold and
some selected psychological effects of early experiences or victimization such as maltreatment,
peer victimization/ bullying, sexual victimization and Witnessing / indirect victimization, the
33
closed-ended questionnaire were developed. The Screen for Child Anxiety Related Emotional
Disorders (SCARED), the socio –demographic Questionnaire and the Juvenile Victimization
Questionnaire (JVQ) was administered for the assessment of participant‟s social anxiety disorder.
3.7.1 Questionnaire
The closed-ended questionnaire was developed to gather information about socio- demographic
variables and victimization of participants. It has 41 questions focused on different social
aspects, psychological aspects and related background information of participants.
3.7.1.1 The Screen for Child Anxiety Related Emotion Disorders (SCARED)
The SCARED is a modified version of the Screen for Child Anxiety Related emotion Disorders
(SCARED) was originally developed in English for a clinical population (Barmier et al., 1997).
However, translated versions have been found to be reliable instruments to assess anxiety
symptoms in other countries and have been used (Hale et al., 2005). This was the case in the
present study
The SCARED was developed by Barmier and his collaborators. It comprises 41 items that can be
grouped in to five sub scales. Four of these sub scales measures anxiety disorders symptoms as
conceptualized in the DSM-IV-TR: social anxiety disorder, panic disorder, generalized anxiety
disorder and separation anxiety disorder. The fifth sub scale, school anxiety, represents a
common anxiety problem in childhood (Barmier et al., 1997). Of which the SCARED consists of
8 items regarding, to SAD based on the DSM-IV diagnostic criteria of SAD (APA, 1994).
First the respondent rates perceived social fear in 8 potentially phobic situations on a three
point scale corresponding to with 0 = 'not true or hardly ever true' 1 = 'sometimes true', and 2 =
'true or often true' (Muris, Mayer, Bartelds, Tierney & Bogie, 2001). No fear, some fear and
34
marked fear. Eight diagnostic questions follow, assessing if the individual meet the DSM-IV
social phobia criteria for one or more of the phobic situations.
Item inventory rated on a 3 point Likert-type scale. It comes in two versions; one asks questions
to parents about their child and the other asks these same questions to the child directly. The
purpose of the instrument is to screen for signs of anxiety disorders in children. The items of the
SCARED consist of short and simple statements in the first person or, for the parent version, of
statements referring to the child. Each item will be scored on a scale from 0 to 2, with 0 = 'not
true or hardly ever true', 1 = 'sometimes true', and 2 = 'true or often true'(Muris, Mayer, Bartelds,
Tierney & Bogie, 2001).
Second, the SCARED has shown good discriminant validity, differentiating between children
with and without anxiety disorders, between individuals with specific anxiety disorders, and also
between children with anxiety disorders and children with depressive disorder (Barmier et al.,
1997, 1999).
Third, the convergent validity of the SCARED is good. A comparison between the SCARED and
the Anxiety Disorders Interview Schedule for Children (A-DISC) found that the SCARED had
strong sensitivity and specificity. When compared to the A-DISC (found that the SCARED is
positively and meaningfully related to other anxiety questionnaires (Muris, Merckelbach, Mayer,
& Prins, 2000).
After reversing the scale of the two items (You feel nervous with people you don't know well and you
feel nervous when you are with children or adults and you have to do something while they watch you )
reliability analysis was carried out.
35
The overall Alpha Cronbach‟s statistics was derived to be 0.628 which is respectable and none of
six items do not increase the overall alpha Cronbach value if they are removed. These items were
be used to compute a variable representing children‟s SAD.
3.7.1.2 The Juvenile Victimization Questionnaire (JVQ)
The JVQ (Hamby, Finkelhor, Ormond, & Turner, 2004) measures offenses against young
people and is in part built on American legal and insurance issues. It is designed as an interview
but can be used in a self‐administered format from the age of 12-17 years, which was the case
in the present study. The self‐administered format has proven to have good test‐retest reliability
and construct validity (Finkelhor, Hamby, Ormond, & Turner, 2005).
A version of the JVQ that investigates victimization during the prior year or six months and
victimization was used in the present study. The 16 items i n the present study cover four
domains, described as maltreatment, victimization from peers or siblings, sexual victimization,
and witnessing victimization. Its internal consistency, assessed by means of Cranach‟s
Alpha, as well as good test–retest reliability (Finkelhor, Hamby, Ormond, & Turner,
2005).
3.7.1.3 Socio-Demographic Questionnaires
Different socio-demographic characteristics were examined for their association with the
prevalence of social anxiety disorder. These included sex, age, household income, educational
level of parent, and, area of residence and family functioning. Socio-demographic questionnaires
which are included in this paper used to mean social situations of respondents (Thabet and
36
Vostanis, 1998). In this study 9 socio-demographic questionnaires were used to measure the
prevalence of social anxiety disorder in children.
3.8 Data Analysis
The data that was obtained from the survey was edited and entered in to the computer for
statistical analysis. SPSS version 20 was used for data processing. Univariate, bivariate, and
multivariate statistical methods were used variables. At Univariate stage frequencies and cross
tabulations was used to see prevalence and the associated risk factors between demographic and
victimization factors of social anxiety disorder. In multivariate analysis, multiple linear
regressions were used to fit for SAD socio-demographic and victimization.
3.9 Ethical Considerations
The researcher carried out the data collection using in line guided with APA guide line and
research ethics. First, the researcher had given adequate information and explanation to all
participants; about the research, its objective and its benefits to various bodies like children and
parents. The researcher informed all participants, which have the right not take part or withdraw
from the research at any stage without any implied deprivation or penalty for their rejection. The
researcher informed all participants on their right to anonymity and confidentiality of the
personal information they give during the data collection.
In the processes of engagement in research, the researcher considered the protection of research
participants by obtaining though voluntary written consent from participants themselves after
appropriate information is given such as the purpose and duration of the study; procedure in the
study right withdraw from the study, right to ask questions and potential risks and benefits of the
study (Krueger &Newman, 2006, p.104).
37
The researcher has taken utmost care to ensure privacy, confidentiality and anonymity of
participants. To maintain confidentiality, the participant‟s real name was not used; rather pseudo
names were names were given to participants throughout the research processes (Krueger &
Newman, 2006, p.106). Besides, participants were informed that they can take a break, skip
questions, and even withdraw at any time during interview.
38
CHAPTER FOUR
RESULTS
This section of the study focuses on the results intended to answer the three basic research
questions indicated in the introduction section of this paper.
4.1 Association between Social Anxiety Disorders with Socio-demographic Characteristics
of Respondents
Table 1: Socio- Demographic Characteristics of the Children Respondents (n=300)
Sex
Sex
Female
Male
Age
Educational Status
Dropped out of school
Reason for Dropping out
Are your parents living
together?
Reason for not living
together with their
parents
Total
No.
%
300
100
99
33.1
No.
170
54
%
56.66
32.0
No.
130
45
%
43.33
34.6
>= 15 years Old
116
68.0
85
65.4
201
66.9
Total
Currently Attending
School
Never Attended any
Formal School
Total
Yes
No
Got a Job
Got Sick
Family Needed
Help
Failed
170
111
100.0
65.7
130
97
100.0
74.6
300
208
100.0
69.6
58
34.3
33
25.4
91
30.4
169
70
91
24
5
33
100.0
41.4
53.8
14.2
3.0
19.5
130
44
86
17
10
3
100.0
33.8
66.2
13.1
7.7
2.3
299
122
177
41
15
36
100.0
40.8
59.2
13.7
5.0
12.0
8
4.7
5
3.8
13
4.3
Yes
163
96.4
121
93.1
284
95.0
6
3.6
9
6.9
15
5.0
169
0
0
3
100.0
.0
.0
100.0
130
2
1
6
100.0
22.2
11.1
66.7
299
2
1
9
100.0
16.7
8.3
75.0
3
100.0
9
100.0
12
100.0
< 15 years old
No
Total
Divorced
Separated
Widowed
Totals
39
Age distribution of the sample is presented in table1. Children in the age group > 15 accounted
for 66.9% of the sample population, of which 68.0 % male and65.4% were female respondents
and the remaining 33.1 % are comprised in age group < 15 of sample population, of which 32%
and 34.6% are male and female respondents respectively.
With regard to the current educational status of respondents 69.6 % of respondents currently
attending their formal school, about 30.4 % were never attended any formal school, of which
34.3% male children and 25.4% were female children. About 40.8% of respondents was dropped
out of school, of which 53.8% males and 66.2% are female respondents. The level of dropped
out from the school is higher in females than males. As it is indicated in Table1, 13.7% of
respondents dropped their school that they have got job, 5.0% were got sick, 12.0% said that they
were dropped from school to help their family and 4.3% were failed.
Concerning to the marital status of the parents, 95.0% said that they are living together with their
parents, of which 96.4% are male respondents and 93.1% are female respondents. About 5.0%
respondents said that they are not living together with their parents, of which 3.6%, 6.9% are
male and female respondents respectively. Respondents those who have not living together with
their parents, 16.7% said their parents were divorced, 8.3% was separated and 75.0 % were
widowed.
40
4.2 Association between Social Anxiety Disorder and Socio-economic Status of
Respondents
Table 2: Socioeconomic Status of the Parents of the Sample Children
Sex
Male
No.
Female
%
No.
Total
%
No.
%
Educational Status of
Illiterate
43
25.4
27
20.8
70
23.4
your parents
Literate but not
44
26.0
43
33.1
87
29.1
Primary (1 - 8)
70
41.4
49
37.7
119
39.8
Secondary (9-12)
10
5.9
10
7.7
20
6.7
2
1.2
1
.8
3
1.0
169
100.0
130
100.0
299
100.0
formal
Tertiary (12+)
Total
Monthly income of
Under 200
6
3.8
6
4.6
12
4.2
your parents
200 – 500
79
50.3
73
56.2
152
53.0
501 – 800
61
38.9
38
29.2
99
34.5
801 – 1000
6
3.8
5
3.8
11
3.8
> 1000
5
3.2
8
6.2
13
4.5
157
100.0
130
100.0
287
100.0
Total
As it is indicated in Table 2, many of the sample respondents (53.3%) are said that their parent‟s
monthly income ranging between 200-500. About 34% have monthly income ranging between
501-800, about 3.8% have got income ranging between 801-1000 and 4.5% have got greater
than 1000Birr.
Child respondents were asked about the educational level of their parents. According to the
above table , it can be seen that significant percentage of parents of children respondents 6.7%
secondary school while 39.8% have primary school ,which is the highest followed by 29.1%
have literate and 23.4% is illiterate. The above data indicated that majority of child respondents
from low educational status parents which is associated with SAD
41
4.3 The Prevalence of Social Anxiety Disorder among Children
Table 3 Prevalence of Social Anxiety Disorder in the Sample Children
Sex
Male
Female
Total
N
%.
N
%.
N
%.
Prevalence of
Almost no SAD
79
46.7
31
23.8
110
36.8
social anxiety
Moderate SAD
59
34.9
57
43.8
116
38.8
disorder in
Severe SAD
31
18.3
42
32.3
73
24.4
children
Total
169
100.0
130
100.0
299
100.0
As it is shown in Table 3, percent of the male and female children who has moderately
experienced social anxiety disorder (SAD) is about 35% and 44% respectively. Similarly the
percent of male and female children who has severely experienced social anxiety disorder (SAD)
about 18% and 32% respectively. Regardless of the sex difference, about 39% and 24% of the
samples children experienced moderate and severe social anxiety disorder (SAD) respectively.
This is to mean about 63% of the sample children experienced social anxiety disorder (SAD).
Therefore, the overall prevalence of social anxiety disorder among children in the study found to
be 63%. And the prevalence of social anxiety disorder is high in females than males.
42
4.4 The Factors Contributed for Social Anxiety Disorder among Children
Table 4: The Predictors of Children’s Social Anxiety Disorder among Children
Dependent Variable: Children's Feeling about their social anxiety disorder
Parameter
B
Std.
T
Sig.
Error
95% Confidence Interval
Lower
Upper Bound
Bound
Intercept
-.198
.626
-.316
.752
-1.431
1.035
Sex
-.348
.050
-.934
.000
-.446
-.249
Education enrolled
-.178
.072
-2469
.014
-.319
-.036
Drop out
.026
.043
.605
.546
-.059
.111
Parents living together
.065
.088
.732
.465
-.109
.239
Education of parents
.121
.236
.515
.607
-.343
.585
Education of parent literate but
.216
.232
.931
.353
-.241
.673
-.115
.233
-.495
.621
-.573
.343
Education of parents Secondary
.068
.254
.268
.789
-.432
.568
Income of parents <200
0.00
.129
.000
1.00
-.254
.254
without formal education
Education of parents Primary
0543
0
Income of parents 201-500
-.208
.098
-2.122
.035
-.401
-.015
Income of parents 501-800
.064
.116
.550
.582
-.164
.292
Income of parents 801-1000
-.081
.133
-.612
.541
-.344
.181
.150
.021
7.035
.000
.108
.192
Maltreatment
-.463
.089
-5.185
.000
-.638
-.287
Peer or sibling victimization
-.437
.138
-3.168
.002
-.708
-.165
Sexual victimization
.317
.158
2.001
.046
.005
.628
Witness victimization
-.070
.151
-.462
.644
-.366
.227
Age
Descriptive statistics part is indicated in the appendix C
A multiple linear regression model was fit for children‟s SAD against the independent dummy
variables (sex, marital status of parents, educational enrolment of the child, educational and
43
income, status of parents) and continuous variables (age, maltreatment, peer and sibling‟s
victimization, sexual victimization and witnessed victimization). The overall regression model is
found to be strongly significant with coefficient of determination (R2) = 0.517. As it is presented
in Table 4, above almost most of variables are found to affect or predict children‟s social anxiety
disorder significantly to the error level less than 0.05.
As the linear regression model showed regarding socio-demographic factors sex, age, income of
parents, educational status of parents are strongly associated with social anxiety disorder. For
example being female sex is more likely for the presence of social anxiety disorder and being
male decreases the presence of social anxiety disorder. As age of children increases also social
anxiety disorder also increases. Regarding to educational enrolment children who have not
enrolled has higher social anxiety disorder and children who have enrolled have decreased social
anxiety disorder.
Regarding to parental education and parental income the prevalence of social anxiety disorder
has higher children from parents of low education and low income level as well as high income
level decreases the presence of social anxiety disorder in children. There is no significance
association between drop out of children and the marital status of parents with social anxiety
disorder. That is why there are no sufficient evidences to say those factors affect social anxiety
disorder.
As the regression model showed regarding to victimization, children who has maltreated by their
family have high social anxiety disorder and children who have treated by their family have not
experience social anxiety disorder. Being victimized by peer, sexually and witnessed have
increases the presence of SAD in children and children who have not victimized by their peer,
sexually, and witnessed decreases the presence of social anxiety disorder.
44
CHAPTER FIVE
DISCUSSION
5.1 Prevalence of Social Anxiety Disorder among Children
The present study showed that social anxiety disorder (SAD) is commonly reported by children
in the age of 12‐17 years. From the total sample children, about 38.8 % of the children
experienced moderate social anxiety disorder. About 24.4 % of the sample children experienced
severe social anxiety disorder. The overall prevalence of social anxiety disorder was found to be
63%.
As this study showed high rated impairment of social anxiety disorder in children is in the school
– domain and impairment of leisure time activities, social anxiety disorder should be considered
a condition to take seriously. Also, social anxiety disorder implies avoidance of restricted
situations which is certainly not the case for most children with social anxiety disorder as feared
stimuli involve a wide range of situations in life. Among children with social anxiety disorder,
the majority reported marked fear of speaking in front of their peer.
These findings indicated that parents be likely not to be aware of social fear and associated
suffering in children and to have limited knowledge of social anxiety disorder. This means that
those who frequently see children in typically difficult situations and thus would have the
opportunity to detect children with social anxiety, are not well-informed on how social anxiety
disorder presents, associated impairment and that social anxiety disorder
with non-problematic shyness.
45
is not the same
5.2 Socio-Demographic and Socio-Economic Variables and Social Anxiety Disorder
The higher prevalence of social anxiety disorder was found to be among > 15 years old. From
total sample respondents about 26.3% is < 15 years old and 34.8% > 15 years old. This indicates
that as the age of children increases, the prevalence of social anxiety disorder also increases.
Almost in all age groups social anxiety disorder was seen high in girls compared to boys and
increased risk of developing social anxiety disorder girls was noted a two-fold increased risk of
social anxiety disorder. Supportive to the present study, higher rates of fears and phobias and an
increased risk of social anxiety disorder in girls compared to boys are reported (Canino et al.,
2004; Lewiston, Gotlib, Lewiston, Seely, & Allen, 1998).
There is a difference between boys and girls in developing social anxiety disorder. Almost at all
age levels (12-17) females were high in experiencing social anxiety disorder. This finding
contradicted one finding which indicated that no differences between boys and girls have
been reported in young Children with symptoms of social anxiety (Weeks et al., 2009). Also
one finding supports this study which indicated sex differences in prevalence of SAD emerges
around age 13 (Bittner et al., 2007; Van Roy et al., 2009) with more girls than boys reporting
SAD (Canino et al., 2004).
Differences between males and females may be limited to fear of certain social situations. For
example, when investigating sex differences closer, it was found that only fear of “doing
something in front of others” was more common in females than in males (Essau et al.,
1999). A similar result was found by Sumter and colleagues (Sumter et al., 2009). However, in
the study of Wittchen and colleagues (1999) higher rates were found in females on all measured
social fear situations. So the finding of this study supports the above idea which means females
were more fear of doing something‟s in front of others.
46
As this study indicated, the age of children increases they experienced social anxiety disorder is
more this is why their level of awareness increases when their age increases. In this way,
concern about physical appearance and others‟ opinions, may explain the greater fear in
females of doing something in front of others. Supportive to this study the development of
self‐consciousness
is suggested to be one condition related to the onset of SAD and self‐
consciousness is reported to be more pronounced in girls (La Greca & Lopez, 1998). The
above indicated idea is one possible explanation of higher rates of social fear in girls.
In studies on children and adolescents, an association with puberty and hormonal changes was
found in girls with anxiety symptoms (Altemus, 2006; An gold, Costello, Erkanli, & Worth
man, 1999). Social anxiety and puberty onset was studied in one cross‐ sectional study which
found that advanced pubertal development was associated with heightened levels of social
anxiety in girls but not in boys (Deardorff e t a l ., 2 0 0 7 ). Another study showed an association
between pubertal status and timing and social anxiety, both in boys and girls aged 10‐12 (Ge,
Brody, Conger, & Simons, 2006).
Early physical development can lead to unwanted sexual attention and body dissatisfaction
where girls are more prone to negative self‐evaluation and being more sensitive to others‟
opinions regarding appearance and behavior, as mentioned earlier. The role of hormones and
other biological factors in the etiology of SAD remains to be further studied. The increasing rate
of internalizing disorders in girls during adolescence has also been linked to interpersonal stress
which becomes more pronounced during adolescence (Nolen‐Hoeksema & Girgus, 1994). Girls
are more oriented towards interpersonal goals like connection and perceive negative experiences
in these domains as more stressing than boys do (Hayward & Sanborn, 2002; Rose & Rudolph,
2006; Rudolph, 2002).
47
As this study indicated the higher rates of self reported social anxiety disorder were seen in
children with low educational status and low income level of parents. Income level and
educational background of the parents are highly affects the children to develop social anxiety
disorder. A study conducted in Cameroon by Rwenge (2000), it was indicated that children and
adolescence having low socio-economic status and low educational status are more likely than to
develop anxiety disorders like social anxiety disorder. As the above data analysis indicated most
of children are belonging from low income status of parents and educational status of parents
which is contributed for children develop social anxiety disorder.
The prevalence of social anxiety disorder is highly correlated and associated with low income
level and low educational background. Epidemiological studies on adults show that SAD is
associated
with
low income levels, lower educational attainment and being unmarried
(Furmark,2002).
Concerning other demographic factors, like parent‟s marital status or living together with
family or not and drop out of school were not significantly associated with social anxiety
disorder which means inconsistent results was found. Sex, age, low economic background, and
low educational background seem to be clearly related to higher rates of SAD in children.
5.3 Victimization and Social Anxiety Disorder
The present study indicated that victimization has been one factor for social anxiety disorder
among children. In this study, results from the study on range of victimizing events and self
reported social anxiety disorder in a sample of older children (> 15) are reported. An association
between victimization and social anxiety disorder was found, with higher rates of victimization
in children with social anxiety disorder. Particularly, experiences of, victimization from
48
peers/bullying (40%), maltreatment (76%), sexual
victimization (27.8%), and witness
victimization (29%) were significantly more common in children reporting social anxiety
disorder.
It should be noted that the present study concluded that there is a contributory
relationship between social anxiety disorder and victimization.
Maltreatment was significant indicator of social anxiety disorder or social anxiety disorder
significantly associated with maltreatment. As this study indicated 76% of respondents were
seriously maltreated by their family which means they are emotionally neglected, kicked and
they experienced parental fighting. Supportive to this finding maltreatment was found to be
associated with social anxiety disorder. The domain of maltreatment consisted of questions on
experiences of physical-and emotional abuse from adults, neglect and of parental fighting
over with whom the child should live. In adults, emotional neglect has been reported as a
significant predictor of incidence of social anxiety disorder (Ataturk et al., 2009) and an
association between maltreatment and severity of social anxiety disorder has been found
(Simon et al., 2009).
In addition those studies, the concept of maltreatment have been reported in studies on
victimization and social anxiety disorder in children and adolescents. Understanding of the
association between maltreatment and social anxiety disorder can be related to findings from a
few studies on information processing in maltreated children (Had win et al., 2006).
A significant association was found between peer victimization and social anxiety disorder in
this study. 54.9% were said they are seriously victimized by their peer about 53.8% said they
are moderately victimized by their peer. The finding of this study showed that peer
victimization has been as one predictor of social anxiety disorder among children.
49
Supportive to this finding experiences of peer victimization are considered as a major health
issue in children (Child and Adolescent Health Research Unit, 2006). The findings from the
present studies support, however cautiously, the above notice of peer victimization as an
important issue for the mental well-being in this case social anxiety and social anxiety disorder,
in children.
Supportive to this finding victimization by peers may be interpreted as a lack of approval
from others (Bovine & Hymel, 1995) and the characteristics of social anxiety is a negative
expectation of being negatively evaluated by others (APA, 1994). This is feelings of
worthlessness and loneliness involved in social anxiety disorder (Stein et al., 2001). The
present study supports the above indicated idea and being victimized by peer in school, home or
elsewhere is significantly associated with social anxiety disorder.
As the result of this study indicated that there is significant association was found between
witness victimization and social anxiety disorder. The association between being victimized by
witness and social anxiety disorder was not found significantly.
In present study sexual victimization was found to be associated with social anxiety disorder.
Sexual abuse is less common in males than in females (Finkelhor, 1994). In the present study
rates of sexual victimization were high in females than to male.
50
CHAPTER SIX
SUMMARY, CONCLUTION AND RECOMMENDATIONS
6.1 Summary and Conclusions
Social anxiety disorder in children is related with low levels of adaptive functioning. Children
with social anxiety disorder has emotional over responsiveness and loneliness, impairments in
adaptive functioning, in peer relations, in self esteem, in school performance, in social behavior
and psychosocial impairment.
It was observed that social anxiety disorder was a highly common disorder among children.
The results are consistent with previous studies showing that the use of modern diagnostic
criteria (DSM-III-R or DSM-IV) usually yields considerably higher prevalence rates than the
older DSM-III studies, public speaking or speaking in front of peers is by far the most prevalent
social fear in children, and in the general social anxiety disorder is more common in female than
in male and also in those with lower educational levels, and economic levels has also
experienced social anxiety disorder and social anxiety disorder is more among children
maltreated by their family, experienced sexual and peer victimization whereas marriage status
and witness victimization have relatively little impact.
SAD is common phenomena among children in the study area especially among girls. Most of
children report impairment in the school-domain and leisure activities due to their fear of public
situations and impairment in performance situation due to their fear of performing their task in
front of others or in front of their peers. The SCARED with the advantage of being a short
instrument and based on the DSM-IV criteria of social anxiety disorder, can be used
as a reliable and valid screening device for non-clinical older children. The higher
51
rates of self reported social anxiety disorder were seen in children with low educational status
and low income level of parents.
S A D is increase when the age of children increases over one stage to another stage .Social
anxiety disorder is highly prevalent under the age level of 15-17 years and it increases as the age
of children increases. The self reported SAD in older children is associated with reports of
victimization, especially peer victimization and maltreatment and sexual victimization.
6.2 Recommendations
The high prevalence of self report social anxiety disorder (SAD) indicated that the high
prevalence of social anxiety in children, which impact on community related issues, calls for
early detection of social anxiety disorder. Social anxiety perceived as shyness and a common
approach to childhood shyness is that the child will grow out of it without any special
intervention. This indicated that low referral rates and mental health service use are seen in
children with social anxiety disorder. So increasing the provision of referral and mental health
service use for children with social anxiety disorder.
According to the results of the study social anxiety disorder increase when the age is increase
and females reported higher levels of social anxiety than boys, thus the results imply that
attention to girls is especially important.
School counselling professionals, teachers and parents need to have knowledge about social
anxiety, and effective interventions to help children overcome social anxiety need to be made
available.
Since social anxiety disorder is a sequential developmental process effective prevention and
treatment strategies in children is important. Emphasize efforts to prevent and deal with
52
victimization like peer victimization, maltreatment and sexual victimization in order to prevent
social anxiety symptoms. Interventions that aim to enhance close and supportive friendship will
be effective.
The findings of these study indicated that parents tend not to be aware of social fear and
associated distress in their children and to have restricted knowledge of SAD and they are not
well informed on how social anxiety disorder
considering
presents,
associated
impairment
and
social anxiety disorder as synonymous with non problematic shyness, thus the
result imply providing information about the problem of social anxiety disorder is important.
53
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Appendix A
Addis Ababa University
College of Education and Behavioral Studies
School of Psychology
Information sheet
My name is Andualem G/Michael, a graduate student in school of psychology, Addis Ababa
University, whom currently doing
the study entitled Social anxiety disorder in children in
Gofermeda sub city, Hosanna town: prevalence and associated factors as partial fulfilment for
the requirement of MA degree in Health psychology.
I would like to request your consent to fill out this questionnaire which will take approximately
30-45 minutes to complete. This questionnaire is aimed at gaining insight in to the prevalence
and factors associated with social anxiety disorder in children Gofermeda sub city, Hosanna
town. The result of the study is supposed to provide valuable information for concerned bodies.
This self- administered questionnaire contains items on social anxiety disorder. All items will be
completed anonymously. There is no need to write your name in any part of questionnaire.
Whatever information you provide will be kept strictly confidential, and will not be shared with
any one without your consent. You participation in the study is completely voluntarily.
The success of the study will depend on your honest response to each question.
Are you willing to participate in this study? Yes ---
No----
Are you willing to participate in the study, answer the questions with a (√) in the box that best
express your participation. Does not more than one box per question? Please answer all the
questions as truthfully as possible. If you don‟t want to answer some or all the questions, you
have the right to do so. However, your willingness to answer all questions will be appreciated.
Part one: Socio-Demographic Characteristics ‘of children Respondents.
01. Sex 1.Male 2. Female
02. How old are you? Age in completed years----------03. What is your educational status?
1. Currently attending school
2. Never attended any formal schooling
04. Have you ever dropped out of school before completing it? 1. Yes 2. No
05. If yes, what was reason for dropping out?
1. Got job
2. Got sick 3. Family needed help
4. Failed
06. Are you parents living together?
1. Yes 2 No
07. If no, why your parents are not living together?
1. Divorced
2. Separated
3. Widowed
08. What was educational status of your parents?
1. Illiterate
2. Literate but not formal
3. Primary (1-8)
4. Secondary (9-12)
5. Tertiary 12+
09. What was the estimated monthly income of your parents?
1. Under 200 2. 200-500 3. 501-800
4.801-1000
5.1001
and
above
Part Two: Victimization or Psychological effects of negative life experiences of children
respondent
Maltreatment Questionnaires
These items described the degree to which the respondents had been maltreated during the
previous life.
10, Did you neglected when you grown-ups in your life or you didn‟t take care of family or you
might not get enough food, take of you to the doctor when you are sick, or make sure you
have a safe place to stay.
1. Yes, it has happened. 2. No, it has not happened
11, Did you get scared or feel really bad because grown-ups in your life called you names, said
mean things to you, or said they didn‟t want you?
1. Yes, it has happened. 2. No, it has not happened
12, Did a grown-up in your life hit, beat, kick, or physically hurt you in any way from
your family?
1. Yes, it has happened 2.No, it has not happened,
13) Sometimes your family fights over where you should live?
1. Yes, it has happened. 2. No, it has not happened
Peer and Sibling Victimization Questionnaires
These items described the degree to which the respondent had been victimized or bullied during
the previous six months.
14) Has anyone… mocked you, teased you or said many things to you in school or on the way
to or from school?
1. Yes, it has happened. 2. No, it has not happened
15) Have you been hit, kicked or attacked at school or on the way to or from school?
1. Yes, it has happened. 2. No, it has not happened
16) Sometimes one can be excluded by someone in class and not be allowed to participate.
Has this happened to you?
1. Yes, it has happened. 2. No, it has not happened
17) Has any kid, even a brother or sister, hit you? Somewhere like: at home, at school, out
playing, in a store, or anywhere else?
1. Yes, it has happened. 2. No, it has not happened
Sexual Victimization Questionnaires
18, Did a grown-up you know force you to have sex or a grown-up that you know touch your
private parts when you didn‟t want it or make you touch your private parts?
1. Yes, it has happened. 2. No, it has not happened
19 Did kids in your age like from school, a boy friend or girl friend, or even a brother or sister,
did another child or teen make you do sexual things?
1. Yes, it has happened. 2. No, it has not happened
20) Did anyone try to force you to have sex; that is, sexual intercourse of any kind, even
if it didn‟t happen?
1. Yes, it has happened. 2. No, it has not happened
21) Did anyone make you looking at your private parts by using force or surprise, or by
“flashing” you?
1. Yes, it has happened. 2. No, it has not happened
Witnessing Victimization Questionnaires
Sometimes these things don‟t happen to you but you see them happen to other people. This
means to other people in real life. Not people on TV, video games, movies, or that you just
heard about.
22) In the last six months, did you see one of your parents get hit by another parent, or their
boyfriend or girlfriend?
1. Yes, it has happened. 2. No, it has not happened
23) In the last six months, did you see your parent hit, beat, kick, or physically hurt your
brothers or sisters?
1. Yes, it has happened. 2. No, it has not happened
24) In the last six months, in real life, did you see anyone get attacked on purpose w i t h a
stick, rock, gun, knife, or other thing that would hurt? Somewhere like: at home, at
school, at a store, in a car, on the street, or anywhere else?
1. Yes, it has happened. 2. No, it has not happened
25) In the last six months, did you see someone murdered in real life? This means not on
TV, video games, or in the movies?
1.
Yes,
it
has
happened.
2.
No,
it
has
not
happened
Part Three: Children version (to be filled out by child)
Directions: Below is a list of sentences that describes how people feel, read each phrases and
deiced if it is “not true or sometimes true” or very true or often true” for you. Then for each
sentence, fill in one circle that corresponds to the response that seems to describe you for the last
six months.
No
Item
26
You don‟t like to be with people
you don‟t know well.
You feel nervous with people you
don‟t know well
It is hard for you to talk with
people you don‟t know well.
You feel shy with people you
don‟t know well.
You feel nervous when you are
with other children or adults and
you have to do something while
they watch you (for example read
aloud speak, play a game ,play a
sport)
You feel nervous when you are
going to parties or any place,
where there will be people that
you don‟t know well.
You are shy.
The fear you experienced in one or
more above mentioned situations
has endured in at least 6 months.
27
28
29
30
31
32
33
0
Not true hardly
ever true
1
Somewhat true or
sometimes true
2
Very true or
often true
Part Four: Parent version (to be filled out by parent)
Directions: Below is a list of sentences that describes how people feel, read each phrases and
deiced if it is “not true or hardly ever true” or somewhat true or sometimes true or “very true or
often true” for your child. Then, for each statement, fill one circle that correspond to the response
seems to describe your child for the last six months. Please respond to all statements as well as
you can, even if some don‟t seem to concern you child.
No
Item
34
Your child doesn‟t like to be with people
he/she doesn‟t know well.
You child feels nervous with people
he/she doesn‟t know well.
It is hard for your child to talk with
people he/she doesn‟t know well.
Your child feels with people he/she
doesn‟t know well
Your child feels nervous when he/she to
do something thing while they watch her
(for example) read aloud, speak, play, a
game play sport).
Your child nervous when he/she is going
to parties dances, or any place where
there will be people that he/she doesn‟t
know well.
Your child is shy.
The fear your child experienced in one
or more above mentioned situations has
endured in at least 6 months.
35
36
37
38
39
40
41
0
Not true hardly
ever true
1
Somewhat true
or sometimes
true
2
Very true or
often true
አባሪ-B
አዱስ አበባ ዩንቨርሲቲ
የትምህርትና ባህርይ ጥናት ኮላጅ
የሳይኮልጂ ትምህርት ቤት
ስሜ አንደዓሇም ገ/ሚካኤሌ ይባሊሌ፡፡ በአሁኑ ሰዓት በአዱስ አበባ ዩንቨርሲቲ በሳይኮልጂ
ትምህርት ቤት የዴህረ ምረቃ ተማሪ ስሆን የሌጆችን ማህበራዊ ጭንቀት ወይም ሰዉ
መፍራትን በተመሇከተ ጥናት በማዴረግ ሊይ እገኛሇሁ፡፡ ስሇዚህ ቀጥል ያሇዉን መጠይቅ
ሇመሙሊት በቅዴሚያ የእናንተን ፇቃዯኝነት እጠይቃሇሁ፡፡ መጠይቁን ሇማጠናቀቅ የሚፇጀዉ
ጊዜ
ከ30-45 ዯቂቃ ሲሆን በመጠይቁ ሊይ ስማችሁን መጻፍ አይጠበቅባችሁም፡፡ እንዱሁም
የማንም ግሇሰብ ምሊሽ አይገሇጽም (ሚስጥራዊ ነው)፡፡ ስሇዚህ የእናንተ እዉነተኛ ምሊሽ
ሇጥናቱ በቂ ግንዛቤና ዕዉቀት ስሇምያስጨብጥ የእናንተን እዉናተኛ ትብብርና ፇቃዯኝነት
እጠይቀሇሁኝ፡፡
ክፍሌ አንዴ: አጠቃሇይ ግሊዊ ሁኔታ
ተ.ቁ
01
ጥያቄ
ፆታ
02
ዕዴሜ
አማራጭ መሌሶች
ሀ. ወንዴ
ሇ. ሴት
በሙለ አመት ----------
03
የትምህርትህ/ሽ ሁኔታ ምን
ይመስሊሌ?
ሀ.በአሁኑ ሰዓት ትምህርቴን በመከታተሌ ሇይ እገኛሇሁ
ሇ. በአሁኑ ሰዓት ትምህርቴን እዮተከታተሌኩ አይዯሇም
04
ትምህርትህን/ሺን
አቋርጠህ/ሽ
ታዉቀሇህ/ታዉቂያሇሽ?
ሇጥያቄ “04” መሌስህ/ሽ
አዎን ከሆነ በምን ምክንያት
ነዉ
ያቋረጥከዉ/ያቋረጥሽዉ?
ሀ. አዎን ሇ. አይዯሇም
በአሁኑ ሰዓት እናትህ/ሽና
አባትህ/ሽ የሚኖሩት በአንዴ
ሊይ ነዉ?
ሀ.አዎን ሇ. አይዯሇም
05
06
ሀ. ቤተሰብን ሇመርዲት
ሇ. በህመም ምክንያት
ሐ የግሌ ሥራ ሇመስራት
መ. ከክፍሌ ወዯ ክፍሌ ማሇፍ ስሇቃተኝ
07
08
09
ሇጥያቄ “06” መሌስህ/ሽ
አይዯሇም ከሆነ አሁን
የለበት ሁኔታ ምን
ይመስሊሌ?
የወሊጆችህ/ሽ የትምህርት
ሁኔታ
የቤተሰቦችህ/ሽ የወር ገቢ
ሀ. ተሇየይተዋሌ ሇ. ተፋተዋሌ ሐ. ሞተዋሌ
ሀ. ያሌተማሩ
ሇ. ማንበብና መጻፍ የሚችለ
ሐ. አንዯኛ ዯረጃ ትምህርት (1-8) የጨረሱ
መ. ሁሇተኛ ዯረጃ ትምህርት (9-12) የጨረሱ
ሠ. ከፍተኛ ትምህርት የተማሩ
ሀ. ከ200 ብር በታች
ሇ. ከ200-500 ብር
ሐ. ከ501-800 ብር
መ. ከ801-1000 ብር
ሠ.1001 እና ከዛ በሊይ የሚያገኙ
ክፍሌ ሁሇት፡ ከዚህ በፊት የዯረሰ የስነ ሌቦና ጉዲትን የተመሇከቱ ጥያቄዎች
2.1 የቤተሰብ እንክብካቤ እጦት
ከዚህ በታች የተዘረዘሩት ጥያቄዎች ሌጆች ከዚህ በፊት
ያጋጠማቸዉን የቤተሰብ የእንክብካቤ
እጦትን የተመሇከቱ ናቸዉ፤፤እያንዲንደን ጥያቄ በጥሞና ካነበባችሁ ቦኃሊ “አዎን” ወይም
“አይዯሇም” በሚሇዉ አማራጭ ሊይ፤ምሌክት በማዴረግ መሌሱ፡፡
አዎን
ተ.ቁ
ጥያቄ
10
ስታዴግ/ጊ ከቤተሰቦችህ/ሽ አስፇሊጊዉን እንክብካቤ ማሇትም በቂ
ምግብ፤የህክምና አገሌግልት ወይም ማንኛዉንም መሰረታዊ ነገሮችን ሳታገኝ/ኚ
የቀረህ/ሽ ይመስሇሀሌ/ሻሌ?
11
ስታዴግ/ጊ በቤተሰቦችህ/ሽ ስትጠሊ/ይ ያዯግህ/ሽ ይመስሇሀሌ/ሻሌ?
12
ስታዴግ/ጊ ከቤተሰቦችህ/ሽ አካሊዊ ጥቃት ዯርሶብህ/ሽ ያዉቃሌ?
13
አሌፎ አሌፎ እንተ/አንቺ በሇህበት/በሇሽበት ቤተሰቦችህ/ሽ እርስ በእርስ ስጋጩ
አጋጥሞህ/ሽ ያዉቃሌ?
ii
አይዯሇም
2.2 የአቻ ጥቃት
ከዚህ በታች የተዘረዘሩት ጥያቄዎች ሌጆች ከዚህ በፊት
የዯረሰባቸዉን የአቻ ጥቃት የሚመሇከቱ
ናቸዉ፡፡ እያንዲንደን ጥያቄ በጥሞና ካነበባችዉ ቦኃሊ “አዎን” ወይም “አይዯሇም” በሚሇዉ አማራጭ
ሊይ፤ምሌክት በማዴረግ መሌሱ፡፡
ቁ
ጥያቄ
አዎን
14
በትምህርት ቤት ዉስጥ፤ ከትምህርት ቤት ስትመሇስ/ሺ ወይም ትምህርት ቤት
አይዯሇም
ስትሄዴ/ጂ በግሌጽ ስምህን/ሽን በመጥራት የመሳዯብ፤ የማሾፍ ወይም የመፎገር
አይነት ሁኔታ ዯርሶብህ/ሽ ያዉቃሌ?
15
ከትምህርት ቤት ስትመሇስ/ሺ ወይም ትምህርት ቤት ስትሄዴ/ጂ ከጓዯኞችህ/ሽ
የአካሌ ጥቃት ዯርሶብህ/ሽ ያዉቃሌ?
16
አሌፎ አሌፎ አንዴ ሰዉ በላሊ ሰዉ በትምህርት ቤት ህይወት ዉስጥ ሉገሇሌ
ይችሊሌ፤ በዚህም ምክንያት ማንኛዉንም ተሳትፎ ሇያዯርግ ይችሊሌ፤፤ ይህ
ክስተት በአንተ/በአንች ሊይ ተከስቶ ያዉቃሌ?
17
በቤት፤በትምህርት ቤት ወይም በጨዋታ ቦታ ሉሆን ይችሊሌ የእዴሜ
እኩዮችህ/ሽ የዴብዯባ ጥቃት አዴርሰዉብህ/ሽ ያዉቃሌ?
2.3 ፆታዊ ጥቃት
ከዚህ በታች የተዘረዘሩት ጥያቄዎች ሌጆች ከዚህ በፊት የዯረሰባቸዉን የፆታ ጥቃትን የሚመሇከቱ
ናቸዉ፡፡እያንዲንደን ጥያቄ በጥሞና ካነበባችዉ ቦኃሊ “አዎን” ወይም “አይዯሇም” በሚሇዉ አማራጭ
ሊይ፤ምሌክት በማዴረግ መሌሱ፡፡
iii
ተ.ቁ
18
አዎን
ጥያቄ
አይዯሇም
ያሇ ፍሊጎትህ/ሽ በግዳታ ጾታዊ አካሌህ/ሽ በላሊ ሰዉ ወይም በራስህ/ሽ
እንዱነካ ተዯርጎ ነበር?
19
የዕዴሜ እኩዮችህ/ሽ ምናሌባት ወንዴምህ/ሽ ወይም እህትህ/ሽ ሉሆኑ
ይችሊለ የተቃራኒ ጾታ ግንኙነት ጨዋታ እንዴታዯርግ/ጊ አዴርገዉ ነበር?
20
ያሇ ፍሊጎትህ/ሽ በግዳታ የግብራ ስጋ ግንኙነት እንዴታዯርግ/ጊ ተዯርጎ
ነበር?
21
ያሇ ፍሊጎትህ/ሽ በግዳታ የሆነ ሰዉ ፆተዊ አካሌህን/ሽን አይቶት ነበር?
2.4 የእይታ ጥቃት
ከዚህ በታች የተዘረዘሩት ጥያቄዎች ሌጆች ከዚህ በፊት የዯረሰባቸዉን የእይታ ጥቃትን የሚመሇከቱ
ናቸዉ፡፡ እያንዲንደን ጥያቄ በጥሞና ካነበባችዉ ቦኃሊ “አዎን” ወይም “አይዯሇም” በሚሇዉ አማራጭ
ሊይ፤ምሌክት በማዴረግ መሌሱ፡፡
ቁ
ጥያቄ
አዎን
22
በመንገዴ፤በትምህርት ቤት ወይም በቤት ዉስጥ ሉሆን ይችሊሌ አንዴ ሰዉ
ላሊዉን በግሌፅ ሆን ብል በደሊ፤ በዴንጋይ፤በጥይት፤ወይም በቢሇዋ
ጥቃት ሲያዯርስበት አገጥሞህ/ሽ ያዉቃሌ?
23
24
አንዴ ሰዉ በግሌፅ ላሊዉን ሲገዴሌ አገጥሞህ/ሽ ያዉቃሌ?
ወሊጆችህ/ሽ በወንዴሞችህ/ሽ ወይም በእህቶችህ/ሽ ሇይ የአካሌ ጥቃት
ሲያዯርሱ ወይም ሲመቷአቸዉ አጋጥሞህ/ሽ ያዉቃሌ?
25
ወሊጆችህ/ሽ ከላልች ወሊጆች ጋር ሲጣለ ወይም ሲማቱ አጋጥሞህ/ሽ
ያዉቃሌ?
iv
አይዯሇም
ክፍሌ ሶስት: በህፃናት ተሳታፊዎች የሚሞሊ
ከዚህ በታች የተዘረዘሩት ጥያቄዎች የሌጆችን መህበራዊ ጭንቀት ሁኔታን የሚመሇከቱ ናቸዉ፡፡
እያንዲንደን ጥያቄ በጥሞና ካነበባችዉ ቦኃሊ “ትክክሌ አይዯሇም” “በተወሰነ መሌኩ ትክክሌ ነዉ”
ወይም “በጣም ትክክሌ ነዉ” በሚሇዉ አማራጭ ሇይ፤ምሌክት በማዴረግ መሌሱ፡፡
ተ.ቁ
ትክክሌ
አይዯሇም
ጥያቄ
26
ከዚህ በፊት ከማታዉቀዉ/ቂዉ ሰዉ ጋር
አብሮ መሆን ትጠሊሇህ/ትጠያሇሽ?
27
ከማታዉቃቸዉ/ቂያቸዉ ሰዎች ጋር
ስትሆን/ኚ ግራ የመጋባት/የመረበሽ
ስሜት ይሰማሃሌ/ሻሌ?
ከዚህ በፊት ከማታዉቀዉ/ቂዉ ሰዉ ጋር
ስታወራ/ሪ የመፍራት ስሜት
ይሰመሃሌ/ሻሌ?
ከዚህ በፊት ከማታዉቀዉ/ቂዉ ሰዉ ጋር
ስትሆን/ኚ የፍርሃት ስሜት
ይሰመሃሌ/ሻሌ?
ከአቻዎችህ/ሺ እና ከአዋቂ ሰዎች ጋር
ስትሆን/ኚ ግራ በመጋባት ወይም
በመረበሽ ስሜት በእነርሱ ፊት ማንበብ፤
መናገር፤መጻፍም እና መብሊት ከባዴ
መስል ይተየሃሌ/ይሻሌ?
በተሇያዩ የመዝናኛ ስፍራዎች ወይም
በተሇያዩ ዝግጅቶች ዙሪያ ከተሇያዩ
አዲዱስ ሰዎች ጋር መዝናናትን
የመፍራት ስሜት ይሰመሃሌ/ሻሌ?
በአጠቃሊይ የአይን አፋርነት ስሜት
ይታይብሃሌ/ሻሌ?
ከሊይ ከተዘረዘሩት የፍርሃት ችግሮች
አንደ እና ከዛ በሊይ ቢያንስ ሇ6 ወር
ያህሌ ቆይቶብሃሌ/ሻሌ?
28
29
30
31
32
33
v
በተወሰነ መሌኩ
ትክክሌ ነዉ
በጣም
ትክክሌ ነዉ
ክፍሌ አራት: በወሊጆች የሚሞሇ
ከዚህ በታች የተዘረዘሩት ጥያቄዎች የሌጆችን ማህበራዊ ጭንቀት ሁኔታን የሚመሇከቱ ናቸዉ፡፡
እያንዲንደን ጥያቄ በጥሞና ካነበባችሁ ቦኃሊ የሌጅዎችን ባህርይ የሚገሌጸዉን “ትክክሌ
አይዯሇም” “በተወሰነ መሌኩ ትክክሌ ነዉ” ወይም “በጣም ትክክሌ ነዉ” በሚሇዉ አማራጭ
ሇይ፤ምሌክት በማዴረግ መሌሱ፡፡
ቁ
ጥያቄ
34
ሌጅዎት ከዚህ በፊት ከማያዉቀዉ/ከማታዉቀዉ ሰዉ
ጋር አብሮ መሆንን ይጠሊሌ/ትጠሊሇች?
ሌጅዎት ከማያዉቃቸዉ/ከማታዉቃቸዉ ሰዎች ጋር
ሲሆን/ስትሆን ግራ የመጋባት/የመረበሽ ስሜት
ይሰመዋሌ/ይሰማታሌ?
ሌጅዎት ከዚህ በፊት ከማያቀዉ/ከማታዉቀዉ ሰዉ ጋር
ሲያወራ/ስታወራ የመፍራት ስሜት ይሰመዋሌ/ማታሌ?
ሌጅዎት ከዚህ በፊት ከማያውቀዉ/ከማታዉቀዉ ሰዉ
ጋር ስሆን/ስትሆን የፍርሃት ስሜት ይሰማታሌ/ዋሌ?
ሌጅዎት ከአቻዎቹ/ዋ እና ከአዋቂ ሰዎች ጋር
ሲሆን/ስትሆን ግራ በመጋባት ወይም በመረበሽ ስሜት
በእነርሱ ፊት ማንበብ፤ መናገር፤መጻፍም እና መብሊት
ከባዴ መስል ይተየዋሌ/ታሌ?
ሌጅዎት በተሇያዩ የመዝናኛ ስፍራዎች ወይም በተሇያዩ
ዝግጅቶች ከተሇያዩ አዲዱስ ሰዎች ጋር መዝናናትን
የመፍራት ስሜት ይሰመዋሌ/ይሰማታሌ?
በአጠቃሇይ ሌጅዎት የአይን አፋርነት ስሜት
ይታይበታሌ/ይታይባታሌ?
ሌጅዎት ከሊይ ከተዘራዘሩት የፍሪሃት ችግሮች አንደ
እና ከዛ በሇይ ቢያንስ ሇ6 ወር ያህሌ
ቆይቶበታሌ/ባታሌ?
35
36
37
38
39
40
41
ትክክሌ
አይዯሇም
vi
በተወሰነ
መሌኩ
ትክክሌ ነዉ
በጣም
ትክክሌ
ነዉ
Appendix C
Descriptive Statistics
Dependent Variable: Children's Feeling about their social anxiety disorder
Source
Corrected Model
Type III Sum of
Squares
28.502a
df
Mean Square
F
Conclusion
Sig.
17
1.677
16.933
.000
Intercept
.046
1
.046
.463
.497
qn1_sex
4.761
1
4.761
48.083
.000
qn3_educ
.604
1
.604
6.098
.014
qn4_dropout
.036
1
.036
.366
.546
.053
1
.053
.536
.465
qn8_educparents
3.880
4
.970
9.795
.000
qn9_incomeparents
2.495
4
.624
6.299
.000
qn2__age
4.901
1
4.901
49.498
.000
qn10_13Mt
2.662
1
2.662
26.885
.000
qn14_17PSV
.994
1
.994
10.037
.002
qn18_21SV
.396
1
.396
4.004
.046
qn22_25_WV
.021
1
.021
.214
.644
Error
26.635
269
.099
Total
280.640
287
55.137
286
qn6_parentslivingto
gether
Corrected Total
a. R Squared = .517 (Adjusted R Squared = .486)
Declaration
I, the undersigned hereby declare that the thesis titled Social Anxiety Disorder among Children
at Gofermeda Sub City, Hosanna Town: Prevalence and Associated factors. An Exploratory
Study is my original work and to the best of my knowledge and belief this thesis contains no
material previously published by any other person except where proper citation and due
acknowledgement has been made. I do further affirm that this thesis has not been presented or
being submitted as part of the requirements of any other academic degree or publication, in
English or in any other language.
_______________________
Andualem Gebremicheal
_______________________
Date