Self-Evaluation in Childhood Social Anxiety Disorder: Effects of Repeated Exposure with Support Strategies

Children with social anxiety disorder (SAD) often perceive their social performance more negatively than external observers, reinforcing negative self-appraisals. Cognitive models suggest a vicious cycle between such distortions and heightened anxiety. This study tested whether repeated exposure to a social-evaluative task, paired with brief, ecologically valid support strategies, improves self-appraisal in children with SAD compared to baseline without support. Participants were 76 children (SAD: n = 33, Mage = 11.73, SD = 1.46, 64% female; healthy controls [HC]: n = 43, Mage = 11.40, SD = 1.45, 62% female), recruited from an urban setting in Germany. In two sessions one week apart, children delivered a 5-min speech to a peer video audience. In Session 1, they performed without support; in Session 2, they received either brief parental support or a self-instruction during preparation. After each speech, children rated their performance. Observer-rated performance was assessed by three independent, trained coders blind to group, session, and condition. Self-rated performance improved across sessions in both groups, but children with SAD consistently rated themselves more negatively than HC peers. Observer-rated performance did not differ between groups or across sessions. No differential effects emerged between support types. Negative self-appraisal is a core, though partially modifiable, feature of childhood SAD. Repeated exposure to social stress paired with brief support may modestly improve self-perception, though effects may reflect exposure rather than specific support. Targeting distorted self-appraisals remains a key clinical focus.