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There has been a substantial increase in the number of students with mental health needs, yet significant discrepancies exist in access to timely intervention. Traditional gatekeeping to intervention has been the provenance of single information sources. Multi-informant decision-making is a promising mechanism to improve equitable access. However, critical advancements are necessary to improve decision-making relating to (a) who is identified, (b) what type of need is determined, (c) the type of intervention necessary, and (d) where or under what circumstances to implement the intervention. We review critical components of effective mental health decision-making, contributors to inequities in school mental health services, and offer future directions for research and practice to increase equitable student outcomes.
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Toma de Decisiones , Accesibilidad a los Servicios de Salud , Servicios de Salud Mental Escolar , Humanos , Estudiantes/psicología , Instituciones Académicas , Adolescente , NiñoRESUMEN
Social anxiety-which typically emerges in adolescence-lies on a continuum and, when extreme, can be devastating. Socially anxious individuals are prone to heightened fear, anxiety, and the avoidance of contexts associated with potential social scrutiny. Yet most neuroimaging research has focused on acute social threat. Much less attention has been devoted to understanding the neural systems recruited during the uncertain anticipation of potential encounters with social threat. Here we used a novel fMRI paradigm to probe the neural circuitry engaged during the anticipation and acute presentation of threatening faces and voices in a racially diverse sample of 66 adolescents selectively recruited to encompass a range of social anxiety and enriched for clinically significant levels of distress and impairment. Results demonstrated that adolescents with more severe social anxiety symptoms experience heightened distress when anticipating encounters with social threat, and reduced discrimination of uncertain social threat and safety in the bed nucleus of the stria terminalis (BST), a key division of the central extended amygdala (EAc). Although the EAc-including the BST and central nucleus of the amygdala-was robustly engaged by the acute presentation of threatening faces and voices, the degree of EAc engagement was unrelated to the severity of social anxiety. Together, these observations provide a neurobiologically grounded framework for conceptualizing adolescent social anxiety and set the stage for the kinds of prospective-longitudinal and mechanistic research that will be necessary to determine causation and, ultimately, to develop improved interventions for this often-debilitating illness.
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During adolescence, youth increase in both independence and conflict with parents. Parents vary in how much they know about their adolescents' whereabouts and activities and how they acquire this information (i.e., the sources of what parents know). We probed how parental knowledge of adolescents' whereabouts and activities-and their information sources-relates to (a) domains of parent-adolescent conflict (fighting about, or having different beliefs about, daily life topics) and (b) parent and adolescent attachment-related behavior during a conflict discussion task. Using the Actor-Partner Interdependence Model, we tested links between parental knowledge and its sources and conflict processes. Eighty-seven adolescents (Mage = 15.18; 55% female) and parents completed surveys about parental knowledge and its sources (i.e., parental solicitation of adolescents' activities, adolescent disclosure to parents about their activities) and separate interviews on conflict domains. A subset of parent-adolescent dyads (n = 65) interacted for 5 min about an adolescent-identified conflict topic. Different beliefs about daily life topics related to parental knowledge: parents' reports of greater different beliefs about daily life topics predicted less knowledge of adolescents' activities/whereabouts, solicitation, and disclosure, for both parent and adolescent reports of these domains. For adolescents, greater different beliefs related to less solicitation and disclosure. Only adolescent reports of parental knowledge, solicitation, and disclosure predicted attachment-related behaviors both dyad members displayed during the conflict discussion task. Findings reveal links between parental knowledge of adolescents' activities and conflict processes and demonstrate dyadic interdependence between parental knowledge of adolescents' activities and conflict processes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Fears of negative (FNE) and positive (FPE) evaluation and safety behaviors feature prominently in cognitive-behavioral models of social anxiety. However, we have a poor understanding of their associations, particularly given evidence that they both vary in form and function. This study aimed to identify the factor structure of safety behaviors and explore their differential associations with FNE and FPE. We addressed these aims across samples that varied in developmental stage, informant, and assessment modality. We collected self-reported data from college students (n = 349; Mage = 19.42) and adolescent-parent dyads (n = 134; Mage_adolescents = 14.49, Mage_parents = 45.01); parents also completed an ecologically-valid evaluation task. We confirmed a two-factor structure of safety behaviors (i.e., avoidance and impression management) that fit the data well for college students, adolescents, and parents' self-report, but not for parents' report about adolescents. Associations between avoidance and impression management and FNE/FPE were significant within-informants but not between-informants. For parents, in-the-moment arousal following receipt of negative, but not positive, feedback was associated with avoidance and impression management. Findings have implications for integrated measurement of FNE, FPE, and safety behaviors, as well as treatments that target social anxiety through each of these domains.
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Miedo , Conductas Relacionadas con la Salud , Adolescente , Humanos , Adulto Joven , Adulto , Autoinforme , Estudiantes , PadresRESUMEN
PURPOSE: Researchers and service providers typically assess pediatric Health-Related Quality of Life (HRQOL) by collecting independent reports from parents and youth. An emerging body of work indicates that patterns of parent-youth reports yield information germane to understanding youth outcomes. We identified patterns of HRQOL among youth and their parents seeking mental health treatment and examined links between agreement patterns and mental and physical health functioning. METHODS: Participants included 227 youth (mean age = 14.40 years, SD = 2.42; 63% female) and parent dyads presenting at a mood disorders clinic between 2013 and 2020. We assessed HRQOL using parallel youth and parent forms of the Pediatric Quality of Life Inventory Generic Core Scales. We also assessed youth clinical correlates of depression, suicidal ideation, and impairment, as well as health information via electronic health record (e.g., psychotropic medication usage, BMI). RESULTS: Latent class analysis showed three parent-youth reporting patterns: Low-Low (LL), High-High (HH), and Parent Low-Youth High (PL-YH). Relative to youth in the HH group, youth in the LL and PL-YH groups reported significantly greater depressive symptoms and had higher rates of suicidal ideation and psychotropic medication use. In addition, youth in the LL group reported significantly greater levels of impairment. CONCLUSIONS: Parent-youth patterns of HRQOL reporting can reveal clinically meaningful information and indicate poorer functioning for certain groups (LL, PL-YH) of youth. These findings have implications for improving accuracy of risk assessments that leverage HRQOL data.
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Trastornos del Humor , Calidad de Vida , Humanos , Niño , Adolescente , Femenino , Masculino , Calidad de Vida/psicología , Padres/psicología , Ideación SuicidaRESUMEN
Youth who experience psychopathy display multiple impairments across interpersonal (grandiose-manipulative [GM]), affective (callous-unemotional [CU]), lifestyle (daring-impulsive [DI]), and potentially antisocial and behavioral features. Recently, it has been acknowledged that the inclusion of psychopathic features can offer valuable information in relation to the etiology of Conduct Disorder (CD). Yet, prior work largely focuses on the affective component of psychopathy, namely CU. This focus creates uncertainty in the literature on the incremental value of a multicomponent approach to understanding CD-linked domains. Consequently, researchers developed the Proposed Specifiers for Conduct Disorder (PSCD; Salekin & Hare, 2016) as a multicomponent approach to assess GM, CU, and DI features in combination with CD symptoms. The notion of considering the wider set of psychopathic features for CD specification requires testing whether multiple personality dimensions predict domain-relevant criterion outcomes above-and-beyond a CU-based approach. Thus, we tested the psychometric properties of parents' reports on the PSCD (PSCD-P) in a mixed clinical/community sample of 134 adolescents (Mage = 14.49, 66.4% female). Confirmatory factor analyses resulted in a 19-item PSCD-P displaying acceptable reliability estimates and a bifactor solution consisting of GM, CU, DI, and CD factors. Findings supported the incremental validity of scores taken from the PSCD-P across multiple criterion variables, including (a) an established survey measure of parent-adolescent conflict; and (b) trained independent observers' ratings of adolescents' behavioral reactions to laboratory controlled tasks designed to simulate social interactions with unfamiliar peers. These findings have important implications for future research on the PSCD and links to adolescents' interpersonal functioning.
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Callosidades , Trastorno de la Conducta , Adolescente , Humanos , Femenino , Masculino , Trastorno de la Conducta/psicología , Reproducibilidad de los Resultados , Trastorno de Personalidad Antisocial/psicología , Encuestas y Cuestionarios , PadresRESUMEN
Validly characterizing youth mental health phenomena requires evidence-based approaches to assessment. An evidence-based assessment cannot rely on a "gold standard" instrument but rather, batteries of instruments. These batteries include multiple modalities of instrumentation (e.g., surveys, interviews, performance-based tasks, physiological readings, structured clinical observations). Among these instruments are those that require soliciting reports from multiple informants: People who provide psychometrically sound data about youth mental health (e.g., parents, teachers, youth themselves). The January 2011 issue of the Journal of Clinical Child and Adolescent Psychology (JCCAP) included a Special Section devoted to the most common outcome of multi-informant assessments of youth mental health, namely discrepancies across informants' reports (i.e., informant discrepancies). The 2011 JCCAP Special Section revolved around a critical question: Might informant discrepancies contain data relevant to understanding youth mental health (i.e., domain-relevant information)? This Special Issue is a "sequel" to the 2011 Special Section. Since 2011, an accumulating body of work indicates that informant discrepancies often contain domain-relevant information. Ultimately, we designed this Special Issue to lay the conceptual, methodological, and empirical foundations of guidelines for integrating multi-informant data when informant discrepancies contain domain-relevant information. In this introduction to the Special Issue, we briefly review the last 12 years of research and theory on informant discrepancies. This review highlights limitations inherent to the most commonly used strategies for integrating multi-informant data in youth mental health. We also describe contributions to the Special Issue, including articles about informant discrepancies that traverse multiple content areas (e.g., autism, implementation science, measurement validation, suicide).
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Trastorno Autístico , Suicidio , Niño , Humanos , Adolescente , Salud Mental , Encuestas y Cuestionarios , PadresRESUMEN
Socially anxious adolescents commonly experience impaired interpersonal functioning with unfamiliar, same-age peers. Yet, we lack short screening tools for assessing peer-related impairments. Recent work revealed that a parent-reported, three-item screening tool produced scores that uniquely related to social anxiety concerns. However, this tool ought to go beyond linking impairments to service needs (i.e., social anxiety symptoms). This tool should also inform the goals of services, in particular by linking impairments to key domains relevant to therapeutically addressing adolescents' anxiety-related needs, such as social skills when interacting with unfamiliar peers. This requires an assessment approach that involves strategic selection of informants who vary in their expertise for observing anxiety-related needs, as well as the therapeutic goals for addressing anxiety-related impairments (e.g., social skills within peer interactions). We leveraged parents' reports to link impairments to social anxiety-related needs. To link impairments to social skills, we leveraged informants (i.e., unfamiliar untrained observers [UUOs]) who observed adolescents within tasks designed to simulate interactions with same-age, unfamiliar peers. We tested this approach using a mixed-clinical/community sample of 134 adolescents, ages 14- to 15 years old. We leveraged multi-informant survey reports to assess adolescent social anxiety, and trained independent observers rated adolescents' social skills within unfamiliar peer interactions. Parents' reports performed best when distinguishing adolescents on referral status and predicting survey-reported social anxiety, whereas only UUOs' reports predicted independent observers' social skills ratings. These findings inform the strategic selection of informants for assessing impairments that commonly prompt the need for adolescents to access mental health services for social anxiety.
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Relaciones Interpersonales , Grupo Paritario , Humanos , Adolescente , Habilidades Sociales , Miedo , Ansiedad/psicologíaRESUMEN
Researchers strategically assess youth mental health by soliciting reports from multiple informants. Typically, these informants (e.g., parents, teachers, youth themselves) vary in the social contexts where they observe youth. Decades of research reveal that the most common data conditions produced with this approach consist of discrepancies across informants' reports (i.e., informant discrepancies). Researchers should arguably treat these informant discrepancies as domain-relevant information: data relevant to understanding youth mental health domains (e.g., anxiety, depression, aggression). Yet, historically, in youth mental health research as in many other research areas, one set of paradigms has guided interpretations of informant discrepancies: Converging Operations and the Multi-Trait Multi-Method Matrix (MTMM). These paradigms (a) emphasize shared or common variance observed in multivariate data, and (b) inspire research practices that treat unique variance (i.e., informant discrepancies) as measurement confounds, namely random error and/or rater biases. Several yearsw ago, the Operations Triad Model emerged to address a conceptual problem that Converging Operations does not address: Some informant discrepancies might reflect measurement confounds, whereas others reflect domain-relevant information. However, addressing this problem requires more than a conceptual paradigm shift beyond Converging Operations. This problem necessitates a paradigm shift in measurement validation. We advance a paradigm (Classifying Observations Necessitates Theory, Epistemology, and Testing [CONTEXT]) that addresses problems with using the MTMM in youth mental health research. CONTEXT optimizes measurement validity by guiding researchers to leverage (a) informants that produce domain-relevant informant discrepancies, (b) analytic procedures that retain domain-relevant informant discrepancies, and (c) study designs that facilitate detecting domain-relevant informant discrepancies.
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Salud Mental , Proyectos de Investigación , Humanos , Adolescente , Padres , Medio SocialRESUMEN
Adolescents with elevated social anxiety commonly experience peer-related impairments - particularly with same-age, unfamiliar peers - stemming from their avoidant behaviors. Yet, peer-related impairments are not unique to social anxiety. For example, adolescents who experience social anxiety may also experience symptoms of attention deficit/hyperactivity disorder (ADHD), which also increase risk for peer-related impairments. Relative to social anxiety, peer-related impairments linked to ADHD symptoms more likely stem from hyperactivity (i.e., approach behaviors). These distinct pathways point to adolescents with elevated social anxiety and ADHD symptoms (i.e., social anxietyâ¯+â¯ADHD) experiencing particularly high peer-related impairments, which commonly manifest as behavioral displays of low social skills when interacting with unfamiliar peers. We tested this notion in a mixed-clinical/community sample of 134 14- to 15-year-old adolescents and their parents. Adolescents participated in a series of social interaction tasks designed to simulate how adolescents interact with same-age, unfamiliar peers. Trained observers independently rated adolescents on observed social skills within these interactions. Both parents and adolescents completed parallel surveys of social anxiety and ADHD symptoms, which we used to identify social anxietyâ¯+â¯ADHD adolescents as well as other combinations of social anxiety and ADHD symptoms (i.e., neither, elevated on one but not the other). Adolescents with social anxietyâ¯+â¯ADHD displayed significantly lower social skills, relative to all other groups. Among adolescents, social anxietyâ¯+â¯ADHD may have a compounding effect on social skills. As such, therapists working with social anxietyâ¯+â¯ADHD adolescents should probe for peer-related impairments and factors implicated in the development and maintenance of these impairments.
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Trastorno por Déficit de Atención con Hiperactividad , Adolescente , Ansiedad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Humanos , Relaciones Interpersonales , Grupo Paritario , Habilidades SocialesRESUMEN
We used multitrait-multimethod (MTMM) modeling to examine general factors of psychopathology in three samples of youth (Ns = 2119, 303, 592) for whom three informants reported on the youth's psychopathology (e.g., child, parent, teacher). Empirical support for the p-factor diminished in multi-informant models compared with mono-informant models: the correlation between externalizing and internalizing factors decreased and the general factor in bifactor models essentially reflected externalizing. Widely used MTMM-informed approaches for modeling multi-informant data cannot distinguish between competing interpretations of the patterns of effects we observed, including that the p-factor reflects, in part, evaluative consistency bias or that psychopathology manifests differently across contexts (e.g., home vs. school). Ultimately, support for the p-factor may be stronger in mono-informant designs, although it is does not entirely vanish in multi-informant models. Instead, the general factor of psychopathology in any given mono-informant model likely reflects a complex mix of variances, some substantive and some methodological.
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Accurately assessing youth mental health involves obtaining reports from multiple informants who typically display low levels of correspondence. This low correspondence may reflect situational specificity. That is, youth vary as to where they display mental health concerns and informants vary as to where and from what perspective they observe youth. Despite the frequent need to understand and interpret these informant discrepancies, no consensus guidelines exist for integrating informants' reports. The path to building these guidelines starts with identifying factors that reliably predict the level and form of these informant discrepancies, and do so for theoretically and empirically relevant reasons. Yet, despite the knowledge of situational specificity, few approaches to integrating multi-informant data are well-equipped to account for these factors in measurement, and those that claim to be well-positioned to do so have undergone little empirical scrutiny. One promising approach was developed roughly 20 years ago by Kraemer and colleagues (2003). Their Satellite Model leverages principal components analysis (PCA) and strategic selection of informants to instantiate situational specificity in measurement, namely components reflecting variance attributable to the context in which informants observe behavior (e.g., home/non-home), the perspective from which they observe behavior (e.g., self/other), and behavior that manifests across contexts and perspectives (i.e., trait). The current study represents the first construct validation test of the Satellite Model. A mixed-clinical/community sample of 134 adolescents and their parents completed six parallel surveys of adolescent mental health. Adolescents also participated in a series of simulated social interactions with research personnel trained to act as same-age, unfamiliar peers. A third informant (unfamiliar untrained observer) viewed these interactions and completed the same surveys as parents and adolescents. We applied the Satellite Model to each set of surveys and observed high internal consistency estimates for each of the six-item trait (α = 0.90), context (α = 0.84), and perspective (α = 0.83) components. Scores reflecting the trait, context, and perspective components displayed distinct patterns of relations to a battery of criterion variables that varied in the context, perspective, and source of measurement. The Satellite Model instantiates situational specificity in measurement and facilitates unifying conceptual and measurement models of youth mental health.
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On page 1 of his classic text, Millsap (2011) states, "Measurement invariance is built on the notion that a measuring device should function the same way across varied conditions, so long as those varied conditions are irrelevant [emphasis added] to the attribute being measured." By construction, measurement invariance techniques require not only detecting varied conditions but also ruling out that these conditions inform our understanding of measured domains (i.e., conditions that do not contain domain-relevant information). In fact, measurement invariance techniques possess great utility when theory and research inform their application to specific, varied conditions (e.g., cultural, ethnic, or racial background of test respondents) that, if not detected, introduce measurement biases, and, thus, depress measurement validity (e.g., academic achievement and intelligence). Yet, we see emerging bodies of work where scholars have "put the cart before the horse" when it comes to measurement invariance, and they apply these techniques to varied conditions that, in fact, may reflect domain-relevant information. These bodies of work highlight a larger problem in measurement that likely cuts across many areas of scholarship. In one such area, youth mental health, researchers commonly encounter a set of conditions that nullify the use of measurement invariance, namely discrepancies between survey reports completed by multiple informants, such as parents, teachers, and youth themselves (i.e., informant discrepancies). In this paper, we provide an overview of conceptual, methodological, and measurement factors that should prevent researchers from applying measurement invariance techniques to detect informant discrepancies. Along the way, we cite evidence from the last 15 years indicating that informant discrepancies reflect domain-relevant information. We also apply this evidence to recent uses of measurement invariance techniques in youth mental health. Based on prior evidence, we highlight the implications of applying these techniques to multi-informant data, when the informant discrepancies observed within these data might reflect domain-relevant information. We close by calling for a moratorium on applying measurement invariance techniques to detect informant discrepancies in youth mental health assessments. In doing so, we describe how the state of the science would need to fundamentally "flip" to justify applying these techniques to detect informant discrepancies in this area of work.
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Effective mental health services require accurate assessment of psychosocial impairments linked to mental health concerns. Youth who experience these impairments do so within and across various contexts (e.g., school, home). Youth may display symptoms of mental health concerns without co-occurring impairments, and vice versa. Yet, nearly all impairment measures presume that those assessed display mental health concerns. Consequently, we recently developed youth and parent versions of a five-item measure of youth psychosocial impairments (i.e., Work and Social Adjustment Scale for Youth [WSASY]), structured to assess any youth, regardless of mental health status. Across two studies, we developed and tested a WSASY teacher version, in a large sample of 382 student teacher reports (Study 1), and a subsample of 66 youth who, along with their parents and teachers, completed the WSASY and a series of school- and home-based behavioral tasks (Study 2). In Study 1, WSASY teacher reports demonstrated excellent internal consistency and unique relations with teacher reports on well-established measures of psychosocial strengths and difficulties. In Study 2, teacher, youth, and parent WSASY reports demonstrated low correspondence with each other and context-specific relations with criterion variables. This low correspondence allowed us to capitalize on an integrative approach designed to optimize informant-specific variance. Integrative scores demonstrated robust, large-magnitude relations with criterion variables across multiple information sources. These findings provide important psychometric support for use of WSASY teacher reports, and pave the way toward integrating WSASY reports from multiple informants who observe youth psychosocial impairments within different contexts and from different perspectives. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Padres , Ajuste Social , Adolescente , Humanos , Salud Mental , Psicometría , Maestros , Instituciones AcadémicasRESUMEN
Biological psychiatry, similar to many other scientific fields, is grappling with the challenge of revising its practices with an eye toward promoting diversity, equity, and inclusivity. One arena in which much of this work will have significant impact is in developmental science generally and the study of adolescence specifically. Adolescence is a critical period during human development during which important social, neural, and cognitive maturation processes take place. It is also a time marked by risky behaviors and the onset of a range of mental disorders. Social and developmental research has provided insight into the cognitive and neural processes by which perceptions of identity-related differences emerge. Clinical research aimed at understanding how individuals from diverse backgrounds navigate the transition period of adolescence is critical for identifying the unique factors underlying risk and resilience in minoritized populations. Taking a developmental perspective, we review processes by which the brain understands group differences and how the developmental timing of this can influence antecedents of psychological distress. We close with a call to action, pointing to important understudied areas within the field of biological psychiatry that are critical for supporting mental health among diverse adolescent populations.
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Neurociencia Cognitiva , Distrés Psicológico , Integración Social , Adolescente , Humanos , Prejuicio , Racismo , Sesgo , Identificación SocialRESUMEN
Harmful alcohol consumption can significantly compromise adherence to antiretroviral therapy (ART). Prior research has identified aggregate relationships between alcohol use and ART non-adherence, largely relying on concurrent assessment of these domains. There is relatively limited evidence on more nuanced day-level associations between alcohol use and ART non-adherence, despite potentially important clinical implications. We recruited adults with HIV treatment adherence challenges and harmful alcohol use (n = 53) from HIV care in South Africa. We examined relationships between alcohol use and same and next day ART adherence, accounting for the role of weekends/holidays and participant demographics, including gender. Results demonstrated that ART adherence was significantly worse on weekend/holiday days. Next day adherence was significantly worse in the context of weekend alcohol use and among men. These results suggest the importance of tailoring intervention strategies to support ART adherence during weekend drinking and for men engaged in heavy episodic drinking.
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Alcoholismo , Fármacos Anti-VIH , Infecciones por VIH , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Masculino , Cumplimiento de la Medicación , Sudáfrica/epidemiologíaRESUMEN
Over 60 years of research reveal that informants who observe youth in clinically relevant contexts (e.g., home, school)-typically parents, teachers, and youth clients themselves-often hold discrepant views about that client's needs for mental health services (i.e., informant discrepancies). The last 10 years of research reveal that these discrepancies reflect the reality that (a) youth clients' needs may vary within and across contexts and (b) informants may vary in their expertise for observing youth clients within specific contexts. Accordingly, collecting and interpreting multi-informant data comprise "best practices" in research and clinical care. Yet, professionals across settings (e.g., health, mental health, school) vary in their use of multi-informant data. Specifically, professionals differ in how or to what degree they leverage multi-informant data to determine the goals of services designed to meet youth clients' needs. Further, even when professionals have access to multiple informants' reports, their clinical decisions often signal reliance on one informant's report, thereby omitting reports from other informants. Together, these issues highlight an understudied research-to-practice gap that limits the quality of services for youth. We advance a framework-the Needs-to-Goals Gap-to characterize the role of informant discrepancies in identifying youth clients' needs and the goals of services to meet those needs. This framework connects the utility of multi-informant data with the reality that services often target an array of needs within and across contexts, and that making decisions without accurately integrating multiple informants' reports may result in suboptimal care. We review evidence supporting the framework and outline directions for future research.
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Servicios de Salud Mental , Salud Mental , Adolescente , Objetivos , Humanos , Padres , Instituciones AcadémicasRESUMEN
Socially anxious adolescents often endure anxiety-provoking situations using safety behaviors: strategies for minimizing in-the-moment distress (e.g., avoiding eye contact, rehearsing statements before entering a conversation). Studies linking safety behaviors to impaired functioning have largely focused on adults. In a sample of one hundred thirty-four 14 to 15 year-old adolescents, we tested whether levels of safety behaviors among socially anxious adolescents relate to multiple domains of impaired functioning. Adolescents, parents, and research personnel completed survey measures of safety behaviors and social anxiety, adolescents and parents reported about adolescents' evaluative fears and psychosocial impairments, and adolescents participated in a set of tasks designed to simulate social interactions with same-age, unfamiliar peers. Relative to other adolescents in the sample, adolescents high on both safety behaviors and social anxiety displayed greater psychosocial impairments, evaluative fears, and observed social skills deficits within social interactions. These findings have important implications for assessing and treating adolescent social anxiety.