Theory of mind, metacognition, and executive functions in adolescents with social anxiety disorder: a comparative study.

Background: Social anxiety disorder (SAD) in adolescence is associated with significant functional impairment and increased risk of chronic mental health difficulties. Recent research highlights the potential roles of theory of mind, executive functions, and metacognitive beliefs in the onset and maintenance of SAD; however, no study has yet evaluated these three cognitive domains simultaneously in a clinical adolescent sample.

Methods: This was a cross-sectional descriptive study including 40 adolescents aged 12-16 years (SAD group: M = 14.45, SD = 1.48; control group: M = 13.89, SD = 1.32) who were diagnosed with SAD and 40 typically developing controls matched for age and sex. The participants completed the WISC-IV, the Reading the Mind in the Eyes Test (Eyes Test), the Faux Pas Recognition Test (FPRT), and the CNSVS subtests assessing Stroop Test, attention shifting, and continuous performance. The Metacognitions Questionnaire for Children and Adolescents (MCQ-C) was also administered. Parental reports provided sociodemographic data.

Results: Compared to the control group, adolescents with SAD demonstrated lower performance in FPRT total scores, cognitive flexibility, and working memory, and reported higher MCQ-C total scores. Binary logistic regression analysis revealed that both working memory (β = -0.10, p < .05) and MCQ-C scores (β = 0.17, p < .01) were significant predictors of SAD diagnosis.

Conclusions: These findings suggest that impairments in metacognitive beliefs and working memory may help distinguish adolescents with SAD from their typically developing peers. Incorporating these domains into clinical assessment and intervention strategies could enhance early detection and treatment outcomes.