Social Anxiety Disorder in Children and Teens

What is social anxiety disorder?

Social anxiety disorder is also known as social phobia. Social phobia is anxiety about social situations. A child with this disorder is afraid of being embarrassed or humiliated. Just thinking about going out in a social situation makes the child very anxious. These situations might include group activities, speaking in front of the class, eating in front of others, or answering questions. The child with social anxiety is very stressed in a social situation.

Most fears are normal at certain ages. For example, toddlers fear strangers and loud noises. Fears are different from anxiety. Fear is a reaction to danger that involves the mind and body. With anxiety, the feeling is that something bad could happen. Anxiety is not a response to something that is actually happening.

What is the cause?

There are different ideas about how social anxiety develops. It may be the result of chemical imbalance in the brain. Social phobia tends to run in families. If a parent suffers from an anxiety disorder, it is more likely the child will too. The condition may also be learned. If parents are shy, they may not take their child to different places to meet different people, and the child will not learn to cope with new situations. Being scared or hurt might have started the anxiety. Being very self-critical might also lead to social anxiety.

What are the symptoms?

Anxiety symptoms include:

• a trembling voice
• crying
• screaming
• staying away from unfamiliar places or situations because they are afraid
• changes in heart rate
• sweaty palms
• nausea
• headaches
• stomachaches
• fear of being embarrassed that is so severe that the child cannot take part in school or social activities

Shy children will generally warm up and relax after a few minutes. Children with social anxiety find it very difficult to relax. Their anxiety interferes with things children normally do, such as make friends, play, participate in class, and even attend school. In severe forms social anxiety can lead to isolation from peers. It can also lead to lack of self-confidence, lack of self-esteem, and a lack of assertiveness skills.

How is it diagnosed?

Your healthcare provider or therapist will ask about your child's symptoms and any drug or alcohol use. Your child may have some lab tests to rule out medical problems.

You may want to contact a mental health therapist who specializes in working with children and teens. The therapist will ask questions, observe the child, and may give some special tests. Parents and teachers will also be asked about the child's behavior. The mental health specialist will assess:

• how severe the child's symptoms are
• how often the child has problems
• how much the anxiety interferes with the child's daily activities
• if the anxiety seems appropriate for the child's age

How is it treated?

There are several ways to treat social anxiety disorder. The first step is usually to help the child and parents learn about the disorder. Cognitive behavior therapy (CBT) helps children learn what causes them to feel anxious and how to control it. CBT might also include social skills training, role-playing, and learning relaxation skills. Exposure and response prevention therapy (ERPT) helps children to face their fears. Children learn ways to control their body's response to anxiety, like breathing exercises.

Sometimes medicine may be used as well as therapy. Your child’s healthcare provider will work with you and your child to carefully select the best one for the child.

How long will the disorder last?

Some children outgrow social anxiety. Others learn ways to manage their anxiety. However, without treatment, social phobia can last a lifetime. It is very important to get help early.

What can I do to help my child?

If you suspect that your child might have social phobia:

• Call your child's healthcare provider about physical problems that might cause anxiety or make it worse.
• Teach children and teens to avoid alcohol, caffeine, and stimulants like ephedra and guarana.
• Let children talk about the scary feelings. The support and understanding that you provide can help children deal with their fears.

When social anxiety seriously interferes with school, making friends, or daily activities, your child needs help. Meet with a mental health specialist for a full assessment.