Social Anxiety Disorder in Children

Children and teenagers with social anxiety disorder (SAD) may live with symptoms into adulthood without ever being diagnosed. Although SAD is the third most common mental health disorder, many parents and teachers are not familiar with the signs and symptoms in children and teenagers.

Social anxiety disorder involves an intense fear or phobia of social and performance situations. Although most teenagers go through periods of normal anxiety related to the changes that go along with adolescence, those with SAD experience fear that is out of proportion to the situations that they face.

Types

Children and teenagers can be diagnosed with a more generalized form of social anxiety disorder or with the performance-only specifier (only performance situations cause anxiety).

Symptoms

Symptoms in children can vary by age.

Pre-School Children

• Fear of new things
• Irritability, crying, or whining
• Freezing or clinging
• Refusing to speak

School-Aged Children

• Fear of reading aloud or answering questions in class
• Fear of talking to other kids
• Fear of being in front of the class
• Fear of speaking to adults
• Fear of musical or athletic performance activities
• Fear of ordering food in a restaurant
• Fear of attending birthday parties
• Fear of having friends visit
• Worry about being judged by others
• Refusal to participate in activities or school

In addition, children with SAD are more likely than adults to experience physical symptoms like headaches, stomach aches, and nausea.

Teens

Temperament

Look for a teenager who...

• is quiet
• keeps to him/herself
• becomes more withdrawn if encouraged to talk
• is hesitant
• is passive
• is overly concerned about negative evaluation
• fears being embarrassed or humiliated
• crosses his/her arms
• keeps his/her head down
• displays few facial expressions
• has nervous habits such as hair twirling or fidgeting

School Behavior

• potentially does poorly in school
• doesn't raise his/her hand in class
• avoids classmates outside class
• fears performing in front of others/public speaking
• fears speaking up in class
• is uncomfortable in the spotlight
• sits alone in the library or cafeteria
• is afraid to ask the teacher for help
• is afraid to walk into class late
• may refuse to go to school or drop out

Behavior With Peers

• is uncomfortable in group settings
• has few friends
• is afraid to start or participate in conversations
• is afraid to ask others to get together
• is afraid to call others
• avoids eye contact
• speaks softly or mumbles
• appears to always be "on the fringes"
• reveals little about him/herself when talking to others

Teenagers with social anxiety disorder are at a disadvantage in all areas of life. They may perform poorly at school and may have trouble attending classes. Students with the disorder are also less likely to make friends and participate in extracurricular activities.

Those with severe SAD may drop out of school or refuse to leave home.

Causes

Just as with adults, social anxiety disorder in children and teenagers may be caused by genetic factors, environmental factors, societal factors, and brain/biological factors. Many parents may blame themselves, but know that it's usually a combination of things that cause the disorder. The most important thing you can do know is support the child and help them find help.

Diagnosis

Diagnosis of social anxiety disorder in children and teenagers involves an evaluation of symptoms in several contexts. This evaluation will often include the perspective of parents and teachers and may involve the use of school records.

Children and teens with SAD can go undetected if parents and teachers interpret the student's behavior as shyness. However, SAD awareness is critical, and early detection and intervention are needed to prevent long-term impairment.

Potential underlying medical conditions are explored and other explanations for the behavior such as bullying are also considered. If the student is at risk of self-harm or suicide, these issues are addressed immediately.

The same diagnostic criteria used to diagnose adults also apply to children and teenagers. However, there are some additional caveats. Children and teenagers may not recognize that their fear is unreasonable and their anxiety must be present when interacting with their peers, not just adults.

Treatment

Treatment of SAD in children and teenagers is aimed at helping to alleviate anxiety and allow the student to cope with school and day-to-day functioning. Effective treatments may include the following:

• Cognitive-behavioral therapy (CBT)
• Family therapy
• Medication such as selective serotonin reuptake inhibitors (SSRIs), for example: Zoloft and Prozac

In addition to standard treatments, there are a number of coping strategies that can be employed by teachers, parents, and students to manage social anxiety both in and out of school.

Schools can play an important role in this process, as it is the place where social anxiety disorder can often have the most negative effect on a teen's functioning. School-based interventions led by psychologists, social skills training, and academic skills training are all helpful ways that schools can intervene in cases of SAD.

Tips for Parents

As a parent of a socially anxious child, it can be hard to know how best to offer your support. It's important to manage your child's social anxiety in a constructive way.

Give your child or teen chances to expose him or herself to feared situations. Don't speak for your child or teen and offer praise when a feared situation is faced.

Choose realistic goals for your child or teen such as joining a club or making a new friend. Then, outline steps that can be taken to achieve this goal. Also, encourage activities that help your child or teen to relax such as arts and crafts, music, yoga, and writing.

Be a good listener and let your child or teen know that what he or she is experiencing can be overcome. Remind your child or teen of past successes and build his or her confidence.

Finally, seek help for your child or teen if anxiety becomes severe. Some problems are too big for you to handle on your own and require intervention such as medication or professional therapy.

A Word From Verywell

If you have a child or teen who you believe is living with social anxiety, it is important to make an appointment for a diagnosis and potential treatment. The longer this disorder goes undiagnosed, the more impairment your child will experience. By the same token, if you are a teen living with social anxiety, reach out to a parent, teacher, or guidance counselor about the symptoms you are experiencing so that you can receive help.