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Social Anxiety Disorder in Children and Adolescents

By Josephine Elia, MD, Professor of Psychiatry and Human Behavior, Professor of Pediatrics;Attending Physician, Sidney Kimmel Medical College of Thomas Jefferson University;Nemours/A.I. duPont Hospital for Children

Social anxiety disorder (social phobia) involves a persistent fear of being embarrassed, ridiculed, or humiliated in social situations.

Sometimes social phobia develops after an embarrassing incident.

Usually, this disorder is first noticed when children throw tantrums, cry, cling, or withdraw in social situations or when adolescents worry excessively before going to a social event or prepare excessively before a class presentation. They may then refuse to go to school or social events. The reason they give is often a physical symptom, such as stomachache or headache.

Children are terrified that they will humiliate themselves in front of their peers by giving the wrong answer, saying something inappropriate, becoming embarrassed, or even vomiting. When the fear is excessive, children may refuse to talk on the telephone or to leave the house.


  • Symptoms

The diagnosis is based on symptoms. For the disorder to be diagnosed, symptoms must last 6 months or more. Also, children must feel anxious in all similar situations—for example, before all class presentations, not just for certain classes or teachers—and they must feel anxious when interacting with other children, not just adults.


  • Behavioral therapy

Behavioral therapy is used most often. It involves not allowing children to miss school. Absence makes them even more reluctant to attend school.

If behavioral therapy is ineffective or children will not participate in it, a drug that can reduce anxiety, such as a selective serotonin reuptake inhibitor (SSRI—see Table: Drug therapy for depression), may help. The drug may reduce anxiety enough to enable children to participate in behavioral therapy.