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Social Anxiety Disorder in Children and Adolescents

(Social Phobia)

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 involves a persistent fear of being embarrassed, ridiculed, or humiliated in social situations.

  • Children and adolescents with social anxiety disorder typically avoid social events and other situations that might expose them to humiliation or embarrassment.

  • Doctors diagnose social anxiety disorder based on symptoms.

  • Behavioral therapy may help, but a drug to reduce anxiety may be needed.

Sometimes social anxiety disorder develops after an embarrassing incident.

Symptoms

Usually, social anxiety disorder is first noticed when

  • Children throw tantrums, cry, cling, freeze up, or withdraw or refuse to speak in social situations.

  • 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.

Diagnosis

  • Symptoms

The diagnosis of social anxiety disorder is based on symptoms, such as crying, tantrums, freezing, clinging, and refusing to speak in social situations. 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.

Treatment

  • 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), may help. The drug may reduce anxiety enough to enable children to participate in behavioral therapy.