Social Anxiety Disorder Social Anxiety Disorder Guide Social Anxiety Disorder Guide Symptoms & Diagnosis Causes Treatment Living With In Children Social Anxiety Disorder in Children How to Recognize and Treat SAD in Kids By Arlin Cuncic Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." Learn about our editorial process Updated on September 18, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Aron Janssen, MD Medically reviewed by Aron Janssen, MD LinkedIn Aron Janssen, MD is board certified in child, adolescent, and adult psychiatry and is the vice chair of child and adolescent psychiatry Northwestern University. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Types Symptoms Causes Diagnosis Treatment Tips for Parents Next in Social Anxiety Disorder Guide Signs That You May Have Social Anxiety Disorder 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. For some teenagers, social anxiety becomes chronic, affecting school performance, extracurricular activities, and the ability to make friends. 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). General vs. Performance-Only SAD Symptoms Symptoms in children can vary by age. As a parent or loved one, know that not all of these behaviors necessarily reflect SAD, but if you consistently recognize them and have cause for concern, consider seeking further evaluation with a psychotherapist. Pre-School Children Fear of new thingsIrritability, crying, or whiningFreezing or clingingRefusing to speak School-Aged Children Fear of reading aloud or answering questions in classFear of talking to other kidsFear of being in front of the classFear of speaking to adultsFear of musical or athletic performance activitiesFear of ordering food in a restaurantFear of attending birthday partiesFear of having friends visitWorry about being judged by othersRefusal 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 settingshas few friendsis afraid to start or participate in conversationsis afraid to ask others to get togetheris afraid to call othersavoids eye contactspeaks softly or mumblesappears 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. In addition, untreated social anxiety disorder in adolescence may lead to increased risk of other mental health problems later in life such as depression, eating disorders, substance abuse, and even suicidal ideation. 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. Understanding the Causes of Social Anxiety Disorder 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. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. 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. How SAD Is Diagnosed 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. As a parent, read about the disorder and increase your awareness of what your teen is experiencing. Be in touch with your school to coordinate efforts with teachers, school counselors, and other personnel. Together, you can work toward improving the situation for a child or teen with SAD. The 7 Best Online Therapy Programs for Kids 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. How to Parent Teens With Social Anxiety 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. 6 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Schneier FR. Social anxiety disorder. BMJ. 2003;327(7414):515-6. doi:10.1136/bmj.327.7414.515 Hitchcock CA, Chavira DA, Stein MB. Recent findings in social phobia among children and adolescents. Isr J Psychiatry Relat Sci. 2009;46(1):34-44. Jefferson JW. Social Anxiety Disorder: More Than Just a Little Shyness. Prim Care Companion J Clin Psychiatry. 2001;3(1):4-9. Child Mind Institute. Social Anxiety Disorder Basics. Masia-warner C, Klein RG, Dent HC, et al. School-based intervention for adolescents with social anxiety disorder: results of a controlled study. J Abnorm Child Psychol. 2005;33(6):707-22. doi:10.1007/s10802-005-7649-z Anxiety and Depression Association of America. Tips for Parents and Caregivers. Additional Reading Kodish I, Rockhill C, Varley C. Pharmacotherapy for anxiety disorders in children and adolescents. Dialog Clin Neurosci. 2011;13(4):439-52. Ryan JL, Warner CM. Treating adolescents with social anxiety disorder in schools. Child Adolesc Psychiatr Clin N Am. 2012;21(1):105-18, ix. doi:10.1016/j.chc.2011.08.011 By Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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