Social Anxiety Disorder in Children and Teens

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KEY POINTS

• Social anxiety disorder is a severe fear of being watched and judged by other people that stops your child from doing things such as making friends, playing, and even going to school.
• Treatment may include cognitive behavioral therapy, exposure and response prevention therapy, assertiveness training, or medicines.
• Learning ways to relax may help.

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What is social anxiety disorder?

Social anxiety disorder is a severe fear of being watched and judged by other people. Many children feel shy or nervous in social situations, but social anxiety disorder is a much more intense fear. If your child has this disorder, he fears that if he does things when other people are around, he will look foolish and be embarrassed. The fear stops your child from doing things such as making friends, playing, and even going to school. A child with social anxiety is always tense and on edge around other people. Social anxiety disorder is also called social phobia.

Without treatment, social anxiety disorder can last a lifetime. However, treatment is very successful.

What is the cause?

The exact cause of this disorder is not known.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. A child with this disorder may have too little or too much of some of these chemicals. Some parts of the brain may be more active or less active than in other people.
• Social anxiety tends to run in families. It is not known if this is caused by genes passed from parent to child. It may also be that parents fear and avoid social events, and children learn this behavior from the parents.
• Social anxiety may start after a frightening or hurtful experience, such as being bullied or abused. Being very self-critical might also lead to social anxiety.

Social anxiety usually starts in the teen years, but may begin in childhood. It is more common in girls.

What are the symptoms?

Symptoms of social anxiety disorder may include trembling voice, fast or irregular heartbeat, hot and flushed skin, sweaty palms, nausea, headaches, or stomachaches. Your child may cry, cling to you, or have tantrums. Feelings your child may have with social anxiety include:

• Anxiety when your child is the focus of attention, even for a short time
• Fear of being judged and rejected
• Fear that other people will notice how nervous your child is
• Fear of offending someone
• Fear of unfamiliar people or social events
• Fear of being embarrassed that is so severe that your child cannot take part in school or social activities

If your child has this disorder, he or she may panic when thinking about a social situation, and worry about what people think of them for hours afterward. Social anxiety can lead to lack of self-confidence, lack of self-esteem, depression, alcohol and drug abuse, and suicide.

How is it diagnosed?

Your child's healthcare provider or a mental health therapist will ask about the child's symptoms, medical and family history, and any medicines the child is taking. He or she will make sure that your child does not have a medical illness or drug or alcohol problem that could cause the symptoms.

You may want to contact a mental health therapist who specializes in working with children and teens. The therapist will ask questions, watch your child, and may give some special tests.

How is it treated?

There are several ways to treat social anxiety disorder. The first step is usually to help you and your child 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.

Group therapy that focuses on social skills may also be helpful.

Sometimes medicine may be used as well as therapy. Your child’s healthcare provider will work with you and your child to select the best medicine. Your child may need to take more than one type of medicine.

Learning ways to relax may help. Yoga, meditation, and deep breathing exercises may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and psychotherapy to treat your child.

How can I help my child?

• Support your child. Let your child talk about the scary feelings if he feels ready. Do not force the issue if your child does not feel like sharing his thoughts. Do not criticize your child for his fears or for acting younger than his age. Let your child know that he is safe and protected. Praise him when he takes part in an activity in spite of his fears. The support and understanding that you provide can help children deal with scary emotions.

  Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.

• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax. For example take up a hobby, listen to music, play, watch movies, or take walks.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that your child takes.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Get emergency care if your child or teenager has ideas of suicide, harming himself, or harming others.

For more information, contact:

• National Alliance on Mental Illness (NAMI)
  800-950-NAMI
  https://www.nami.org
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/