Social anxiety disorder or social phobia is an excessive fear of being negatively evaluated, rejected,
humiliated or embarrassed in front of others. Therefore children and adolescents with social phobia fear a
wide range of situations such as giving oral reports, participating in gym class, speaking to adults or peers,
starting or joining in conversations, eating in public, and taking tests. They may fear unfamiliar persons, and
therefore have difficulty making friends or meeting new people. Children and teenagers with social phobia
typically respond to these feelings by avoiding the feared situation. They may stay home from school or
avoid parties. Social phobia can be limited to specific situations, so the adolescent may fear dating and
recreational events but be confident in academic and work situations. While studies have reported cases of
social phobia in children as young as 8 years, it is more frequently diagnosed in adolescents.
Social anxiety disorder is one of the most common of all mental disorders. Studies estimate rates of social
phobia in youth at approximately 1-9%, depending on the age and gender. Twice as many females as males
have social anxiety disorder. Social anxiety disorder usually begins in the early to mid-teens, although it can
sometimes begin earlier in childhood or in adulthood. Family history, negative life experiences, anxious
temperament and new social demands are also risk factors.
Researchers believe that a combination of genetic and environmental influences results in the emergence and
maintenance of social phobia. Biological theories suggest that some children are born with a genetic
predisposition for shyness or an inhibited temperament, which is translated into social phobia when stressful
life situations occur. Some research has found that parents of socially phobic children and adolescents tend
to be socially anxious themselves and overly concerned with the opinions of others.
Social Anxiety Symptoms
• Intense fear of social and performance situations
• Avoids social situations or endures them with intense distress
• Fears situations such as unstructured interactions with peers, initiating conversations, performing in
front of others, inviting others to get together, talking on the telephone, and eating in front of others
• Minimal interaction and conversation with peers
• Appears isolated and on the fringes of the group
• May sit alone in the library or cafeteria, hang back
• Excessive shyness
• Concern about negative evaluation, humiliation or embarrassment
• Difficulty with public speaking, reading aloud, being called on in class, gym class
• Anticipation of a social event may provoke a panic attack
• Physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, nausea, muscle
Treatment Social Anxiety Disorder
The scientific literature supports the use of Cognitive Behavioral Therapy. CBT uses practical and reasonable
strategies directed at changing the issues that hold anxiety such as negative thoughts or expectations,
physical symptoms, avoidance, and the reactions and responses of adults to an anxious child. Children learn
to think more realistically about fears and to confront the feared social situations.
Group therapy which provides experiences in social skills, such as initiating conversations, inviting others to
get together, and being assertive is also helpful. When deemed necessary by a child and adolescent
psychiatrist, a combination of CBT and medication may be prescribed.