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Social Anxiety Disorder in Children and Teens



  • 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.


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. With this disorder, your child fears that if your child does things when other people are around, your child 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 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 you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals. Anxiety disorders can happen because of brain chemicals, certain genetic factors you inherit from your parents, and life events.
  • 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 self-critical might also lead to social anxiety. You may feel a lot of pressure to look or to act a certain way, or feel pressure to meet certain goals by a certain age.

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, your child 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 use disorders, 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. Your provider will check for 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) is a good way to help your child identify and change views your child has of self, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help your child learn new thought and behavior patterns even after your child stops going to therapy. It can help your child learn to manage stress and improve self-esteem. 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 such as using 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 your child feels ready. Do not force the issue if your child does not feel like sharing thoughts. Do not criticize your child for the fears or for acting younger than your child’s age. Let your child know that he or she is safe and protected. Offer praise when your child takes part in an activity in spite of the 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, help your child take up a hobby, listen to music, play, watch movies, or take walks.
  • Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical activity 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 prescription and nonprescription medicines, natural remedies, vitamins, and supplements you take.
  • 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 self, or harming others.

For more information, contact:

Developed by Change Healthcare.
Pediatric Advisor 2022.1 published by Change Healthcare.
Last modified: 2021-12-07
Last reviewed: 2019-12-23
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2022 Change Healthcare LLC and/or one of its subsidiaries
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