Social Anxiety Disorder in a Child

Summary of this page

  • Children with social anxiety are fearful of embarrassing themselves in social situations and it is usually first identified in school
  • Social Anxiety can be confused with separation anxiety and Fear of Harm 
  • Children will usually cry or tantrum or may have physical symptoms when they are experiencing  social anxiety and will try to avoid the situations where they are experiencing the anxiety. They can have these symptoms in the situations  or outside the situations when they think about them
  • Social anxiety is partially inherited and also can be can be made worse by allowing your child to avoid social situations
  • Treatment for social anxiety in children includes individual, group, and school interventions as well as ssris if necessary. Details are described
  • Parent suggestions for work you can do at home with your child are described


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Symptoms of Social Anxiety Disorder in a Child

Could you be dealing with separation anxiety disorder ( fear mostly of separating from you) or FEAR OF HARM (marked by even more severe anxiety that fear of harm will come to self, obsessive nighttime rituals, fear of dark, intruders, separation anxiety and aggression?) instead?

 Learn about separation anxiety here

AND

FEAR OF HARM HERE


Social anxiety disorder in a child is also called social phobia. Children who have social anxiety disorder are afraid of social situations, often embarrassing themselves. Approximately 5 percent of children have Social anxiety disorder.  Social situations for children usually involve school, and this may be the first place it is identified. Children with social anxiety disorder may be terrified of new social situations, class activities or projects where they may have to perform in front of others, or gym class. Social anxiety disorder in a child may also cause panic attacks, cry, and tantrum or have physical symptoms of stomach aches and headaches. These behaviors can occur while in actual social situations or even just when thinking about social situations. Children will often avoid the painful experience of anxiety by engaging in behaviors to avoid or escape situations where there is pressure to interact socially.



If your child shows anxiety about activities that should be fun for them, such as birthday parties, is reported by teachers to withdraw or have trouble interacting with children at school or seem to struggle with peers or in other social situations possible social phobia. Seek professional help to determine if they meet the criteria for social anxiety disorder in a child.

Is there a Test for Social Anxiety Disorder?

There is no test for social anxiety disorder in a child. You need to bring your child to a therapist or psychologist  skilled in child anxiety disorder if you would like an accurate diagnosis.

Shyness or Social Anxiety Disorder in a Child?


Shyness is not social anxiety. However, young children who are shy or have difficulty with new social situations are more likely to develop a social anxiety disorder as they age. If you are concerned about any of the above symptoms, it may be important for you to seek help. Adults with a social anxiety disorder also often had a childhood-onset. Without treatments, a social anxiety disorder in a child can lead to more serious problems.

Causes of Social Anxiety Disorder in a Child

Where does anxiety come from? It definitely results from some combination of environment and genetics. Children who have social phobia may have parents who are very anxious and learn anxious behavior. Some children develop a social phobia after a traumatic experience, such as throwing up in the classroom or falling in front of others who laugh at them. They may also have an impairment that makes them feel socially different, such as speech or learning disabilities. Brain structure and biology (neurotransmitter levels) may also contribute to social anxiety. There is some evidence that there is a trait called behavioral inhibition that is inherited. This appears to be related to social anxiety and other forms of anxiety. It is important to look at all of the factors that may have contributed to your child's social phobia so that when coming up with a treatment plan, these areas can be targeted and modified.

How do I Help my Child with Social Anxiety?

Social anxiety disorder in a child must be addressed comprehensively. Social phobias can lead to later social and occupational problems, depression, and substance abuse if not treated. Like most anxiety disorders, it is also very amenable to treatment. Early intervention and the right treatment are the key. A holistic approach to treating your child's social phobia includes working with the school, educating yourself about the disorder, looking at your own possible behaviors that may be contributing, and individual or group therapy for your child.

COGNITIVE BEHAVIOR THERAPY

The best-researched treatment for social anxiety disorder in a child, cognitive behavior therapy, focuses on changing the thoughts that lead to behaviors and reactions. Cognitive-behavioral therapy for children may incorporate art, writing or play. A child may be asked to make a list or drawing of the thoughts contributing to their social fears, gently challenged the reality of those thoughts or beliefs, and then asked to generate new alternatives.

Components include:

  • Psychoeducational treatment- educating yourself about the nature and treatment of social anxiety disorder in a child.
  • Creative visualization, deep breathing, and progressive muscle relaxation - techniques to relax a child's body and mind.
  • Cognitive restructuring- changing the beliefs and thoughts that are causing your child's social anxiety.
  • Exposure therapy - exposing a child to disturbing thoughts and ideas in a safe environment and pairing these fears with mental and physical relaxation so they can be conquered outside of the therapy room. Children will be gradually encouraged in therapy to face fearful situations from the least to the most fearful.
  • Family Therapy/Parent Support

Family therapy is also helpful when treating social anxiety disorder in a child. The parents provided the tools and support necessary to help their child and become partners in their child's treatment. Some children prefer to have parents with them for the whole session, others for part of the session to discuss what they learned or achieved during the session.


GROUP THERAPY

Social Effectiveness Training (SET-C). SET-C is a group treatment program for social anxiety in a child, which involves the assistance of same-age peers using many of the above interventions and the added benefit of peer feedback.

MEDICATIONS

Medications typically utilized for social anxiety disorder in a child are selective serotonin reuptake inhibitors. There is some evidence that these are helpful for children with social phobia. However, a recent study showed that SET-BC a group therapy program was more beneficial for children than drug therapy. If possible, it is important to try good therapy before medication. (Beidel D. Turner SM, 2007)

THE SCHOOL

The school teacher can work closely with parents to assist with a social anxiety disorder in a child. In most cases, the parent will have to spearhead this effort and advocate for their child. The teacher will need to be aware of a child's actual diagnosis of social anxiety disorder, especially if in a public school setting to make the necessary accommodations. Each child will have different and specific needs in the school setting, so plans will need to be individually tailored. In most cases, close teacher and parent contact and the school counselor's involvement may need to occur.



Strategies for Parents

Get your child to a therapist familiar with anxiety disorders.

Create a thermometer with your child that expresses their level of anxiety.

Use this daily to examine where they are at the beginning and the end of the school day.

This can also help you become aware of what experiences your child might not yet be ready for. Please don't push your child into social activities he is not ready for ( also don't allow complete avoidance).

  1. Slowly expose them to experiences you have prepared them for ahead of time through roleplays. If your child is anxious about meeting new children, for example, don't push them into going to a slumber party; they may be overwhelmed and unable to cope.
  2. Educate yourself and your child about social phobia. Talk about social anxiety regularly, checking in daily to see where your child is.
  3. Please remind your child of successful times they have had socially.
  4. Roleplay with your child ways they might interact with other kids when getting ready for social interaction such as a birthday party.
  5. Create a sticker reward system for your child for talking about or dealing with their anxiety.
  6. Praise your child each time they discuss or verbalize their anxious feelings.
  7. Work on setting up play dates with children or other small social experiences when your child can handle them.
  8. Convey to your child that you know they can learn the skills to conquer their anxieties and that you will help them through it.
  9. Model the self-soothing ability and relax your body through progressive muscle relaxation: deep breathing, yoga, and creative visualization.
  10. Take field trips to serene settings to practice these techniques with your child.
  11. Use artwork to help your child create a calm and peaceful place to help relax them when fearful.
  12. Practice positive self-talk with your child. For example, if your child is going to visit a friend's house, they can say, "I will be fine; I did this last week and had a great time. I will probably have a great time again."

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Sources consulted in writing this document. Albano, A. M. (January 2000). Social Phobia in Children and Adolescents. Child Study Center Letter , Volume 4 Number 3.


American Psychiatric association. (1994). Diagnostic Manual of Mental Disorders, 4th edition. Washington,DC: American Psychiatric Association.

Beidel D. Turner SM, S. F. (2007). . SET-C versus fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry , 1622-1632.

Beidel DC, Turner SM, Morris TL (1999), Psychopathology of childhood social phobia. J Am Acad Child Adolesc Psychiatry 38(6):643-650.

Ellen Jaffe-Gill, M. M. (n.d.). Social Anxiety and Social Phobia:Symptoms,Treatment, and Support. 

Malouff, J. (2002). Helping Young Children Overcome Shyness. 

Massachusetts General Hospital, School Psychiatry Program and MADI Resource Center. (n.d.). Social Phobia ( Social Anxiety Disorder). Retrieved 12 31, 2007, from massgeneral.orghttp://www.massgeneral.org/schoolpsychiatry/info_socialphobia.asp#interventions_home Return to types of anxiety from social anxiety disorder in a child

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Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.