Social anxiety disorder (SAD, also called social phobia) is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:
These disorders are characterized primarily by the experience of excessive fear and anxiety. Children with generalized anxiety disorder spend a lot of time worrying about a lot of different things. Children with social anxiety disorder feel very anxious around other people because they are afraid of embarrassing themselves or being disliked. Children with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. Children with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like or other embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. Children with a specific phobia are afraid of a certain object or situation, such as flying, heights, animals, or seeing blood. Children with separation anxiety disorder are afraid of being away from a certain person, often a parent, usually because they are afraid that something bad might happen to them or the other person if they are separated. Children with selective mutism do not speak in situations where it would be socially appropriate for them to speak, such as at school.
The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the child or adolescent is only excessively fearful of a very specific object or situation. In other anxiety disorders, like GAD, the child or adolescent may feel anxious a great deal of the time or about a lot of different things.
SAD is a psychiatric disorder that affects approximately 3-7% of children and adolescents. SAD is characterized by the following symptoms:
Sometimes social anxiety symptoms occur only in performance situations (like giving a class presentation or during a sports game). In other cases, the child may feel extremely fearful or anxious in a variety of social situations. Some of the most common situations that socially anxious children and adolescents fear and avoid include:
Anxiety may be expressed in conventional ways (e.g., shyness) or may appear as crying, tantrums, freezing, clinging, or failure to speak in social situations. Note that for social anxiety disorder to be diagnosed, the child show social anxiety around peers, not just adults.
SAD severity can range from mild to severely impairing. In severe cases, SAD can lead to inability to attend or perform well at school or in sports, or to develop relationships with peers. Many children and adolescents with SAD also have other psychiatric conditions, most commonly other anxiety disorders, major depressive disorder, autism-spectrum disorders, and selective mutism.
SAD is characterized by abnormalities of brain function, including hyperactivation of the amygdala (involved in emotion generation) and abnormal connectivity between the amygdala and the ventral prefrontal cortex (involved in emotion regulation), which are thought to contribute to symptoms. In addition, certain beliefs ("no one likes me," "I will embarrass myself") and avoidance of feared situations is thought to contribute to the persistence of anxiety.
SAD is treatable. Currently there are no published guidelines specifically for pediatric SAD. However, published guidelines for pediatric anxiety, broadly defined, are provided by the Society of Clinical Child and Adolescent Psychology. The American Academy of Child and Adolescent Psychiatry offers historical practice parameters (last updated in 2007); new parameters are being developed.
Clinical research suggests that the following treatments are effective in treating pediatric anxiety:
For more information about drug prescribing in SAD, click here.
Other Treatments to Consider
In the event of non-response to established treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric anxiety:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.
Clinical research suggests that the following treatments are effective in treating pediatric anxiety:
For more information about drug prescribing in SAD, click here.
Other Treatments to Consider
In the event of non-response to established treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric anxiety:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.