Social Anxiety Disorder in Children and Adolescents

ICD-10 code: F40.10

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:

  • Generalized anxiety disorder
  • Social anxiety disorder
  • Panic disorder
  • Agoraphobia
  • Specific phobia
  • Separation anxiety disorder
  • Selective mutism

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.

What is social anxiety disorder?

SAD is a psychiatric disorder that affects approximately 3-7% of children and adolescents.  SAD is characterized by the following symptoms:

  • Significant fear or anxiety about one or more social situations in which the child might be evaluated (judged) by others
  • The child fears that he or she will be judged negatively because of his or her behavior or because he or she appears anxious
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Understanding Social Anxiety Disorder

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.

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How is social anxiety disorder treated?

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.

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