Social Anxiety Disorder (Pediatric)

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    Social Anxiety Disorder, Pediatric

    Social Anxiety Disorder, Pediatric

    Social anxiety disorder (SAD), previously called social phobia, is a mental health condition. Children with SAD often feel nervous, afraid, or embarrassed when they are around other people in social situations. They worry that other people are judging or criticizing them for how they look, what they say, or how they act.

    SAD involves more than just feeling shy or self-conscious at times. It can cause severe emotional distress. It can interfere with activities of daily life. SAD may also lead to alcohol or drug use, and even suicide.

    SAD is a common mental health condition. It can develop at any time, but it usually starts in the teenage years.

    What are the causes?

    The cause of this condition is not known. It may involve genes that are passed through families. Stressful events may trigger anxiety.
    • This disorder is also associated with an overactive amygdala. The amygdala is the part of the brain that triggers the response to strong feelings, such as fear.

    What increases the risk?

    This condition is more likely to develop in:
    • Children who have a family history of anxiety disorders.
    • Females.
    • Children who have a physical or behavioral condition that makes them feel self-conscious or nervous, such as a stutter or a long-term (chronic) disease.

    What are the signs or symptoms?

    The main symptom of this condition is fear of embarrassment caused by being criticized or judged in social situations. These symptoms persist for 6 months or longer and are present on more days than not. Your child may be afraid to:
    • Perform or speak in front of others.
    • Play team sports or do other group activities.
    • Go to school.
    • Use a restroom in public or at school.
    • Play with other children.
    • Eat at a restaurant or go shopping.
    • Meet adults.

    Extreme fear and anxiety may cause physical symptoms, including:
    • Crying or temper tantrums.
    • Refusing to speak.
    • Blushing or sweating.
    • A fast heartbeat or shortness of breath.
    • Shaky hands or voice.
    • Confusion.
    • Light-headedness.
    • Upset stomach, diarrhea, or vomiting.

    How is this diagnosed?

    This condition is diagnosed based on your child's history, symptoms, and behavior in social situations. Your child's health care provider may ask about your child's use of alcohol, drugs, and prescription medicines.

    Your child's health care provider may refer you and your child to a mental health specialist for further evaluation or treatment. The health care provider may also want to talk with your child's teachers and caregivers.

    How is this treated?

    A child talking with a mental health specialist.

    This condition may be treated with:
    • Cognitive behavioral therapy (CBT). This type of talk therapy helps your child learn to replace negative thoughts and behaviors with positive ones. This may include learning better skills for managing anxiety and calming himself or herself.
    • Exposure therapy. This therapy involves helping your child practice self-calming skills and then exposing your child to social situations that cause fear. The treatment starts with imagining situations that your child fears while he or she maintains calmness. Over time, your child will learn to manage harder situations while being less reactive.
    • Prescription medicines. These medicines are often used in addition to other therapies.
    • Biofeedback. This process trains your child to manage the body's response (physiological response) through breathing techniques and relaxation methods. Your child will work with a therapist while machines are used to monitor your child's physical symptoms.
    • Relaxation techniques and self-calming for managing anxiety. These include deep breathing, self-talk, meditation, visual imagery, listening to music, muscle relaxation, and yoga. These are often used with other forms of therapy. Your child can practice them on his or her own with your coaching.

    These treatments are often used in combination.

    Follow these instructions at home:


    • Help your child practice strategies for relaxation and managing anxiety at times when there is no stress. Gradually work toward using these strategies in stressful situations.
    • Encourage your child to engage in social activities as he or she feels ready to do so. Discuss appropriate activities with your child and his or her health care provider. Help your child develop a plan.

    General instructions

    • Give over-the-counter and prescription medicines only as told by your child's health care provider.
    • Work closely with your child's health care providers, including any therapists. You can learn ways to help yourself and your child deal with stressful situations.
    • Tell your child's teachers or caregivers about your child's social anxiety. Discuss ways they can be sensitive and helpful.
    • Have your child avoid caffeine, alcohol, and certain over-the-counter cold medicines. These may make your child feel worse. Ask your pharmacist which medicines to avoid.
    • Keep all follow-up visits. This is important.

    Where to find more information

    Contact a health care provider if:

    • Your child's symptoms do not improve or get worse.
    • You think your child is using drugs or alcohol.
    • Your child has signs of depression, such as:
      • Persistent sadness or moodiness.
      • Loss of enjoyment in activities that used to bring joy.
      • Change in weight or eating.
      • Changes in sleeping habits.
    • Your child becomes more isolated than usual.
    • Your child speaks less than is normal for him or her.
    • You cannot manage your child at home.

    Get help right away if:

    • Your child harms himself or herself.
    • Your child has serious thoughts about hurting himself or herself, or hurting others.

    Get help right away if you feel like your child may hurt themselves or others, or if they have thoughts about taking their own life. Go to your nearest emergency room or:
    • Call 911.
    • Call the National Suicide Prevention Lifeline at 1-800-273-8255 or 988. This is open 24 hours a day.
    • Text the Crisis Text Line at 741741.

    This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

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