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Child and adolescent mental health

Social anxiety disorder

What is social anxiety disorder?

Children with social anxiety disorder struggle with excessive self-consciousness that goes beyond common shyness. They can worry so much about being embarrassed or judged negatively by others that they can stop doing the things that they normally love to do, as well as everyday activities. Although social anxiety disorder mostly affects adolescents, it can also begin exhibit in younger children. Undiagnosed and untreated, ithey can become isolated and depressed. Social anxiety disorder is sometimes known as social phobia. The Child Mind Institute (see below) explain social anxiety as "when you worry so much about how you appear to others that you stop doing things you need to (and want to) do for fear of embarrassing yourself".

There are two main types of social anxiety that children and young people typically experience:

  1. Performance anxiety is when they worry excessively about things like speaking in class or trying out for a team.

  2. The second type involves social situations in general — not just situations when a child is in the spotlight. They may fear things like going to school, eating in public, using public toilets, meeting new people and even talking to other children or adults.

Symptoms of social anxiety disorder in childhood

  • shyness or withdrawal 

  • difficulty meeting other children or adults, or joining in groups

  • having a limited number of friends

  • crying more than usual

  • having frequent tantrums

  • sleeping badly before an event

  • fear of going to school or taking part in classroom activities/answering questions; school performances; and social events

  • not asking for help at school

  • being very reliant on their parents/carers

  • physical symptoms such as nausea, stomach aches, blushing and trembling.

Symptoms of social anxiety disorder must be present for 6 months in order for a diagnosis to be made. It’s easy not to notice social anxiety in a child because they are often quiet and well-behaved in preschool or school and might not talk about their fears or worries.

Case studies

Emma, now an adult, tells how her social anxiety started when she was just three-years-old and continued through her school years, culminating in it becoming so severe in the sixth form that she was traunting to avoid reading outloud in A Level English and eventually had to drop that subject. It was not until Emma had to leave university after one semester, being unable to cope with group work, that she finally got some help. She was able to return to university to do a different course, and is now a successful young woman, credting her dog Harry as having played a large part in her recovery.

This paper presents the first known case reports of very young children with GAD to examine these developmental challenges at the item level. Three children, five-to-six years of age, were assessed. One case appeared to show attenuation of the worries but not when followed over two years. The other two cases showed stability of the full complement of diagnostic criteria. The cases were useful for demonstrating that the current diagnostic criteria appear adequate for this developmental period.The challenges of accurateassessment of young children that might cause missed diagnoses are discussed. Future research on the underlying dysregulation of negative emotionality and long-term follow-ups are needed to better understand the aetiology, treatment, and course of GAD in this age group. Case Reports in Psychiatry paper.

No more constant fear

Wills tells his story of constant fear as a child. At the age of five, he discovered baseball and it soon become apparant that he was very gifted at the sport and for the first time he wasn't scared and didn't feel inferior. But he didn't understand that his self-worth shouldn’t depend on other people. In his late teens he suffered a knee injury that ended his baseball career and his anxiety returned with a vengence.

Websites and web pages

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Anxiety Canada™ is a leader in developing free online, self-help, and evidence-based resources on anxiety and anxiety disorders and promotes understanding about anxiety and anxiety disorders  in children, young people and adults. They have a page dedicated to social anxiety in children and adolescents, including a list of facts about social anxiety; signs, symptoms, physical sensations, and behaviour. There is also an animated video about symptoms and strategies.

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Care for Your Mind is part of Families for Depression Awareness, an American charity that provides training, advocacy, and programs for family caregivers of people living with depression or bipolar disorder.


In this article a clinical psychologist explains the impact social anxiety can have on children and young people and how, as a 'silent disorder', it can go unnoticed for years. She explains the warning signs and what parents can do to help their child. 

An article written for young people explaining social anxiety. It includes examples of social anxiety experienced by teenagers; how it differs from simply being shy and that it is not a phobia of being in social situations; and how the person with social anxiety feels and how other people see them. There is also a page of tips on managing social anxiety.

GPonline provides daily news, information and guidance on all the issues that affect GPs in their working lives.This article discusses the diagnostic criteria for social phobia in children and young people, plus causes, assessment and management.

General information about social anxiety disorder including information about social anxiety in children. There are plenty of links

NICE - National Institute for Health and Care Excellence produce evidence-based health and social care guidance, including Identification of children and young people with possible social anxiety disorder. is an Australian parenting website. It looks at social anxiety in children under nine in depth, covering what social anxiety is in children of that age and ways of helping them, including the stepladder approach.

The University of Rochester Medical Center (URMC) is one of America’s leading academic medical centers. It forms the centerpiece of the University of Rochester’s health research, teaching and patient care missions. Although some of the information given here may not be applicable to the UK, it gives a comprehensive overview of what GAD is and how it presents in children and teens; possible causes; diagnosis; ttreatment; and how parents can help their children.

Aware that social anxiety disorder can leave a person feeling isolated, Hannah Kara is keen to show those living with the condition that help is at hand. 

A mother talks about how social anxiety tormented her son while he was growing up, yet this went unrecognised. She hopes this video will help other parents recognise it in their child and get them some help.


Rose speaks about her social anxiety as a teen and how cognitive behavioral therapy (CBT) helped.

Animated video about children and teens with social anxiety disorder, including strategies for overcoming it.

Danielle talks about her social anxiety and describes three ways she uses to overcome her fears: challenging anxiety thoughts;  focussing on thw now; and thinking outside your comfort zone.

Dr Sarah Newth, a cognitative behvioural therapist explains social anxiety disorder in children and what their parents and carers can do to help them.

Young people from Fife are shedding light on social anxiety disorder because they’re worried that teachers can be unsympathetic. With the help of Fixers, the group has made a film that gives a creative insight into how an anxiety attack can feel from the inside, when a young person has been singled out from a crowd.

Diagnostic criteria

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