Social Anxiety Disorder in Children and Adolescents

(Social Phobia)

ByJosephine Elia, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Reviewed ByAlicia R. Pekarsky, MD, State University of New York Upstate Medical University, Upstate Golisano Children's Hospital

Reviewed/Revised Modified Oct 2025

v11624245

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Social anxiety disorder is a persistent fear of embarrassment, ridicule, or humiliation in social settings. Typically, affected children avoid situations that might provoke social scrutiny (eg, school). Diagnosis is based on clinical criteria. Treatment is with behavioral therapy; in severe cases, selective serotonin reuptake inhibitors (SSRIs) are used.

Symptoms and Signs
Diagnosis
Treatment

Social anxiety disorder in children and adolescents is defined as an intense and persistent fear of social situations that may lead to embarrassment or negative evaluation. This disorder causes significant distress and impairment in functioning, as individuals avoid situations such as speaking in public, attending school, or interacting with peers. The anxiety must persist for ≥ 6 months for the diagnosis to be made.

(See also Social Phobia.)

Symptoms and Signs of Social Anxiety Disorder

The first symptoms of social anxiety disorder in adolescents may be excessive worrying before attending a social event or excessive preparation for a class presentation or other similar performance. The first symptoms in children may be tantrums, crying, freezing, clinging, or withdrawing in social situations. Avoidant behaviors (eg, refusing to go to school, not going to parties, not eating in front of others) can follow. Symptoms may often have a somatic focus (eg, “My stomach hurts,” “I have a headache”). Some children have a history of many medical appointments and evaluations in response to these somatic complaints.

Affected children may be terrified that they will humiliate themselves in front of their peers by giving the wrong answer, saying something inappropriate, becoming embarrassed, or having somatic symptoms such as vomiting. In some cases, social anxiety disorder emerges after an unfortunate and embarrassing precipitating incident. In severe cases, children may refuse to talk on the telephone or even refuse to leave the house.

Diagnosis of Social Anxiety Disorder

Psychiatric assessment
Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, Text Revision (DSM-5-TR) criteria

For social anxiety disorder to be diagnosed, the anxiety must persist for ≥ 6 months and be consistently present in similar settings (eg, children are anxious about all classroom presentations rather than only occasional ones or ones for a specific class) (1). The anxiety must occur in peer settings and not only during interactions with adults.

Diagnosis reference

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), Washington: American Psychiatric Association, 2022.

Treatment of Social Anxiety Disorder

Behavioral therapy
Sometimes an anxiolytic

Behavioral therapy is the cornerstone of treatment for social anxiety disorder. Encouraging consistent school attendance is crucial, as it helps foster a positive routine and makes returning to the classroom easier.

If children and adolescents are not sufficiently motivated to participate in behavioral therapy or do not respond adequately to it, an anxiolytic such as a selective serotonin reuptake inhibitor (SSRI) may help. Treatment with an SSRI may reduce anxiety enough to facilitate children’s participation in behavioral therapy.

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