Anne Marie Albano, Ph.D.
Associate Professor, Clinical Psychology in Psychiatry
Director, Columbia University Clinic for Anxiety and Related Disorders,
Columbia University Medical Center
Social anxiety disorder (SAD), or social phobia, can have a crippling effect on young people. Children who avoid raising their hand or speaking up in school can become tweens who withdraw from extracurricular activities, and then teens who experience isolation and depression. In fact, children with social anxiety disorder are more likely than their peers without SAD to develop depression by age 15 and substance abuse by age 16 or 17.
As they head toward adulthood, young people with social anxiety disorder tend to choose paths that require less involvement with other people, and so cut short a lot of opportunities. Bright, intelligent young people who have yearnings to be lawyers or doctors, but cannot interact with other people, may choose a profession or work that is very solitary; or they might not enter the work force at all.
Understanding that social phobia is a gateway disorder to depression, substance abuse, and lifetime impairment, we must make it a priority to identify it when children are younger. If we can reach children in the early stages of the disorder, we can provide them basic skills to help them manage their feelings and increase their ability to interact with people.
Parents play an important role in identifying and helping children overcome social anxiety. Learning to distinguish a shy child from one with social phobia, and understanding how parents can empower—rather than enable—children with social anxiety will help our children live full, socially rich lives.
Recognizing the “silent disorder”
Social anxiety disorder is sometimes called a silent disorder because it can affect children for years before it is diagnosed. As children grow and mature, they learn how to avoid being the focus of attention at school or home; as a result, their extreme discomfort in social situations can go unnoticed.
Because children with social phobia are generally content and compliant around home, and because parents do not receive reports of misbehavior at school, many families fail to recognize a problem until their child is already withdrawn from activities and peers. By this point, the child may be experiencing extreme isolation and falling behind developmentally and academically.
Sometimes social phobia goes undiagnosed because parents confuse it with shyness. Shyness is a temperament; it is not debilitating the way social anxiety disorder is. A shy child may take longer to warm up to a situation, but they eventually do. Also, a shy child engages with other kids, just at a different level of intensity than their peers. In contrast, children with social phobia will get very upset when they have to interact with people. It is a frightening situation for them, and one they would rather avoid altogether.
Understanding the warning signs
The average age of onset is 13 years, but you can see social phobia as early as 3 and 4 years old. In young children, it may take the form of selective mutism, meaning that the child is afraid to speak in front of other kids, their teachers, or just about anyone outside of the immediate family.
In elementary school, children with social phobia may start to refuse activities and you see kids dropping out of Scouts or baseball. By middle school, they may be avoiding all extracurricular activities and social events. And by high school, they may refuse to go to school and exhibit signs of depression. (Read about SAD in children and adolescents.)
Parents can help prevent social phobia from taking hold by being attuned to warning signs and symptoms. These questions highlight warning signs:
- Is a child uncomfortable speaking to teachers or peers?
- Does he or she avoid eye contact, mumble or speak quietly when addressed by other people?
- Does a child blush or tremble around other people?
- Does a young child cry or throw a tantrum when confronted with new people?
- Does a child express worry excessively about doing or saying something “stupid”?
- Does a child or teen complain of stomachaches and want to stay home from school, field trips or parties?
- Is he or she withdrawing from activities and wanting to spend more time at home?
If a parent observes these signs, a doctor or mental health professional can help evaluate the child and determine if the disorder is present.
Understand parents’ role
For most young people, social phobia is successfully treated with therapy and sometimes medication. Additional support and accommodations at home can support recovery. For example, we know that some parents unknowingly contribute to a child’s condition by protecting them from situations that cause discomfort. If a teacher says “hello” and asks a child his or her name, the parent may answer: “His name is John. He’s a little shy.” The parent is stepping in to make the situation less stressful for their child, but a simple act like that can exacerbate the disorder because it does not help the child learn to manage the feelings and anxiety such an interaction invokes.
We need parents to take a look at themselves and how they are helping their child navigate their way into these sorts of everyday social interactions, rather than avoiding or going around them. Parents can be sensitive to the anxiety these situations cause without isolating their children from them. With the help of professionals, parents can learn to be exposure therapists, encouraging and supporting a child through the social situations that cause anxiety. (See how one teen overcame social anxiety disorder with the support of her mother and exposure therapy.)
The important thing to remember about social anxiety disorder is that there are effective ways of turning this around. Anxiety is a natural emotion and we all have the ability to harness it; some kids just need extra help developing those skills. But when they do learn these skills, it is so heartwarming to see how their world opens up and their lives improve. It is what has kept me working in this field for almost 30 years.
- What intervention would have helped you as a child in dealing with social anxiety?
- How can we educate parents about social anxiety disorder so they can help their kids to be diagnosed and treated?
- What should pediatricians, schools and community institutions do to support parents in knowing about SAD and how to help their kids?