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Social Phobia In Children

What is social phobia?

  • Social phobia (or SP), also called social anxiety disorder, is a fear-based anxiety problem. It is the most common type of anxiety problem seen in older children and adolescents (teenagers). With SP your child has a phobia (strong, ongoing fear) of social situations or ones where he performs. Your child's SP may be limited to public speaking or other performing activities. Your child may seek to avoid or get through these events, but with much worry and stress. Your child may have a more severe (very bad) form of SP. He may be afraid of most events where he is around others or has to perform in front of others. SP may be seen in grade-school-aged children, but more often it starts during early adolescence. When your child has SP, he may also have one or more other types of anxiety disorders. SP can be a problem through your child's life, even as an adult.

  • When your child has SP he may be very shy and quiet around other people, even those he knows. He may try to avoid talking to other people he does not know well. Younger children with SP may also get a condition called selective mutism (not talking). If your child has this condition, he cannot talk to other people in social settings. Your child may also be very self-conscious whenever he is around people other than his own family. He fears being judged by others and thinks he will do or say something to embarrass himself. He may be unable to eat in public or use a public toilet. In school he may fear having to answer questions, read aloud, or do sports or musical activities. He may avoid going to parties or dating, and have few or no friends.

What causes social phobia?

No one knows for sure what causes this disorder. SP may come after your child has a shameful experience, or a major life stress. Your child may be stressed when away from his parents or if his parents areno longer living together. Having an illness for a long time may cause stress. History of sexual abuse orfighting in the family may also be stressful for your child. The following may increase your child's risk for SP:

  • Child's temperament: Some children are more afraid of unknown people, places, or things than other children. This may been seen even when they are babies. These children may more easily get SP.

  • Family history: Having a close family member with SP or other anxiety disorder.

  • Family social behavior: Behavior (how one acts) may be copied by a child from parents who show fear in social situations. For example, if a parent avoids going out in public, their child may also avoid it.

  • Parents' behavior towards child: Having parents who over protect, demand, or judge too much.

What are the signs and symptoms of social phobia?

Signs and symptoms of SP may increase over time. Your child may show any of the following:

  • Fear level and duration: He has an increased, very bad, and ongoing fear of one or more social or performance situations. This includes fear your child has about being around other children, not just adults.

  • Knowledge of fear level: Depending on your child's age, he may be aware that his fear is not reasonable. He may know that his worrying is too much, or uncalled for.

  • Response to feared situations: He is almost always anxious and fearful before an event. He tries to avoid or just get through it, but with much distress.

  • Physical signs and complaints: When your child is anxious about feared social situations, he may show it as any of the following:

    • Blushing or turning red, sweating, or dry mouth. Shaky voice or being unable to speak.

    • Crying, freezing, or shrinking fromcertain places and times where there are other people.

    • Fast or pounding heartbeat.

    • Problem focusing on a task.

    • Shaking, trembling, or tense muscles.

    • Stomachache, nausea (upset stomach), or diarrhea (loose or frequent bowel movements).

    • Tantrums (angry outbursts), and being easily angered.

How is social phobia diagnosed?

  • Your child's caregiver will ask you and your child questions. These include information about your child's health history, behavior, and fears and worries. He will also need to know if other family members have had anxiety disorders or other mental health problems. He may want to know how your child is doing at school or with other activities. He may also want to know about how your child gets on with other children and if he has friends. Tests may need to be done to check for medical problems that may be causing your child's symptoms.

  • Your child's caregiver will watch your child's behavior, fears, and worries in looking for signs and symptoms of SP. If your child has all four signs and symptoms of SP, he may have this disorder. To have this disorder, the signs and symptoms must have been present for at least six months. They are bad enough to cause problems in his learning, social skills, his relationships, and other areas of life. Your child's worry should not be caused by another mental health problem or a medical condition. It should not be due to side effects of a medicine or from substance abuse.

How is social phobia treated?

Because of the bad problems that can come with having SP, getting treatment is very important. With treatment, your child's social phobia may decrease, and he may be able to do more activities. If your child is treated for SP when he is young, this may help prevent him from having SP as an adult. Your child's caregivers may use any of the following to treat your child:

  • Medicines: These may include antidepressants, tranquilizers, or other antianxiety medicines. They may be given if your child has severe anxiety symptoms.

  • Behavioral therapies: These are programs that work towards changing how a person behaves (acts) and responds in certain situations:

    • Cognitive behavior therapy: This is the most commonly used therapy for SP. It works to change how a person acts in part by changing how he thinks. It may be done by your child alone, with a group, or along with you or your family. This therapy helps your child learn how to control his actions and improve his behavior. Your child may be taught how to change his behavior by looking at the results of his actions. He may learn that certain actions have different results that may make him feel either good or bad about himself. Good behaviors will be rewarded and encouraged, while unwanted behaviors will be discouraged. This therapy may include any of the following:

      • Assertiveness training: This is therapy to help your child better control his feelings. It may help him understand his feelings and learn how they cause him to act. This therapy can train your child to become more confident. It teaches him ways to handle situations that cause negative thinking and anxiety.

      • Exposure or desensitization: Exposure or desensitization therapy helps your child face a feared object, person, or situation. Fantasy (not real) or real-life situations are used with this therapy. The goal of desensitization therapy is to help decrease your child's fear or anxiety.

      • Parent training: You may be given special training to help you cope and handle your child's anxiety. This training will also help you control your own anxiety.

      • Relaxation training: Your child may be taught ways to relax through special exercises. This therapy teaches your child how to calm his body and mind. The goal is to decrease your child's body and emotional (mental feelings) stress.

      • Social skills training: This teaches and trains your child how to get along with other people. Training may include teaching your child to maintain eye contact and smile. He may also be taught on how to accept praises and ask questions.

  • Cognitive therapies: This is a type of therapy that helps people understand why and how they think a certain way. How they think can affect how they act. This is therapy or counseling that is usually done in a series of meetings or talks. These may be attended by you, your child, and your family. These therapies include:

    • Cognitive restructuring: Caregivers help your child learn which thoughts bring anxiety. These thoughts are replaced with realistic and more pleasant ones. Your child may be taught on using positive self-statements to help him handle his anxiety.

    • Psychodynamic therapy: This therapy helps your child to deal with conflict in a healthier way. It helps your child deal with rejection and bad things that happened in his past. This therapy may help your child to feel better about him, and to feel more in control of his life.

What can I do to help my child with social phobia?

  • Be a positive role model for your child. Learn ways to control your own anxiety. Your child learns from watching your behavior. He may be more likely to face his fears if he sees that you can do it. Be careful that your actions do not support or strengthen your child's social phobia behavior. These actions may include you avoiding anxiety-causing situations or drinking alcohol to control your anxiety. Talk to your child's caregiver if you are having trouble controlling your own anxiety.

  • Encourage your child to socialize. Help your child develop his social skills. Help him face his fears and develop ways of coping, such as thinking about other things. Praise and reward your child when needed.

  • Learn more about social phobia. Ask your caregiver for websites and books about SP. The more you know about your child's condition, the better you can help him manage his anxiety. Work with your child's teacher to help your child in school.

What are the risks to my child of having social phobia?

  • Your child's SP may not go away and can get much worse if left untreated. In avoiding social activities, your child may become isolated, lonely, and depressed (feeling deeply sad). He may have problems with his school learning and problem-solving skills. His social skills may be poor and he may have problems with friendships and other relationships. He may have a poor image of himself and low self-esteem. Adolescent children with SP have higher rates of cigarette smoking, and of using alcohol and drugs. Adolescent girls with SP may have an increased risk for unplanned pregnancy. Children with SP may also have other anxiety disorders or mental problems.

  • If not recognized and treated, SP may become a lifelong problem that continues as your child becomes an adult. Adults with SP can become very socially isolated as they fear both being teased and not liked by others. They have lower rates of attending college and problems with being steadily employed. They have lower rates for getting married and higher rates for divorce and separation. They also have higher rates of drug and alcohol use and abuse. Most adults with SP also have at least one other mental disorder. They have an increased risk for getting major depression that can be very bad, long lasting, or recurring. They are at an increased risk for suicide (wanting to harm or kill oneself) attempts.

When should I call my child's caregiver?

Call your child's caregiver if:

  • You and your child cannot make it to your next meeting with his caregiver.

  • Your child has problems with eating or is eating more than usual.

  • Your child is not able to sleep well or is sleeping more than usual.

  • Your child's social phobia is getting worse or he is having new signs or symptoms of mental health problems.

  • You have questions or concerns about social phobia or your child's treatment.

When should I seek immediate care?

Seek immediate help or call 911 if:

  • Your child feels like hurting himself.

  • Your child has trouble breathing, chest pains, or a fast heartbeat.

  • Your child just had a seizure (convulsion).

Where can I find support and more information?

Accepting that your child has social phobia can be hard. Your child's condition may make you feel angry, sad, or frightened. These feelings are normal. Talk to your child's caregivers, family, or friends about your feelings. Your child's caregivers can help your family better understand how to support your child with SP. You and your family may join a support group. Contact any of the following:

  • American Academy of Child and Adolescent Psychiatry
    3615 Wisconsin Avenue NW
    Washington , DC 20016
    Phone: 1- 202 - 966-7300
    Web Address: http://www.aacap.org
  • Anxiety Disorders Association of America (ADAA)
    8730 Georgia Avenue, Suite 600
    Silver Spring , MD 20910
    Phone: 1- 240 - 485-1001
    Web Address: http://www.adaa.org
  • National Institute of Mental Health (NIMH), Public Information & Communication Branch
    6001 Executive Boulevard, Room 8184, MSC 9663
    Bethesda , MD 20892-9663
    Phone: 1- 301 - 443-4513
    Phone: 1- 866 - 615-6464
    Web Address: http://www.nimh.nih.gov/

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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