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Key Features

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Essentials of Diagnosis
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  • Excessive worrying in social settings

  • Inability to perform in front of others as expected for age

  • Avoidance of events or settings that are social in nature or involve large groups

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General Considerations
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  • Characterized by significant, persistent fear in social settings, or performance situations

  • Results in overwhelming anxiety and inability to function when exposed to unfamiliar people and/or scrutiny

  • Seen more often in older children and adolescents than in younger children

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Clinical Findings

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  • Common manifestations

    • Consistent avoidance of social functions

    • Persistent somatic complaints that occur in a social setting and resolve in the absence of social exposure

  • Children are at increased risk for depression and school avoidance

  • They can also experience panic attacks

  • There is high comorbidity between substance use disorders and anxiety disorders

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Diagnosis

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  • Child's and family's lives are significantly disrupted

  • Parents often describe a pattern of overly accommodating their child's avoidance and/or incentivizing their child to attend routine social, extracurricular, or family functions

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Treatment

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  • Cognitive-behavioral therapy (CBT) is mainstay

  • If ongoing CBT therapy is not effective, then psychopharmacologic agents may be helpful

  • Selective serotonin reuptake inhibitors have demonstrated efficacy for children with social anxiety disorder

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Outcome

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Prognosis
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  • Early age of onset, more severe avoidance, and the presence of panic symptoms are all predictors of persistence over time

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References

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American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA, American Psychiatric Association; 2013.
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Beesdo-Baum  K, Knappe  S: Developmental epidemiology of anxiety disorder. Child Adolesc Psychiatric Clin N Am 2012;21:457–478
[PubMed: 22800989] .
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Ghandhi  B, Cheek  S, Campo  JV: Anxiety in the pediatric medical setting. Child Adolesc Psychiatric Clin N Am 2012;21:643–653
[PubMed: 22800999] .
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Ginsberg  GS, Kendall  PC, Sakolsky  D  et al: Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. J Consult Clin Psychol 2011;(79):806–813
[PubMed: 22122292] .
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Manassis  K: Silent suffering: understanding and treating children with selective mutism. Expert Rev Neurother 2009 Feb;9(2):235–243
[PubMed: 19210197] .
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Mohatt  J, Bennett  SM, Walkup  JT: Treatment of separation, generalized and social anxiety disorders in youths. Am J Psychiatry 2014;171:741–748
[PubMed: 24874020]
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Sakolsky  D, Birmaher  B: Pediatric anxiety disorders: management in primary care. Curr Opin Pediatr 2008;20(5):538–543
[PubMed: 18781116]
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Strawn  JR, Sakolsky  DJ, Rynn  MA: Psychopharmacologic treatment of children and adolescents with anxiety disorders. Child Adolesc Psychiatric Clin N Am 2012;21:527–539
[PubMed: 22800992] .

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