Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

Key Features

Essentials of Diagnosis

  • 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

General Considerations

  • 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

Clinical Findings

  • 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


  • 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


  • 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



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


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA, American Psychiatric Association; 2013.
Beesdo-Baum  K, Knappe  S: Developmental epidemiology of anxiety disorder. Child Adolesc Psychiatric Clin N Am 2012;21:457–478
[PubMed: 22800989] .
Ghandhi  B, Cheek  S, Campo  JV: Anxiety in the pediatric medical setting. Child Adolesc Psychiatric Clin N Am 2012;21:643–653
[PubMed: 22800999] .
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] .
Manassis  K: Silent suffering: understanding and treating children with selective mutism. Expert Rev Neurother 2009 Feb;9(2):235–243
[PubMed: 19210197] .
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]
Sakolsky  D, Birmaher  B: Pediatric anxiety disorders: management in primary care. Curr Opin Pediatr 2008;20(5):538–543
[PubMed: 18781116]
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] .

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.