Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ 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 +++ Diagnosis ++ 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 +++ Treatment ++ 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 +++ Outcome +++ Prognosis ++ Early age of onset, more severe avoidance, and the presence of panic symptoms are all predictors of persistence over time +++ References + +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] . GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPediatrics 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPediatrics Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options