Parents worry whether their child’s shyness is just part of their personality later allowing them to navigate the world more as a happy viewer or whether the problem lies in their anxiety. Social anxiety causes many children social development problems that can lead to issues with school as well as friends.
Social anxiety is the fear of interactions with other people. Social anxiety symptoms include feeling nervous or uncomfortable in social situations. For some, their anxiety can be so great that they struggle to speak with others and make friendships. They are very concerned that they will do or say something embarrassing or humiliating or that others will think badly of them, so they often avoid others.
People with social anxiety typically know that their anxiety is irrational and not based on fact. Nevertheless, thoughts and feelings of anxiety persist, are chronic, and can greatly impact their ability to interact with others.
Social anxiety is extremely common and is the third largest mental health disorder in the US. According to the Anxiety and Depression Association of America, social anxiety affects 15 million adults or 6.8% of the U.S. population. Even though social anxiety is incredibly common, most parents and teachers don't know the signs and symptoms. Social Anxiety is equally common among men and women, with the most common age of onset being age 13. According to a 2007 American Depression Association of America survey, 36% of people with Social Anxiety Disorder report experiencing symptoms for 10 or more years before actually seeking support from a professional. Since depression and anxiety are often comorbid, parents may miss the social avoidance and attribute it to solely depression.
Shyness is a personality trait and not a clinical issue so we shouldn’t pathologize it. A child being more comfortable viewing the world from the sidelines does not automatically mean they have a problem. Several considerable symptoms distinguish being shy from being socially anxious at a clinical level. Shy children may not always feel comfortable around people they don’t know and are more reserved, but they live a normal life and can connect with others.
On the other hand, children with social anxiety struggle due to irrational fears and worries that they might say or do something to embarrass themselves. Social Anxiety Disorder has accompanying negative emotions and feelings that limit and interfere with a person’s life which isn’t the case with a shy person. The key difference between social anxiety disorder and shyness are the pervasive negative feelings and emotions that limit interactions with others.
For some children and teens, the fear and anxiety created by social interactions can be so overwhelming that they can have a panic attack. A panic attack is a sudden episode of intense fear that triggers severe physical reactions (heart palpitations, sweating, shortness of breath, chest pain, dizziness, etc.) when there is no real danger or apparent cause. For those with Social Anxiety Disorder, the irrational fear of saying or doing something wrong can throw one into a panic attack, which can be very frightening and further cause one to avoid social interactions.
For many children and teens with ADHD or attention problems, they also have anxiety because of the shame they feel with having difficulty regulating their focus and behaviors. However, not all kids with ADHD and anxiety have social anxiety. Children with ADHD are definitely more prone to social skills and friendship issues if they are impulsive and therefore may have social anxiety as a result. Working on their difficulties putting the breaks on, underlying shame, and anxiety are important for these kids to be successful in all areas of their life.
People often ask if ADHD medication can help anxiety and most report that ADHD medication aggravates the anxiety. It is important to calm the nervous system and stimulants can cause a serious acerbation of anxiety of symptoms. We use PEMF for anxiety and neurofeedback to calm the neurofeedback.
People with social anxiety display behaviors that go beyond shyness, they avoid social interactions and situations altogether. They worry about what they might say or do (or have said and done) when interacting with most people. Many people with social anxiety scrutinize all interactions, even with family members, and review them over and over, fueling their avoidance behaviors.
Signs and Symptoms of Social Anxiety
Physical Signs of Social Anxiety
It is important to note that generalized anxiety in children is different than social anxiety. The signs and symptoms can overlap, but a child or teen with social anxiety worry very specifically about social interactions.
With young children, young children’s anxiety about social interactions looks different than with adults, but they both avoid others. Behaviorally, social interactions may cause young children to cry more, have temper tantrums, display separation anxiety, or refuse to speak. Ultimately, children’s fear of speaking with others may be more outwardly behavioral and, therefore, more noticeable.
As the child with social grows into a teen, some differences in avoidant or fearful behaviors become more obvious. Although most teenagers experience periods normal anxiety, those with social anxiety experience disproportionate fear and worry. Typically, a teen may avoid social interactions or speak very little when in groups or with unfamiliar people. Physical signs of anxiety, such as headaches, stomach aches may become more prevalent.
Some teenagers learn to throw themselves into their school work to mask their intense anxiety. Most experience a waxing and waning periods of situationally dependent intense anxiety. Parents often think their teen is just shy, telling themselves “Their grades are so good, and they spend so much time studying, that they don’t have time for friends.” Teenagers with social anxiety can be masterful at hiding just how intense their worries and irrational thinking is. In more extreme or long-term cases, social anxiety can be a chronic issue impacting attendance, school performance, sports, and the ability to make and keep friends. As the behaviors become more observable, the teen is more in distress making parents are more likely to seek help.
College students with social anxiety experience many of the same issues as high school students, but the social demands often intensify their problems. College is equal parts academic and social learning causing those with social anxiety to fall apart with the intensity of increased interpersonal demands. For some college students, their heightened anxiety propels them to seek support while others leave school.
Selective Mutism is a more extreme, complex version of Social Anxiety Disorder where children cannot speak or communicate effectively in select social settings. For example, they may not speak at school or out in public, but they speak and communicate in settings where they are comfortable, secure, and relaxed (such as at home). While not as common as Social Anxiety Disorder, it is an increasing problem, especially with young children. We are social anxiety and selective mutism specialists and with our trademarked BrainBehaviorReset™ Method, kids are able to gain control of their brain, bodies and thoughts.
Parents often know that their child or teen struggles but become perplexed by their functionality (e.g., good grades or pleasant at home). Professionals classify persistent anxiety (typically 6 or more months) that interferes with one’s daily functioning (school performance, home life, social functioning, etc.) as a disorder. Thus, parents need to observe behaviors (social avoidance, physical signs) and listen for negative self-talk and worry talk.
Since no specific psychological or laboratory social anxiety test exists, a mental health professional needs to diagnose Social Anxiety Disorder as part of the clinical interview process. . During intake, the trained clinician can assess the presence of excessive and irrational worry, as well as their impact on that child’s or individual's life and functioning.
At our center with use a QEEG brain map or brain check in the intake process to understand exactly how the anxiety is impacting the brain, so we can recommend the right type of therapy and make a customized treatment plan.
As with any clinical issue, addressing social anxiety early is critical to prevent the habituation of avoidant behaviors and irrational or negative thinking. Learning how to deal with anxiety in one’s child is important. Trying to force a child or teen into social situations isn’t going to help and may fuel the fire. Instead, they need to be taught tools and learn how to break their cycle of negative thinking.
Prior to medicating a child, children should begin a course of anxiety treatment therapies. Although anxiety pills may temporarily help with anxiety relief, they usually don’t address the root cause. Moreover, they may negatively reinforce avoidant behaviors instead of learning how to deal with stress and uncomfortable feelings and learning coping skills is the key to lifelong mental health. Working with a therapist to address the causes of anxious feelings and how to manage them is more effective than medication. Moreover, medication certainly is not best for young children and is too often recommended before clinical and natural therapies are tried. Additionally, several effective natural remedies for anxiety are changes in diet (anti-inflammatory), exercise, improving sleep, homeopathy, supplements, and working with a naturopathic physician to look at nutrient deficiencies and genetic issues, as well as irritants to the system.
To prevent social anxiety becoming a clinical condition, parents can learn how to deal with anxiety by recognizing emotional and behavioral signs. Children and parents benefit from psychotherapy and parent coaching, particularly Cognitive Behavioral Therapy (CBT). CBT practitioners believe individuals’ perceptions of a situation closely connect to their reaction and work through those misperceptions to bring relief. Helping children and teens address their faulty perceptions and negative thinking about social interactions can mitigate the effect of anxiety, as well as give them lifelong tools to manage stress. Building stress tolerance for uncomfortable emotions and teaching kids that they can talk back to anxiety is paramount in tacking social anxiety or any form of anxiety.
We treat social anxiety with a combination of neurofeedback and psychotherapy. With our BrainBehaviorReset™ Method. It is imperative that central nervous system be calmed, so a child or teen with social anxiety can be calm enough to do the work in psychotherapy to address their anxieties and worries.
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Dr. Roseann is a Children’s Mental Health Expert and Therapist who has been featured in/on hundreds of media outlets including, CBS, NBC, FOX News, PIX11 NYC, The New York Times, The Washington Post,, Business Insider, USA Today, CNET, Marth Stewart, and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She is the founder and director of The Global Institute of Children’s Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).
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