The problem of social anxiety disorder in teenagers

It comes as a surprise to many parents and educators that anxiety is the most prevalent mental health problem in children. According to the US Surgeon General's report on mental health , 13% of children and adolescents suffer from anxiety disorders, which is 1 in 8 children aged 9 to 17. Social anxiety is the most common anxiety disorder in teenagers, and is associated with significant impairment in functioning and long-term negative outcomes such as depression and alcohol use. Unfortunately, many teenagers with social anxiety go undetected and without appropriate treatment. Therefore, being able to identify the warning signs in youngsters is important to early detection and intervention efforts.

A typical case of a teenager with social anxiety disorder

Sean is a quiet 17-year-old who is easily "lost in the crowd." His grades are above average in school and he is compliant. and well-behaved in class He keeps to himself and does not speak to many peers. He has one or two friends he made in first grade. Sean avoids being around his peers and seems to be intensely uncomfortable in situations where there are large numbers of students, such as in the cafeteria or gym class. He has not joined any school clubs and goes home immediately after school. The teacher has encouraged him to speak up but he withdraws more or becomes angry.

Common symptoms of social anxiety disorder

  • Intense fear of social and performance situations
  • Avoids social situations or endures them with intense distress
  • Fears situations such as unstructured interactions with peers, initiating conversations, performing in front of others, inviting others to get together, talking on the telephone, and eating in front of others
  • Minimal interaction and conversation with peers
  • Appears isolated and on the fringes of the group
  • May sit alone in the library or cafeteria, hang back,
  • Excessive shyness
  • Concern about negative evaluation, humiliation or embarrassment
  • Difficulty with public speaking, reading aloud, being called on in class, gym class
  • Anticipation of a social event may provoke a panic attack

What treatment approach is most effective for social anxiety disorder?

The scientific literature supports the use of Cognitive Behavior Therapy (CBT) for treating social anxiety disorder. CBT uses practical and logical strategies directed at changing the factors that maintain anxiety such as negative thoughts or expectations, physical symptoms, avoidance, and the reactions and responses of adults to an anxious child. Children learn to think more realistically about fears and to confront the feared social situations. Training in social skills such as initiating conversations, inviting others to get together, and being assertive are also incorporated into treatment.

What can schools do to assist socially anxious teenagers?

  • Provide Education and Training for school personnel that would increase awareness of anxiety disorders, identify specific criteria to determine need for intervention, recognize anxiety as a legitimate disorder rather than willful misbehavior, teach appropriate skills to manage anxiety in school and educate parents of children with anxiety about the problem.
  • Establish Helping Partnerships between parents and school personnel. It is critical that both be involved so that progress made in one place is not undone by the other. A school counselor can organize all involved individuals.
  • Maintain a Physically and Emotionally Supportive Environment for anxious teenagers at school by: 1) being inclusive in class activities and ensuring opportunities for shy children to participate, 2) using structured classroom activities or assigning partners so that shy children are not left out, 3) assigning a classroom buddy who provides support and assistance, 4) providing structured social activities and assisting the initiation of social interactions, and 5) rewarding efforts to initiate social interaction.
  • Define Specific Problem-Focused Interventions that help address specific goals and increase confidence. For example, a student might be encouraged to ask two questions in class, ask two kids what they did over the weekend or start a conversation in the cafeteria about the food.
  • Make Appropriate and Timely Referrals to Mental Health Professionals.

How can parents help to manage social anxiety in their children?

  1. Reward Brave, Nonanxious Behavior: Provide praise and attention and small rewards.
  2. Prevent Avoidance: Refuse to engage in your child's behaviors that allow him/her to avoid the situations s/he fears. For example, refrain from ordering your child's food, speaking for your child in stores, making phone calls for your child, or taking care of other things that your child is avoiding due to social anxiety. Gradually encourage your child to handle social tasks on his/her own to foster more independence and confidence.
  3. Prompt Your Child to Cope Constructively: Encourage your child to come up with his/her own solutions, Help your child to brainstorm ways to handle the anxiety and to independently decide how to cope more constructively. Prompt your child to use the cognitive and behavioral skills being learned in treatment.
  4. Limit Reassurance: Anxious children will constantly ask for reassurance that things will turn out okay or that they will be alright. This prevents them from learning how to cope with anxiety on their own and maintains the belief that they are unable to do so.
  5. Help Your Child to Use a Problem Solving Approach:
    • 1) Summarize what your child has said,
    • 2) Help your child brainstorm possible ways in which the anxiety may be reduced,
    • 3) Make sure not to take over the task for your child or tell him/her what to do,
    • 4) Go through each idea that the child has generated and ask questions such as, "What do you think would happen if you did this? Do you think that would help to reduce your anxiety in the long-run? What would be the worst that would happen? What is the likelihood that it would happen?"
    • 5) Praise your child for discussing possible solutions and outcomes,
    • 6) Prompt your child to select the strategy that allows him/her to approach feared situations rather than avoid them and is most likely to have a positive outcome.
References and Related Books

Report of the Surgeon General on Mental Health

Worried No More: Help and Hope for Anxious Children by Aureen Pinto Wagner, Ph.D. Lighthouse Press, Inc. 2002

Helping Your Anxious Child: A Step-by-Step Guide for Parents by Ronald Rapee, Ph.D., Susan H. Spence, Ph.D., Vanessa Cobham, Ph.D. and Ann Wignall M.Psych. New Harbinger Publications, Inc. 2000

Keys to Parenting Your Anxious Child by Katharine Manassis M.D. Barron's Educational Series, Inc. 1996

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About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at