Social anxiety disorder in children

Social anxiety disorder in children is a disorder characterized by persistent, excessive avoidance of contact with peers and strangers, lasting more than 6 months and combined with a distinct desire to communicate with family members and those the child knows well.

Synonym: avoidant disorder of childhood and adolescence.

ICD-10 code

F93.2 Social anxiety disorder of childhood.

Epidemiology

Social anxiety disorder is rare and is mostly seen in boys. There is no precise data on prevalence, as not all children are observed by psychiatrists.

[ 1 ], [ 2 ]

Causes and pathogenesis of social anxiety disorder

The presence of pathological features of the psychasthenic, asthenic or sensitive-schizoid type in the child's character. Mental trauma suffered in early childhood is important.

[ 3 ], [ 4 ]

Symptoms of Social Anxiety Disorder

Caution in front of strangers is considered a normal psychological phenomenon from the second half of the first year of a child's life until 2.5 years, when he has to face a new, unfamiliar social environment.

A child with social anxiety disorder has a constant fear and/or avoidance of unfamiliar people and unknown situations. Fear may mainly manifest itself in the presence of adults and/or peers. In new social situations or in which the child participates against his/her will, he/she experiences significant distress, manifested by crying, lack of spontaneous speech, and social autism. The child shows tension in the presence of strangers, tries to avoid contact, refuses to answer questions, and does not look into the eyes. Unlike true autistic disorders, the child communicates normally with parents, other family members, and people he/she knows well. With them, he/she is quite open, talkative, and emotional.

Milder cases of social anxiety disorder in childhood may be expressed as excessive shyness, inhibition, timidity, resentment, and an inability to stand up for oneself.

In prepubertal and pubertal age, changes in character become more distinct. Timidity, shyness, and inability to stand up for oneself become more pronounced. A feeling of self-doubt, a desire to be less noticeable in public, increased sensitivity, and impressionability appear. Public speaking becomes the most difficult.

As a rule, anxiety that arises even before the speech itself leads to the so-called emotional disorganization of thinking. Children and teenagers who know the subject well, are confused when answering, inconsistent, and give the impression of being poorly prepared. This increases the feeling of inferiority and dissatisfaction with oneself. The severity of the described features of emotional and personal response can be so significant that it interferes with the child's socialization.

Diagnosis of social anxiety disorder

The diagnosis is made on the basis of the above-mentioned behavioral characteristics and emotional and personal reactions of the child or teenager, which must meet the following criteria:

• beginning at the appropriate developmental age;
• degree of anxiety - pathological;
• anxiety is not part of a more generalized disorder.

[ 5 ], [ 6 ], [ 7 ]

Indications for consultation with other specialists

If social anxiety disorder in childhood leads to social maladjustment of a child or teenager and is not completely reduced by psychological and pedagogical intervention, additional consultation with a psychiatrist and clinical psychologist is necessary.

Forecast

The described features of emotional and personal response, as a rule, persist to one degree or another throughout the life of the individual. In more severe cases of the disorder, as well as in the presence of a chronic unfavorable psychosocial situation, a transformation into a mature personality disorder of the anxious (evasive) type is possible.

[ 8 ], [ 9 ], [ 10 ]