Social Anxiety in Children: Symptoms and Treatment

What is social anxiety disorder in children?

Social anxiety disorder is an anxiety disorder in which a child or teen feels intense fear or anxiety in situations where they might be watched, judged or evaluated by others, such as answering a question in class, eating in front of others or meeting new people.⁠¹ The fear can feel uncontrollable, and the child often avoids those situations.⁠¹

It usually starts in childhood or adolescence and can look like extreme shyness.⁠¹ For a diagnosis, the fear must last at least six months and interfere with daily life, such as school or relationships.⁠¹

It is treatable, and cognitive behavioral therapy (CBT), which helps a child gradually face the situations they fear, is commonly used.⁠^1,4

Is social phobia the same as social anxiety disorder?

Yes. Social phobia is the older name. The DSM-5 made social anxiety disorder the main name with social phobia in parentheses, and the 2022 DSM-5-TR dropped the parenthetical because the field has fully adopted the newer term.⁠¹⁷

What are the symptoms of social anxiety in children?

The core symptom is fear of being judged or embarrassed, which shows up in the body, in thoughts and in avoidance.⁠¹ Children and teens share many adult symptoms, and NIMH lists some that are more typical of the young.⁠¹

A child may want to join in and still not manage it: NIMH describes difficulty talking to people in social situations even when they want to.⁠¹ The CDC describes social anxiety in children as being very afraid of going to places where there are people, such as school.⁠¹⁸

Anxiety can also look like irritability or anger rather than fear, and some anxious children keep their worries to themselves, so it can be missed.⁠¹⁸

What does social anxiety look like in young children and toddlers?

In young children the fear may come out as crying, tantrums, freezing, clinging, shrinking or not speaking, rather than in words.⁠² NICE suggests watching for children who avoid social or group activities or talking, or who are excessively shy or overly reliant on their parents.⁠⁴

Some wariness is normal at this age: apprehension with strangers at 12 to 18 months is a typical stage known as stranger anxiety.⁠¹⁹ Social anxiety disorder usually appears in the later school years, and the USPSTF found too little evidence to recommend screening children 7 or younger.⁠²⁰

What can be seen early is a temperament called behavioral inhibition, a lasting tendency to meet new people, places and things with wariness or avoidance; about 15% of children show it to an extreme degree, and it raises the risk of later social anxiety disorder.⁠⁸

What does social anxiety look like in teenagers?

In teens it often shows as avoiding school, parties, sports or speaking up, worrying about social events for weeks beforehand, and picking apart their own performance afterward.⁠^1,4 Some concern about peer acceptance is normal in adolescence; the difference is how much the fear drives avoidance and gets in the way.⁠^1,19

Social anxiety is more common in teenage girls than boys, a gap NIMH notes is more pronounced in adolescents and young adults.⁠^1,6

Is it shyness or social anxiety?

Shyness is a common trait; social anxiety disorder is an impairing condition. In a national survey of 10,123 US teens, 46.7% described themselves as shy, but only 12% of those shy teens had ever met the criteria for social phobia.⁠³

A useful question is not how quiet a child is, but how much they are avoiding and how much it costs them at school, with friends and at home.⁠^1,21

How is social anxiety diagnosed in children?

A clinician diagnoses social anxiety disorder from an interview with the child and parents, checking for strong fear of social situations where the child might be judged, avoidance or great discomfort, at least six months of symptoms, and interference with daily life.⁠^1,4

For children, the DSM-5 requires that the anxiety happen in settings with peers, not only in interactions with adults.⁠² NICE advises giving the child a chance to be interviewed alone and gathering information from a parent or another adult who knows them.⁠⁴

1. Feared situations. Which social situations the child fears and avoids, and what they are afraid might happen, such as blushing or looking anxious.⁠⁴
2. Daily life. Friendships and peer groups, school, family circumstances and support.⁠⁴
3. What keeps it going. Parenting patterns that support anxious behavior, and peer victimization at school or elsewhere.⁠⁴
4. Other conditions. Depression, other anxiety disorders, OCD and ADHD can occur alongside social anxiety.⁠¹

Is there a test for social anxiety in children?

There are screening questionnaires, but no test that diagnoses it on its own. The USPSTF recommends screening for anxiety from age 8 to 18, and notes that two instruments are widely used in practice: the SCARED and the Social Phobia Inventory.⁠²⁰

A positive screen leads to a full assessment. NICE suggests simple questions, such as whether a child finds it hard to do things when others are watching, like answering questions or reading aloud in class.⁠⁴ The AAP and Bright Futures recommend yearly screening for behavioral, social and emotional problems.⁠²⁰

Not sure where to start?Does my child need an evaluation?

How common is social anxiety in children, and when does it start?

It is common: with specific phobias, it is one of the two most common anxiety disorders in teens.⁠^1,8 In a national US survey conducted from 2001 to 2004, an estimated 9.1% of teens aged 13 to 18 had had social anxiety disorder, and 1.3% had it with severe impairment; rates were higher in girls (11.2%) than boys (7.0%).⁠⁶

It usually begins in late childhood or early adolescence. In a 2022 meta-analysis of age at onset worldwide, the median age at onset of social anxiety disorder was 13, about half of cases began by age 14, and nine in ten by 25.⁠⁷ The USPSTF notes that it generally appears in the later school years, after separation anxiety and selective mutism.⁠²⁰

Many affected teens never get help: in the national survey, nearly 80% of teens with social phobia did not seek or obtain professional treatment for their anxiety.⁠³

What causes social anxiety in children?

There is no single known cause. Social anxiety may run in families, genetics influences how the brain areas involved in fear and anxiety work, and researchers are studying the role of stress and environment.⁠¹

• Genes

  In a meta-analysis of 13 twin cohorts, genetic and non-shared environmental factors explained most of the differences in social anxiety; the genetic share was larger in young people than in adults.⁠⁹

• An inhibited temperament

  Behaviorally inhibited children had more than seven times the odds of developing social anxiety disorder in a meta-analysis of seven studies.⁠⁸

• Bullying and rejection

  In a review of 17 studies, peer victimization was linked with social anxiety in every study; the CDC lists being bullied or rejected as a risk.⁠^10,18

• Family factors

  Risk factors include parental overprotection, conflict between parents and child mistreatment, and a parent’s own anxiety or depression.⁠^18,20

These raise risk; they do not decide it. The meta-analysis authors estimate that almost half of strongly inhibited children eventually develop social anxiety disorder, so many do not, and a parent program for inhibited preschoolers lowered later anxiety disorders.⁠^8,22

Can parenting cause social anxiety?

Parenting is one influence among several, not a single cause, but how parents respond can help keep anxiety going. Overprotection is a recognized risk factor, and NICE asks clinicians to look for parenting patterns that support anxious behavior.⁠^1,4,20

Most often this is loving help that backfires. Nearly all parents of anxious children (97.3% in one clinic study) make some accommodations, most often by taking part in the child’s anxious behaviors or changing family routines, and more accommodation goes with more severe anxiety.⁠¹⁴

How are social anxiety and selective mutism related?

Closely. Selective mutism is a consistent failure to speak in certain social situations, such as school, while speaking normally in others, such as at home, and most children with it also have social anxiety.⁠¹¹

In a meta-analysis of 22 studies with 837 children, 80% of children with selective mutism had another anxiety disorder, most often social phobia (69%).⁠¹¹ NICE notes that a child with possible selective mutism may not be able to speak at all during an assessment, so clinicians should accept information from parents and let the child answer in writing or drawing.⁠⁴

Read nextSelective mutismSpeech therapy

Is it social anxiety or autism?

They are different conditions that can occur together. Autism is a developmental disorder that affects how a person interacts, communicates, learns and behaves, with signs that generally appear in the first two years.⁠²³ Social anxiety disorder is a fear of being judged in social situations, which usually begins later.⁠^1,7

The DSM-5 diagnoses social anxiety disorder only when the fear, anxiety or avoidance is not better explained by another condition, such as autism spectrum disorder.⁠² Where autism does not explain the fear, an autistic child can have social anxiety disorder as well.⁠²⁴

The two often overlap. In a meta-analysis of 31 studies of 2,121 autistic young people, 39.6% had at least one anxiety disorder and 16.6% had social anxiety disorder.⁠²⁴ See autism.

Can sensory overload look like social anxiety?

It can overlap. A child who is overwhelmed by noise or crowds may avoid busy places for sensory reasons rather than fear of judgment. In a study of 917 preschoolers, 43% of those with sensory over-responsivity also had an impairing anxiety disorder, and sensory over-responsivity predicted later anxiety symptoms.⁠²⁵

That link was driven mainly by generalized anxiety rather than social phobia, so sensory sensitivity is better seen as a risk to watch than as social anxiety itself.⁠²⁵ Sensory over-responsivity or anxiety? explains how to tell them apart.

How does social anxiety affect school and friendships?

It can affect both deeply. Children and teens with social anxiety disorder have significant distress and impairment at school and with peers, and may try to avoid school or have difficulty making friends.⁠^1,8 The AAP lists dropping grades and school avoidance among signs of anxiety.⁠²⁶

The effects can last. Adults with social anxiety disorder are more likely to have lower educational attainment and fewer or poorer-quality relationships with family, partners and friends.⁠⁸ Peer victimization is linked with social anxiety and may help keep it going.⁠¹⁰

What school accommodations help a child with social anxiety?

Supports that help a child take part, rather than excusing them from it. NICE asks clinicians to work with teachers and peers to create an environment that supports the goals of treatment, and CBT for social anxiety builds in gradual exposure to feared situations such as speaking in class.⁠⁴

Ask the school whether accommodations such as an IEP are appropriate.⁠²¹ A child whose anxiety substantially limits learning may qualify for a Section 504 plan.⁠²⁷ How to request a school evaluation has a letter you can adapt.

How is social anxiety treated in children?

Cognitive behavioral therapy (CBT) is the main treatment. NIMH calls CBT the gold standard psychotherapy for social anxiety, and NICE recommends individual or group CBT focused on social anxiety for children and young people, with parents involved, especially for young children.⁠^1,4

CBT for childhood anxiety is well supported. In the USPSTF’s review, where social anxiety disorder was one of the most common diagnoses, CBT nearly doubled the chance of a treatment response compared with usual care or a wait list (pooled relative risk 1.89).⁠²⁰

Social anxiety can be slower to respond than other anxiety disorders. In a study of 842 children given broad family-based group CBT, those with social anxiety disorder improved more slowly and had poorer diagnostic outcomes than children with other anxiety disorders.⁠²⁸ NICE recommends CBT focused specifically on social anxiety.⁠⁴

What is exposure therapy for social anxiety?

Exposure is the part of CBT in which a child gradually faces the situations they fear, step by step, so they can do the things they have been avoiding.⁠¹ The CDC describes it as helping children learn that bad things do not happen.⁠¹⁸

NICE describes individual CBT for children as 8 to 12 sessions of about 45 minutes, combining education about anxiety, exposure to feared situations, social skills training and practice in real social situations.⁠⁴ Group CBT can offer extra benefits for social anxiety.⁠¹

Can parents lead treatment for a young child with social anxiety?

Yes, and for very young children involving parents is key.⁠¹⁸ In a trial of 194 children with anxiety disorders, the full version of guided parent-delivered CBT, in which a therapist coaches the parent over four face-to-face and four telephone sessions, led to recovery in 50% against 25% on a wait list; a briefer version did not do significantly better than the wait list.⁠¹²

For inhibited preschoolers, a six-session parent group with parenting skills and gradual exposure lowered the number and severity of anxiety disorders three years later, though the children’s inhibited temperament itself did not change.⁠²²

Parent-only treatment can work for older children too. In a trial of 124 children aged 7 to 14, SPACE, a parent program with no direct therapist contact with the child, was as effective as child CBT and reduced family accommodation more.⁠¹⁶

Is medication used for social anxiety in children?

Sometimes, and guidelines differ. AACAP’s 2020 guideline finds that CBT and SSRI antidepressants both have considerable support as safe and effective short-term treatments for childhood anxiety, while NICE says not to routinely offer medication for social anxiety disorder in children and young people.⁠^4,13

In a major US trial of 488 children aged 7 to 17 with anxiety disorders, including social phobia, the response rate was 80.7% with CBT plus medication, 59.7% with CBT alone, 54.9% with medication alone and 23.7% with placebo.⁠²⁹

Antidepressants can take several weeks to work, and children, teens and young adults may have an increase in suicidal thoughts or behavior, especially in the first weeks or after a dose change, so they need close monitoring.⁠^1,30 Medication should not be stopped without the prescriber’s help.⁠³⁰ If your child talks about suicide, use the crisis lines at the top of this page.

Should parents let a child with social anxiety avoid social situations?

Not as a rule. Avoidance brings relief in the moment, but without treatment the anxiety is likely to remain, and treatment works by helping a child face feared situations gradually.⁠^1,4

Helping a child avoid is called family accommodation: the ways parents change their own behavior to spare a child distress, such as speaking in the child’s place so they do not have to talk.⁠¹⁴ It is almost universal, reported by 97.3% of parents in one clinic study, and most of those parents also found it distressing.⁠¹⁴

Across studies, more accommodation goes with more severe anxiety, a moderate link on parent reports and a small one on children’s reports.⁠¹⁵ Reducing it is part of treatment: in the SPACE trial, a parent program built on reducing accommodation was as effective as child CBT.⁠¹⁶

How can parents help a child with social anxiety at home?

By encouraging small, steady steps toward feared situations, praising effort, and working with the child’s therapist and school.⁠^4,18 NICE describes training for parents, especially of young children, to promote and reinforce the child’s exposure to feared situations and new skills.⁠⁴

1. Name the fear. Talk with your child about what they worry might happen; the AAP suggests talking with children about stressors and helping them keep perspective.⁠²⁶
2. Plan small steps. With the therapist, list situations from easiest to hardest and practice them in order, as exposure in CBT does.⁠^1,4
3. Let them speak for themselves. Step back gradually from speaking in your child’s place, since accommodation is tied to more severe anxiety.⁠^14,15
4. Practice social skills. Rehearse greetings, questions and joining in; CBT for social anxiety includes social skills training and practice.⁠^1,4
5. Work with school. Agree on supports that help your child take part, and ask whether an IEP or 504 plan fits.⁠^21,27

Watch for signs that need more help: worsening avoidance, school refusal, low mood, or talk of self-harm.⁠^21,26

Does social anxiety in children go away?

It often does not go away on its own, but it is treatable. NIMH notes that without treatment the anxiety is likely to remain, and the USPSTF notes that an anxiety disorder in childhood or adolescence raises the chance of a later anxiety disorder or depression.⁠^1,20

With treatment, most children improve: in a US trial of 488 children with anxiety disorders, 60% responded to CBT alone and 81% to CBT with medication within 12 weeks.⁠²⁹ Social anxiety can be slower to shift than other anxiety disorders, so it is worth sticking with treatment.⁠²⁸

When should you get help for a child’s social anxiety?

When the fear or avoidance lasts for weeks or longer, upsets your child or family, or gets in the way of school, home or friendships.⁠²¹ The AAP advises talking with your pediatrician if you notice signs of anxiety.⁠²⁶

Your child’s doctor can screen for anxiety and refer you to a qualified mental health professional.⁠^1,20 When choosing a therapist, NIMH suggests asking whether they use treatments supported by research and whether they involve parents.⁠²¹

If your child’s behavior is unsafe or they talk about wanting to hurt themselves or someone else, seek help immediately, using the crisis lines at the top of this page.⁠²¹

Related on DrSensory

• Selective mutism

  When a child speaks at home but not at school.

• Generalized anxiety disorder

  Constant worry about many things, and what helps.

• OCD in children

  Obsessions and compulsions in children, and what helps.

• Childhood depression

  The signs, and when to worry.

• CBT for anxiety

  What cognitive behavioral therapy involves.

• Sensory over-responsivity or anxiety?

  How to tell sensory overload from anxiety.

• Autism

  Signs, diagnosis and support.

• ADHD in children

  Signs, diagnosis and treatment.

• Separation anxiety strategies

  Sensory-friendly ways to ease separations.

Sources

1. National Institute of Mental Health. Social Anxiety Disorder: What You Need to Know. Revised 2025. Checked October 22, 2026.
   Show the passageHide the passage

   “A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others”; “Social anxiety disorder is a common type of anxiety disorder”; “Social anxiety disorder usually starts during childhood or adolescence and may resemble extreme shyness or avoidance of public situations or social interactions”; “It occurs more frequently in women than in men, and this difference is more pronounced in adolescents and young adults”. People may “Blush, sweat, or tremble”, “Have a rapid heart rate”, “Have a rigid body posture or speak with an overly soft voice”, “Find it difficult to make eye contact, be around people they don’t know, or talk to people in social situations, even when they want to”, “Expect the worst possible consequences from a negative social situation”, “Analyze their performance and identify self-perceived flaws in interactions”; they “may worry about engaging in social situations for weeks before they happen”. Children and teens also may “Try to avoid going to school”, “Have difficulty making friends”, “Complain of stomachaches or headaches”, “Have emotional outbursts in social situations” and “Refuse to speak or participate in social situations”. “Avoiding situations that cause anxiety may feel helpful in the short term, but the anxiety is likely to remain without treatment”. “Social anxiety disorder may run in families”; “genetics influences how these brain areas function”; “researchers are looking at the role that stress and environmental factors play in the disorder”. Diagnosis: “They may try to avoid these situations or face them with extreme discomfort”; “These feelings must last at least 6 months and interfere with daily life, such as work, school, or relationships”. Co-occurring conditions include “depression, other anxiety disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder (ADHD)”. “CBT has been well studied and is the “gold standard” choice for psychotherapy”; CBT “also can help a person learn and practice social skills, which is very important for treating social anxiety disorder”; “Exposure therapy is a CBT method that focuses on progressively confronting the fears underlying an anxiety disorder to help a person engage in activities they have been avoiding”; “CBT delivered in a group therapy format also can offer unique benefits for social anxiety disorder”; “Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat social anxiety disorder”; antidepressants “may take several weeks to start working”. “talk to a primary care provider. They can refer you to a qualified mental health professional”. “call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org”. “In life-threatening situations, call 911”.
2. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; June 2016. Checked October 22, 2026.
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   Section 3.3.7 and Table 16 (DSM-5 social anxiety disorder): “In children, the anxiety must occur in peer settings and not just during interactions with adults”; “for children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations”; “The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more”; “The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder”. The DSM-IV note, “there must be evidence of the capacity for age-appropriate social relationships with familiar people”, is not in the DSM-5 note.
3. Burstein M, Ameli-Grillon L, Merikangas KR. Shyness versus social phobia in US youth. Pediatrics. 2011;128(5):917–925. doi:10.1542/peds.2011-1434 (PMID 22007009; PMC3208958). Checked October 22, 2026.
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   “a nationally representative, face-to-face survey of 10 123 adolescents, aged 13 to 18 years”; “62.4% of parents reported that their adolescents were shy, whereas a more-moderate 46.7% of adolescents thought that they were shy”; “Only 12% of the youth who identified themselves as shy also met the criteria for lifetime social phobia”; adolescents with social phobia “displayed significantly greater role impairment and were more likely to experience a multitude of psychiatric disorders”; “nearly 80% of adolescents with social phobia failed to seek or to obtain professional treatment for their anxiety”.
4. National Institute for Health and Care Excellence. Social anxiety disorder: recognition, assessment and treatment (CG159), Recommendations. Published May 22, 2013. Checked October 22, 2026.
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   Professionals should be alert to children “who avoid school, social or group activities or talking in social situations, or are irritable, excessively shy or overly reliant on parents or carers”; “Do you/does your child find it difficult to do things when other people are watching, like playing sport, being in plays or concerts, asking or answering questions, reading aloud, or giving talks in class?”; assessment should “provide an opportunity for the child or young person to be interviewed alone at some point during the assessment” and consider “parenting behaviours that promote and support anxious behaviours or do not support positive behaviours” and “peer victimisation in school or other settings”; children “with a potential diagnosis of selective mutism may be unable to speak at all during assessment or treatment”, so “accept information from parents or carers” and let the child answer “through writing, drawing or speaking through a parent or carer if necessary”. “Offer individual or group CBT focused on social anxiety”; “Consider involving parents or carers to ensure the effective delivery of the intervention, particularly in young children”; individual CBT: “8 to 12 sessions of 45 minutes’ duration” with “psychoeducation, exposure to feared or avoided social situations, training in social skills and opportunities to rehearse skills in social situations”. “Do not routinely offer pharmacological interventions to treat social anxiety disorder in children and young people”.
5. Crisis Text Line. Crisis Text Line | Text HOME to 741741 Free, 24/7 Mental Health Support. “Text HOME to 741741 from anywhere in the United States – 24/7, free, confidential”. Checked October 22, 2026.
6. National Institute of Mental Health. Social Anxiety Disorder (statistics). Checked October 22, 2026.
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   From the adolescent part of the National Comorbidity Survey (NCS-A), ages 13–18: “An estimated 9.1% of adolescents had social anxiety disorder, and an estimated 1.3% had severe impairment”; “The prevalence of social anxiety disorder among adolescents was higher for females (11.2%) than for males (7.0%)”; the survey years: “Lifetime Prevalence of Social Anxiety Disorder Among Adolescents (2001-2004)”.
7. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry. 2022;27(1):281–295. doi:10.1038/s41380-021-01161-7 (PMID 34079068; PMC8960395). Checked October 22, 2026.
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   Table 1, social anxiety disorder (42 samples): peak age at onset 14.5 years; onset by age 14 in 50.9%, by 18 in 79.1%, by 25 in 87.5%; median 13. “the proportion of patients developing disorders before age 25 is” “nine out of ten for social anxiety disorder”.
8. Clauss JA, Blackford JU. Behavioral inhibition and risk for developing social anxiety disorder: a meta-analytic study. Journal of the American Academy of Child and Adolescent Psychiatry. 2012;51(10):1066–1075. doi:10.1016/j.jaac.2012.08.002 (PMID 23021481; PMC3611590). Checked October 22, 2026.
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   “Seven studies met inclusion criteria”; “BI was associated with a greater than sevenfold increase in risk for developing SAD (odds ratio = 7.59”; “15% of all children show extreme BI” and “almost half of these inhibited children will eventually develop SAD”; “specific phobias and social anxiety disorder (SAD; social phobia) are the most common” anxiety disorders in adolescents; BI is “the chronic tendency to respond to novel persons, places, and objects with wariness or avoidant behaviors”; “Children and adolescents with SAD experience significant distress and functional impairment at school and with peers”; adults with SAD “lower education attainment” and “fewer or poorer quality of relationships with family, romantic partners, and friends”.
9. Scaini S, Belotti R, Ogliari A. Genetic and environmental contributions to social anxiety across different ages: a meta-analytic approach to twin data. Journal of Anxiety Disorders. 2014;28(7):650–656. doi:10.1016/j.janxdis.2014.07.002 (PMID 25118017). Checked October 22, 2026.
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   “13 cohorts (42,585 subjects)”; “genetic and non-shared environmental factors explain most of individual differences for SAD/SAS”; “In adults, the genetic contribution was half than that in younger patients”; “the shared environmental factors seem to be less relevant”.
10. Pontillo M, Tata MC, Averna R, Demaria F, Gargiullo P, Guerrera S, et al. Peer victimization and onset of social anxiety disorder in children and adolescents. Brain Sciences. 2019;9(6):132. doi:10.3390/brainsci9060132 (PMID 31174384; PMC6627045). Checked October 22, 2026.
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    Citing the DSM-5, the reaction “could be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak”; “Seventeen studies are included”; “All studies showed that peer victimization is positively correlated to the presence of social anxiety”; “the perpetration of peer victimization may contribute to the maintenance and the exacerbation of social anxiety symptoms”.
11. Driessen J, Blom JD, Muris P, Blashfield RK, Molendijk ML. Anxiety in children with selective mutism: a meta-analysis. Child Psychiatry and Human Development. 2020;51(2):330–341. doi:10.1007/s10578-019-00933-1 (PMID 31650460; PMC7067754). Checked October 22, 2026.
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    “On the basis of 22 eligible studies (N = 837), we found that 80% of the children with SM were diagnosed with an additional anxiety disorder, notably social phobia (69%)”; selective mutism is “a consistent failure to speak in specific social situations where there is an expectation for speaking (e.g., at school), while the production of speech appears to be normal in other situations (e.g., at home)”.
12. Thirlwall K, Cooper PJ, Karalus J, Voysey M, Willetts L, Creswell C. Treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: randomised controlled trial. British Journal of Psychiatry. 2013;203(6):436–444. doi:10.1192/bjp.bp.113.126698 (PMID 23969483). Checked October 22, 2026.
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    “A total of 194 children presenting with a current anxiety disorder”; full guided CBT was “four face-to-face and four telephone sessions”; “Full guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not”; “25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list”; “Full guided parent-delivered CBT is an effective and inexpensive first-line treatment for child anxiety”.
13. Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J, et al. Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry. 2020;59(10):1107–1124. doi:10.1016/j.jaac.2020.05.005 (PMID 32439401). Checked October 22, 2026.
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    “both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents”; research needs include “additional evaluation of the degree of suicide risk associated with SSRIs and SNRIs”.
14. Lebowitz ER, Woolston J, Bar-Haim Y, Calvocoressi L, Dauser C, Warnick E, et al. Family accommodation in pediatric anxiety disorders. Depression and Anxiety. 2013;30(1):47–54. doi:10.1002/da.21998 (PMID 22965863; PMC3932435). Checked October 22, 2026.
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    “Family accommodation describes the ways in which family members, particularly parents, change their behavior so as to help a relative to diminish or avoid the distress caused by a disorder”; “Virtually all parents (97.3%) endorsed at least some level of family accommodation”; “Most parents reported participation in symptoms and modification of family routines”; “Most parents also reported experiencing distress resulting from accommodation (70.7%)”; a child “with social phobia may have her parents speak in her place”; “Accommodation is common across childhood anxiety disorders and associated with severity of anxiety symptoms”.
15. Iniesta-Sepúlveda M, Rodríguez-Jiménez T, Lebowitz ER, Goodman WK, Storch EA. The relationship of family accommodation with pediatric anxiety severity: meta-analytic findings and child, family and methodological moderators. Child Psychiatry and Human Development. 2021;52(1):1–14. doi:10.1007/s10578-020-00987-6 (PMID 32246361). Checked October 22, 2026.
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    “Positive moderate association was observed for measures administered to parents”; “Global effect sizes were small for measures administered to children”.
16. Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK. Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of supportive parenting for anxious childhood emotions. Journal of the American Academy of Child and Adolescent Psychiatry. 2020;59(3):362–372. doi:10.1016/j.jaac.2019.02.014 (PMID 30851397; PMC6732048). Checked October 22, 2026.
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    “Participants were children with primary anxiety disorders (N=124; 7–14 years old”; SPACE had “no direct child-therapist contact”; “SPACE was noninferior, relative to CBT, on primary and secondary anxiety outcomes”; parents were “taught supportive responses to child anxiety that acknowledge the child’s experience while also conveying confidence in the child’s ability to cope”; “a target accommodation was selected for modification” and “parents were instructed in how to communicate the plan to the child”; “significantly greater reduction in family accommodation following SPACE”.
17. American Psychiatric Association. Social Anxiety Disorder (DSM-5-TR fact sheet). 2022. “The parenthetical “(Social Phobia)” in social anxiety disorder was removed” in the DSM-5-TR; “the field has completely adopted the term “Social Anxiety Disorder.”” Checked October 22, 2026.
18. Centers for Disease Control and Prevention. Anxiety and Depression in Children. Page dated May 15, 2026 (read in the Internet Archive copy of October 9, 2026). Checked October 22, 2026.
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    “Social anxiety disorder: Being very afraid of going to places where there are people, such as school”; “Anxiety may present as fear or worry but can also make children irritable and angry”; “For very young children, involving parents in treatment is key”; “Separation anxiety disorder: Being very afraid when away from parents”; “gradually exposing them to their fears to help them learn that bad things do not occur”; risk rises with “being bullied or rejected by other children” or “when their own parents have anxiety or depression”.
19. Siegel RS, Dickstein DP. Anxiety in adolescents: update on its diagnosis and treatment for primary care providers. Adolescent Health, Medicine and Therapeutics. 2012;3:1–16. doi:10.2147/AHMT.S7597 (PMID 24600282; PMC3916014). Checked October 22, 2026.
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    DSM-IV-TR social phobia, as tabulated: “In children, there must be evidence that they are able to have age-appropriate relationships, and the anxiety must occur with peers, not just adults”; “it is common for infants and toddlers to be apprehensive of strangers at 12–18 months of age, known as stranger anxiety”; “for adolescents to be somewhat concerned about peer acceptance or rejection”; “these normative fears are typically transient”.
20. US Preventive Services Task Force. Anxiety in Children and Adolescents: Screening. Final recommendation statement, October 11, 2022. Checked October 22, 2026.
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    “The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years”; for children 7 and younger “the current evidence is insufficient”. “Separation anxiety, selective mutism, and GAD tend to appear earlier in childhood (preschool and early school years), whereas social anxiety and specific phobias generally appear in later school years”; “Developing an anxiety disorder during childhood or adolescence increases the likelihood of a future anxiety disorder (the same disorder or another anxiety disorder) or secondary depression”; risk factors include “attachment difficulties, conflict between parents, parental overprotection, early parental separation, and child mistreatment”; “only 2 screening instruments are widely used in clinical practice for detecting anxiety: SCARED and Social Phobia Inventory”; “The most common primary diagnoses in these trials were social anxiety disorder and GAD”; CBT “treatment response (pooled relative risk [RR], 1.89”. “The American Academy of Pediatrics and Bright Futures recommends annual screening for behavioral, social, and emotional problems”.
21. National Institute of Mental Health. Children and Mental Health: Is This Just a Stage?. Checked October 22, 2026.
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    “Consider seeking help if your child’s behavior or emotions last for weeks or longer, cause distress for your child or your family, or interfere with your child’s functioning at school, at home, or with friends”; “If your child’s behavior is unsafe, or if your child talks about wanting to hurt themselves or someone else, seek help immediately”; ask a therapist “Do you use treatment approaches that are supported by research?” and “Do you involve parents in the treatment?”; “A first step may be to ask the school whether accommodations such as an individualized education program (IEP) are appropriate for your child”; accommodations might include “allowing more time for tests, or adjusting seating in the classroom to reduce distraction”.
22. Rapee RM, Kennedy SJ, Ingram M, Edwards SL, Sweeney L. Altering the trajectory of anxiety in at-risk young children. American Journal of Psychiatry. 2010;167(12):1518–1525. doi:10.1176/appi.ajp.2010.09111619 (PMID 20810472). Checked October 22, 2026.
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    “146 inhibited preschool-age children and their parents”; “The six-session group-based intervention included parenting skills, cognitive restructuring, and in vivo exposure”; “Children whose parents received the intervention showed lower frequency and severity of anxiety disorders”; “Levels of inhibition did not differ significantly based on either parent report or laboratory observation”.
23. National Institute of Mental Health. Autism Spectrum Disorder. “Autism spectrum disorder is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave”; “symptoms generally appear in the first two years of life”. Checked October 22, 2026.
24. van Steensel FJA, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clinical Child and Family Psychology Review. 2011;14(3):302–317. doi:10.1007/s10567-011-0097-0 (PMID 21735077; PMC3162631). Checked October 22, 2026.
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    “31 studies involving 2,121 young people (aged <18 years) with ASD”; “39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder”, including “social anxiety disorder (16.6%)”; diagnoses of social anxiety disorder in ASD must be ““to be not better accounted for by the ASD itself””.
25. Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, et al. Sensory over-responsivity: an early risk factor for anxiety and behavioral challenges in young children. Journal of Abnormal Child Psychology. 2019;47(6):1075–1088. doi:10.1007/s10802-018-0502-y (PMID 30569253; PMC6508996). Checked October 22, 2026.
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    “a community sample of 917 at 2-5 and again in 191 of these children at 6 years old”; “Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder”; “Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six”; the relationship “was predominantly driven by children who met criteria for GAD”.
26. American Academy of Pediatrics, HealthyChildren.org. Anxiety in Teens is Rising: What’s Going On?. Claire McCarthy, MD, FAAP; last updated November 20, 2019. Checked October 22, 2026.
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    Signs include “Avoiding activities, school, or social interactions”, “Dropping grades or school avoidance” and “Chronic physical complaints, such as fatigue, headaches, or stomachaches”; “If you are noticing signs of anxiety in your child or are worried that something you are seeing could be related to anxiety, talk with your pediatrician”; “Talk with kids about potential stressors”. The most effective treatments are CBT and SSRI medications; “Exposure therapy, a type of CBT, focuses on increasing exposure to feared objects or activities”.
27. Section 504 regulations, Electronic Code of Federal Regulations. 34 CFR § 104.3 Definitions. Paragraph (j), “Handicapped person” (the regulation’s own term for a person with a disability): “has a physical or mental impairment which substantially limits one or more major life activities”; mental impairments include “any mental or psychological disorder”; major life activities include “learning”. Checked October 22, 2026.
28. Hudson JL, Rapee RM, Lyneham HJ, McLellan LF, Wuthrich VM, Schniering CA. Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy. Behaviour Research and Therapy. 2015;72:30–37. doi:10.1016/j.brat.2015.06.007 (PMID 26164621). Checked October 22, 2026.
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    “a clinical sample of 842 children and adolescents”; “children with a diagnosis of social anxiety disorder experienced a slower rate of change and poorer diagnostic outcomes at post treatment and follow-up than children with other anxiety disorders”.
29. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine. 2008;359(26):2753–2766. doi:10.1056/NEJMoa0804633 (PMID 18974308; PMC2702984). Checked October 22, 2026.
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    “488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia”; “80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%)”; “Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group”.
30. National Institute of Mental Health. Mental Health Medications. Checked October 22, 2026.
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    “In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting the medication or when the dose is changed”; “People should not stop taking a prescribed medication, even if they are feeling better, without the help of a health care provider”.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. If you are worried about immediate safety, call or text 988 (US). Never start, stop, or change a dose without medical guidance.