Shyness is an observable characteristic in many people and about 40-50% of the general population displays this characteristic. In children however, shyness is not considered as problematic and parents and teachers especially view it as a desirable sign if it comes in the form of compliance, kindness, or respect. Social phobia or anxiety is often confused with shyness and for this reason; there is a tendency to overlook the need for intervention.
While dimensions of social phobia are actually cognitive, routine tasks such as asking for help or starting a conversation are often taken for granted. Yet, for a child suffering from social phobia, the mental anguish accompanying such simple acts can be overwhelming.
Social phobia can seriously disrupt a child’s emotional, social and/or academic functioning, leading to lifelong implications (Eisen 53).
The DSM-IV-TR defines social phobia as an anxiety disorder that is characterized by a persistent and strong fear of performance or social situations in which the affected person might experience a sense of humiliation or embarrassment. When defined in a general term, social phobia refers to a condition in which a patient suffers from a combined fear of most social interaction and performance situations such as eating in a restaurant and public speaking. The DSM-IV-TR however gives criteria for social phobia in children quite different from that of adults. In the course of development, children and adolescents experience very many fears.
Childhood fears however vary not only in severity but also in duration and frequency.
These fears are however age-specific, typically mild and quickly dissipate. They often do not involve persistent or intense reactions and at times are adaptive to situations. During childhood, fears can usually be predicted and they are interrupted by children’s cognitive capacities and daily experiences. In infancy, children generally have a fear of incentives within their immediate environment but as they mature, whatever fears they experience are largely characterized by anticipatory events and imaginary stimuli. In contrast to normal fears however, childhood phobias are characterized by marked and persistent fear which is realistically unreasonable or excessive although children may not view them in such way (Fatemi, Clayton & Sartorius 2008, p.378)
Although social phobia varies in its initial presentation and development, its onset most often occurs in childhood or mid-teens (adolescent) stage and is quite unusual after the age of 25 years, social phobia is most times a lifelong problem but its severity normally diminishes in adult life.
Like adults and teens suffering from this disorder, many children have enough perceptions that they have unwarranted excessive fears and this factor most often causes them more distress and inferiority complex. Social phobia has become a major concern in contemporary society because of its simultaneous appearance with such other problems as substance abuse and major depression. The disorder also affects the larger society through the loss of various talents and gifts possessed by the patients.
Young people can suffer devastating effects to their intellectual life and career choices, leading to pre-mature termination of education or making of self-defeating choices due to a fear of participating in the classroom among others in both education and workplace settings (Eisen 97-99).
To be diagnosed with social phobia, children must exhibit a capacity for regular peer relationships and anxiety must result from both peer and adult interactions. Children suffering from social phobia also display a constant worry of ridicule by their peers when they for example give a wrong answer to a question in class. Symptoms of anxiety may include crying, freezing, tantrums, or avoidance of social situations and the children may also not reach the realization that their fears are unreasonable or extreme.
Most children who suffer from social phobia exhibit the general type that involves the fear of performance or social situations. The mean age at which childhood social phobia begins in a clinical setting has been reported to be between 11.3-12.3 years. Although no sex differences exist in the presentation of childhood social phobia, more girls than boys are diagnosed with the condition (Biedel & Turner 2005, p. 204-205; Fatemi, Clayton & Sartorius 2008, p.378).
Children suffering from social phobia have the tendency to view themselves as having lesser social skills then their peers. They fare much less in social interactions; expect poor results in normal social settings and have negative peer interactions.
Compared with less anxious children, children suffering from social phobia have a higher profitability of being excluded, ignored and rejected by their classmates. Among the causes of childhood social phobia is environmental factors; the main area of consideration being the child-rearing practices those parents to people with social phobia exhibit. Parents may lack parental affection as well as be overly overprotective and such factors may lead to development of social phobia in children.
Isolating a child from other children may also prevent him or her from engaging in those situations through which the child can acquire social skills or help to extinguish social fears.
A child who is constantly exposed to excessive parental admonitions regarding how important others, opinions could be sensitized about the negativity of scrutiny or attention from others. Parents may also have the tendency to use shame as a mode of disciplining children and this isolates children with social phobia from others, making social situations appear fearful and avoidant. Children being brought by parents who are already suffering from social phobia are most likely to end with the condition.
Although social phobia is a disorder that appears to run in families, it is not directly transmitted. It is most likely inherited, learned or the child may otherwise develop a predisposition in which he or she experiences social anxiety in favorable circumstances (Heimberg & Becker 2002, pp22-27; Beidel & Turner 2005, pp.214-215).
Although the extent to which childhood social phobia remains prevalent is still unknown, the disorder is a very common reason why children are referred to specialized clinics for childhood disorders. Children suffering from social phobia display various symptoms such as:
Social phobias are generally treated through both pharmacology and psychotherapy with varying approaches being taken in performance situations and for the generalized type.
Results from some studies have indicted that combined use of both psychotherapy and pharmacotherapy in dealing with social phobias produces much better results than therapy alone although such a finding may not be applied to all patients and situations. Drugs that have proved effective in treatment of social phobia include benzodiazepines, selective serotonin reuptake inhibitors (SSRI), buspirone (Buspar) and venlafaxine (Effexor). SSRIs are however preferred by most clinicians as first-line choice for patients suffering from generalized social phobia. Psychotherapy normally involves a combination of cognitive and behavioral methods which include cognitive retraining, rehearsal during sessions, desensitization and various homework assignments (Sadock B, Kaplan & Sadock V 2007, pp.603-604).
Cognitive and behavioral patterns in the treatment of social phobia are intended to have an effect on the patient by changing his or her thought patterns and subsequently; the reactions that trigger anxiety-inducing situations.
Through the cognitive component, the patient can be assisted to question their surety about others constantly watching and judging him or her. The behavioral component on the other hand seeks to change a person’s reactions to those situations that are anxiety looking. Cognitive therapy therefore serves to show people the reality that their personal thought processes are actually very unrealistic. Also included in CBT treatment for social phobia are such other processes as anxiety management training, and group sessions which can be quite helpful. New psychological interventions in the treatment of childhood social phobia include Group Cognitive therapy (GCT), and the antidepressants venlafaxine and pregabalin. Through GCT, an intervention consisting of cognitive restructuring, psycho-education and behavioral exposure of a group of twenty three 8-11 year olds to real life situations by giving them homework was carried out. Measures taken included interviewing the parent and child as well as self-report measures of depression and anxiety.
During the third week of follow-up, those children receiving intervention demonstrated significant improvements as compared to those at all. But this procedure was limited in that a waiting list could not rule any effects to the active condition and future research carried out should include much larger samples (Curr Opin Psychiatry 2005, pp.51-54).
Early diagnosis of childhood social phobia could be very helpful in minimizing symptoms as well as controlling the development of such additional problems as depression. This is because early onset of the condition can adversely affect the social and academic development patterns of a child.
If the condition is left untreated, it can lead to a high risk of drug abuse, alcoholism, suicide as well as development of other psychological problems. It is therefore very important never to dismiss a child’s anxiety by assuming that they will gradually outgrow their self-consciousness or excessive shyness because many of them will not achieve such a goal without treatment from a mental health professional or parents or other members of his or her family.
Beidel, D.C and Turner S.M. (2005). Childhood anxiety disorders: A guide to research and treatment. London, UK: Routledge.
Current Opinion in Psychiatry. (2005). “Recent developments in research and treatment for social phobia (social anxiety disorder).” 18(1): 51-54. Baltimore, MD: Lippincott Williams & Wilkins http://medgenmed.medscape.com/viewarticle/497225_print.
Eisen, A.R. (2007). Treating childhood behavioral and emotional problems: A step-by-step, evidence-based approach. New York: Guilford Press.
Fatemi, S.H, Clayton P.J and Sartorius N. (2008). The medical basis of psychiatry. Totowa,NJ: Humana Press.
Sadock, B.J, Kaplan H.I and Sadock V.A. (2007). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Baltimore, MD: Lippincott Williams & Wilkins.