Is your teen just shy or do they have social anxiety disorder?

Here’s what you need to know about social anxiety disorder in teens and how to help them cope.

Photo: iStockphoto

Most people can relate to getting butterflies in their stomachs before starting a new school or giving a presentation in class. But for some teens, the fear of doing or saying the wrong thing—and consequently being judged by their peers—can be overwhelming. For these kids, navigating the social complexities of junior high and high school can feel like tiptoeing through a minefield because their social anxiety goes beyond what’s considered normal. It’s estimated that up to eight percent of all youth will meet the criteria for social anxiety disorder, which is the most common type of anxiety disorder.

What is social anxiety disorder?

“Social anxiety is an intense and overwhelming fear of being judged in social or performance situations,” explains Lynn Miller, a registered psychologist and co-chair of the Scientific Advisory Committee for Anxiety Canada.

Picture a teen walking down the hallway at school. Instead of chatting with friends or considering typical adolescent thoughts like “Is it lunchtime yet?” they worry about their outfits, complexion and hair. They imagine that others notice their acne or clothing and then gossip about them.

“These kids feel like they’re under the spotlight all the time,” says Miller. “It’s out of proportion to the situation.”

They also fear that their peers will know they’re anxious and, for example, see them blush when they’re called on in class. As a result, teens with social anxiety disorder begin to avoid situations that, literally, make them sweat.

But a lot of kids are shy. Won’t my teen grow out of it?

Many people feel a bit anxious in social settings and it comes and goes, depending on the situation, say experts. In fact, about half of teens identify as being shy at least some of the time, says Carlton Duff, a registered psychologist and clinical lead for the Confident Parents: Thriving Kids program at the Canadian Mental Health Association’s BC division. “But it crosses the line when it starts to significantly interfere with someone’s life,” says Duff, “and, in fact, it’s one of the main criteria of social anxiety.”

Young girl sitting in the hospital talking to a doctor Anxiety is sending twice as many kids to the emergency room as it was a decade agoA shy or introverted teen might feel apprehensive in social situations but will be able to push through and make friends, take part in group projects and give school presentations as needed. A kid with social anxiety disorder, on the other hand, will start avoiding settings that spike anxiety, such as parties, tryouts for sport teams, social activities with friends and even classes at school.

Parents can add to the problem by dismissing social anxiety as common shyness, says Duff. “They think their child will grow out of it in time because of one specific situation, such as a peer that isn’t nice to them, but that’s almost never the case,” he says.

Who’s at risk for social anxiety disorder?

If you, as a parent, have social anxiety, your child is more likely to develop an anxiety problem. “We say it runs in families, even though there is no genetic marker for it,” says Miller, who is also co-chair of the Scientific Advisory Committee for Anxiety Canada.

And helicopter parents, take note: Duff says overprotective parenting may exacerbate any existing anxiety. For example, if a toddler acts fearful around strangers and a parent responds by removing the child from the situation, she learns to respond to fear or anxiety by avoiding it. “We call this process that parents go through to keep their kids safe ‘accommodation,’” says Duff. “They accommodate their child’s anxiety when, in fact, there’s nothing to be afraid of.”

Finally, some kids just seem more vulnerable to developing the disorder. They might have an introverted temperament that turns into social anxiety in adolescence, says Duff (most kids develop the disorder after the age of nine). Other kids develop it after a “precipitating event,” such as being bullied, so their anxiety appears to balloon from out of the blue.

Keep in mind, too, that early to mid-adolescence is a time when youth become aware of social status and where they fit in with that junior high or high school hierarchy. “This is a time when there can be a spike in social anxiety disorder,” says Duff.

What are the symptoms of social anxiety disorder in teens?

Most teens with social anxiety tend to keep it under wraps. They become good at “holding it together,” so parents have to be detectives if they think their child is struggling, say experts.

“What parents should look for is if their teen starts to slowly withdraw from social life—from having friends over or going to friends’ houses,” says Miller. It could also come on quite suddenly, like unexpectedly quitting a sports team or not attending events. “They might become highly perfectionistic and avoidant with their homework, thinking ‘What if I don’t get an A+?’” says Miller. “They’re fidgety kids—they’re not chill kids.”

A classic example is the teen who is really looking forward to a slumber party but then develops a headache or stomachache and cancels at the last minute. Doing this once is probably not a problem, but if it becomes a pattern of social avoidance, it’s a red flag. In fact, experts say that any of the physical signs of anxiety, such as chronic stomach upsets, shaky hands, sweaty palms, lightheadedness, a racing pulse or even panic attacks, are cause for concern.

Treatment for social anxiety disorder

There are many resources for parents of children with social anxiety. Both Anxiety Canada and the Canadian Mental Health Association post videos, stories and information about the disorder, as well as strategies for managing it.

Parents can try to tackle social anxiety as a family, but sometimes they need professional help, says Duff. The first line of treatment he recommends is cognitive behavioural therapy (CBT), which teaches youth how to manage their thoughts—or change how they think—to influence their behaviour and reactions in social settings. The second line of treatment is medication.

“If you have concerns about your child, reach out to your family doctor or a mental health professional for more information,” says Duff. “The longer you wait, the worse it can get.”

How to parent a teen with social anxiety: One family’s story

By the time Ava Cronin* was 15, her social anxiety was so acute, she would call her mom to pick her up from school dances after just 30 minutes. She had always been shy and avoided the spotlight, but when she reached high school, her apprehension around social situations hit critical mass.

“As she got older and social interactions became more complicated, we definitely saw it intensify,” says Deirdre,* a mother of two.

Ava would make plans to go out with friends and then back out because her stomach hurt. In new situations, she would stand with her arms crossed and dig her fingernails into her arms or bite the insides of her cheeks—outward physical signs of internal distress.

The Cronins sent Ava for talk therapy with a psychologist and tried a range of anxiety medications, but nothing seemed to help much. Finally, they enrolled her in an 11-week wilderness therapy program, followed by a nine-month stint at a therapeutic boarding school that included group therapy, work with animals and dialectical behaviour therapy (DBT). Ava learned to identify the onset of physical anxiety symptoms and quash them before they took hold. It made a huge difference.

“She is at a new high school where she doesn’t know anyone,” says Deirdre, “and it’s amazing to see the confidence she has going in.”

*Names have been changed

Read more:
Anxiety in girls is skyrocketing—are our expectations to blame?
How to know if your preschooler is struggling with anxiety

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