Social Anxiety Disorder
Signs of Social Anxiety Disorder
Separation Anxiety Disorder (or Social Phobia)
Signs of Separation Anxiety Disorder
Selective Mutism
Causes of Selective Mutism
Helping a Child with Selective Mutism
Panic Disorder
What Causes Panic Disorder
How you can help your child or adolescent with Anxiety Disorder.
Treatment of Anxiety Disorders


Social Anxiety Disorder

Fear, anxiety, or avoidance caused by Social Anxiety Disorder is persistent, typically lasting six months or more and causes significant distress that interferes with his or her ordinary routine, school work, or social activities. Older adolescents will recognize this fear is unreasonable or excessive.

Social anxiety disorder usually begins in adolescence. It can develop suddenly after a stressful or humiliating experience or slowly over time. An equal number of girls and boys experience social anxiety. Some of the problems associated with social anxiety disorder include poor school performance, low confidence in social situations, trouble developing and maintaining friendships, and depression.

Young children may cry, whine, freeze, or cling to parents in certain social situations. They may refuse to participate in social activities or attend school. They also may not speak in certain situations (e.g., when meeting new people).

In middle childhood, children may become more self-conscious and expect things to go “bad” when they are around other children. They might be overly concerned about others looking at them or talking about them.

Teens may have negative thoughts about themselves. They may be more likely to mumble or avoid eye contact. They might “skip” school or use drugs or alcohol in order to feel less shy or inhibited.

Many children and teens with social anxiety go unnoticed by teachers or parents. They are not children who act out; instead they try to remain invisible. These children tend to get recognized when they begin to miss school or their grades start to drop.

Signs of Social Anxiety Disorder:

  • Has excessive fear of social and/or performance situations
  • Is concerned with making mistakes in front of others
  • Has difficulty speaking in class
  • Has a fear or a lack of interest in trying new things
  • Is afraid of speaking to unfamiliar people
  • Is uncomfortable in the spotlight
  • Avoids eye contact
  • Mumbles or speaks quietly
  • Has few or no friends

Physical signs:

  • Racing heart
  • Turning red or blushing
  • Excessive sweating
  • Dry mouth and throat
  • Difficulty swallowing
  • Shaking
  • Muscle twitches (usually around the face and neck)

Separation Anxiety Disorder (or Social Phobia)

Separation anxiety is developmentally normal in infants and toddlers until approximately age 3-4 years. During these early years mild distress and clinging behavior may occur when children are separated from their primary caregivers or attachment figures (i.e. being left in a daycare setting).

Separation Anxiety Disorder causes significant distress or impairment in social and academic functioning. The fear, anxiety, or avoidance is persistent, typically lasting
six months or more.

Separation Anxiety Disorder occurs when there is evidence of persistent and excessive anxiety related to separation or impending separation from the attachment figure (i.e.  parent, primary caregiver, close family member).

Separation anxiety disorder occurs because a child feels unsafe in some way. The following are common causes of separation anxiety disorder in children:

  • Change in environment. In children prone to separation anxiety, it is possible that changes in surroundings—like a new house, school, or day care situation—could trigger separation anxiety disorder.
  • Stress. Stressful situations like switching schools, or the loss of a loved one, including a pet, can trigger separation anxiety disorder.
  • Over-protective parent. In some cases, separation anxiety disorder may be the result of the parent’s own anxiety—parents and children can influence each other’s anxieties.

Signs of Separation Anxiety Disorder

Separation Anxiety causes severe distress and difficulty in social and academic functioning. The following are signs your child may display if he or she fears separation:

  • Reluctance to fall asleep without being near the primary attachment figure
  • Excessive distress (i.e. tantrums) when separation is imminent
  • Fear that something terrible will happen to the primary attachment figure
  • Excessive worry that an unpredictable event will lead to permanent separation from the primary attachment figure
  • Nightmares involving separation-related themes
  • Homesickness (ie, a desire to return home or make contact with the primary caregiver when separated)
  • Refusal to go to school or social functions due to anticipated separation
  • Frequent physical or somatic symptoms (especially in older children and adolescents):
    • abdominal pain
    • heart palpitations
    • dizziness
    • lightheadedness
    • nausea
    • stomachache
    • cramps
    • vomiting
    • muscle aches.

These symptoms occur when the child is separated or is anticipating separation from the major attachment figure. These symptoms may cause the child to miss school or avoid social activities.

Boys and girls typically display similar symptoms.


Selective Mutism

Selective Mutism is a complex childhood anxiety disorder. Many children with Selective Mutism are early speakers without any speech delays/disorders or processing disorders. Selective Mutism is most prevalent between the ages of 4 and 8; onset usually occurs when the child first enters school where speech is expected, but sometimes onset is gradual – the child speaks less and less until he eventually stops.

Psychological diagnostic criteria (DSM 5) states that Selective Mutism can be diagnosed after one month of the child not speaking. This does not include the first month at school during which the child’s initial silence is not necessarily an indication of Selective Mutism.  More than 90% of children with Selective Mutism also have Social Anxiety Disorder. Children and adolescents with Selective Mutism have an actual fear of speaking and of social interactions where there is an expectation to speak and communicate. Many children with Selective Mutism have great difficulty with nonverbal communication as well.

Not all children with Selective Mutism express their anxiety in the same way. Some may be completely unable to speak or communicate to anyone, others may be able to speak to a select few or perhaps whisper.

Causes of Selective Mutism:

  • Family History: In most children with Selective Mutism there is a family history of anxiety traits. We all have a ‘fear system’ called our fight or flight response. When we feel we are in danger this response turns on. We become ready to ‘fight’ or flee the danger. In children with Selective Mutism they perceive social situations as danger so their ‘fear system’ gets activated and they become very anxious.
  • Environment and Experience: When children feel a social situation is ‘dangerous’, they try to avoid the situation by being quiet, hiding behind their parents develop other ways to cope. Their anxiety decreases when people speak for them or they are able to leave the situation. These children learn that not speaking or avoiding social interaction helps them feel less anxious, and this behaviour becomes a pattern.

The majority of these children are as socially appropriate as any other child when they are in a comfortable environment such as home. However, they become unable to speak and communicate when they encounter uncomfortable social situations such as school.

Children with Selective Mutism are not being mute on purpose. They are not trying to control a situation by being mute. Not speaking is the way they protect themselves fromsevere anxiety. Very often, these children show signs of severe anxiety, such as:

  • separation anxiety
  • frequent tantrums and crying
  • moodiness
  • inflexibility
  • sleep problems
  • extreme shyness from an early age.

These children are uncomfortable being introduced to people, being the center of attention, afraid to make a mistake, embarrassed to eat in front of others. Physical Symptoms such as:

  • mutism
  • tummy ache
  • nausea & vomiting
  • joint pains
  • headaches
  • chest pain
  • shortness of breath
  • diarrhea
  • nervous feelings
  • scared feelings

How you can help...

  • Remove all pressure and expectations for the child to speak.
  • Spend time with your child; choose activities that promote conversation (i.e. board games)
  • Create a safe space for sharing feelings.
  • Let your child know that whatever she is feeling is OK.

If you are concerned that your child may have Selective Mutism, speak to your family doctor. The earlier you get help for your child, the better.



Experiences fear and avoids at least two of the following situations where they think they will not be able to escape, or where help may not be available if a panic attack occurs:

  • going to school
  • being separated from their parents
  • being alone
  • open spaces
  • public transportation (buses, planes)
  • closed spaces (theatre, elevator)
  • crowded places (restaurants, malls)

The child or adolescent will either avoid the situation(s) or will endure them with great distress and anxiety. Avoidance behaviors negatively affect the child or adolescent’s quality of life and overall functioning.


Panic Disorder

Experiences unexpected and repeated panic attacks. This is typically followed by at least one month of worry about having another attack and/or a fear of something bad happening because of the panic attack (such as going crazy, losing control, or dying).

A panic attack is a sudden surge of intense fear or discomfort and includes at least four of the following symptoms:

  • Racing heart
  • Sweating
  • Shaking
  • Shortness of breath
  • Feeling like they are choking
  • Chest pain or discomfort
  • Chills or hot flashes
  • Nausea or upset stomach
  • Dizziness or light headedness
  • A sense of things being unreal or feeling detached from oneself
  • Numbness or tingling sensation
  • Fear of losing control
  • Fear of dying

Panic attacks may begin in early adolescence. Panic Disorder usually starts in late adolescence(18-25 years) and is more common in girls than boys. Children and adolescents with a family history of anxiety or depression are at greater risk of developing Panic Disorder.

Problems associated with panic disorder include:

  • low self-esteem
  • poor school performance
  • problems with peer and family relationships
  • difficulty separating from parents or transitioning from home to school
  • sleep problems
  • depression
  • alcohol and/or drug use

Panic attacks are fairly common and having one does not mean your child has panic disorder. Panic attacks become a problem when someone worries about having more attacks, or fears something bad will happen because of the attack. He or she may begin to avoid going certain places or doing certain things due to the fear of having a panic attack. As a result, their quality of life suffers and they have significant problems at home and or at school.

What causes Panic Disorder?

The exact causes of panic attacks and panic disorder are unclear; experts believe the tendency to have panic attacks runs in families (heredity). There also appears to be a connection with life experiences, such as periods of transition for example, graduating from high school or university and entering the workplace, getting married, and having a baby. Severe stress, such as the death of a close friend or family member.


How you can help your child or adolescent with an Anxiety Disorder?

  • Do not blame yourself or your child
  • Help your child understand what anxiety is
  • Listen to and respect your child’s feelings
  • Encourage your child to talk about his or her feelings
  • Do not expect your child to ‘snap out of it’ or ‘grow out of it’
  • Be patient
  • Ask your child how you can help
  • Focus on the positives, the rational, and the good
  • Live in the present; avoid focusing on the past or future
  • Let your child face his fears while being supportive
  • Tell your child it is normal to sometimes feel anxious about different things
  • Offer choices so your child can feel some control in an unfamiliar situation. This will help him or her feel more safe and at ease
  • Work with the school to help your child with coping
  • Help your child develop coping skills:
    • teach him or her how to relax with calm breathing and muscle relaxation techniques (i.e. pretend to be a rag doll)
  • Take care of yourself. Pay attention to your own anxiety

Do not give up on getting help for your child. It can be very frustrating getting the right help but keep trying. If you suspect your child may have any of the above Anxiety Disorders, talk to your family doctor.

All of these mental illnesses can be treated effectively. The sooner your child gets treatment, the better it is for him or her and your family.


How are Anxiety Disorders treated?

Anxiety Disorders are often treated with Cognitive Behavioural Therapy or CBT.

If counseling is not working or if the anxiety is so severe that counseling is not possible, medication scan be prescribed by your doctor. For some people the combination of CBT and medications is necessary.

The goal of treatment is to have your child return to normal functioning without experiencing the distress caused by anxiety.