Is my child shy or socially anxious?

Shyness is common and normal. Most shy children are fine. Social anxiety disorder is different: the fear is strong, lasts for months, and stops a child from doing everyday things. In a large US survey, only 12 in 100 teenagers who called themselves shy had social anxiety disorder. So the question to ask is not “is my child shy?” but “is fear getting in the way of their life?”

Shyness and social anxiety: the difference

Social anxiety disorder is not rare in teenagers. About 9 in 100 US teenagers have had it at some point. It usually starts in childhood or the early teens. Half of all cases start before age 14.

Signs it may be more than shyness

UK guidelines (NICE) ask professionals to watch for children who avoid school, social or group activities, or talking in social situations, and those who are irritable, very shy or very reliant on their parents. Other signs include:

• refusing to answer the phone, order food or ask a teacher for help;
• tummy aches, headaches or tears before school, parties or clubs;
• dropping activities they used to enjoy;
• having no friends, or only one, and seeming lonely;
• speaking freely at home but not at all at school (see selective mutism);
• refusing to go to school (see school refusal);
• in teenagers: worrying for days before events and going over them afterwards.

Young children often can’t say “I’m afraid of being judged”. They show it with clinging, freezing, crying or tantrums.

Very cautious toddlers: should I worry?

Some toddlers are very cautious with new people and places. Researchers call this behavioural inhibition: a temperament, present from early on, of pulling back from anything unfamiliar. Psychologist Jerome Kagan found that most toddlers who were very inhibited at age 2 were still quiet with strangers at age 7.

Behavioural inhibition raises the risk of social anxiety later. In a review of 7 studies, inhibited children were much more likely to develop social anxiety disorder. But most inhibited children do not develop it. A recent study that followed 291 children for 16 years found that inhibition at age 2 to 3 did not predict anxiety diagnoses in the teenage years. Another study found that being very controlled and restrained at age 5 to 6 mattered more than inhibition itself.

A cautious temperament is not a disorder. It is one risk factor among many.

Did I cause this?

Probably not, and blame doesn’t help. In a study that combined 47 studies, parenting explained only about 4% of the differences in children’s anxiety. Genes, temperament, experiences such as bullying, and chance all play a part.

One thing parents do matters more than others: how much a child is helped to do things for themselves. Doing too much for an anxious child, or helping them avoid things, can keep fear going. The good news is that this is something you can change. See how parents can help.

Can it be prevented?

There is some good evidence for early help. In Australia, a six-session group for parents of very inhibited preschoolers led to fewer anxiety disorders a year later. Three years later, the children still had fewer and milder anxiety problems, even though they were no less cautious than the other children.

A large trial in 95 English schools offered parent-led online CBT to children aged 4 to 7 who were screened as at risk of anxiety. It did not clearly reduce anxiety disorders a year later, though some other measures improved.

Will my child grow out of it?

Ordinary shyness often softens with age. Social anxiety disorder usually does not go away by itself. A study that followed 14- to 24-year-olds for 10 years found that only about 15 in 100 had fully recovered. Treatment works well for children and teens, so it is worth acting early. See therapy for children and teens.

When to get help

Talk to your child’s doctor, school counsellor or a mental health service if:

• fear has stopped your child from doing normal things for several months;
• they are missing school, or not speaking at school;
• they seem very unhappy, lonely or low;
• they talk about hurting themselves or not wanting to be alive. In that case, get help the same day. See crisis lines.