Below is an informal screening questionnaire that covers many of the situations commonly feared by children with social anxiety disorder, as well as typical symptom patterns. By going through these questions, you will gain a snapshot of your child and his or her problems. You can answer the questions yourself based on your knowledge of your child. Or, depending upon the age of your child and how motivated and cooperative he or she is, you can ask for your child’s help. Consider also asking your child’s teacher for input. Teachers have a lot of first-hand knowledge about how your child behaves in school—information that you quite possibly wouldn’t be able to obtain on your own.

These are the situations my child is likely to complain about or is known to avoid:

Answering questions in class
Raising hand in class
Writing on the blackboard
Musical or drama performances
P.E. class (often a lot of social and performance pressures)
Giving an oral report
Eating in the cafeteriaAsking the teacher a question
Using the school restrooms (not due to fear of germs)
Doing anything that involves getting out of one’s seat in class and drawing attention to self (e.g. getting up to sharpen your pencil)
Participating on team sports
Going to parties
Informal conversations with other kids
“Hanging out” by the lockers
Riding the school bus
Going to a friend’s house
Inviting a friend over
Using the telephone
Participating in a sleep-over
Going to the store
Ordering food at a restaurant
Talking to neighbors or other adults
Joining in with kids at recess
Doing things while being watched
Taking tests
Dating or going to dances
Other:____________________________
Other: ___________________________
Other:___________________________

These are the things I hear my child tell him or herself before, during, or after a social situation: (Keep in mind that young children often don’t know what they’re thinking, so you may not be able to answer this section very easily.)

I don’t fit in.
No one likes me.
I don’t have any friends.
I’m stupid.
I’m ugly.
I can’t do it.
I’m boring.
It’s going to be horrible.
I won’t know what to say.
People will notice I’m nervous.
Other: ______________________________________
Other: ______________________________________

These are the physical symptoms my child is likely to experience when anxious: (Keep in mind that many of these symptoms can be internal and not visible to someone else. Your child may look okay but actually be quite anxious. In addition, children may experience shame about their physical symptoms and go to great lengths to hide them. Some symptoms, like blushing, are impossible to hide. These type of symptoms—those that can’t be disguised—often cause kids the greatest concern.)

Headaches
Stomachaches
Diarrhea
Nausea
Feeling like he/she might vomit
Blushing
Sweating
Shaking
Hot flashes/cold flashes
Muscle tension
Heart palpitations or racing heart
Tightness in chest
Shortness of breath
Feelings of weakness (e.g. legs feel like Jell-O)
Light-headedness/dizziness
Choking sensations, lump in throat, dry mouth
Feelings of unreality (like in a fog)
Other: _________________________
Other: _________________________

My child experiences panic attacks, either in social situations, or in anticipation of them: (A panic attack is a sudden surge of intense fear and anxiety, usually accompanied by several or many of the above physical symptoms. It will usually reach a peak in five to twenty minutes before subsiding.)

Yes
No

My child is likely to experience panic attacks in these situations:

My child experiences panic attacks approximately _____ times per week.

These are the behavioral reactions I notice in my child when he or she is confronted with a feared social situation:

Throwing a temper tantrum
Having a crying fit
Refusing to go or participate
Clinging, staying close to a family member’s side
"Freezing”—literally acting as if frozen by fear, not moving, not speaking
Avoiding eye-contact with others, looking down
Asking for excessive and repeated reassurance
Acting agitated, irritable, begging to go home early

Other key questions to ask yourself about your child’s reactions to feared social situations:

Do your child’s problems interfere with his academic (school) functioning?
Does your child’s anxiety interfere with her making and keeping friends?
Is your child missing out on fun activities that many children of the same age enjoy?
Do people comment on your child’s excessive shyness?
Do you spend time worrying about your child’s shyness?
Is shyness or social anxiety affecting how you feel about your child, or how your child feels about himself?
Is your family environment affected by your child’s anxiety? Do you tip-toe around, trying not to set him or her off?