Should my child see a therapist or a public speaking coach for presentation anxiety?

Parents often ask this as if they have to pick one. The two do different jobs. A therapist treats anxiety itself: the thoughts, the physical panic, the avoidance that has spread into daily life. A coach builds a skill: how to structure a talk, open it, hold eye contact, recover from a mistake. Nervousness shrinks as the skill grows, because a student who knows what they are doing has less to fear.

Signs a coach is the right starting point

• The nerves arrive close to the event and ease once your child starts talking.
• They speak normally with friends, teachers and relatives.
• The fear is specific to presenting, performing or being graded.
• They want to get better, even if they complain about it.

Signs to start with a therapist

• Dread starts days or weeks ahead and shows up as stomachaches, sleep trouble or refusing school.
• The fear has spread: ordering food, phone calls, answering in class, talking to new people.
• Your child talks freely at home but cannot speak at school at all, which can indicate selective mutism.
• It is getting worse over months instead of settling.

Social anxiety is common. The National Institute of Mental Health estimates that about 9% of US adolescents have social anxiety disorder, so there is no shame in asking your pediatrician for a referral. Many families use both: therapy for the anxiety and coaching for the skill, with the coach following the therapist's pacing.

A related question is the difference between a speech coach and a speech-language pathologist, who treats articulation, stuttering and language disorders. Our guide to speech coaching vs speech therapy covers that one.