Associated features of SM may include profound shyness, little eye contact, social isolation, fear of social embarrassment, withdrawal, clinging behavior, compulsive traits, negativism and oppositional behavior when attempting to avoid feared social situations, and temper tantrums, particularly at home. Since children are unable to communicate verbally, they may opt for using nonlinguistic cues such as gestures, nodding or shaking the head to get their messages across. A child may pull or push objects and obstacles, and in some cases, communicate in monosyllabic, short or monotone utterances or in an altered voice (APA, 2000). Some of these behaviors may not be present at the onset of SM. At the onset of SM, children may often stand motionless and expressionless due to anxiety and then slowly progress from nonverbal and non-communicative stages to communicative and verbal stages in treatment (Shipon-Blum, 2001). Some individual with social anxiety symptoms may also experience parureis, the fear of using public restrooms perhaps to fear of making sounds while urinating that others may hear (Stein & Walker, 2002).