Social anxiety disorder (SAD) is one of the most common anxiety disorders diagnosed during adolescence. SAD is associated with both psychological stress reactivity and heightened physiological arousal; however, no study has systematically examined which aspects of autonomic nervous system function mediate the likely links between stress sensitivity and symptoms of SAD in adolescents. In this study, we assessed 163 adolescents (90 females; 12.29±1.39 years) with respect to severity of life stress and social anxiety symptoms and measured respiratory sinus arrhythmia (RSA) and skin conductance levels (SCL) during a well-validated psychosocial stress paradigm composed of baseline, reactivity, and recovery periods. We operationalized stress sensitivity as the residual variance in subjective stress severity after accounting for objective stress severity and changes in autonomic regulation (relative to baseline) during reactivity and recovery using standardized change scores in RSA and SCL. We found that in females only, stress sensitivity and symptoms of SAD were significantly correlated with each other (p<0.001) and with autonomic regulation during both reactivity and recovery (all ps<0.04). Further, sympathetic nervous system dominance during recovery specifically mediated associations between stress sensitivity and symptoms of SAD (B=1.06, 95% CI: 0.02–2.64). In contrast, in males, stress sensitivity, autonomic regulation during reactivity or recovery, and symptoms of SAD were not significantly associated (all ps>0.1). We interpret these results in the context of psychobiological models of SAD and discuss implications for interventions targeting autonomic processes in this disorder.