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Ease your child's anxieties

The authors of "Nurturing the Shy Child" share advice for parents on assessing and assisting their kids. Read an excerpt.
/ Source: TODAY

Is your child shy? Wondering how to handle it? In "Nurturing the Shy Child," psychologists Barbara Markway and Gregory Markway give parents and educators practical advice to help kids overcome their shyness and anxieties. Read an excerpt.

Because adults represent authority and are in a position of power, it’s not uncommon for children to be uncomfortable and quieter around them. For this reason, to be diagnosed with social anxiety disorder children must demonstrate anxiety with both peers and adults.

My seven-year-old son seems to have no awareness that his fears are unreasonable. Does that matter?

The DSM-IV guidelines for diagnosing social anxiety disorder state that the person must realize that his or her fears are greatly exaggerated. This criterion does not need to be met for children, however. Given their less mature cognitive development, we would not expect them to have insight into the unreasonableness of their fears and reactions.

My child has a bad case of test anxiety. Could this be a part of social anxiety disorder?

Yes. Test anxiety can be a part of the social anxiety spectrum. Drs. Sam Turner and Deborah Beidel, two prominent researchers in the area of social anxiety, found that 24 percent of test-anxious children also met the criteria for social anxiety disorder. If a child has only test anxiety, it is considered a specific form of social anxiety. If the test anxiety goes along with other social fears, it is part of generalized social anxiety disorder. In addition, test anxiety may be unrelated to social anxiety. For example, if a child has a severe learning disability in math, you would obviously expect some anxiety before a math test. Many of the treatment strategies we discuss throughout this book can help children overcome test anxiety.

Shyness and social anxiety in children and adolescents: A very common problem
Shyness in children and adolescents is by no means uncommon. According to Jerome Kagan, Ph.D., a professor of psychology at Harvard University, roughly 10 to 15 percent of kids in kindergarten through eighth grade are very shy, 25 percent tend to be outgoing and sociable, with the rest falling somewhere in between. In a separate study, Bernard Carducci, Ph.D., a shyness expert at Indiana University, has found that the percentage of shy teens is about the same as shy adults—around 40 percent.

According to Jerilyn Ross, president of the Anxiety Disorders Association of America, about 13 percent of youth aged nine to seventeen suffer from anxiety disorders, making them the most common mental disorder in young people. Depending on the research study reviewed, between 5 and 6 percent of children and adolescents have generalized social anxiety disorder.

In addition, the prevalence of problems that coexist in children with a primary diagnosis of social anxiety is similar to those in adults. A research study conducted by Drs. Beidel and Turner found that in children with social anxiety disorder:

  • 20 percent had other specific phobias
  • 16 percent had generalized anxiety disorder
  • 8 percent had depression
  • 16 percent had attention deficit hyperactivity disorder
  • 16 percent had learning disabilities

These figures illustrate the fact that children with social anxiety disorder often exhibit numerous problems and complex symptoms. In fact, another respected researcher, Dr. Murray Stein, admits that it can be difficult to diagnose social anxiety disorder in children and thus it’s difficult to obtain a true picture of how many youth are affected. This is because of the numerous interwoven fears some children have. He uses the term “anxious triad” to describe how separation anxiety disorder, generalized anxiety disorder, and social anxiety disorder often overlap in children. We discuss these disorders and their overlap with social anxiety throughout the book and more specifically in Chapter 11.

The spectrum of shyness and social anxiety disorder
As we mentioned, making a diagnosis of social anxiety disorder in children and adolescents is not always simple. Part of what makes it a challenge is that shyness and social anxiety disorder actually exist on a continuum. Let’s look at a number of brief examples.

Shy but basically secure and successful. Sixth grader Vanessa fits into the category of someone who is shy but also someone who is basically secure and successful. She has always been on the quiet side. In fact, every teacher throughout her elementary school years commented that she was “reserved.” She doesn’t like giving oral book reports or having to stand in front of the class, but she is able to do so when required. She has a few good friends, although not a very wide circle. She attends parties of kids she knows well, although she frequently turns down invitations for slumber parties.

Her parents accept her shy temperament and have never made a big deal of it. They are both on the quiet side themselves and seem to understand that this is simply who Vanessa is. They try to encourage her to break out of her comfort zone and try new things, put they’re not overly pushy. She is usually reluctant at first, but with support, she participates in a few extracurricular activities, such as Girl Scouts.

Vanessa’s parents worried that the transition from grade school to middle school would prove challenging for her. Indeed, Vanessa was a bit “stressed out” for the first month of school. She complained that the hallways were too crowded and she didn’t like switching classrooms for every subject. But in a month or so, she got into the swing of things and now seems to be faring quite well.

Shy but showing some problems. Like Vanessa, Sydney is cautious in new situations. She likes to check everything out before jumping into anything. She is always the one on the playground watching the other kids from the perimeter. She might eventually join in if she knows the kids and the game they are playing. At home, Sydney is content to play by herself for hours. Creative and with a keen imagination, she likes to sit and draw or play makebelieve games with her dolls.

Unlike Vanessa’s situation, however, Sydney’s parents are outgoing and love to entertain. They frequently have other families over for casual dinner parties, and this makes Sydney very uncomfortable. Her mother becomes upset with Sydney for not coming out of herroom to talk with their guests. At times, she thinks Sydney does this to make her mad. She has even punished Sydney for not being “polite” to their guests.

I first saw Sydney when she was in the third grade. Her parents were sure there was some deep-seated reason why their daughter wasn’t more sociable. Similarly, Sydney didn’t feel very good about herself. She realized she wasn’t measuring up to her parents’ expectations. She wished she could be more outgoing, but she simply didn’t feel comfortable with her parents’ friends. She didn’t know what to say or how to act.

Sydney’s parents were truly concerned about what they perceived as their daughter’s lack of social interest. They didn’t understand that this was part of her temperament—not something she was doing on purpose. I helped her parents learn to accept Sydney’s quietpersonality style and not to put so much pressure on her to be different. This went a long way toward helping Sydney feel better about herself. I also worked with Sydney to develop some social skills and some much-needed confidence.

Specific social anxiety disorder. Rob is in the eighth grade and just a little bit shy. He’s always had a lot of friends and done well in school. He loves music and has been in the orchestra for years. He’s developed into quite a talented violinist, and his orchestra teacher selected him to perform a solo in the spring concert.

This has made Rob a nervous wreck. The concert isn’t for several months, and already Rob is having trouble sleeping, has lost his appetite, and is considering dropping out of the orchestra.

Rob’s reaction may sound extreme, but we’ve worked with people of all ages where this sort of situation occurs. The anxiety leading up to a feared event (what we call anticipatory anxiety) is so uncomfortable that it doesn’t seem worth it to the person to go through all that misery. Rather than endure the discomfort, he withdrawsfrom the feared event. We’ve also worked with people who have had a panic attack during a performance situation and vowed never to go through that experience again, thus quitting some activity they were good at and enjoyed.

Mild to moderate generalized social anxiety disorder. Megan is now in high school and has been shy all her life. Her parents have been supportive and tried to encourage her, yet quite a few odds were stacked against Megan. Her family has a strong history of anxiety and depression on both sides. Megan’s father is in the military and they have had to move every few years, which has made it difficult for her to make friends.

Megan gets lower grades than she’d like in school. Although she is of at least average intelligence, because she always sits in the back of the class and never asks any questions, she sometimes misses important points the teacher is making. She’s also lost out on extra credit toward her grade based on class participation.

In addition, Megan suffers from physical symptoms of anxiety. For example, when she’s in class, if it appears they’ll have to go around the room and take turns answering questions, she feels as if she’s going to have a panic attack. Her heart beats wildly, she feels flushed, and she has difficulty concentrating. She’s sure she won’t be able to speak coherently when her turn comes. Sometimes she even feels dizzy and worries she might faint. Of course, fainting in class would prove embarrassing to Megan, and worrying about that possibility just makes matters worse.

Severe generalized social anxiety disorder. The distinctions among the categories are somewhat arbitrary in nature. If Megan’s symptoms progressed, she could easily fit in the severe generalized social anxiety disorder category. Here we include children who have selective mutism or school refusal. We also include children and teens who’ve become depressed as a result of their social anxiety. For example, kids like Megan can become isolated, lonely, and even hopeless. Children who have numerous physical symptoms or panic attacks and kids who avoid most social situations also fit into this category.

As we said, the categories themselves aren’t important. What is important is understanding the range of problems that can exist so that you’re better able to understand your child’s particular situation. In addition, rest assured that the strategies presented in this book can help you help your child, regardless of where he or she falls along the continuum of shyness and social anxiety.

For the child who is shy but basically secure and successful, this book will strengthen what you already know and what you’re already doing correctly with your child. In addition, feel free to skip ahead to Chapter 8 for ideas on making friends and feeling comfortable in large groups. For the child who falls somewhere along the middle of the continuum, you can learn to be a knowledgeable coach who can help your child reach his or her full potential. And if your child falls on the end of social anxiety disorder, there is a lot you can do to help. But keep in mind that you may also need a psychologistwho is trained in treating childhood anxiety disorders to guide you through the process.Look at the diagram below. Where do you think your child’s problems fall?

  • Shy but secure
  • Shy with problems
  • Specific social anxiety disorder
  • Mild-moderate generalized social anxiety disorder
  • Severe generalized social anxiety disorder

The good news in all this is that you’re not alone. Many parents of children who are shy and socially anxious have learned skills to help their children grow into socially confident and capable adults. The next step is gaining more specific information into the nature and extent of your child’s social concerns.

Does my child have social anxiety disorder?
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 firsthand 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
  • PE class (a lot of social and performance pressures)
  • Giving an oral report
  • Eating in the cafeteria
  • Asking 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 pencil)
  • Participating on team sports

Excerpted from “Nurturing the Shy Child: Practical Help for Raising Confident and Socially Skilled Kids and Teens,” by Barbara G. Markway, Gregory Markway. Copyright © 2005 by Barbara G. Markway, Gregory Markway. Published by St. Martin's Press. All rights reserved. No part of this excerpt can be used without permission of the publisher.