Category: Children

The Quiet Child: At What Point is Shyness… “Too Shy?”

By Sara Berlin, LMSW

It is common for people, especially children, to struggle with transitioning to the fall season. At the start of each school year, many children present as shy and struggle to interact with peers and teachers. While the majority of such children will “open up” over the first month of school, some children remain sheepish such that their parents and teachers become concerned. At what point is shyness “too shy”?

Intense shyness that lasts beyond the typical 1-month adjustment period to school may be a sign of Social Anxiety Disorder, an anxiety disorder that affects 4-9% of children and adolescents, or approximately 1 in 10-20 children. While feelings of anxiety in social situations are a normal part of life (and even healthy in some cases!), Social Anxiety Disorder is characterized by persistent and excessive fears about being negatively evaluated by others, which causes notable distress or impairment in everyday life. Children with Social Anxiety Disorder often struggle to attend school, perform as required, and/or socialize with peers, since they tend to be overly quiet and avoid activities that may draw attention to themselves.

In other cases, children may show signs of Selective Mutism, another anxiety disorder in which children refuse to speak in situations where talking is expected or necessary. Children with Selective Mutism may turn their heads away when others approach them or chew/twirl their hair in order to avoid eye contact. They may also stand motionless and expressionless or withdraw into a corner to avoid talking. Interestingly, children with Selective Mutism can be talkative and display normal behaviors at home or other places where they feel comfortable, such that parents are sometimes surprised to learn from a teacher that their child refuses to speak at school.

Here are some practical tips for parents with children who are struggling with social anxiety or selective mutism:

 Understand Your Child’s Intentions

Know that socially anxious or selectively mute children are not trying to be troublesome by ignoring friends and teachers. In fact, such children are usually highly compliant, since they are afraid of being judged or evaluated negatively by others. Avoidance of social situations or speaking are simply (maladaptive) ways of not feeling distressing feelings of anxiety. Almost all socially anxious children would do anything to stop being so anxious and “difficult!” So, be compassionate and validate their feelings of anxiety and fear.

 Give Praise (even) for Small Social Interactions!

Overcoming social anxiety and selective mutism involves a child gradually facing their fears and interacting more with others over time. As such, give your child praise right away whenever they try to interact with or communicate to others (verbally or even non-verbally). Any baby steps your child takes towards overcoming their anxiety should be reinforced. So, when you see your child struggling to speak in spite of their fear, make sure to praise them right away! And needless to say, refrain from making negative comments when you see them struggling. Punishing good behavior (trying to interact with others) can make things much worse, since socially anxious kids tend to be very sensitive to criticism. In addition, it is very important to identify and “label” your child’s specific behavior as you praise them. For example, if you see your child struggling to speak, instead of giving a generic praise such as “great job” you can say something like “I can see how hard it is to speak to these unfamiliar people in your class, and I’m proud of how you made sure to ask the entire question.” In sum, (1) praise your child ASAP after they do something hard, (2) be as specific as possible when praising, and (3) do it often.

 Don’t Probe, Validate

Parents naturally want to ask children questions about their fears (probe) when they start noticing them getting tense in certain social settings. Believe it or not, asking questions to children to alleviate anxiety can actually have the opposite effect, since it directs a child’s thoughts even deeper into their anxiety. Instead of probing, ignore the negativity and focus on praising positive behavior. With that said, it’s important to validate your child’s anxiety, especially if he feels overwhelmed. For example, note that they are overcoming an emotional challenge when they resist the urge to avoid. For example, you can say, “I know that speaking with your classmate was really hard for you today and I am proud that you are practicing your bravery.”

 Resist the Urge to Speak for Your Child

When you see that your child is feeling uncomfortable and anxious, it’s common to want to intervene and speak on their behalf. After all, what parent wants to see their child in distress?! However, saving your child from anxiety will make it harder for them to learn how to speak – if you communicate for them when they are anxious they will never learn to manage their anxiety! Instead, try to encourage them to speak or, if they are really struggling, you can tell guests that your child is working on bravely talking and he’ll try again in a minute or two. Just make sure you do in fact come back to it a minute or two later, though! If you don’t, and you simply “save” your child from speaking, it will reinforce their silence by preventing them from ever having to learn to speak for themselves.

 Make Talking Fun!

There are some games you can play that encourage continued speech, like Go Fish, Battleship, Surveys of “Favorites,” Hangman, Spot It, and Tell Tale. Be patient and positive as your child finds new ways to cope! Secure attachment and strong social support are huge protective factors for all children, particularly those experiencing anxiety disorders. Continue to provide a warm, safe, loving, and fun environment for your child!

 Seek Help

Finally, and perhaps most importantly, childhood anxiety disorders are easily treated and many families can benefit from consulting a mental health professional. A therapist can help assess, diagnose, and treat the anxiety disorder and help you create a plan to help your child cope and overcome their fears. Cognitive-behavior therapy (CBT) is the gold standard to treat childhood anxiety disorders as it helps children learn new ways to think in anxiety provoking situations, and teaches them concrete techniques to manage and tolerate their anxiety. If you are concerned about your child’s anxiety, seek help from a trained professional who can help you and your child.

Back to School

By Tonya Swartzendruber, MA

For many families, the fall represents a significant transition period. Returning to a school schedule can be daunting for kids and parents alike. Earlier bedtimes, packed morning routines, performance expectations, and more time away from parents are just a few changes kids face during the school year. A little planning can go a long way to help your family make this transition a smooth one.  Here are a few tips to consider:

Establish a school-like schedule gradually a week or two before the first day of school.

During the summer, many families relax bedtime, wake time, and meal schedules. Changing all of this at once on the first day of school can be a challenge. Try to gradually adjust sleep and wake times and bring more structure to the day 1-2 weeks before school starts. This can help the back-to-school transition feel more natural by the time Labor Day comes around.

 Address school-related anxieties with your child.

Even for kids that have already been in school for several years, the transition to a new grade can bring anxiety. Ask children about how they are feeling, listen carefully to any concerns they raise, and see if any can be addressed ahead of time. Normalize these concerns for your kids. Convey that transitions are hard for most people. At the same time, help them to refocus on what they are excited about in order to get into a positive space to face the challenges of school.

Involve kids in preparing for school.

This could be as simple as buying school supplies and new clothes together. The night before the first day of school, involve your kids in packing backpacks, lunches, choosing what to wear, and laying out their clothes. This will make the first morning of school much less hectic and stressful for everyone.

Convey excitement and confidence about this transition!

Kids are keen observers of their parents. They often take their cues from their parents to help them know how to feel about and prepare for new challenges. If you, as a parent are feeling anxious or uptight about any upcoming school challenges, find support and a place to talk about this with people other than your children. That way you can convey excitement and confidence about the new school year.

Anxiety Disorders in Children: A Family Affair

Written by Regine Galanti

When a child has anxiety, it often becomes a family rather than individual problem. While an adult with anxiety might suffer alone with racing thoughts of danger, or avoidance of anxiety provoking situations, children with anxiety are best viewed from a perspective that incorporates the whole family. This family-perspective is often true of adults with anxiety and OCD, but in the case of anxious children, it is the norm rather than the exception.

Take the case of Emma, an 11 year old who begins to have panic attacks. When she had her first panic attack, she was alone in her room, and felt her heart pounding, her breathing quickened, and her body began to shake. She was sure she was having a heart attack, and felt terrified, helpless and alone. When she felt better, she was determined to avoid those feelings of being alone and helpless forever. In order to feel safe, she refused to stay alone in her house, despite the fact that she used to do so easily. She demanded that her parents drive her to and from school, despite having taken the bus for years. Her father had to rearrange his work schedule to go in late every day, and her mother had to leave work early to pick her up. She was also incredibly fearful of being the last one awake in the house, and would constantly check on her parents to make sure they weren’t sleeping before she did. Her parents took to sitting in the living room to “prove” to Emma that they were awake, despite previously reading in bed, and sometimes going to sleep before their pre-teen daughter. She also asked her parents an endless string of health related questions, which she demanded the answers to, even though she challenged every answer. Emma’s mother and father were distressed by the effects of her anxiety on her own life, but recognized it was taking over their lives as well.

The term family accommodation is used to describe the ways in which family members of individuals with anxiety disorders adapt or modify their own behaviors to reduce their child’s anxiety. Accommodation in families most frequently involves parents – over 90% of parents of anxious children report that they change their own behavior to reduce their child’s anxiety in some way — but sometimes incorporate siblings as well. On its face, this may seem like a positive, as the family members are changing their behavior in order to reduce anxiety to help a child function better. Higher degrees of accommodation, however, are related to many negative factors in childhood anxiety, including a higher level of impairment in anxious children, and more severe symptoms. Accommodation sends the message to a child that their anxiety actually IS dangerous. In the case of Emma, her parents modifying their behavior to reduce her anxiety tells her that if she does stay home alone, something bad might actually happen, and that would be dangerous. Her parents are protecting her from something that isn’t actually dangerous, thereby sending her the message that she needs protecting. Instead, our goal when helping families with anxious children is to help parents support their anxious children – teaching parents how to tell their children that anxiety is a normal emotional experience, and that the best way to handle it is to face those fears even though it’s difficult rather than avoid them. The important factor to keep in mind here is that, though the child might be the one in treatment, often parents can play a role in reducing anxiety as well – though not in the way that you might think. By stripping away the layers of accommodation, parents can teach children how to face their fears in a healthy, adaptive way, and improve their long term functioning.