Child Social Anxiety

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Child Social Anxiety is also called social phobia. Children who have social anxiety disorder are afraid of social situations, usually because they are afraid of embarrassing themselves or being judged.

Social situations for children usually happen at  school, and this may be the first place it is identified. Children with social anxiety disorder may be especially afraid new social situations, class activities or projects where they may have to perform in front of others. Gym class is often a big one.  Child social anxiety may also cause children to have panic attacks, cry, and tantrum or have physical symptoms of stomach aches and headaches.

These behaviors can occur while in the actual social situations or even just when thinking about social situations. Children will often deal with their thoughts and feelings of anxiety by engaging in behaviors to help them avoid or escape situations where there is pressure to interact socially. If your child tries to avoid activities that should be fun for them such as birthday parties, is reported by teachers to withdraw or have trouble interacting with children at school, or seems to struggle with peers or in other social situations it is possible that they have social phobia. Seek professional help to determine if they meet the criteria for social anxiety disorder in a child.

Shyness or Social Anxiety?

Shyness is not social anxiety. However, young children who are shy or have difficulty with new social situations are more likely to develop social anxiety disorder as they age. This is a trait referred to as behavioral inhibition.  If you are concerned about any of the above symptoms it may be important for you to seek help. Adults with social anxiety disorder  often had a childhood onset. Without treatments child social anxiety can lead to more serious problems.

Causes of Child Social Anxiety

Where does child social anxiety come from?

It definitely results from some combination of environment and genetics. Children who have social phobia may have parents who are very anxious and learn anxious behavior.

Some children develop a social phobia after a traumatic experience such as throwing up in the classroom or falling in front of others who laugh at them. They also may have an impairment that makes them feel socially different, such as speech problem or learning disabilities.

Brain structure and biology (neurotransmitters levels) may also contribute to social anxiety. There is some evidence that there is a trait, called behavioral inhibition that is inherited. This appears to be related to social anxiety and other forms of anxiety. It is important to look at all of the factors that may have contributed to your child’s social phobia so that when coming up with a treatment plan these areas can be targeted and modified.

What can I do about my Child's Social Anxiety?

Child social anxiety must be addressed in a comprehensive manner. Social phobias can lead to later social and occupational problems, depression and substance abuse if not treated. Like most anxiety disorders, it is also very amenable to treatment. We know treatment can successfully change the brain! Early intervention and the right treatment is the key. A holistic approach to treating your child’s social phobia includes working with the school, educating yourself about the disorder, looking at your own possible behaviors that may be contributing, and individual or group therapy for your child.

COGNITIVE BEHAVIOR THERAPY

The best researched treatment for social anxiety disorder in a child, cognitive behavior therapy, focuses on changing the thoughts that lead to behaviors and reactions. Cognitive behavioral therapy for children may incorporate art ,writing ,or play. A child may be asked to make a list or drawing of the thoughts contributing to their social fears, gently challenged on the reality of those thoughts or beliefs, and then asked to generate new alternatives.

Components include:

• Psycho educational treatment- educating yourself and your child about the nature and treatment of social anxiety disorder in a child.
• Creative visualization , deep breathing, and progressive muscle relaxation- techniques to relax a child’s body and mind.
• Cognitive restructuring- changing the beliefs and thoughts that are causing your child’s social anxiety.

Exposure therapy 

Exposure therapy consists of exposing a child to disturbing thoughts and ideas in a safe environment, and pairing these fears with mental and physical relaxation so they can be conquered outside of the therapy room. Children will be gradually encouraged in therapy to face fearful situations from the least to the most fearful.

Family Therapy/Parent Support

Family therapy is also helpful when treating social anxiety disorder in a child. The parents are provided with the tools and support necessary to help their child, and also can become partners in their child’s treatment. Some children prefer to have parents with them for the whole session, others for part of the session where they can discuss with the parent what it is that they learned or achieved during the session.

Group Therapy

Social Effectiveness Training (SET-C) is an evidenced based treatment for child social anxiety . SET-C is a group treatment program for  which involves the assistance of same age peers using many of the above interventions but with the added benefit of peer feedback.

Medications

Medications typically utilized for child social anxiety are selective serotonin re uptake inhibitors. There is some evidence that these are helpful for children with social phobia. However, a recent study showed that SET-C a group therapy program was more beneficial for children than drug therapy. If possible, it is important to try good therapy prior to medication. (Beidel D. Turner SM, 2007)

The School

The school teacher can work closely with parents to assist with social anxiety disorder in a child. In most cases, the parent will have to spearhead this effort and advocate for their child. The teacher will need to be aware of a child’s actual diagnosis of social anxiety disorder, especially if in a public school setting so they can make the necessary accommodations. Each child will have different and specific needs in the school setting and so plans will need to be individually tailored. In most cases, close teacher and parent contact as well as the involvement of the school counselor may need to occur.

What Can You do at Home to Help Your Child?

• First get your child to a therapist familiar with anxiety disorders.
• Create a thermometer with your child that expresses their level of anxiety. Use this daily to examine where they are at the beginning and the end of the school day. This can also assist you in becoming aware of what experiences your child might not yet be ready for.
• Don’t push your child into social activities he is not ready for. Slowly expose them to experiences you have prepared them for ahead of time through role plays. If your child is anxious about meeting new children for example, don’t push them into going to a slumber party, they may be overwhelmed and unable to cope. But do push them beyond what they would agree to do without your support. 
• Educate yourself and your child about social phobia.
• Talk about the social anxiety on a regular basis checking in daily to see where your child is.
• Remind your child of successful times they have had socially.
• Role play with your child ways they might interact with other kids when getting ready for a social interaction such as a birthday party.
• Create a sticker reward system for your child for talking about , or dealing with their anxiety.
• Praise your child each time they discuss or verbalize their anxious feelings.
• Work on setting up play dates with children or other small social experiences when your child can handle them.
• Convey to your child that you know they can learn the skills to conquer their anxieties and that you will help them through it.
• Model the ability to self soothes and relax your body through progressive muscle relaxation. deep breathing ,yoga, and creative visualization.
• Take field trips to serene settings to practice these techniques with your child.
• Use artwork to assist your child in creating a calm and peaceful place to help relax them when fearful.
• Practice positive self talk with your child. For example, if your child is going to visit a friend’s house, they can say “I will be fine; I did this last week and had a great time. I will probably have a great time again.”

If you are more interested in helping your child with social anxiety, here is my favorite book on the topic.

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Sources consulted in writing this document

Albano, A. M. (January 2000). Social Phobia in Children and Adolescents. Child Study Center Letter , Volume 4 Number 3.American Psychiatric association. (1994). Diagnostic Manual of Mental Disorders, 4th edition. Washington,DC: American Psychiatric Association.

Beidel D. Turner SM, S. F. (2007). . SET-C versus fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry , 1622-1632.

Beidel DC, Turner SM, Morris TL (1999), Psychopathology of childhood social phobia. J Am Acad Child Adolesc Psychiatry 38(6):643-650.

Ellen Jaffe-Gill, M. M. (n.d.). Social Anxiety and Social Phobia:Symptoms,Treatment, and Support. Retrieved December 31, 2007, from helpguide.org: http://www.helpguide.org/mental/social_anxiety_support_symptom_causes_treatment.htm#online

Malouff, J. (2002). Helping Young Children Overcome Shyness. Retrieved 12 31, 2007, from University of New England: http://www.une.edu.au/psychology/staff/malouffshyness.phpMassachusetts General Hospital, School Psychiatry Program and MADI Resource Center. (n.d.).

Social Phobia ( Social Anxiety Disorder). Retrieved 12 31, 2007, from massgeneral.org: http://www.massgeneral.org/schoolpsychiatry/info_socialphobia.asp#interventions_home

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