Feature Archive

Kids Afraid of Life

Too Shy

By Carol Sorgen
WebMD Feature

It's not uncommon for kids -- as well as adults -- to be shy. They may be uncomfortable when meeting new people or being in new situations. But once they've gotten their feet wet, so to speak, they're usually fine. For others though, that initial feeling of discomfort never goes away and keeps them from leading a normal life. When shyness reaches that level, it takes on a different name -- social anxiety.

There's more awareness of social anxiety -- also known as social phobia -- in adults than in children, says Barbara Markway, PhD, co-author with her husband, Greg Markway, PhD, of Painfully Shy: How to Overcome Social Anxiety and Reclaim Your Life. But the condition actually often starts in adolescence, or even childhood, she says. "The sooner you can diagnose it, the sooner you can treat it and avoid the pain and suffering that come along with the disorder," says Markway, who suffered from social anxiety as a young adult.

Adults and kids alike who suffer from social anxiety fear that others are judging them, that they're the center of (unwanted) attention, that they're being scrutinized all the time, says Markway. In kids, those feelings can translate into such behaviors as not raising their hand in class, not eating in the cafeteria with the other kids, not playing with the other kids on the playground, not joining after-school activities, and in some instances, refusing to go to school at all.

In severe cases, a condition known as selective mutism can develop in which a child won't speak to anyone outside his or her family -- interfering with both school performance and social interaction. "It's as if the voice box is frozen," Markway explains.

It's Different for Kids

One difference between kids and adults with social anxiety, says Markway, is that because youngsters find it harder to articulate their feelings verbally -- may not even recognize what they're feeling -- they may be prone to tantrums, crying spells, or frequently complain of stomachaches.

"Adults often realize that their fears are excessive," Markway says. "But kids don't." The bottom line, however, may be the same ... they try to avoid situations that make them nervous.

The difference between garden-variety shyness and social anxiety can be found in how much the condition is affecting daily life. "If the child is avoiding things that normal kids like to do, you may be in the realm of disorder rather than just shyness," says Markway.

Approximately 3-5% of the population suffers from social anxiety, says Deborah Beidel, PhD, professor of psychology and co-director of the Maryland Center for Anxiety Disorders at the University of Maryland in College Park. The incidence in children younger than 12 is about 3%, and in adolescents, about 5%, she says. Beidel is co-author with Samuel M. Turner, PhD, of Shy Children, Phobic Adults: The Nature and Treatment of Social Phobia.

Boys and girls are equally affected, but girls are more likely to admit it, says Beidel. The condition can be clearly diagnosed as young as age 8. Younger children may also suffer from social anxiety, but it's harder to diagnose them because they may be unable to fully express their feelings.

Because the children who suffer from social anxiety usually aren't the troublemakers in school, they may get overlooked, says Beidel.

Social phobia tends to run in families. If a parent suffers from any kind of anxiety disorder, it's more likely the child will, too, says Beidel. The condition may also be learned: If parents are shy, they may not take their child to different places, to meet different people, and the child will not learn to cope with new situations.

Getting Help

It's important to treat social anxiety as early as possible, both experts agree.

"This is not something you outgrow without intervention," says Beidel.

Adds Markway, "Social anxiety can be a precursor to depression in adolescence, and in adults can lead, along with depression, to substance abuse, even suicide."

When treating social anxiety in adults, medications such as SSRIs. Paxil, for example, has been FDA approved to treat social anxiety in adults. Though SSRIs have not received FDA approval for the treatment of social anxiety in children, they can be used successfully, says Markway.

But the standard treatment is cognitive behavioral therapy, geared to the child's age. The use of puppets, for example, can help children change the way they think about things and how they talk to themselves. Kids are also taught relaxation techniques to use in situations that make them uncomfortable.

"Through treatment, the kids can learn that the horrible things they fear won't happen," says Beidel.

Beidel is currently conducting a four-year study funded by the National Institute of Mental Health, comparing behavior therapy, Prozac, and placebo in youngsters aged 8-16. Part of the behavioral component consists of a program in which children in the trial meet with "peer helpers," for an hour and a half at a time, in a social situation.

"This is a chance for the kids with social phobia to mix with the kids who usually ignore them in a setting they usually don't go to," says Beidel. "It gives them the opportunity to practice the skills they have been learning."

While it's important to get help as early as possible, the good news is that studies indicate that treatment is effective and need not go on for an unlimited length of time, says Markway. "Short-term [six to 12 weeks perhaps, although it does depend on the severity of the disorder] usually works," he says. "You're not looking at years and years of therapy."

If you suspect your child suffers from social anxiety or social phobia, look for a mental health professional who specializes in the behavioral treatment of children, says Beidel.

For more information on the condition, these sources may be of help:

  • Association for Advancement of Behavior
  • Therapy Anxiety Disorders Association of America
  • Maryland Center for Anxiety Disorders

Originally published Sept. 23, 2002.

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Last Editorial Review: 1/31/2005 4:44:07 AM



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