Social Anxiety

Avoid Avoidance

Hello brave caregivers!

I hope you enjoyed a relaxing Thanksgiving holiday! Honestly, my head has been spinning knowing that the holiday season is already upon us and I know that for many of my patients and their families this can be a really difficult time.  I thought I’d devote the next couple posts to topics that may be salient for kids and families during the holiday season. This week, I’d like to explore social anxiety disorder. Holiday gatherings and parties can be downright terrifying for kids with social anxiety disorder.  I’ve noticed that  I’ve had friends approach me for help with their children’s temper tantrums, sadness, oppositionality, you name it; but I’ve never had a friend seek my advice for a child who is struggling socially.  

Huh? Why is this? Social anxiety disorder is actually pretty common in kids!  I’m inclined to think that maybe people attribute social struggles to shyness, believing this is just their kids’ personality. So let’s discuss the difference between shyness and social anxiety disorder and the importance of recognizing and treating social anxiety disorder.

Shyness is a personality trait while social anxiety disorder is a mental health condition. As a mental health condition, social anxiety disorder causes significant distress and impairment in several areas of functioning. For instance, while the shy individual may be reserved or uncomfortable at a party, as familiarity grows, s/he may eventually relax and enjoy it. The individual with social anxiety disorder, on the other hand, tends to avoid the party completely or endure it with unrelenting intense distress. At its core, social anxiety disorder is the fear of doing something embarrassing in settings involving exposure to social scrutiny, such as classrooms, restaurants, and extracurricular activities.

The key word is fear.

Back to our kids.  I apologize in advance if what I’m about to say sounds judgy. I really don’t mean to, but this is so important.  Please don’t let your child live in fear.  If your kid struggles to answer questions in class, read aloud, start conversations, go to parties, or talk to unfamiliar people, it may be social anxiety disorder.  If you suspect social anxiety disorder, it’s critical to intervene as early as possible. If left untreated, it will persist (i.e., your child is unlikely to “grow out” of it), and it can negatively impact academic performance and peer relationships, socioeconomic status and quality of life, and increase a child’s risk for development of depression and substance use disorders.

Treatment is important and, truly, the earlier the better. Treatment may involve cognitive behavioral therapy (CBT) and/or medication depending on the severity of the anxiety, the clinician’s recommendation, and/or family preference.   A visit with your pediatrician for an evaluation is a good starting point.

I’ve seen many well-meaning families allow a child to stay home from school or skip an event to relieve his/her social anxiety. Sure, this helps with anxiety in the moment, but how does it affect a child’s long-term development? The unfortunate outcome is that the child learns to manage anxiety by staying away from what causes it and, as you might expect, avoidance breeds more avoidance. Again and again, this sends the child a message that social situations are indeed scary and that s/he is not capable of managing them.  Also, avoidance robs the child of the opportunity to learn how to navigate social environments, which interferes with the acquisition of the social-emotional skills necessary for healthy development.  Bottomline, the key to addressing social anxiety is avoiding avoidance.  The idea behind CBT is to provide therapeutic exposure to anxiety-provoking situations while building skills to manage those situations. By practicing exposures, the child learns to tolerate discomfort, combat associated maladaptive thinking, and ultimately to participate in various social situations (yay!).  How awesome for kids to be relaxed enough to be themselves in all kinds of social environments!

I hope I’ve shed some light on the underappreciated issue of social anxiety disorder. If you suspect your child may be struggling with this mental health condition, please seek an evaluation.  I know it takes bravery to seek help, but your bravery may help your child discover hers/his.

Until next time,  

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