Is My Child Shy Or Is It Something Else?

Anyone who has spent time with children knows they come in a wide array of shapes, sizes and personalities. Indeed, temperament is one thing that can vary substantially among children, even within individual families. One domain of temperament often neglected in kids is shyness.

Shyness can be a normal and expected behavior, especially in new situations. It is completely appropriate for a child to cling to a parent and bury his or her head upon meeting a first-grade teacher, or to initially hesitate when approaching a large group of unfamiliar peers on the playground. Such behaviors do not typically pose a problem.

However, sometimes ordinary shyness crosses the boundary and keeps children from leading normal lives. Extreme shyness, known as social phobia or social anxiety disorder, affects 5 percent to 15 percent of youngsters ages 10 to 17. Unfortunately, parents and teachers sometimes overlook social anxiety because children who suffer from the disorder are usually not troublemakers or inattentive in school. Yet, social anxiety can contribute to poor academic performance and psychological pain such as depression, substance use, and limited development of social skills.

Children and adolescents who suffer from social anxiety fear others are judging them negatively or are embarrassed by routine social interactions. They feel anxious or upset when unable to avoid situations that make them nervous. At school, they have difficulty raising their hands, speaking in front of the class and eating with others in the cafeteria. Socially, they often avoid talking with other children, joining group activities like clubs and inviting friends to spend time together. They may even experience discomfort with everyday transactions, such as ordering food or speaking to a salespeople, and try to enlist family members to do such tasks for them. They often complain of physical symptoms such as stomachaches or headaches when exposed to feared situations.

It is important to intervene as early as possible, because social anxiety is not outgrown. The socially anxious child's patterns of avoidance can develop into lifelong ways of coping with anxiety-provoking situations.

Parents can try several things to help reduce a child's anxiety. For example, if your child always clings to you when introduced to new people, you might try bringing him or her to meet a small group of familiar peers, which may also include an unknown person or two. Next, increase the child's exposure to a larger group of peers with more unfamiliar faces. The goal is to gradually encourage shy children to face their anxieties, because their fears will eventually subside if they endure the initial anxiety and realize nothing bad happened. Ask "What's the worst that can happen?" and "What has happened in the past?" to help challenge your child's nervous thoughts.

When this approach isn't enough to overcome social fears, working with a mental health professional may be appropriate. Two approaches work very well in treating socially anxious youngsters - cognitive-behavioral therapy and medication. A recent study showed that both treatments are similarly effective at reducing childhood anxiety symptoms, with some added benefit from combining both. If you worry that extreme shyness may be interfering with your child's life, consult a psychologist or psychiatrist who specializes in treating social anxiety disorder for further evaluation.

Dr. Storch is an associate professor of pediatrics and psychiatry at USF Health.