Her parents also noticed that she would try to avoid situations that triggered her anxiety, for example, she’d complain of stomach aches and headaches and refuse to go to school when she had oral presentations.
Dr Siobhan Kelly, principal psychologist (clinical), Psychology Service, at KK Women’s and Children’s Hospital (KKH) notes that Jane was worried that she would make a mistake, do something embarrassing and be judged negatively by her peers, teachers or shop attendants.
Another child, Sarah*, 12, was fearful of class presentations and kept quiet during group discussions. Her anxiety worsened until she could not attend school assembly, go for recess, and she eventually refused to go to school. These situations caused her heartbeat to accelerate until she became breathless and unable to talk.
“Children with social anxiety typically experience intense anxiety about a number of different triggers, including speaking to other people, reading aloud or giving oral presentations…and attending social events or even extended family events.”
Dr Kelly explains, “Children with social anxiety typically experience intense anxiety about a number of different triggers, including speaking to other people, reading aloud or giving oral presentations, fear of being evaluated by others, and attending social events or even extended family events.”
Adds psychiatrist Dr Lim Boon Leng, of Dr BL Lim Centre for Psychological Wellness, “They feel they are under the spotlight in situations where there are many people, and worry about being judged.”
Children with social anxiety will typically try to avoid the feared situations or endure them with intense anxiety or distress, “In children, this manifests as tantrums, clinging to parents, crying, complaining of frequent somatic symptoms (stomach aches, headaches, freezing up or failure to speak),” Dr Kelly notes.
Dr Lim explains that if a child is shy, the anxiety is not so intense and despite an initial mild fear, shy kids often warm up and are able to interact or perform. In social anxiety, the fear is out of proportion and intense.
“Shyness does not disrupt the child's life significantly while kids with social anxiety disorder will not be able to function normally in the social situations they fear,” he adds.
Dr Lois Teo, head and senior principal psychologist (clinical) at KKH, states that many factors give rise to a person’s premorbid personality ― low self-esteem, environmental factors, role modelling by parents or significant adults in an individual’s life, previous negative experiences when seeking peer relationships and only to experience and endure rebuffs.
She adds, “This avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, academic functioning, or social activities or relationships. The fear, anxiety, or avoidance is persistent, typically lasting six months or more.”
Recognise the signs
Dr Teo advises parents to seek professional help immediately if your child shows marked distress about their phobia as this may impact their academic life, social activities or relationships. Your offspring’s changes (for example, avoidance, anxious anticipation, or distress in the feared social or performance situation) may begin to interfere with their or their family’s normal routine.
Daniel Koh, a psychologist at Insights Mind Centre, thinks that one contributing factor is that kids these days have less social interaction, more protected in social settings, or may not have the chance to learn and practise social skills.
They can have low self-esteem, depression, anger and other psychological and emotional issues. Other symptoms are physical or somatic issues, stammering, nervousness, fear of being judged or humiliated, excessive negative thinking, inability to control self, tiredness, sleep or eating issues, and irritability, he adds.
Koh advises, “Parents should be encouraging and supportive, and avoid being critical and demanding or expect the child to change immediately. Instead, praise small progress and set realistic goals.”
Children often need to be taught to make eye contact, shake hands, smile, and respond to polite and light-hearted conversation appropriately.
The psychiatrist or psychologist will start a treatment plan if your child is diagnosed with social anxiety. Dr Lim notes that this may include medication and therapy, and parents should assist the child in complying with the plan.
“Parents should avoid being punitive on the child, and they can help by staying calm themselves when the child refuses or avoids certain situations. Adopt a gradual exposure approach to expose the child to the feared situation,” he suggests.
Ways to help your child overcome their social fears
Both Drs Teo and Kelly offer suggestions on helping your child get a grip on their phobia.
#1 Help them face it
Do not allow your child to avoid situations that he or she is scared of. Avoidance takes away her opportunity to learn that the feared outcome will not happen and how to manage their anxiety.
Help your child break down the task and get them to learn how to cope with the feared outcomes. For example, if your child is anxious about their oral presentation, have them practise giving the talk in front of immediate family members, followed by family friends and so on.
#2 Show empathy
Listen and take time to spend quality time with your child. When your child shares about how their day (for example, in school), you would be able to find out how they are coping outside of home. Maintain a curious, supportive and caring attitude, and take care not to blame your child. Empathise with your child’s worries and avoid shaming them.
#3 Deal with the negativity
Avoid providing excessive reassurance, as this can often make the anxiety worse. Instead, help your child identify the thoughts that are making them anxious and replace those thoughts with more realistic or calm ones.
#4 Be positive
Do not label your child as shy and let them “hide” behind that word. Instead, acknowledge his or her feelings of worry and point out that he or she can work towards overcoming the fears. For example, “Sometimes, it takes you a while to warm up in a new situation. Remember, at Mark’s birthday party, how you held my hand all through the games? But by the end, you were having lots of fun with the other kids. Good job!”
#5 Teach social skills
Dr Teo lists five tips you can use to help your child deal with social anxiety. This includes teaching your child basic social skills to respond to both adults and children or peers. Children often need to be taught to make eye contact, shake hands, smile, and respond to polite and light-hearted conversation appropriately. Make learning fun and have an overall relaxed attitude.
Help your child learn how to make friends. Role-play with your child how to observe and respond when another child initiates being friends. For example, how to join a game at the playground or how to introduce themselves to another child at a party.
#6 Teach them how to stand up for themselves
Coach your child to express his or her needs and stand up for himself or herself in social situations. All children need the confidence to know that they can handle whatever comes their way, especially when their parents aren’t with them. For example, every child needs to know how to respond to challenging situations with phrases such as, “It’s my turn now”, “I was still using that”, “I don't like it when you say that...”.
#7 Role play stressful situations
Role-playing is essential in learning skills and very helpful in managing anxiety. Asking your child questions such as, “What would you do?’, is invaluable in helping them think through possible responses and outcomes. Brainstorm with your child as to how he or she might handle a situation that makes him or her nervous.
#8 Create opportunities
Give your child small daily opportunities to interact with others. Children who are socially anxious need some downtime, especially if they prefer to keep to themselves. However, they also need plenty of opportunities to practise their social skills. Remember that empathising with your child does not mean being over-protective. If your child is worried, remind him or her that he or she can do challenging things. It’s also helpful for them to share openly with the family as to what they find is challenging. Applaud every little step your child takes on his or her own.
* Not her real name.
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