Social Anxiety:
Informed Parents Avail Early Treatment

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Social anxiety leads to several emotional and physical symptoms, avoidance behaviour being the earliest and the commonest. School refusal, messy rooms, shirking of responsibilities, disinterest in group games, attention seeking, poor peer relations, dating phobia are some of the common safety seeking actions employed by children and adolescents who fear social interactions. Such behaviour invariably leads to considerable distress in the parents, who are unable to correlate it to the possibility of upcoming social phobia. 

Informed parents would be able to understand their children's avoidance behaviour and safety seeking actions induced by ongoing emotional unrest. They could thereby minimise the stress, extend positive support to their children and avail early treatment. The nice thing is that total recovery is possible with early appropriate approach.

Social avoidance behaviour

Symptoms That Miss Being Correlated To Upcoming Social Anxiety Disorder

Children suffering from social anxiety disorder fear self-image damaging embarrassment in social encounters.

They therefore work genuinely hard to avoid all forms of social events, which contrary to their belief, is their worst enemy and the biggest barrier in path of progress.

Avoidance behavior masks their personality and hinders their cognitive development.

  1. School refusal
    Reluctance to go to school even after the age of 6 is the earliest symptom of social anxiety in children. 
    It may be associated with crying spells and complaints like “teacher does not like me”, “no one plays with me”, “Lara pinches me”, “I lost my book” and so on.

  2. Often complain of feeling sick as the school time approaches.
    The complaints are usually vague; "stomach is paining", "have a headache", "my throat hurts", "I have fever!, etc. Some actually start coughing, have nausea or vomiting.  In school these children need to visit the school nurse frequently. Challenging situations at school further aggravate their avoidance tactics.

  3. Avoidance shows even in their usual playing and fun time activities.

    --- a) Avoid organized, competitive and team games.

    --- b) Shy off from participating in school sports.

    --- c) Refrain from picnics and other supervised school excursions.

  4. Safety seeking behaviour to avert or cope with perceived threat.
    Socially anxious children and adolescents avoid challenges and try to get out of situations that would bring forth the feeling of anxiety. But this gives only a temporary feeling of relief. It actually perpetuates social anxiety and blocks progress.

    Three forms of safety seeking behaviour have been described;

    --- a) Subtle, specific to anxiety causing situation.

    -------- i. Generally well behaved child misbehaves - often abruptly.

    ------- ii. Perform ineffectively.

    ------ iii. Project exhausted helpless attitude.

    --- b) Situational avoidance.

    -------- i. Avoid to raise hand in the class to answer a question

    ------- ii. Shrink away from reading in class

    ------ iii. Ask lots of questions to divert the focus from self.

    -------iv. Take tasks that do not involve social interaction.

  5. --- c) Cognitive avoidance: Mental distraction

    -------- i. Avoid eye contact with others to evade being noticed.

    ------- ii. Subdued grooming to avoid being noticed.

    ------ iii. Take to smoking, alcohol or drugs in hope to calm the nerves

Fear any activity that involves public self-presentation

Being under the gaze of audience does invariably give somewhat uncomfortable feeling to all. But socially inhibited children with long standing feeling of inadequacy fear any activity that would get them noticed by onlookers. 

  1. Stage fright
    Even children with remarkable proficiency, fear performing on the stage. 

  2. Communication apprehension results in ineffective communication when in a social or public situation.

  3. Participating in school tournaments.

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Seem content alone

  1. Seek company of caregivers.

  2. Insist on regular and frequent contact with family.

  3. Prefer older or younger companions rather than those of the same age.

  4. Uncomfortable dating and having a relationship.

Low self-esteem

  1. Demand self-focused attention.

  2. Frequent negative self-focused thoughts that are attributed toperceived unpleasant and injurious observer-perspective images of self.

  3. Need repeated reassurance from others.

Physical symptoms and signs

  1. Headache off and on.

  2. Frequent tummy upset.

  3. Abnormal eating pattern.

  4. Feeling of dryness in mouth or throat.

  5. Cold hands and feet.

  6. Frequent urge to use the restroom.

  7. Insecure.

  8. Fidgety.

  9. Bear worried and unhappy look.

  10. Body language that shows lack of confidence and uneasiness.

Treatment is possible

Awareness on the possibility of social anxiety helps in the recovery from the problem. Many can recover fully even from long standing social anxiety with medications, sustained self-help and professional counselling. Nevertheless, success of treatment depends on child’s own positive efforts and by eliminating the genuine negative environmental influences if any.

  1. Medications

  2. Relaxation techniques

  3. Cognitive behavioral therapy has been noted to be particularly effective in treatment of social anxiety disorder.  Presence of a caregiver during therapy sessions helps children's compliance with model adaptive functioning.

  4. Minimizing caffeine drinks may help to some extent.

  5. Face the fear:

    a.) Safety aids only perpetuate avoidance and do not help to reduce the fear of social embarrassment and judgement.

    b.) Children should be helped to first identify the safety actions they employ in event of perceived threat, then encouraged not to employ them, and finally persuaded to discard their safety aids.

    c.) Be vigilant: Apparently successful fading of safety behavior could be associated with evolution of new safety strategies by the child.  

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