Nurturing the Shy Child

CHAPTER 1

How Shy Is Too Shy?

Understanding Painful Shyness and Social Anxiety in Kids

WHEN I first met eight-year-old Austin, I had to greet him under the table in the waiting room.

There he sat with his freckles and red, curly hair, arms locked around his knees, eyes glued to the ground. As his parents tried to coax him out from under the table, I could tell this was a scared little guy. "Hey, Austin. I've got some toys in my office. You can play while I talk with your parents," I said. His blue eyes glanced up as I told him he wouldn't have to say a word if he didn't want to. His parents sighed with relief as Austin scooted out from under the table and followed us back to my office.

In talking with his parents, I asked about Austin's interests. I learned that he loved baseball. He and his dad watched major league games on television together, and they played catch in the backyard almost every evening. This year Austin was finally old enough for "coach pitch" baseball. When the day came for the first practice, Austin fell apart. He clutched his stomach saying it hurt, and he begged his parents not to make him go. "I knew he wasn't sick because he acted fine moments before I said it was time to leave," his mother told me.

The whole season went poorly and everyone became frustrated in the process. Austin cried before every practice and threw a major temper tantrum before each game. Some of the episodes were so severe that his parents carried him off the floor kicking and screaming to put him in the car. He didn't talk with the other boys on the team, and he could barely look the coach in the eye. Although Austin apparently had some talent from all the practicing he had done in the backyard with his father, he froze on the field and couldn't perform.

The problems they had with Austin and baseball that summer were eerily familiar, his parents told me. The previous fall Austin said he wanted to be in Cub Scouts. They signed him up, but when the first meeting rolled around, Austin cried and had a fit, refusing to go. His parents didn't push scouting and let him quit after a few traumatic attempts to get him to attend.

His parents explained that Austin could be quite a chatterbox at home and got along well with his brother and sister. When he was at school, however, it was a different story. During the parent-teacher conferences throughout the year, his teacher repeatedly expressed concern that Austin was "so quiet" and never participated in any group discussions. She also told them he played by himself at recess. He didn't seem to know how to join in with the other children. In addition, Austin frequently complained of stomachaches at school and asked to be sent to the nurse's office.

While many of their friends and relatives told them Austin was "just shy," his parents weren't convinced. I was glad they brought Austin to see me. From many years of working with children like Austin, I knew he wasn't "just shy." He waspainfully shy. His shyness was interfering with his life. It kept him from fun things like baseball and Boy Scouts, and it prevented him from being happy at school. Eventually, if left untreated, his severe shyness could lead to other issues, such as academic problems, low self-esteem, and depression.

The technical term for the condition Austin suffers from issocial anxiety disorder,orsocial phobiaas it's sometimes called. In the rest of this chapter, you'll learn what social anxiety is, at what point it becomesa disorder, and the common symptoms children with this problem are likely to experience. You'll also have the opportunity to complete a questionnaire to determine if your child may have social anxiety disorder and where his or her particular problems lie. Perhaps the most important information you'll take from this chapter is the realization that you're not alone. As was the case for Austin's parents, it can be a relief to know your child's problem has a name and that help is near.

WHAT IS SOCIAL ANXIETY?

SOCIAL ANXIETY IS a universal experience, one that's necessary for survival. It was easier to see its survival value in previous times, when people had to band together to hunt food, build shelter, and ward off enemies. Social anxiety served the function of keeping people close to the "pack." To veer off from the group was to risk death.

Even now, we've evolved in such a way that we're motivated to remain a part of the group. We want to be accepted. We want to fit in. Thus, some social anxiety is normal and beneficial. After all, people whonevercare about others' opinions are often not very pleasant to be around and have a completely different set of problems.

But what exactly is social anxiety? It's the experience of apprehension or worry that arises from the possibility, either real or imagined, that one will be evaluated or judged in some manner by others. Sometimes it's easier to explain what social anxiety is by listing some ordinary, everyday examples:

• embarrassment after spilling a drink

• "stage fright" before a big performance

• awkwardness while talking to someone you don't know well

• nervousness during a job interview

• feeling jittery before giving a speech

These are common experiences almost everyone has had at one time or another. Children, too, naturally experience some social anxiety throughout their day-to-day lives. Because most children attend school, many situations that elicit social anxiety are for them particular to their environment:

• being called on by the teacher

• giving a report in class

• reading aloud

• eating in the school cafeteria

• writing on the blackboard

• using school restrooms

Since social anxiety is so universal, how do you know where your child's reactions fall? Are they within the range of normal? Or, like Austin, does social anxiety pose more of a problem? In other words, how can you tell when social anxiety becomes social anxiety disorder--a clinical diagnosis?

RECOGNIZING SOCIAL ANXIETY DISORDER

MENTAL HEALTH PROFESSIONALS useThe Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV)to make diagnostic decisions. While it's not a perfect system, diagnoses are important for a number of reasons. Without a name for the problem, research vital to understanding and developing effective treatments for it simply doesn't take place. On a practical level, if you try to receive mental health services for a problem that has no diagnosis, you're not likely to get your insurance to pay.

Let's look at the specific criteria that must be met for a clinical diagnosis of social anxiety disorder. Then we'll discuss some of the nuances involved in diagnosing social anxiety disorder in children. TheDSM-IVsays an individual with social anxiety disorder

• shows significant and persistent fear of social situations in which embarrassment or rejection may occur

• experiences immediate anxiety-driven, physical reactions to feared social situations

• realizes that his or her fears are greatly exaggerated but feels powerless to do anything about them

• often avoids the dreaded social situation--at any cost

Someone may fear just one or a few social situations--public speaking is a common example--in which case the problem is referred to as aspecificordiscretesocial phobia. In contrast,generalizedsocial anxiety disorder exists when a person is afraid and avoids many, or most, social situations.

Once these basic criteria are met for a diagnosis of social anxiety disorder, the individual symptoms can vary, but they generally fall into three categories: the cognitive or mental symptoms (what you think); the physical reactions (how your body feels); and the behavioral avoidance (what you do). Let's look at these three areas in more detail.

The mental anguish.People with social anxiety disorder are plagued with negative thoughts and doubts about themselves:

• Do I look okay?

• Will I know what to talk about?

• Will I sound stupid or boring?

• What if other people don't like me?

The fear of possible rejection or disapproval is foremost in socially anxious people's minds, and they scan for any signs that confirm their negative expectations.

The cognitive symptoms of social anxiety disorder are often not as evident in children, especially young children. They may reactwith intense anxiety yet not be able to verbalize what is upsetting them. This was the case for six-year-old Claire. Whenever it was time to go someplace, for example, Sunday school or a friend of the family's house, Claire balked. She usually began by stating, "I don't want to go." When her parents questioned her further about why she didn't want to go, she'd reply, "I don't know. It will be boring." That's what her parents heard a lot--"It will be boring." With further questioning, Claire's tone and volume became more distressed. She'd beg and plead not to go but could never give what her parents considered a good reason to justify her discomfort.

The physical distress.Many people don't realize that actual physical discomfort can accompany social anxiety. For example, someone may experience a panic attack in a social situation, in which they feel an acute and severe rush of fear and anxiety, accompanied by some or all of the following symptoms: shortness of breath, tightness or pain in the chest, racing heart, tingling or sensations of numbness, nausea, diarrhea, dizziness, shaking, and sweating. Panic attacks usually come on quite quickly, build to a peak in approximately five to twenty minutes, and then subside. It's not uncommon for people to say that their panic attacks last a lot longer; however, it's probably the aftereffects of the attack that they're feeling, such as residual anxiety and increased alertness to bodily sensations, rather than the panic attack itself.

Adolescents are much more likely to experience panic attacks than are younger children. In fact, panic attacks in young children are unusual. Rather, younger children with social anxiety typically complain of headaches and stomachaches, although they may have other physical symptoms as well.

Regardless of which particular physical symptoms your child experiences, anxiety is never pleasant. Having one's body in a state of constant alert takes its toll and can lead to low energy, muscle tension, irritability, and sleep disturbances.

Also keep in mind that the physical symptoms are usually real.Many parents think their children are merely making up excuses, and while this can sometimes be the case, more typically these kids have truly worked themselves up into a state of physical discomfort.

The toll of avoidance and other behavioral reactions.It's human nature to try to avoid pain and suffering. From an evolutionary perspective, we're "hardwired" either to fight or flee a dangerous situation. It's no surprise, then, that people with social anxiety disorder tend to avoid or painfully tolerate situations that they believe will cause them harm. This might mean never attending a party. It might mean having few, if any, friends. It might even mean dropping out of school.

The consequences of avoidance naturally vary depending on the person and the severity of his or her anxiety. In all cases, though, people with social anxiety disorder limit their choices out of fear. Decisions in life are based on what they're comfortable with rather than what they truly want to do.

Because children are not as able to avoid the situations they fear (for example, theyhaveto go to school), parents are likely to witness more behavioral symptoms in these anxious children, such as:

• crying

• tantrums

• freezing

• clinging

• staying close to a family member

Unfortunately, these kids are often labeled as "oppositional" and "defiant." This is usually not the case. When you consider the fact that children don't enjoy the same freedom as adults to avoid the situations they fear, their behavior makes more sense. When an anxious child perceives that he's being backed into a corner and forced into something frightening, "acting out" with tears or tantrums seems like the only option.

Thirteen-year-old James is exceedingly bright, but he's never been athletically inclined. To make matters worse, he has exercise-induced asthma. He's always had problems in physical education classes. He frequently gets teased by other kids, and to make matters worse, last year his PE teacher humiliated him in front of the other kids because he couldn't run a mile. At the beginning of the next school year, James dressed out and did as he was told in PE, to the best of his ability. He'd always been a well-behaved student who tried to get along well with others. But one day, another kid called him "fat," and James lost it. He knocked the kid to the ground and started punching him, and both boys ended up in detention. From that day on, James had had enough. He refused to dress out in PE and told his school counselor he didn't care if he got an F. Someone who didn't look closely at the situation might have concluded that James was a troublemaker. But this was hardly the case.

Let's look briefly at two extreme examples of the behavioral avoidance associated with social anxiety--selective mutismandschool refusal. Children with selective mutism do not speak at school or in other public places where others might hear them, or they speak only in a barely audible whisper. These children speak freely and easily, however, at home with family members. This condition used to be called "elective mutism," reflecting the thinking that these children were deliberately not speaking, perhaps being stubborn or trying to get attention. Current theories argue that the problem isnotelective. Rather, it's as if these children's voice boxes are frozen with fear, preventing them from communicating with words.

School refusalapplies to children who have a pattern of avoiding or refusing to attend school. Although children can refuse to attend school for a variety of reasons, in many cases social anxiety is the root cause. We discuss selective mutism and school refusal in Chapters 9 and 10.

FREQUENTLY ASKED QUESTIONS REGARDING THE DIAGNOSIS OF SOCIAL ANXIETY DISORDER IN CHILDREN AND ADOLESCENTS

EVEN FOR A seasoned professional, the diagnosis of social anxiety disorder in children and adolescents can be complex due to developmental factors and the frequency of more than one anxiety disorder involved. In addition, here are a few other issues to keep in mind.

My son has always been socially awkward. His language was delayed and he still hasn't caught up to other children his age. Could he have social anxiety disorder?

Most likely, no. Social anxiety disorder is an appropriate diagnosis only for children who have developed age-appropriate language skills and who demonstrate the ability to interact socially. A child with social anxiety disorder frequently is outgoing and charming around close family members yet has difficulty interacting around unfamiliar children and adults. Children with developmental disorders such as autism or Asperger's disorder would not be diagnosed with social anxiety disorder.

Won't my child grow out of this?

To diagnose social anxiety disorder in children, the problems must have persisted for at least six months. This helps rule out the possibility that your child is simply going through a phase. Once your child's difficulties have gone on for at least six months and are serious enough to warrant a diagnosis of social anxiety disorder, it's best not to take a wait-and-see approach. By this point unhealthy patterns of avoidance and withdrawal probably have become habitual and aren't likely to be changed without some concerted effort.

My child acts fine around kids her own age, but she is extremely shy around adults. She hides behind my leg and refuses to talk. Is this common?

Because adults represent authority and are in a position of power, it's not uncommon for children to be uncomfortable and quieter around them. For this reason, to be diagnosed with social anxiety disorder children must demonstrate anxiety with both peers and adults.

My seven-year-old son seems to have no awareness that his fears are unreasonable. Does that matter?

TheDSM-IVguidelines for diagnosing social anxiety disorder state that the person must realize that his or her fears are greatly exaggerated. This criterion does not need to be met for children, however. Given their less mature cognitive development, we would not expect them to have insight into the unreasonableness of their fears and reactions.

My child has a bad case of test anxiety. Could this be a part of social anxiety disorder?

Yes. Test anxiety can be a part of the social anxiety spectrum. Drs. Sam Turner and Deborah Beidel, two prominent researchers in the area of social anxiety, found that 24 percent of test anxious children also met the criteria for social anxiety disorder. If a child has only test anxiety, it is considered aspecificform of social anxiety. If the test anxiety goes along with other social fears, it is part ofgeneralizedsocial anxiety disorder. In addition, test anxiety may be unrelated to social anxiety. For example, if a child has a severe learning disability in math, you would obviously expect some anxiety before a math test. Many of the treatment strategies we discuss throughout this book can help children overcome test anxiety.

SHYNESS AND SOCIAL ANXIETY IN CHILDREN AND ADOLESCENTS: A VERY COMMON PROBLEM

SHYNESS IN CHILDREN and adolescents is by no means uncommon. According to Jerome Kagan, Ph.D., a professor of psychologyat Harvard University, roughly 10 to 15 percent of kids in kindergarten through eighth grade are very shy, 25 percent tend to be outgoing and sociable, with the rest falling somewhere in between. In a separate study, Bernard Carducci, Ph.D., a shyness expert at Indiana University, has found that the percentage of shy teens is about the same as shy adults--around 40 percent.

According to Jerilyn Ross, president of the Anxiety Disorders Association of America, about 13 percent of youth aged nine to seventeen suffer from anxiety disorders, making them the most common mental disorder in young people. Depending on the research study reviewed, between 5 and 6 percent of children and adolescents have generalized social anxiety disorder.

In addition, the prevalence of problems that coexist in children with a primary diagnosis of social anxiety is similar to those in adults. A research study conducted by Drs. Beidel and Turner found that in children with social anxiety disorder

• 20 percent had other specific phobias

• 16 percent had generalized anxiety disorder

• 8 percent had depression

• 16 percent had attention deficit hyperactivity disorder

• 16 percent had learning disabilities

These figures illustrate the fact that children with social anxiety disorder often exhibit numerous problems and complex symptoms. In fact, another respected researcher, Dr. Murray Stein, admits that it can be difficult to diagnose social anxiety disorder in children and thus it's difficult to obtain a true picture of how many youth are affected. This is because of the numerous interwoven fears some children have. He uses the term "anxious triad" to describe how separation anxiety disorder, generalized anxiety disorder, and social anxiety disorder often overlap in children. We discuss these disorders and their overlap with social anxiety throughout the book and more specifically in Chapter 11.

THE SPECTRUM OF SHYNESS AND SOCIAL ANXIETY DISORDER

AS WE MENTIONED, making a diagnosis of social anxiety disorder in children and adolescents is not always simple. Part of what makes it a challenge is that shyness and social anxiety disorder actually exist on a continuum. Let's look at a number of brief examples.

Shy but basically secure and successful.Sixth grader Vanessa fits into the category of someone who is shy but also someone who is basically secure and successful. She has always been on the quiet side. In fact, every teacher throughout her elementary school years commented that she was "reserved." She doesn't like giving oral book reports or having to stand in front of the class, but she is able to do so when required. She has a few good friends, although not a very wide circle. She attends parties of kids she knows well, although she frequently turns down invitations for slumber parties.

Her parents accept her shy temperament and have never made a big deal of it. They are both on the quiet side themselves and seem to understand that this is simply who Vanessa is. They try to encourage her to break out of her comfort zone and try new things, put they're not overly pushy. She is usually reluctant at first, but with support, she participates in a few extracurricular activities, such as Girl Scouts.

Vanessa's parents worried that the transition from grade school to middle school would prove challenging for her. Indeed, Vanessa was a bit "stressed out" for the first month of school. She complained that the hallways were too crowded and she didn't like switching classrooms for every subject. But in a month or so, she got into the swing of things and now seems to be faring quite well.

Shy but showing some problems.Like Vanessa, Sydney is cautious in new situations. She likes to check everything out beforejumping into anything. She is always the one on the playground watching the other kids from the perimeter. She might eventually join in if she knows the kids and the game they are playing. At home, Sydney is content to play by herself for hours. Creative and with a keen imagination, she likes to sit and draw or play make-believe games with her dolls.

Unlike Vanessa's situation, however, Sydney's parents are outgoing and love to entertain. They frequently have other families over for casual dinner parties, and this makes Sydney very uncomfortable. Her mother becomes upset with Sydney for not coming out of her room to talk with their guests. At times, she thinks Sydney does this to make her mad. She has even punished Sydney for not being "polite" to their guests.

I first saw Sydney when she was in the third grade. Her parents were sure there was some deep-seated reason why their daughter wasn't more sociable. Similarly, Sydney didn't feel very good about herself. She realized she wasn't measuring up to her parents' expectations. She wished she could be more outgoing, but she simply didn't feel comfortable with her parents' friends. She didn't know what to say or how to act.

Sydney's parents were truly concerned about what they perceived as their daughter's lack of social interest. They didn't understand that this was part of her temperament--not something she was doing on purpose. I helped her parents learn to accept Sydney's quiet personality style and not to put so much pressure on her to be different. This went a long way toward helping Sydney feel better about herself. I also worked with Sydney to develop some social skills and some much-needed confidence.

Specific social anxiety disorder.Rob is in the eighth grade and just a little bit shy. He's always had a lot of friends and done well in school. He loves music and has been in the orchestra for years. He's developed into quite a talented violinist, and his orchestra teacher selected him to perform a solo in the spring concert.This has made Rob a nervous wreck. The concert isn't for several months, and already Rob is having trouble sleeping, has lost his appetite, and is considering dropping out of the orchestra.

Rob's reaction may sound extreme, but we've worked with people of all ages where this sort of situation occurs. The anxiety leading up to a feared event (what we callanticipatory anxiety) is so uncomfortable that it doesn't seem worth it to the person to go through all that misery. Rather than endure the discomfort, he withdraws from the feared event. We've also worked with people who have had a panic attack during a performance situation and vowed never to go through that experience again, thus quitting some activity they were good at and enjoyed.

Mild to moderate generalized social anxiety disorder.Megan is now in high school and has been shy all her life. Her parents have been supportive and tried to encourage her, yet quite a few odds were stacked against Megan. Her family has a strong history of anxiety and depression on both sides. Megan's father is in the military and they have had to move every few years, which has made it difficult for her to make friends.

Megan gets lower grades than she'd like in school. Although she is of at least average intelligence, because she always sits in the back of the class and never asks any questions, she sometimes misses important points the teacher is making. She's also lost out on extra credit toward her grade based on class participation.

In addition, Megan suffers from physical symptoms of anxiety. For example, when she's in class, if it appears they'll have to go around the room and take turns answering questions, she feels as if she's going to have a panic attack. Her heart beats wildly, she feels flushed, and she has difficulty concentrating. She's sure she won't be able to speak coherently when her turn comes. Sometimes she even feels dizzy and worries she might faint. Of course, fainting in class would prove embarrassing to Megan, and worrying about that possibility just makes matters worse.

Severe generalized social anxiety disorder.The distinctions among the categories are somewhat arbitrary in nature. If Megan's symptoms progressed, she could easily fit in the severe generalized social anxiety disorder category. Here we include children who have selective mutism or school refusal. We also include children and teens who've become depressed as a result of their social anxiety. For example, kids like Megan can become isolated, lonely, and even hopeless. Children who have numerous physical symptoms or panic attacks and kids who avoid most social situations also fit into this category.

As we said, the categories themselves aren't important. What is important is understanding the range of problems that can exist so that you're better able to understand your child's particular situation. In addition, rest assured that the strategies presented in this book can help you help your child, regardless of where he or she falls along the continuum of shyness and social anxiety.

For the child who is shy but basically secure and successful, this book will strengthen what you already know and what you're already doing correctly with your child. In addition, feel free to skip ahead to Chapter 8 for ideas on making friends and feeling comfortable in large groups. For the child who falls somewhere along the middle of the continuum, you can learn to be a knowledgeable coach who can help your child reach his or her full potential. And if your child falls on the end of social anxiety disorder, there is a lot you can do to help. But keep in mind that you may also need a psychologist who is trained in treating childhood anxiety disorders to guide you through the process.

Look at the diagram below. Where do you think your child's problems fall?

The good news in all this is that you're not alone. Many parents of children who are shy and socially anxious have learned skills tohelp their children grow into socially confident and capable adults. The next step is gaining more specific information into the nature and extent of your child's social concerns.

DOES MY CHILD HAVE SOCIAL ANXIETY DISORDER?

BELOW IS AN informal screening questionnaire that covers many of the situations commonly feared by children with social anxiety disorder, as well as typical symptom patterns. By going through these questions, you will gain a snapshot of your child and his or her problems. You can answer the questions yourself based on your knowledge of your child. Or, depending upon the age of your child and how motivated and cooperative he or she is, you can ask for your child's help. Consider also asking your child's teacher for input. Teachers have a lot of firsthand knowledge about how your child behaves in school--information that you quite possibly wouldn't be able to obtain on your own.

These are the situations my child is likely to complain about or is known to avoid.

Answering questions in class

Raising hand in class

Writing on the blackboard

Musical or drama performances

PE class (a lot of social and performance pressures)

Giving an oral report

Eating in the cafeteria

Asking the teacher a question

Using the school restrooms (not due to fear of germs)

Doing anything that involves getting out of one's seat in class and drawing attention to self (e.g., getting up to sharpen pencil)

Participating on team sports

Going to parties

Informal conversations with other kids

Hanging out by the lockers

Riding the school bus

Going to a friend's house

Inviting a friend over

Using the telephone

Participating in a sleepover

Going to the store

Ordering food at a restaurant

Talking to neighbors or other adults

Joining in with kids at recess

Doing things while being watched

Taking tests

Dating or going to dances

Other: ____________________________

These are the things I hear my child tell himself or herself before, during, or after a social situation.(Young children often don't know what they're thinking, so you may not be able to answer this section very easily.)

I don't fit in.

No one likes me.

I don't have any friends.

I'm stupid.

I'm ugly.

I can't do it.

I'm boring.

It's going to be horrible.

I won't know what to say.

People will notice I'm nervous.

Other: ____________________________

These are the physical symptoms my child is likely to experience when anxious.(Many of these symptoms can be internal and not visible to someone else. Your child may look okay but actually be quite anxious. In addition, children experience shame about their physical symptoms and go to great lengths to hide them. Some symptoms, like blushing, are impossible to hide. These type of symptoms--those that can't be disguised--often cause kids the greatest concern.)

Headaches

Stomachaches

Diarrhea

Nausea

Feeling like he or she might vomit

Blushing

Sweating

Shaking

Hot flashes/cold flashes

Muscle tension

Heart palpitations or racing heart

Tightness in chest

Shortness of breath

Feelings of weakness (e.g., legs feel like Jell-O)

Light-headedness/dizziness

Choking sensations, lump in throat, dry mouth

Feelings of unreality (like in a fog)

Other: ____________________________

My child experiences panic attacks, either in social situations or in anticipation of them.(A panic attack is a sudden surge of intense fear and anxiety, usually accompanied by several or many of the above physical symptoms. It usually reaches a peak in five to twenty minutes before subsiding.)

Yes

My child is likely to experience panic attacks in these situations:

My child experiences panic attacks approximately _____ times per week.

These are the behavioral reactions I notice in my child when he or she is confronted with a feared social situation.

Throwing a temper tantrum

Having a crying fit

Refusing to go or participate

Clinging, staying close to a family member's side

"Freezing"--literally acting as if frozen by fear, not moving, not speaking

Avoiding eye contact with others, looking down

Asking for excessive and repeated reassurance

Acting agitated or irritable, begging to go home early

Other key questions to ask yourself about your child's reactions to feared social situations.

Do your child's problems interfere with academic (school) functioning?

Does your child's anxiety interfere with making and keeping friends?

Is your child missing out on fun activities that many children of the same age enjoy?

Do people comment on your child's excessive shyness?

Do you spend time worrying about your child's shyness?

Is shyness or social anxiety affecting how you feel about your child, or how your child feels about himself or herself?

Is your family environment affected by your child's anxiety? Do you tiptoe around, trying not to set him or her off?

Now review your answers. As you do, refer back to The Spectrum of Shyness and Social Anxiety Disorder where we discuss the criteria for and categories of social anxiety disorder. Also keep in mind some of the differences that exist in diagnosing children and adults (e.g., children don't have to realize their fears are unrealistic and excessive). Although this is not a substitute for an evaluation with a mental health professional, you will likely be able to tell whether your child's anxiety problems fall into this diagnostic category. If you think your child has more problems than are covered in this questionnaire, refer to Chapter 11, which covers other problems commonly associated with social anxiety disorder.

WHAT DO I DO NOW?

IF YOU FEEL overwhelmed at this point, that's natural. We've covered a lot of ground, and it can be disconcerting to think that your child has a "disorder." In the chapters ahead, we cover each of the areas in the questionnaire and show you proven techniques to help your child overcome the mental, physical, and behavioral symptoms of social anxiety disorder.

Many of you will make good progress by reading this book and following the strategies presented. There are times, however, when parents need to consult a professional about their child's problem. Appendix A, "Seeking Professional Help," will guide you on how to recognize such times.

It can be painful for some parents to admit they need help with their child or that their child has problems. But there's nothing to be ashamed of. Start by taking the blame off yourself and giving up the guilt--you have not failed your child. Channel your energy into seeking the help your child needs. Realize that now, more than ever, there are ways to minimize the harmful effects of unchecked social anxiety. Together, we'll teach your child the skills he needs to master his social anxiety and to lead the rich life he was meant to live.