By Wasim Kakroo
DOES your child or adolescent find it challenging to socialize with other kids or join in groups? Is it difficult for them to have a small group of friends? Do they tend to avoid social situations in which they might be the centre of attention or stand out from the crowd, such as asking or answering questions in class? In social situations, do they appear withdrawn and take other’s comments too seriously especially in social situations?
If this is the case then your child or adolescent may be developing or has developed social anxiety.
It's easy to miss signs of social anxiety especially among preschoolers or those who have recently joined school. This is due to the fact that in preschool or school, children with social anxiety are often quiet and obedient. They may not express their fears or concerns and thus social anxiety may remain unnoticed.
Physical symptoms of social anxiety include nausea, stomach aches, flushing, and trembling.
Social anxiety disorder affects some children and teenagers. This is when a child's social anxiety has been present for more than 6 months and has a substantial impact on their life.
SAD or Seasonal Affective Disorder is characterised by intense fear and anxiety in social situations, resulting in considerable levels of distress. A child or adolescent with SAD is afraid of offending others, shame from exhibiting anxious symptoms in public, and public scrutiny and negative evaluation. SAD patients often have a high level of distress that is out of proportion to their actual social situation.
Signs Among Children
Many situations that require interaction with other people may be avoided by children with social anxiety disorder. Talking on the phone, joining teams or groups, and answering questions in class are examples of these scenarios. Severe and prolonged crying episodes, tantrums, sobbing, freezing, clutching, or withdrawing, being unable to speak in social circumstances may be the first signs of SAD in children. Somatic complaints are common (e.g., "My stomach hurts," "I have a headache"). Some children have a history of numerous physician sessions and evaluations in response to these somatic complaints. Children as young as four years old might be diagnosed with social anxiety disorder.
Signs Among Adolescents
Excessive concern before a social function or excessive preparation for a class presentation may be the earliest signs of social anxiety disorder in teens. Avoidant behaviours (e.g., refusing to attend school, refusing to attend parties, refusing to eat in front of people) may be present in the teen’s life.
Adolescents with Social anxiety disorder are afraid of embarrassing themselves in front of their classmates by providing the wrong response, saying something inappropriate, becoming ashamed, or even vomiting. In certain circumstances, social anxiety disorder may develop as a result of a humiliating event. Children may refuse to chat on the phone or even leave the house in extreme circumstances. Symptoms of SAD can interfere with all aspects of a child's life, including relationships, friendships, educational pursuits etc.
Social Anxiety Behind the Scenes
SAD usually manifests in infancy or adolescence. The cause and maintenance of SAD are influenced by a number of interconnected factors such as genetic predisposition, temperament, parental factors, and environmental impacts.
There are genetic factors that might contribute to the development of SAD. A positive association has been found between development of SAD in children who have parents with SAD. When occurring at important developmental phases of life, such as infancy or adolescence, environmental stresses such as child abuse, parental separation, or early trauma may alter genetic expression of anxiety. As a result, a kid or adolescent may have important periods of susceptibility to unique environmental stresses in addition to inheriting genetic inclinations for SAD.
A growing body of evidence suggests that early personality traits are linked to the development of social anxiety later in life. Behavioral inhibition is a personality trait that makes a child feel distressed and worried in new situations. Shyness around strangers and withdrawal from new places are examples of behavioral inhibition in children. High behavioral inhibition has been found to be strongly linked with an increase in social anxiety symptoms in children. Behavioral inhibition can be seen in newborns and toddlers, and it lasts for a long period. As toddlers get older, they learn to react more rationally to new events and individuals. However, some children and adolescents will exhibit anxious behaviors throughout their lives and well into adulthood.
The fear of anxiety-related physical sensations is known as anxiety sensitivity. Children and adolescents with SAD may show higher levels of anxiety sensitivity and may be more likely to see events with unclear social threats as anxiety triggering. Children and adolescents with social anxiety disorder feel that physical symptoms of anxiety would be noticed by others, resulting in embarrassment, mental incapacitation, illness, or higher anxiety level. Individuals with anxiety sensitivity not only exaggerate the significance of physical anxiety sensations, but they also create increasing mental scenarios in which they feel helpless.
Family is an important set up in the learning, growth, and development of children. In addition, the family is a very significant source of recreation and social connection. A large body of research exists about the role of parenting and family in the development of SAD.
When a child has a stable and trustworthy relationship with his or her parents, they are more likely to become independent, trust other people, and overcome difficult childhood events. Insecure parental attachment, on the other hand, leads to poorer levels of social competence in areas such as social skills, peer interactions, and social status. An insecurely attached youngster learns that they can't rely on their caregiver to be available or responsive. Insecure attachment is characterised by a wide range of negative emotion expressions, displeasure with touch, clinging, and obsession with the parent. Infants born to mothers who themselves suffer from social anxiety have higher rates of insecure attachment. Research has found that high levels of behavioral inhibition and insecure attachment significantly predicted social anxiety in teenagers. Social anxiety can be exacerbated by the separation of the mother, father, or both parents throughout childhood due to illness or marital problems. Children who repeatedly experience that their parent is unavailable or untrustworthy develop a maladaptive attitude toward future interpersonal situations or relationships based on the belief that others will not meet their demands.
Harsh parenting by either parent, including physical punishment and verbal aggression such as severe criticism or humiliation, has been linked to insecure attachment and an increased likelihood of social anxiety.
Research has found a pattern of maternal overprotection, paternal rejection, and decreased emotional warmth linked to SAD. Overcontrol by mothers has been linked to greater levels of social anxiety symptoms and increased chances of SAD rates during adolescence. Other negative parenting practices (for example, lack of affection, poor communication, limited autonomy, and a lack of humour) contribute to social anxiety in teenagers by inducing low self-esteem and inefficient ways of handling emotions.
Parents who themselves suffer from SAD may unwittingly contribute to their children's social anxiety. Maternal overprotection induced by their own anxiety can increase social anxiety in adolescents, whereas parental emotional warmth due to a stable emotional atmosphere can reduce chances of SAD among children and adolescents. Parental rejection and poor family climate all contributed to loneliness and decreased friendship quality and hence more chances of SAD.
Though children who are subjected to abuse may suffer from a variety of mental health issues, however, emotional abuse (defined by being screamed or yelled at, outright shaming, being put down or humiliated, or being made to feel unimportant) has been particularly found to be a significant predictor of the development of social anxiety.
Higher degrees of parental social support and acceptance have been linked to reduced levels of social anxiety, in contrast to negative parenting styles. Adolescents who have a strong bond with their mothers and fathers have reduced levels of social anxiety. It has been found that fostering open communication, including children in personal activities, and reinforcing positive behaviors can help parents reduce anxiety sensitivity in their children.
When fathers use strategies to push their young children's boundaries playfully, encourage them to step outside of their comfort zones, and employ innovative ways to play with toys, it may lead to a higher sense of self-esteem and, hence, a lower risk of social anxiety later in life.
Adolescents have been found to have lower levels of social anxiety when their parents provide explicit guidance on how to handle difficult peer situations. Parental modelling helps children acquire social skills including how to welcome new people.
When a child experiences a fear, a parent's natural reaction is to acknowledge the fear and protect the vulnerable child from harm. However, protecting children from fear-inducing, ambiguous situations might stifle social development and increase fear. Overprotection, while well-intentioned, may prevent a youngster from being exposed to new and challenging social situations. Although there are no perfect formulas for parenting a child with social anxiety risk factors, a balance must be struck between warmth and excessive care.
Siblings play an important role in socialization, understanding emotions, and developing empathy. During infancy, children spend more time with siblings than with parents and friends. Research has found that adolescents who had a same-sex twin with high levels of anxiety symptoms were more likely to have increased anxiety themselves 1 year later.
In settings where children had low sibling companionship reported more psychological symptoms of SAD. Furthermore, strong sibling relationships characterized by warmth and closeness buffered the negative effects of interparental conflict and subsequent emotional insecurity and had lower chances of developing SAD.
Without examining the family context, a discussion of family factors impacting the development of SAD would be incomplete. Childhood stressors with a significant social component, such as family interpersonal conflict, can contribute to the development of social anxiety symptoms. Conflict between the parents has been demonstrated to enhance social anxiety symptoms in children, potentially affecting their peer relationships. Witnessing violence, family mental illness, significant injury or illness of a parent, parental divorce, relocation to a different school, and separation from one or both parents have all been found to have an impact on the development of SAD. Children or adolescents who have had numerous stressful life experiences or a single, severe experience during childhood are more likely to develop SAD. Adolescents who do not have a solid family environment or who have bad parental ties are more likely to engage in conforming behaviours with their peers, which can lead to victimisation, rejection, and heightened social anxiety. Emotional intimacy and frequent interaction with family members, especially immediate family members, grandparents, and other relatives, has been shown to protect children and adolescents from developing SAD. Peer acceptance and support has been demonstrated to reduce social anxiety. In adolescence, higher teacher support has been linked to reduced chances of social anxiety and more assertive behavior with peers. Finally, providing cumulative emotional support to children and adolescents across many contexts such as family, friends, and school has been identified as a method for reducing loneliness and social anxiety.
- The author is a licensed clinical psychologist (alumni of Govt. Medical College Srinagar). He works at Kashmir Life Line, a free mental health counseling service. Author can be reached at [email protected]
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