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Distinguishing Childhood Shyness From an Anxiety Disorder

June 10, 2008 - 7:30am
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Distinguishing Childhood Shyness From an Anxiety Disorder

A Case Of Shyness

Image for shyness article Shyness is common among children and can take various forms at different ages. Fear of separation, fear of new situations, and inhibition in social situations are all common signs of shyness. Parents and teachers often try to involve shy children in activities so they don’t miss out on social or developmental activities. But there are other important reasons to try to curtail shyness in your child. Researchers have found that shy people have a more negative self-perception, increased health problems (due to a lack of social support network), and earn less money than non-shy people.

If you are the parent of a shy child, there are a number of techniques you can use to help your child:

  • Curb judgmental comments. This is important because the child is already afraid of being judged and being evaluated negatively.
  • Avoid being overly protective. This may actually reinforce your child’s shy behavior by lowering his or her expectations.
  • Anticipate situations in which a child is likely to exhibit shyness and set a reasonable goal for your child. Some parents find offering a reward in exchange for meeting a goal is one of the best motivators for change.
  • Expect gradual improvement and don’t push your child too hard.
  • Work with your child’s teachers and caregivers to communicate which techniques are working so that together you can help your child overcome shyness.

Beyond Shyness

If your child’s shyness reaches the point where anxieties and fears are overwhelming, persistent, and interfere with everyday life, it’s possible your child may actually be suffering from an ]]>anxiety disorder]]> .

Anxiety disorders are the most common psychiatric illness affecting both children and adults. Experts believe these disorders are caused by a combination of biological and environmental factors. The good news is that once diagnosed, anxiety disorders are highly treatable.

Different Types Of Disorders

There are three common anxiety disorders in children:

  • Separation anxiety disorder
  • Generalized anxiety disorder
  • Social anxiety disorder

Separation anxiety disorder typically peaks between the ages of seven and nine years of age. Symptoms include excessive worry about losing a caregiver, refusal to go to school, nightmares, and excessive worry about being lost, kidnapped, or dying.

Generalized anxiety disorder is diagnosed in the child who worries excessively about everything. These children may often exhibit physical symptoms, such as having a stomachache or headache more days than not over a six month period. Generalized anxiety disorder is often difficult to diagnose because its symptoms may overlap with other disorders.

Social anxiety disorder is characterized by extreme anxiousness in social situations with an average age onset of 11 or 12 years old. While the shy child takes time to warm to new situations, a child with social anxiety disorder will avoid the situation completely and often exhibit physical symptoms, such as heart palpitations, faintness, profuse sweating, and blushing. Children who experience social anxiety disorder may be at risk for depression, substance abuse, and truancy later in life.

Clinical Studies

Current areas of research include determining who is at risk for these common disorders and whether there are other associated risks. One study from the University of Bremen, Germany, looked at 1,035 adolescents between the ages of 12-17 to see if those with an anxiety disorder also exhibited signs of other psychiatric disorders. The study found that approximately half the adolescents with an anxiety disorder also showed signs of ]]>depression]]> . In most of these cases, the child’s initial anxiety disorder later developed into depression, suggesting a need for intervention strategies.

In another study at Duke University Medical Center, social phobia and separation anxiety were examined by age, gender, and race. A sample of 2,384 children in the community and 217 children in a clinical setting were analyzed. The study found that, in general, adolescents were more likely to have more symptoms of social phobia and less separation anxiety symptoms than preadolescent children. They also found that white children exhibited more symptoms of social phobia and fewer symptoms of separation anxiety than African-American children.

In yet another study, researchers examined families to determine if there was a link between parents and their children for anxiety disorders. The researchers looked at four groups of children, those whose parents had ]]>panic disorder]]> with depression, panic disorder without depression, depression without panic disorder, and finally those whose parents had neither panic disorder nor depression. Dr. Biederman and colleagues found that in parents with panic disorder or major depression, their children were at an increased risk for separation anxiety disorder and two or more anxiety disorders.


If you suspect your child may be suffering from an anxiety disorder, it’s important to talk to your child’s doctor. Cognitive-behavioral therapy is the gold standard of treating anxiety disorders. It teaches children (and adults, for that matter) to understand their thinking patterns, why they react to certain factors, and how to react differently. Therapists work with children by gradually and safely exposing children to their fears over time. They may also teach them breathing techniques. As a parent or caregiver, you can be taught how to help children practice coping skills at home and in new situations. Older children can benefit from being able to identify their fearful thoughts and replace them with more positive ones. Encourage your child to work on these coping skills at home, trying them out in new situations.


Anxiety Disorders Association of America

National Institute of Mental Health


Biederman J, Faraone SV, Hirshfeld-Becker DR, et al. Patterns of psychopathology and dysfunction in high-risk children of parents with panic disorder and major depression. The American J of Psychiatry. 2001;158:49-57.

Compton SN, Nelson AH, March JS. Social phobia and separation anxiety symptoms in community and clinical samples of children and adolescents. J of the American Acad of Child & Adolescent Psychiatry. 2000;39:1040-1046.

Essau CA. Comorbidity of anxiety disorders in adolescents. Depression and Anxiety. 2003;18:1-6.

Walsh KD. Welcome advances in treating youth anxiety disorders. Contemporary Pediatrics. 2002;19:66-82.

Last reviewed October 2006 by ]]>Jill D. Landis, MD]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.



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