How to Support Children With Social Anxiety

COVID-19 has forced many of us to change our behaviours – for children and youth in crucial developmental stages, the pandemic has also had a devasting impact on their social development. In light of the health crisis and keeping people safe, many of us who work on the frontlines of the mental health field are starting to see the effects of the lockdown. It has undoubtedly impacted the emotional well-being of children, youth, teens, and adults. Although the psychological impacts of the lockdown remain unclear, research indicates that there are negative implications on individual mental health.

In the mental health field, we refer to children who may be at risk for a mental health condition as subclinical. In other words, the child doesn’t quite meet all the criteria required for a diagnosis, but it’s important to begin a period of “watchful waiting” or active surveillance. Children who were identified as being “at risk” or subclinical when COVID-19 first hit are now meeting the criteria for a formal diagnosis. The likely cause? The pandemic.

The lockdown and ongoing pandemic are a breeding ground for perpetuating social anxiety.

A common model that is used in psychology is the diathesis-stress model. This model explains how individuals may have a predisposition, based on genetic factors, for a certain diagnosis. When the predispositions interact with a series of stressors like the current health pandemic, the genes turn on and the individual symptoms increase. Anecdotally, there has been an increase in the area of social anxiety, particularly with children and teens.

Social anxiety is often overlooked and seen as the child being shy, or a period they may be going through as they approach adolescence. However, an extreme fear of social situations that typically leads to avoidance of people and interactions is much more than a personality trait.

According to the National Social Anxiety Center, individuals who suffer from social anxiety “avoid situations that are important or endure them with a great deal of distress.” In children and teens, it can be fear that causes them to avoid eye contact, speaking to others, talking on the phone, and going out in public where they may have to interact with people, which can then lead to extreme fear and avoidance of leaving the house. Anxiety Canada indicates that social anxiety peaks during adolescence and can be triggered by a stressful or embarrassing situation. COVID-19 would certainly fit the criteria for a stressful situation.

Social anxiety peaks during adolescence and can be triggered by a stressful or embarrassing situation.

Let’s review how children and teens struggling with social anxiety may have presented before the pandemic and after the initial lockdown:

Before COVID-19

• Physical symptoms of blushing, nausea, stomach aches, “butterflies,” sweaty palms, and other physical symptoms in anticipation of having to interact with others; this includes going to school, playdates, and extracurricular activities
• May have expressed an unwillingness or concerns regarding public places and interactions but still continued to go out

After Lockdown

• Avoidance and extreme fear in resuming regular activities, such as school, play dates, birthday parties, extracurricular activities, and talking on the phone
• Emotional meltdowns and regulation struggles in thinking about being around people
• Refusal to leave the house and extreme emotional outbursts in anticipation of leaving the house
• Possible symptoms of depression
• Increased need to be close to primary caregivers
• Avoidance of eye contact
• Reliance upon caregiver to communicate with others on behalf of themselves
• Increased somatic experiences, including vomiting
• Refusal to leave the house, or will only go places if their caregivers accompany them
• Refusal to engage in conversation on the phone, significant decrease in interactions with others, or complete avoidance of people and social interactions

One of the ways that social anxiety is treated is through exposure, and the difference between pre-COVID-19 and post-lockdown is a lack of practice for anxiety-related activities. Exposure is engaging in an activity that causes some distress, but it can be successfully managed by increasing the frequency and duration of being in a situation that causes anxiety or fear. When children and youth are placed in a situation where they can no longer practice exposure, the fear is able to grow. The cyclical nature in avoiding the feared stimuli results in reinforcement of the behaviour. This ultimately causes an increase in distress when the feared stimuli need to be confronted.

The act of going to school and spending time with friends or ordering ice cream can become so distressing that the child’s brain becomes emotionally flooded. Then the cycle repeats again. In many cases, the fear and distress of interacting with others has grown to a level where even attend counselling to obtain support and treatment provokes anxiety and fear. The child or teen is afraid to talk, cannot make eye contact, and breaks down in tears. The mere idea of having to interact with others causes so much distress that it may lead to agoraphobia. The lockdown and ongoing pandemic are a breeding ground for perpetuating social anxiety.

Here are some strategies to prevent social anxiety from increasing:

• Find ways for the child to continue to have face-to-face contact with people. For example, engaging in regular video calls.
• Notice if they are starting to avoid people and places. If so, find ways for them to practice that skill such as going for walks, riding their bike, etc.
• Ensure the child is not avoiding communication with others. When possible, get them to practice ordering from restaurants, drive-throughs, etc.
• Work on their nonverbal skills. For example, making eye contact with others and smiling.
• Lastly, prevention is key to addressing the possibility of social anxiety from increasing. Connect with a mental health therapist who can support the child in mitigating their negative thought patterns and avoidance.

Through the use of different models such as cognitive behavioural therapy, exposure therapy, and other well-studied approaches, social anxiety can be managed, and children and teens can resume their regular functioning. Identification of the feared stimuli is what should be explored first so a proper approach can be provided to the child or youth.

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