Running head: ANXIETY, CHILDREN, AND BEHAVIOR 1 ......Thank you, Ali and Jenny, for encouraging me...

Running head: ANXIETY, CHILDREN, AND BEHAVIOR 1

Introducing the WAVE Framework: An Adlerian Approach to Support Children

with Social Anxiety

A Literature Review

Presented to

The Faculty of the Adler Graduate School

_____________________

In Partial Fulfillment of the Requirement for

The Degree of Master of Arts in

Adlerian Counseling and Psychotherapy

______________________

By

Kelly L. Bourne

______________________

Chair: Amy Foell, MA

Reader: Emily Stevenson, PhD

_____________________

July 2019

ANXIETY, CHILDREN, AND BEHAVIOR 2

Anxiety and Disruptive Behavior: An Adlerian Approach to Support Children at Risk

Copyright © 2019

Kelly L. Bourne

All rights reserved


Abstract

The purpose of this literature review is to examine the impact of early recognition and

intervention for childhood social anxiety on reducing secondary disruptive behaviors. The

literature indicates links between parental influences, negative interpretation bias and self-

imagery, shame, internalized negative memories, and an overactive sympathetic nervous system

response on the development of childhood social anxiety. Individual Psychology concepts

including social interest, striving, inferiority, holism, the creative self, and encouragement –

when coupled with evidence-based, practical interventions that include parental education, self-

regulation and social skills training, re-scripting negative experience, problem solving, role-play,

and exposure training – lessen the experience of childhood social anxiety and decrease the use of

secondary disruptive behavior. To distill the many factors implicated in the successful

identification and treatment of childhood social anxiety into practical guidance for achieving

behavior change, the author proposes the WAVE framework. The WAVE acronym guides

parents and teachers to (a) consider why the child is using disruptive behavior, (b) acknowledge

the child’s feelings and articulate their experience, (c) validate and re-script their experience, and

(d) encourage exposure opportunities. This methodical, hands-on approach allows parents and

teachers to confidently manage the disruptive externalizing symptoms associated with childhood

social anxiety while decreasing the frequency and severity of the child’s anxious feelings.

Implementation and rigorous study of the WAVE framework’s effectiveness is warranted to

assess its potential for realizing positive outcomes for children living with social anxiety.

Keywords: childhood social anxiety, Individual Psychology, WAVE framework


Acknowledgments

This paper would not have been written if it weren’t for the company of a few good

friends, a bottle of wine, and The Bachelor. Thank you, Ali and Jenny, for encouraging me to

explore the relationship between social anxiety and disruptive behavior in children and cheering

me on along the way.

I would also like to acknowledge Rachelle Reinisch, DMFT, for her early support in

refining my topic and drafting the initial proposal. Her feedback and suggestions were

instrumental in crafting my thesis and her keen edits helped tighten my writing style. A huge

thank you also goes to Michael Grohs, MFA, for his ongoing assistance during the editing

process.

To my Chair, Amy Foell, MA, thank you for taking a risk on an unknown graduate

student. Your early encouragement and ongoing enthusiasm motivated me to think deeply and

relentlessly pursue my best work. I also offer appreciation and thanks to Emily Stevenson, PhD,

for her time and effort in serving as the reader for this literature review.

And finally, to my husband, Jared, and my sons, Grayson and Cooper – we did it! These

past four years would not have been possible without your continued encouragement and

support. I wake up every morning thankful to have you in my life and I can’t wait to see what

the future holds. Now let’s celebrate!


Dedication

To the parents and teachers who see the light in every child.


Table of Contents

Background ..................................................................................................................................... 7

Childhood Social Anxiety ............................................................................................................... 9

Parental Influence ..................................................................................................................... 10

Negative Interpretation Bias ..................................................................................................... 12

Negative Self-Image and Shame ............................................................................................... 13

The Role of Memory ................................................................................................................. 14

Fight-or-Flight........................................................................................................................... 15

Untreated Anxiety ..................................................................................................................... 15

Anxiety and Disruptive Behavior ................................................................................................. 17

Oppositional Defiant Disorder .................................................................................................. 18

Conduct Disorder ...................................................................................................................... 19

Anxiety or Disruptive Behavior ................................................................................................ 19

The Impact of Childhood Social Anxiety ..................................................................................... 21

The Impact on the Child ........................................................................................................... 22

The Impact on the Family ......................................................................................................... 23

The Impact at School ................................................................................................................ 24

Individual Psychology .................................................................................................................. 25

Social Interest............................................................................................................................ 26

Striving and Inferiority ............................................................................................................. 27

Holism and the Creative Self .................................................................................................... 30

Encouragement ......................................................................................................................... 32

Effective Intervention ................................................................................................................... 33

Parental Influences .................................................................................................................... 33

Coping Strategies ...................................................................................................................... 35

Self-regulation. ...................................................................................................................... 35

Articulate and re-script experience. ...................................................................................... 37

Education and Training ............................................................................................................. 38

Social skills training. ............................................................................................................. 39

Problem solving, role play, and exposure training................................................................ 39

Discussion ..................................................................................................................................... 41

Implications for Practice ........................................................................................................... 43

W – Why this behavior? Why now? .................................................................................... 43

A – Acknowledge feelings and articulate experience. .......................................................... 44

V – Validate and re-script the child’s experience. ................................................................ 46

E – Encouragement and exposure. ........................................................................................ 49

Utilizing the WAVE framework. .......................................................................................... 50

Recommendations for Future Research .................................................................................... 52

Conclusion .................................................................................................................................... 52

References ..................................................................................................................................... 54


Anxiety and Disruptive Behavior: An Adlerian Approach to Support Children at Risk

Background

Young children face an unprecedented transition of rapid social and emotional

development. No longer helpless infants with their every need managed and met by their

parents, from the pre-school years and onward, children must learn to navigate their environment

with increasing independence. A large part of mastering this transition to social life is finding

one’s place and learning to cooperate and interact with one’s peers (Ollendick & Benoit, 2012).

While some children make the transition to social life with ease, others become burdened with

anxiety fueled by feelings of inadequacy and the fear of rejection and humiliation. Social

anxiety can become intense and unmanageable since children are often unable to avoid stressful

social situations such as speaking in front of the class, going out for recess, or sitting with peers

at lunch. This inability to evade feared social situations can contribute to intense feelings of

being overwhelmed and the desire to escape. A child’s inability to cope with acute social

anxiety can lead them to self-protect in a variety of disruptive ways that may include yelling,

becoming argumentative, creating a disruption, or getting in trouble on purpose – all in the name

of avoiding their fears and hiding their feelings of inferiority.

The disruptive manifestation of a child’s social anxiety has wide-reaching negative

effects on the child and their family, peers, teachers, coaches, and wider social environment.

When a child’s social anxiety is met with punishment and reprimand, rather than support and

guidance, they are at increased risk of further social isolation and withdrawal (Ollendick &

Benoit, 2012), chronic loneliness and difficulty in social situations (Rapee, Wignall, Spence,

Cobham, & Lyneham, 2008), poor school performance (Ng & Abbott, 2016), and the

development of substance-abuse disorders, other anxiety disorders, depression, mood disorders


and suicide (Foa & Wasmer Andrews, 2006; Hollander & Bakalar, 2005). The consequences of

childhood social anxiety ripple through the child’s greater social circles and lead to increased

parental stress levels (Hinshaw, 2005), sibling conflict (Dunn, 2000), and increased job stress

and burnout among teachers (Sezer, 2017).

While the ramifications of childhood social anxiety can be severe, research has identified

key mechanisms implicated in the development and treatment of this complex and oft-

misunderstood disorder. Factors contributing to the development of social anxiety, including

parental behavior, negative interpretation bias and self-image, shame, and overactive fight-or-

flight responses can be ameliorated through a variety of interventions that include parental

education, self-regulation strategies, re-scripting negative experiences, social skills training,

problem-solving, role-play, and exposure opportunities. Since factors contributing to the

development of social anxiety and its treatment are varied and complex, the author introduces the

WAVE framework to aid parents and teachers in supporting children at risk. Underpinned by

core components of Individual Psychology that include social interest, striving, inferiority

feelings, holism, the creative self, and encouragement, the WAVE framework directs parents and

teachers through the process of (a) staying curious and considering why the child is using

disruptive behavior, (b) acknowledging the child’s feelings and articulating their experience, (c)

validating and re-scripting their experience, and (d) encouraging exposure opportunities. With

appropriate intervention guided by the WAVE framework, the early identification of anxious

behavioral responses in children will decrease problematic and disruptive behaviors at school

and at home.


Childhood Social Anxiety

Childhood is a time of rapidly expanding social influences, from first playdates, to

starting school, to engaging in group activities such as art, music, and sports. As children’s

exposure to new people and new situations grows, developmentally appropriate increases in

social anxiety are expected as the child assesses and modifies their actions to increase the

chances of fitting in with their peers (Ollendick & Benoit, 2012); however, for increasing

numbers of young people, the normal developmental response to anxiety-provoking stimuli shifts

into overdrive and results in the development of substantial distress and interference with daily

living.

Social anxiety involves fear or anxiety about being humiliated, rejected or scrutinized in

social situations, causing distress and impairment in daily functioning lasting at least six months

(American Psychiatric Association [APA], 2013; Centre for Addiction and Mental Health

[CAMH], 2019). Exposure to social and performance situations produces an anxiety response

that is extreme and unreasonable, manifesting behaviorally as submissiveness, crying, screaming,

tantrums, freezing, and clinging to familiar people or objects (CAMH, 2019; Ollendick &

Benoit, 2012). While behavioral avoidance of anxiety-provoking stimuli is a common coping

mechanism in both adolescents and adults, socially anxious children are rarely able to avoid

distressing situations because parents, teachers, coaches, and other adults expect them to

persevere. This inability to mitigate their exposure to anxiety-inducing situations can lead

children to become disinterested in age-appropriate social, academic, and athletic activities, and

in severe cases can result in social isolation and school refusal (Ollendick & Benoit, 2012).

Children and youth who try to avoid anxiety-provoking situations are often misidentified as

oppositional or defiant because of their refusal to participate, often resulting in time spent in the


principal’s office rather than getting the support and tools they need to better manage their

anxiousness (Sezer, 2017).

The average age of social anxiety disorder onset in the United States is 13 years with

75% of individuals having onset between 8 and 15 years (APA, 2013). While prevalence rates of

social anxiety in young people are not well established, the lifetime adult prevalence of social

anxiety disorder is 13.3% with most unable to recall a time when they were not socially cautious

or moderately anxious (Ollendick & Benoit, 2012). The development and maintenance of social

anxiety is influenced by several factors including parenting behaviors, behavioral inhibition,

negative interpretation bias, negative self-imagery and shame, overactive fight-flight responses,

and deficits in emotional regulation (Keil, Asbrand, Tuschen-Caffier, & Schmitz, 2017;

Ollendick & Benoit, 2012; Vassilopoulos & Moberly, 2013).

Parental Influence

A child’s relationship with his or her parents forms the core context from which they

make meaning of their experiences and impacts the development of his or her internal mental

framework for how they view themselves, others, and the world around them (Groh et al., 2014).

Parent-child interaction, parent-child attachment, overall family cohesion, parental mental health

status, and parenting behaviours all contribute to a child’s relative risk for developing social

anxiety disorder (Jongerden, Simon, Bodden, Dirksen, & Bögels, 2015; Lewis-Morrarty et al.,

2015; Ollendick & Benoit, 2012; Weymouth & Buehler, 2018). With such varied and potent

influence, the home environment provides a fertile breeding ground for either the roots of

anxiety or the foundations of resilience.

Parental mental health concerns play a significant role in the development of social

anxiety in youth. Children whose parents have social anxiety, panic disorder with agoraphobia,


or high levels of phobic anxiety are at increased risk for social anxiety disorder (Bernstein,

Layne, Egan, & Nelson, 2005; Manassis & Hood, 1998; Ollendick & Horsch, 2007). Traits

predisposing individuals to these disorders, including behavioral inhibition, or the tendency to

experience distress and withdraw from unfamiliar situations, are heavily genetically influenced

(APA, 2013). This genetic influence is also impacted by gene-environment interaction, meaning

that children susceptible to behavioral inhibition are also influenced by their parents’ socially

anxious modelling. This creates a double-whammy effect of influence since they receive social-

anxiety inducing feedback from both their genes and their environment (APA, 2013). Adding to

this impact, anxiety in the parent-child relationship is reciprocal, with parenting behaviors

increasing anxiety levels in children and anxiety levels in children evoking additional anxiety-

enhancing behaviours in parents (Barret, Fox, & Farell, 2005; Rapee & Spence, 2004; Silverman,

Kurtines, Pina, & Jaccard, 2009).

Parenting behaviors linked to the emergence of social anxiety disorder in children include

overprotection, excessive control, criticism (Norton & Abbott, 2017; Ollendick & Benoit, 2012),

rejection, and lack of autonomy encouragement (Jongerden et al., 2015). Overprotection and

over-controlling parenting styles place children at risk for anxiety because they shield children

from critical learning experiences. Being sheltered from adversity robs children of the

opportunity to learn critical coping skills and the confidence and satisfaction that come from

knowing they have what it takes to meet life’s challenges. Conversely, parents who criticize or

reject their children create an environment where making mistakes is dangerous and put the

child’s self-worth and sense of belonging on the line. Children reared in environments high in

conflict and lacking supportive interaction are at increased risk of social anxiety because they


have learned it’s easier to avoid anxiety-provoking situations out of the fear of being humiliated

or embarrassed than to experience the crushing pain of vulnerability and rejection.

Negative Interpretation Bias

Socially anxious people display cognitive biases in several areas of information

processing including interpretation and self-imagery (Hofmann, 2007; Rapee & Heimberg,

1997). These genetically-influenced biases are also shaped by social and family environments,

leading individuals to interpret ambiguous social information as threatening or negative and can

result in the relentless experience of distorted self-images where they imagine their performance

in social scenarios in an unfavorable light (Vassilopoulous & Moberly, 2013). Children with a

negative interpretation bias are adept at imagining worst case scenarios because their default

perception is that of a negative, humiliating, or embarrassing outcome. This leads them to

mistakenly believe they will fail, be excluded, or not fit in, even in scenarios where there is no

evidence or little chance of experiencing the imagined traumatic outcome.

The development of a negative interpretation bias has its roots in traumatic early social

experiences such as being bullied, humiliated or criticized (Norton & Abbott, 2017; Ollendick &

Hirshfeld-Becker, 2002; Rapee & Spence, 2004; Vassilopoulous & Moberly, 2013), and other

types of early trauma such as sexual abuse (Bruce, Heimberg, Goldin, & Gross, 2013; Cougle,

Timpano, Sachs-Ericsson, Keough, & Riccardi, 2010; Norton & Abbott, 2017), the death of a

parent(s) or other means of separation from parents (Bandelow et al., 2004; Kessler, Davis, &

Kendler, 1997), and family conflict such as parental marital discord, divorce, or separation

(Norton & Abbott, 2017). Traumatic experiences are most likely to influence the development

of social anxiety when they are severe, chronic, occur during critical stages of vulnerability


(transferring to a new school, following parental separation, or the death of a sibling, for

example), and are social in nature (Wong & Rapee, 2015).

Of the traumatic experiences influencing a child’s tendency to view even benign social

situations as threatening, none has more potent impact than peer victimization (Norton & Abbott,

2017). Peer victimization includes relational victimization (passive-aggressive bullying,

exclusion, rude and demeaning non-verbal communication), and overt victimization, such as

verbal and physical aggression, and is linked to the development of social anxiety over time

(Siegel, La Greca, & Harrison, 2009). The pain of peer trauma in children is on par with the

distress experienced in post-traumatic stress disorder (PTSD), the key difference being that

social belonging and connectedness are threatened rather than threats to physical life (Erwin,

Heimberg, Marx, & Franklin, 2006; Norton & Abbott, 2017). These socially traumatic events

may trigger symptoms resembling a post-traumatic reaction including re-experiencing,

avoidance, negative alterations in cognitions and mood, and hyperarousal (Carleton, Pelso,

Collimore, & Asmundson, 2011; Norton & Abbott, 2017). These symptoms often lead to poorer

social performance and, therefore, an increased likelihood of further social rejection and

victimization (Blöte, Miers, & Westenberg, 2015; Norton & Abbott, 2017) and create fertile

ground for the ongoing maintenance of social anxiety in children and youth.

Negative Self-Image and Shame

The interaction between negative interpretations and their impact on self-imagery is

highlighted in Rapee and Heimberg’s (1997) influential model of social anxiety disorder, which

proposes that socially anxious people have a negatively distorted view of social situations with

corresponding effects on self-imagery. These maladaptive self-beliefs and negative imagery act

to maintain, and in some cases exacerbate, childhood social fears (Ng & Abbott, 2016). This


negative bias can lead children to develop negative self-talk undermining their social

capabilities, internalizing the belief that “No one likes me,” or “Why try when I’m just going to

make a fool of myself?”

The development of such cutting and demeaning negative self-images form the roots of

shame: the intensely painful feeling that one is unworthy of love and belonging (Brown, 2012).

Children carrying a deep sense of shame view themselves as undeserving of acceptance, often

creating unattainable pre-requisites that exempt them from ever being welcomed into their wider

social environment. Thinking “I’ll be cool enough when I’m taller,” or “They’ll like me if I’m

better at soccer” can lead young people to further exclude themselves from social situations,

deepening their feelings of shame and unworthiness while maintaining their social fears. These

negative self-beliefs are more than child’s play or “kids being kids.” A 2011 study by Kross,

Berman, Mischel, Smith, and Wagner found that the need for social acceptance and connection is

reinforced in the brain’s chemistry meaning that from the brain’s perspective, intense physical

pain and extreme experiences of social pain hurt in the same way. When children say peer

victimization hurts, they mean it.

The Role of Memory

Memory bias has been found to play an important role in maintaining social anxiety since

socially anxious people are more likely than controls to recall negative social experiences that

support negative self-imagery (Clark & Wells, 1995). Children use recollections of past social

events to make predictions of what to expect from current or future social events and are more

likely to perceive social situations negatively if they have a history of negative memories and

memories related to social anxiety (Krans, de Bree, & Bryant, 2014). Memory is additionally

implicated in the development and maintenance of social anxiety since socially anxious people


incorporate negative experiences into their identity and form beliefs related to who they are and

what they are capable of and defining themselves, to their detriment, based on unfavorable past

experiences.

Fight-or-Flight

In addition to negative perceptions of personal performance and the fear of

embarrassment in social situations, children with social anxiety also experience a physical

reaction (Rapee et al., 2008). When a child gets anxious, his or her sympathetic nervous system

sounds the alarm, putting them on high alert of imminent threat. This “fight or flight” system

readies the child to either do battle against their perceived stressor (fight) or to escape (flight),

resulting in physical changes including increased heart rate, rapid breathing, sweating, and

nausea (Rapee et al., 2008). In children, these symptoms manifest as complaints of

stomachaches, headaches, vomiting, diarrhea, or tiredness, and can be displayed behaviorally as

fidgeting, pacing, crying, clinging, yelling, and shaking (Rapee et al., 2008). Given the

involuntary sympathetic nervous system response children face when experiencing social

anxiety, it is expected they may act out impulsively by yelling, crying, or arguing or attempt to

avoid the threatening situation altogether through complaints of stomach pain, gastrointestinal

upset, or clinging to a parent or teacher.

Untreated Anxiety

When left unchecked, the emotional, behavioral, and relational toll of social anxiety, as

well as the avoidance behaviors adopted to escape negative feelings, keep children from fully

participating in their youth (Foa & Wasmer Andrews, 2006). In addition to these immediate

consequences of social anxiety, children diagnosed with social anxiety are at risk of other


lifelong complications including mood disorders, other anxiety disorders, and substance use

disorders (Hollander & Bakalar, 2005).

In 60% of individuals with untreated anxiety, remission can take years (APA, 2013).

This extension of childhood anxiety into adulthood can lead to a lifetime of anxiousness (Rapee

et al., 2008) and become a serious hindrance to leading a full life. According to Rapee et al.

(2008), adults with social anxiety are more likely to abuse drugs and alcohol, miss work or be

unemployed, experience depression, or contemplate suicide. As adults struggle to cope with

social anxiety and its far-reaching consequences, many use alcohol for relief, resulting in

alcoholism rates for socially anxious people twice that of the general population (Hollander &

Bakalar, 2005). Alcohol provides a social lubricant that makes otherwise intolerable social

interactions possible and is the most common way people cope with anxiety; however, alcohol

can also serve to further increase anxiety by trapping individuals in a vicious cycle. For

example, individuals who feel compelled to drink to relieve social anxiety may begin to consume

even more alcohol to relieve the anxiety caused by their substance abuse (Hollander & Bakalar,

2005).

In addition to the serious complications of comorbid alcohol abuse, up to 50% of people

with social anxiety also suffer from depression (Foa & Wasmer Andrews, 2006). Furthermore,

individuals with social anxiety may be nervous about others’ perceptions of their appearance,

placing them at increased risk of eating disorders (Foa & Wasmer Andrews, 2006). They are

more likely to smoke, become pregnant (e.g., socially anxious teens are more eager to be

accepted and loved, less skilled at negotiating sexual situations, and less likely to use

contraception or demand that their partners do so), and fail to transition from high school to

college because anxious feelings compel them to avoid the fear associated with leaving home or


navigating new situations (Hollander & Bakalar, 2005). With such far-reaching and varied

consequences of untreated social anxiety, early recognition and intervention is critical in

supporting children and teens so they can mature into confident, capable, socially-interested

members of society.

Anxiety and Disruptive Behavior

Children with social anxiety self-protect in a variety of ways due to accompanying fears

related to rejection, criticism, exclusion, and humiliation (Ollendick & Benoit, 2012; Ollendick

& Hirshfeld-Becker, 2002; Rapee & Spence, 2004). At the foundation of these self-protection

behaviors is the drive toward avoidance. Children use their creative power to dodge people,

places, and situations where they anticipate feeling socially inadequate or incompetent (Blöte et

al., 2015; Norton & Abbott, 2017; Rapee et al., 2008). Avoidance is generally assumed to be a

passive activity where people make themselves scarce or quietly remove themselves from

situations, but avoidance behaviors can also manifest as crying, yelling, fighting, and arguing

when children try to escape anxiety-provoking situations by any means necessary (Déry et al.,

2017; Rapee et al., 2008). Externalizing symptoms are linked to social anxiety in terms of

relational aggression and the fear of negative evaluation. That is, children may overcompensate

for feelings of social inferiority by putting others down through gossip and deliberate exclusion

(Kunimatusu & Marsee, 2012). The relational aggression in children with social anxiety is

generally reactive in nature when children with low emotional regulation skills act out in

response to a perceived threat (Kunimatusu & Marsee, 2012). These aggressive behaviors often

go misidentified by parents, caregivers, and teachers as oppositional defiance or conduct

disorder. As a result, children are punished for their behavior and do not receive the support and

tools they need to overcome their anxiety (Sezer, 2017).


Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is characterized by a pattern of angry or irritable

mood, argumentative or defiant behavior, or vindictiveness occurring for six months or longer

(APA, 2013). Similar to social anxiety, maladaptive behaviors are likely to be confined to

specific settings or social situations. Oppositional defiant disorder shares other similarities with

social anxiety, and symptoms are linked to deficiencies in emotional regulation skills. For

example, those diagnosed with ODD experience high emotional reactivity, poor frustration

tolerance, and harsh, neglectful, and inconsistent child-rearing (APA, 2013). Of the two main

forms of disruptive behavior associated with ODD, antagonistic (i.e., blaming or annoying

others) and oppositional (i.e., defiance and argumentativeness), oppositional behaviors are more

difficult to distinguish from social anxiety because children with anxiety can defy and argue to

escape fear of social appraisal (Déry et al., 2017). Other factors that make it problematic to

distinguish between oppositional and anxious behaviors include that social anxiety and

aggression frequently coincide in typically developing children (Caron & Rutter, 1991), and the

in-your-face presence of defiance often masks more subtle, internalizing symptoms such as

anxiety (Déry et al., 2017). Aggression related to social anxiety is more likely to occur in

children anticipating social rejection, especially in those who struggle with emotional regulation

(Ayduk et al., 2000) and hostile attribution tendencies (Drabick, Ollendick, & Bubier, 2010).

With so many similarities, and only a few critical differences, defiance related to ODD must be

distinguished from defiance related to social anxiety to ensure children and their families receive

appropriate support and intervention.


Conduct Disorder

Conduct disorder symptoms generally emerge from middle childhood to middle

adolescence and manifest as a repetitive and persistent pattern of violating age-appropriate social

norms and the basic rights of others (APA, 2013). Specific behaviors can include aggression

toward people and animals, destruction of property, deceitfulness or theft, and serious rule

violations that cause clinically significant impairment in social, academic, or occupational

functioning (APA, 2013). While aggression in socially-anxious children is usually reactionary in

nature (APA, 2013), those with conduct disorder generally display symptoms in a wide variety of

situations and often initiate aggressive behavior. Similar to social anxiety, children with conduct

disorder often come from a background of maladaptive parenting practices that include parental

rejection and neglect, inconsistent child-rearing, harsh discipline, and trauma. Additionally,

children with conduct disorder have often experienced peer rejection or victimization (APA,

2013). Children with conduct disorder and children with social anxiety both usually display

deficits in emotional regulation skills; however, children with conduct disorder show a

generalized pattern of deficits whereas children with social anxiety are specifically

hypersensitive to perceived social threat (Short, Sonuga-Barke, Adams, & Fairchild, 2016).

Anxiety or Disruptive Behavior

The main challenge in supporting children with social anxiety is recognizing patterns of

disruptive behavior rooted in social stress vs. disruptive behavior rooted in conduct problems

(Rapee et al., 2008). Determining the cause of externalizing behaviors (e.g., yelling, arguing,

and refusal to cooperate) is essential because effective intervention for problematic behavior

depends on treating the cause of the symptoms. The challenge in determining the cause of the

child’s externalizing symptoms is further complicated when adults, teachers, and other


caregivers cannot agree on the intentions behind the child’s behavior. Children punished for

externalizing behaviors rooted in anxiety do not receive the support they need, which further

prolongs their symptoms and the continuation of social fears. There are a few key factors

parents, teachers, and caregivers can keep in mind to distinguish between disruptive behavior

related to opposition or defiance and disruptive behavior rooted in anxiety, including triggers,

intent, and level of relief.

One of the easiest ways to distinguish between oppositional or defiant behavior and

behavior rooted in the desire to self-protect is to carefully examine the events that took place

immediately before the observed behavior. Anxious children will do just about anything to

avoid a feared social situation even if that means getting in trouble (Rapee et al., 2008). Refusal

to cooperate with common requests such as going out for recess, speaking in front of the class,

engaging in group work, or getting changed for gym class are common scenarios where socially

anxious children will deliberately get in trouble to escape the risk of humiliation, rejection, or

victimization they fear (Foa & Wasmer Andrews, 2006; Rapee et al., 2008). Socially-anxious

children typically get into low-risk and predictable trouble and often show relief when removed

from the situation (Rapee et al., 2008). In comparison, children with oppositional or defiant

behavior tend to display more hostile intent with their behaviors (Kunimatusu & Marsee, 2012)

and often act out proactively. The hostile intent and proactive acting out is in stark contrast to

the socially-anxious child’s reactive behavior in response to a perceived threat.

Understanding the key differences between oppositional behavior and the symptoms of

social anxiety allows parents, teachers, and caregivers to make informed decisions regarding the

most effective way to intervene with problematic behavior. Rather than jumping to punishment

or reprimand, a more effective approach would be to consider why the child engaged in that


behavior, why now, and how often the child engages in the behavior pattern. When asking these

questions, one should remain curious and open to the possibility that the child is attempting to

avoid a feared situation by intentionally getting in trouble (Rapee et al., 2008). Nervous blushing

or sweating, confusion or freezing in social situations, difficulty talking in class or reading aloud,

extreme discomfort being the center of attention, refusal to attend social events or have friends

over, mumbling, avoiding eye contact, or presenting as if they want to disappear during group

activities are other red flags that behavior may be an attempt to evade the potential of social

embarrassment, humiliation, or judgement (Foa & Wasmer Andrews, 2006). No matter the

symptom or display of disruptive behavior, effective intervention lies in recognizing the

underlying fear of negative evaluation, peer victimization, humiliation, or social rejection (APA,

2013).

The Impact of Childhood Social Anxiety

Just as the influences on the development childhood social anxiety are varied and

complex, so too are its impacts on the child, the family, and the school environment. Social

anxiety and its associated symptoms can contribute to children holding themselves back from

living a full life, which can lead to chronic loneliness and difficulty in social situations (Rapee et

al., 2008). In addition, children may display poor school performance and academic

achievement, which can eventually result in poor job prospects, unemployment, and substance

use disorders. Social anxiety can have an impact on the child’s family as parents struggle to

support and advocate for their child. Parents may develop feelings of inadequacy and shame

surrounding their child’s diagnosis, which increases the risk for parents to develop anxiety over

their perceived failures and inadequate support of their child. Additionally, social anxiety has an

impact on teachers and classmates as teachers struggle to manage the classroom disruptions and


externalizing behaviors of children desperate to escape anxious feelings. Teachers may become

emotionally taxed, burned out, and unable to perform at the level they initially imagined upon

entering the profession. The impacts of childhood social anxiety can be severe and have a

negative effect on everyone in the child’s world, which makes early recognition, support, and

adequate intervention necessary to decrease potential suffering.

The Impact on the Child

Children and teens with social anxiety often experience nervousness or preoccupation

with embarrassment, inadequacy, self-criticism, and rejection (Ollendick & Benoit, 2012).

These overwhelming thoughts and negative self-appraisals can lead to elevated stress levels that

make it impossible for them to think clearly. The inability to think clearly cultivates an

environment where children are likely to become awkward or inept in social exchanges, which

further increases their social fears (Ollendick & Benoit, 2012). This self-fulfilling prophecy can

lead to life-long challenges in social situations. For example, when children fail to develop age-

appropriate social skills, they often have difficulty initiating and maintaining friendships, which

can result in high levels of loneliness (Beidel, Turner, & Morris, 1999; Rapee et al., 2008).

Awkward social encounters can lead to difficulties in school since the mental load of

anxiousness can result in poor performance in affective, cognitive, and academic tasks (Ng &

Abbott, 2016). When children are preoccupied with how they look, if they will embarrass

themselves, or if their peers will criticize them, it is understandable they would struggle to focus

in an academic environment, especially when the expectation exists that they will contribute

equally and interact with their peers. If untreated, difficulties in school can spill into adjustment

problems in adulthood, particularly if children have become accustomed to avoiding group work,

speaking in front of the class, or failing to make full use of resources (e.g., refusing to ask for


help or not raising their hands to answer questions). If children with social anxiety do not learn

these skills in childhood, it may become difficult for them to interact with others and engage in

teamwork, which are essential skills for many careers (Rapee et al., 2008). Poor school

performance, decreased job prospects, preoccupation with negative thoughts and poor self-

concept, and failure to develop social skills and lasting friendships interfere with the young

person’s life and the lives of everyone in the family.

The Impact on the Family

Children with social anxiety do not live in isolation but develop in the context of their

families and social environments. The distressing and often intense symptoms they experience

can have serious consequences for their health and well-being and serious implications for the

family’s level of functioning (Towe-Goodman, Franz, Copeland, Angold, & Egger, 2014).

While anxiety disorders are among the most common mental disorders, they are still widely

misunderstood resulting in many people, including relatives, coaches, friends, and the general

community, being quick to judge and slow to recognize the impact of intense, persistent anxiety

(Foa & Wasmer Andrews, 2006). In their effort to support their children and battle on the front

lines of mental health stigma, parents face ongoing stress, which can undermine their confidence

and lead to increasing levels of self-blame and shame (Hinshaw, 2005). Self-blame and shame

coupled with (a) additional expenses and the loss of income from taking time off work (Meltzer,

Ford, Goodman, & Vostanis, 2011), (b) increased worrying, (c) higher levels of depression and

fatigue, and (d) increasing avoidance of social activities can create emotional ripple-effects

through the family and have a negative impact on the family’s social-emotional health (Towe-

Goodman et al., 2014). While it can be tempting to put the needs of their child above all else,


when it comes to effectively supporting children with the consequences of social anxiety, parents

need to prioritize their emotional needs as well.

In addition to the impact of social anxiety on parents, siblings also experience significant

repercussions from living with someone affected by social anxiety. According to Dunn (2000),

sibling relationships have a profound, reciprocal impact on a child’s development and influence

one’s quality of friendships, level of self-esteem, depression, loneliness, and delinquent behavior

(Yeh & Lempers, 2004); therefore, the brothers and sisters of children with social anxiety are at

risk from multiple angles since they must navigate the environmental consequences of their

parents’ increased stress and discouragement and their sibling’s disruptive and maladaptive

coping methods all while being at increased genetic risk of developing their own problems with

anxiety (APA, 2013). Research has also indicated that siblings of children with social anxiety

are at increased risk of being caught in negative parent-child interactions that impact family

functioning and sibling relationships (Eisen & Kearney, 1995). Siblings also face increased

issues of conflict and control and less warmth when compared to families without a diagnosis of

social anxiety (Fox, Barrett, & Shortt, 2002). Dia and Harrington (2006) found that more than

half of siblings without a mental health diagnosis had at least one elevated scale score for

disorders related to anxiety (e.g., phobia, obsessive-compulsive disorder, depression, or post-

traumatic stress disorder) and underlined the importance of assessing and treating the whole

family and not just the identified client.

The Impact at School

Of children with social anxiety, 75% experience onset between the ages of 8 and 15

(APA, 2013). According to Foa and Wasmer Andrews (2006), children’s most important social

interactions at this stage of development occur at school, making the school system ground-zero


for the recognition and effective treatment of childhood social anxiety. In the school

environment, positive, proactive support is often lacking because when children display

externalizing symptoms of social anxiety (e.g., physically avoiding stressful situations, yelling,

arguing, or purposely getting in trouble to avoid anxiety-provoking situations), they are often

labelled as disruptive or defiant and treated punitively for their outbursts. This misclassification

of behavior not only has a negative impact on the child but the teacher and greater classroom

environment as well. Teachers at a loss for how to manage disruptive behavior often report

increased job stress, low job satisfaction, higher levels of burnout, a loss of self-respect, and

regret about entering the teaching profession (Sezer, 2017). Low teacher confidence, high levels

of burnout, and teacher disengagement create a recipe for emotionally-strapped teachers and

unsupported students, which is antithetical to receiving an adequate education or appropriate

mental health support. Recognizing a child’s social anxiety while in the classroom is not only a

benefit to children at risk but to the emotional well-being of teachers and the educational

experience of their classmates as well.

Individual Psychology

Austrian physician Alfred Adler first introduced Individual Psychology and its focus on

the holistic, indivisible nature of personality in 1912 as an alternative to Freud’s division of the

psyche into the Id, Ego, and Superego (Ansbacher & Ansbacher, 1956; Oberst & Stewart, 2003).

Adler believed that a person was more than the sum of their parts, and to understand an

individual was to understand them in the context of their social environment (Oberst & Stewart,

2003). Adler believed health was not just biologically based but influenced by social, familial,

and cultural factors with encouragement being a key component of optimal health and well-being

(Sommers-Flanagan & Sommers-Flanagan, 2015).


At its core, Individual Psychology holds several key assumptions, including

(a) people are social and their main desire is to belong,

(b) behavior is goal-directed,

(c) people are responsible for making their own decisions,

(d) people are whole and cannot be defined by individual characteristics or behaviors, and

(e) people see reality as they choose to see it and can hold beliefs or basic mistakes about

themselves, others, and the world around them that cause distress (Mosak & Maniacci,

1999; Oberst & Stewart, 2003; Sommers-Flanagan & Sommers-Flanagan, 2015).

Several of Adler’s concepts hold promise in the understanding and effective intervention

for childhood social anxiety including social interest, the purposefulness of behavior, holism, the

creative power of the individual, and encouragement.

Social Interest

Adler’s concept of social interest stems from the German term Gemeinschaftsfefühl.

While there is no direct English translation, the most accurate alternative is community feeling or

the awareness of belonging to the wider human community and the universe in which it is a part

(Griffith & Powers, 2007). The concept of social interest stems from the action of practicing

community feeling – how one’s thoughts, attitudes, and behaviors shape the experiences of

others and the community at large (Ansbacher, 1992; Griffith & Powers, 2007). Adler believed

that an individual’s concern and commitment to improving the well-being of their human

community – their level of social interest – is a requirement for healthy human functioning

(Dreikurs Ferguson & Page, 2014). To exhibit a high level of social interest, and therefore to be

well-adjusted and healthy, means to participate, contribute, share, feel accepted, appreciated and

loved, as well as to accept, appreciate, and love others (Oberst & Stewart, 2003).


Individual Psychology holds that healthy human functioning depends on a person’s level

of social interest in facing the three major tasks of life: love, work (or for children, school), and

community (Ansbacher, 2011). Used as a measure of adaptation, Adler believed the higher an

individual’s social interest, the more capable he or she is at managing life’s difficulties in these

three areas. He associated lower levels of social interest with increased feelings of inferiority,

alienation, and isolation (Griffith & Powers, 2007). Fueled by feelings of discouragement, lack

of social interest results in the individual’s direction of striving focused toward what Adler

described as the useless side of life, where one attempts to gain superiority or personal comfort

by turning away from others rather than focusing on the betterment of all involved (Mosak &

Maniacci, 1999). Children experiencing social anxiety and its associated avoidance-related

behaviors reflect this lack of social interest because they are preoccupied with thoughts of

themselves and use their feelings of anxiety to escape the tasks of life rather than meeting them

with courage (Sperry, Carlson, Duba Sauerheber, & Sperry, 2015).

Striving and Inferiority

A central tenet of Individual Psychology is Adler’s belief that all behavior is goal-directed

(Ansbacher & Ansbacher, 1956). This goal-directed movement is ceaseless because all

individuals, regardless of their station in life, seek to improve upon their present situation and

strive for something better (Ansbacher & Ansbacher, 1956; Watts & Ergüner-Tekinalp, 2017).

This purposeful and relentless striving is the powerful motivator behind all human progress

(Mosak & Maniacci, 1999). Whether lofty and bold or subtle and small, one does not have to

look farther than their daily life for proof of the goal-directed nature of behavior. Every

movement, action, and decision brings one closer to what they seek – from combatting fatigue


via a second cup of coffee to popping open an umbrella to keep the rain away to smiling and

greeting superiors at work – each action serves a purpose.

Alfred Adler recognized that people hold different motives, or purposes, for behaving the

way they do. Some people choose goals to elevate, uplift, and overcome difficulties by

improving upon their own condition and the condition of their greater community. He called this

horizontal striving or striving motivated by moving with others toward greater cooperation

(Watts & Ergüner-Tekinalp, 2017). People striving for goals on the horizontal plane act with

social interest and are concerned not only in bettering their own position but also the position of

those around them. In contrast, Adler defined vertical striving as movement toward a goal with

the purpose of improving one’s station over that of another (Ansbacher & Ansbacher, 1956;

Mosak & Maniacci, 1999; Oberst & Stewart, 2003). Vertical striving is more self-interested than

socially-interested and is motivated not by a desire to cooperate, grow, and improve in concert

with one’s human community but rather by feelings of inferiority.

Inferiority feelings are universal human feelings. The experience of perceiving oneself as

incapable, incomplete, small, weak, ignorant, or dependent occurs as early as infancy and

reemerges throughout life (Griffith & Powers, 2007). These feelings, though uncomfortable, are

normal. Ansbacher and Ansbacher (1956) argued that feelings of inferiority were the cause of all

improvements in the history of humankind. For socially-interested people, feelings of inferiority

motivate them to learn and grow, spurring them to work tirelessly to overcome obstacles and

improve living conditions (e.g. the discovery and continued improvement of the use of fire,

flight, vaccines, computing, and other technologies) for themselves and those around them.

Problems arise when an individual’s inferiority feelings, coupled with a lack of social interest,

motivate them not to overcome the problem through adaptive means but to instead place


psychological distance between themselves and that which they feel incapable of facing (Oberst

& Stewart, 2003). Rather than meeting the challenge with courage, discouraged individuals

choose to evade the task to maintain their self-esteem when they fear defeat or are concerned

their efforts won’t measure up (Oberst & Stewart, 2003).

According to Adler’s view of Individual Psychology, psychological maladjustment is caused

by the evasion of obstacles due to feelings of inferiority. The drive to evade leads individuals to

create symptoms as an excuse for not meeting the tasks of life (Oberst & Stewart, 2003). For

example, an individual with anxiety “uses” avoidance behaviors as an excuse for backing away

from social encounters they do not feel capable of handling (Sperry et al., 2015). These

avoidance symptoms serve to mask inferiority feelings while providing justification for why they

are incapable of meeting the demands of community life (Mosak & Maniacci, 1999). Avoidance

behaviors that stem from inferiority can lead to shame and discouragement, perpetuating

maladaptive behavior as the individual continues to use their symptoms to conceal perceived

inadequacies (Ansbacher & Ansbacher, 1956). The individual’s symptoms of psychological

distress (e.g. anxiety, avoidance, aggression, depression) serve to cover up or distract from the

more painful hurt they would endure if forced to face feelings of rejection, unworthiness, and

criticism associated with their perceived inferiority (Oberst & Stewart, 2003).

In Adler’s view, an individual’s psychological distress and self-absorbed vertical striving will

not resolve until their underlying feelings of inferiority have been defined (Ansbacher &

Ansbacher, 1956). The key then, in conquering psychological maladjustment, is to determine

where the individual feels inferior and lacks courage in facing the tasks of life. The only way to

understand a person’s behavior is to know their goals, and in knowing their goals one can predict

their approximate next steps and intervene accordingly (Oberst & Stewart, 2003). For example,


in carefully observing a child’s continued attempts to evade recess by causing distractions or

finding ways to get in trouble (e.g. conveniently being sent to the principal’s office at the exact

time they would otherwise be forced to interact with their peers), one could develop a well-

informed hunch that the child’s goal in being disruptive is to avoid social interaction. By

understanding this goal, the teacher can respond in a matter sensitive to the child’s anxiety

without being fooled by the disruptive “mask” they are using to avoid disclosing more painful

feelings of discouragement and inferiority. Everyone has emotions, and all emotions serve a

purpose. The key in assisting children at risk is to understand how they are using their emotions

to obtain what they desire (Rasmussen & Dover, 2006).

Holism and the Creative Self

Holism, or the belief that a person is more than the sum of their thoughts, feelings, and

behaviors, is a basic principle of Individual Psychology. Alfred Adler stressed the importance of

looking beyond an individual’s outward actions and instead striving to understand the totality of

the person as one interacting system (Sperry et al., 2015). This complex system, influenced by

one’s genetic makeup, family environment, social and economic status, and myriad other

environmental factors, determines how an individual makes meaning of their life circumstances.

In Individual Psychology, one’s unique way of interpreting circumstances is referred to as their

creative power. This creative force is present in children from birth, enabling them to make their

own decisions and develop opinions on what happens to them (Oberst & Stewart, 2003). From

crying to signal hunger, smiling to indicate pleasure, or hiding to indicate fear, children use their

creative power to get what they desire. Far from being helpless bystanders, the creative power of

children allows them to become both the creators of their experiences and the designers of their

lives (Oberst & Stewart, 2003).


According to Stein (2012), the most decisive indicator of an individual’s personality is

their creative power, or how they see and interpret events around them. Given identical

circumstances, no two people will respond the same way because each filters reality through a

unique lens. Just as creative energy can act as a catalyst to overcome an obstacle with courage or

face hardship with dignity, it can also be used to evade the tasks of life. By sidestepping the

demands of community living and igniting the internal conflict accompanying it, discouraged

individuals are not helpless victims of their circumstances but the architects of their discomfort –

the pain they feel is the price they are willing to pay for not having to face the tasks of life with

courage (Mosak & Maniacci, 1999). While choosing to remain in conflict or live in discomfort

may seem illogical, it is not when one understands the purposefulness of behavior. People

choose to remain in conflict for one reason and one reason only – because it serves a purpose

(Mosak & Maniacci, 1999).

Whether children purposefully use defiance to avoid social situations or use disruptive

tactics to mask feelings of inferiority, their actions are guided by the same driving force – to

achieve their desired goals (Oberst & Stewart, 2003). Rather than viewing maladaptive behavior

as a character flaw, Individual Psychology holds that since a person has the creative power to

create their own disturbances, they also have the creative power to overcome perceived

inferiorities (Carlson & Maniacci, 2012). The key to assisting children at risk is to re-direct their

creative energies toward facing life’s challenges rather than avoiding them. Alfred Adler’s belief

that everything can be different – that all people are capable of change – marks the path toward

reaching this goal (Stein, 2008). Everyone makes mistakes, and all mistakes can be corrected

once an individual’s motivation has been redirected to the courageous side of life through the

skillful use of encouragement.


Encouragement

Encouragement is an essential construct of Individual Psychology (Adler, 1946).

Defined by Dinkmeyer and Losoncy (1996) as the process of promoting “the development of a

person’s inner resources and courage toward positive movement,” (p. 7) Adler’s view of

encouragement was not to simply “fix” or change problematic behavior but to motivate the

individual toward positive change (Sweeney, 2009). Since Adlerian practitioners view

discouragement and loss of courage as the root of all dysfunction, there is no greater tool in the

Individual Psychologist’s tool kit than the intentional use of encouragement (Carns & Carns,

1998; Griffith & Powers, 2007). When used effectively, encouragement techniques serve to

promote and activate one’s social interest, level of belonging, personal value, and sense of

worthiness in the greater human community (Griffith & Powers, 2007).

The discouraged individual displaying maladaptive behavior holds the same goals as the

socially-interested person acting with courage – to overcome feelings of inferiority. The

difference lies in motivation. The socially-interested person summons courage to face life’s

challenges in a manner that benefits not only their own station in life but those of their fellow

human beings. In contrast, discouraged individuals act to evade or distance themselves from

life’s challenges because they are afraid of being exposed as deficient (Griffith & Powers, 2007).

Using encouragement, Individual Psychologists challenge these unhealthy attitudes and motivate

individuals to develop more functional, alternate beliefs (Britzman & Henkin, 1992). Initially

proposed by Evans, Dedrick and Epstein (1997), there are four dimensions of encouragement

Individual Psychologists can use to assist clients develop courage to face life’s challenges,

including


(a) positive view of oneself,

(b) positive view of others,

(c) being open to experience, and

(d) developing a sense of belonging with others.

No matter the maladaptive belief or behavior, the aim of treatment in Individual Psychology is

always to increase a person’s courage in meeting life’s challenges (Ansbacher & Ansbacher,

1956).

Effective Intervention

The experience of childhood social anxiety has consequences lasting well into adulthood

(Hollander & Bakalar, 2005), making prompt, effective intervention critical to supporting

children at risk. The externalizing symptoms of a child’s response to social anxiety can be

disruptive, argumentative and defiant, and trigger anger, frustration, and exasperation in their

parents and teachers, further inflaming the child’s stress response. The potential of a child’s

symptoms to provoke emotional responses in their caregivers makes it crucial that parents and

teachers look beyond the child’s disruptive behavior and stay curious about the roots of why the

child chooses to act out. Keeping alert to the wider influences on a child’s behavior allows

parents and teachers to make the crucial distinction between defiant or oppositional behavior and

that which is rooted in anxiety allowing them to intervene effectively through identifying and

minimizing family triggers, introducing coping skills, teaching valuable social and emotional

regulation skills, and practicing these new tools in both simulated and real-life environments.

Parental Influences

Parental factors play a major role in the onset and maintenance of childhood social anxiety.

The parent-child relationship is one of the strongest influences on a child’s developing sense of


self and impacts their internal working model for what to expect from social relationships

(Weymouth & Buehler, 2018). Parents with their own un- or under-controlled anxiety may

inadvertently model anxiety-promoting behavior and social avoidance to their children through

their words and behaviors. These fear-based actions can lead to an environment of over-control

where the parent, with good intentions of protecting their child from hardship, promotes the idea

that it is normal to be afraid of social interaction. These over-protective behaviors are far from

benign because maternal over-control at 7 years-of-age has been found to predict adolescent

social anxiety (Lewis-Morrarty et al., 2012; Norton & Abbott, 2017). In addition to modeling

anxiety-promoting behavior, another key parental influence on childhood social anxiety is

negative parental feedback. Persistent criticism and continual negative evaluation have been

found to induce hypervigilance and preoccupation with social evaluation (Lewis-Morrarty et al.,

2012), two risk factors associated with the development of social anxiety (APA, 2013).

While hypervigilance, over-control, overprotection, criticism (Norton & Abbott, 2017;

Ollendick & Benoit, 2012), rejection, and lack of autonomy encouragement (Jongerden et al.,

2015) influence the development of childhood social anxiety, warmth and responsiveness are

positive parenting behaviors associated with socially adaptive behavior in children (Ollendick &

Benoit, 2012). Teaching parents supportive strategies for guiding their children to engage

socially and embrace novel situations as opportunities to learn and grow acts to protect their

children from developing inhibited behaviors associated with social anxiety (Ollendick & Benoit,

2012). By seeking treatment and support for their own untreated anxiety and learning strategies

for providing consistent and encouraging support to their children, parents generate trust that

they can be relied on for support. Supportive, encouraging modelling also serves to increase

children’s confidence in their ability to competently navigate peer relationships with


independence (Ainsworth, 1989) and master their fears (Ollendick & Benoit, 2012), lessening

their experience of social anxiety.

Coping Strategies

Creating a supportive, encouraging home environment is an excellent first step in helping

children conquer their social fears. Coping strategies are a crucial companion to parental support

and encouragement because they provide in-the-moment tools for children who struggle to

manage their emotions and responses to peers. Effective coping strategies that help children

overcome social anxiety include introducing self-regulation skills, coaching them to articulate

their feelings, and showing them how to re-script anticipated negative experiences.

Self-regulation. When children anticipate social rejection, their sympathetic nervous

system is activated and signals a fight-or-flight response while simultaneously stifling their pre-

frontal cortex – the area of the brain responsible for rational, logical thought and self-control

(Rapee et al., 2008). This reduction in the brain’s ability to reason results in children being less

able to manage and make sense of their emotions. Poor emotional regulation skills, coupled with

anxious feelings from anticipated social rejection, influence the development and maintenance of

childhood social anxiety (Keil et al., 2017; Ollendick & Benoit, 2012; Vassilopoulos & Moberly,

2013) and can lead to the increased likelihood of the child retaliating against the perceived threat

with aggression or other disruptive behavior (Ayduk et al., 2000; Kunimatusu & Marsee, 2012).

Since the rational, logical pre-frontal cortex is essentially offline during periods of sympathetic

nervous system activation, the first step in supporting children who struggle with perceived

social threat is to help them quiet their survival impulses so they can re-engage the part of their

brain responsible for thinking and learning.


Effective modeling is crucial for teaching children self-regulation skills. Since a child’s

neuroceptive system, the part of their brain responsible for monitoring people and situations and

assessing for safety and danger, is not fully developed until their mid-20s, children are especially

susceptible to the emotional influence of others (Siegel & Hartzell, 2014). Because of this

increased sensitivity, it is critical that parents and teachers not fuel the child’s out-of-control

response by modeling their own anger or exasperation since this will exacerbate and prolong the

child’s disruptive behaviors. Instead, parents and teachers facing the disruptive externalizing

symptoms of a child’s social anxiety need to model the calm, rational decision-making they wish

to see in the child. While often easier said than done, effective emotional regulation modelling

not only allows parents and teachers to remain level-headed and calm in times of stress but

provides an excellent example to children of how they too can manage their impulses and make

appropriate decisions when emotionally flooded.

Once the parent or teacher has awareness of their personal emotional response to stress

and is confident in their ability to model calm, the next step in promoting self-regulation skills is

to provide the child effective alternatives for coping with their anxious feelings. This can be a

challenge because children experience stress differently, and what one child finds soothing may

be stressful to another. To assist in streamlining this process, parents and teachers can help

children first recognize what stress and anxiety feel like in their body, contrasted to what it feels

like to feel calm, alert, safe, and secure (Shanker, 2016). Once children can recognize the

oncoming symptoms of their stress response, they can activate their personal arsenal of strategies

or activities known to help them feel calm and alert. These strategies will be different for every

child and may include drawing, painting, playing sports, meditation, deep breathing, listening to

music, photography, or writing. The key is to explore the child’s unique interests and create


practical options to help calm their aggravated sympathetic nervous system response in times of

stress.

Articulate and re-script experience. Once children have learned to recognize their

stress response and regulate their emotions, the next step in helping them cope is teaching them

to re-script the internal dialogue that initiated their feelings of anxiety. To accomplish this, it

helps to understand how the brain processes and stores information. In basic terms, the human

brain can be divided into two hemispheres: the left side, which is responsible for logic and helps

make sense of one’s lived experience, and the right side, which is responsible for processing

emotion and storing autobiographical memories (Siegel & Payne Bryson, 2011). The challenge

for children is that the right hemisphere of their brain matures at a faster rate than the left. This

mismatch means that while children can feel strong emotions and store this information to

memory, they are not capable of using logic and reason to accurately explain their experience

(Siegel & Payne Bryson, 2011). For example, a child who feels rejected after walking past a

group of friends who failed to notice her may tell herself that the reason they did not say hello is

because they do not like her. If the child, unable to logically explain or rationalize her

experience, repeatedly tells herself mistaken stories that define her as unworthy or unlovable in

social situations, the right hemisphere of her brain will consolidate this information to memory

and negatively define her developing sense of self (Siegel & Hartzell, 2014). Because the role of

memory, especially memory containing negative self-imagery (Clark & Wells, 1995), is

implicated in the maintenance of social anxiety, it is critical parents and teachers work with

children to re-frame their experiences away from self-defeating narratives.

An effective coping strategy for children plagued by negative attribution bias or self-

image is to help them articulate what they are experiencing. Since the rational, logical left


hemisphere of their brain is not fully developed, they may need help assigning language to their

experience. Helping children articulate their experience and giving them language to explain

what they are feeling calms the emotional circuitry of the brain (Siegel & Payne Bryson, 2011)

and gives them the opportunity to respond to their feelings without becoming overwhelmed with

their emotions. Providing time and space for a child to tell their story allows them to make sense

of the event and move to a place where they can feel better about what happened (Siegel &

Payne Bryson, 2011). Being able to voice their version of events and explain what they were

telling themselves while it was happening offers fertile ground for acknowledging their lived

experience and correcting any mistaken ideas they may have developed about who they are and

of what they are capable. Parents and teachers can guide children to use the language, “The

story I’m telling myself is…” to help them separate their thoughts and feelings from who they

are as people (Brown, 2015). With practice, the child can learn to re-script their experiences and

eschew maladaptive thought patterns and negative self-evaluations by writing an alternative

ending that highlights their capability at facing life’s challenges with courage.

Education and Training

Managing one’s initial stress response is an essential first step in tackling the debilitating

impact of childhood social anxiety. Once parents, teachers, and children have learned to

recognize the stress response, articulate their feelings, identify calming coping mechanisms, and

correct their faulty logic and negative attributions, education and training promoting effective

social skill building can teach children to manage social situations without sparking a

sympathetic nervous system response. Proactive training can include specific instruction on

social skills and healthy friendships, problem solving, and practical experience managing their

new skills through curated role play and exposure scenarios.


Social skills training. Defined broadly, social skills include the ability to confidently

engage in conversation, make friends, ask questions, assert one’s rights when treated unfairly,

offer help, ask for help, and express one’s point of view (Rapee et al., 2008). The development

of these skills in childhood contributes to several indicators of well-being including educational

achievement, employability, and positive mental health outcomes (Abrahams et al., 2019).

According to Rapee et al. (2008), children with social anxiety have poorer social skills compared

to their peers. The fear of rejection and humiliation associated with social anxiety prevents them

from confidently interacting with their peers and robs them of crucial experience developing

these skills. Parents and teachers can encourage children in honing these skills, beginning with

mastery of body language (eye contact, posture, hand gestures), and moving toward more

complex skills including voice-quality skills (tone and pitch, volume, rate, clarity), conversation

skills (greetings and introductions, starting conversations, holding conversations and answering

questions, taking turns, using polite conversation), friendship skills (offering help or items,

offering invitations, asking to join in, expressing affection, giving compliments, showing

concern when others are hurt or upset), and assertiveness skills (sticking up for one’s rights,

asking for help, articulating needs, saying no, dealing with teasing, managing bullying; Rapee et

al., 2008).

Problem solving, role play, and exposure training. Emotional regulation and social

skills training are essential for increasing children’s confidence in social situations. While

training provides crucial insight, for this valuable knowledge to be effective, children must be

given safe opportunities to practice. Skills such as initiating and maintaining conversation,

joining in on group activities, standing up for oneself, and asking for help are rarely as

straightforward to put into action as they seem and make proactive problem solving about what


to do when interactions don’t go as planned, role play, and exposure training critical for

preparing children to face their fears and feelings of inferiority.

One of the first steps to internalizing education and training is to practice problem

solving. By thinking of potential problems and brainstorming solutions, children can learn to

anticipate challenges, correct maladaptive thought processes, and prepare appropriate responses

fueled by courage and confidence. During this process, it is important to explain to the child

why the skill is important, its purpose, and what happens if it is not used (Rapee et al., 2008).

For example, a child self-protecting against feelings of inferiority by avoiding eye contact or not

responding to a greeting may not realize how these behaviors could be viewed as rude by others.

During the problem-solving process, adults can explain the importance of these skills while also

exploring what to do when the child is feeling awkward or uncomfortable, so they are better

prepared when similar situations arise.

Once children have learned new skills, brainstormed potential hurdles, and thought of

ways to handle them, they need practice implementing their new knowledge through role play

and exposure to real situations. Role play is an excellent place to start because it provides a low-

stakes, nonjudgmental atmosphere to test out their new skills. Parents and teachers can take

children through scenarios, role-play social interactions, and test out different responses and

adjust them as needed. Practice situations could include any situation where the child struggles

or feels uncomfortable such as starting a conversation, asking to join in, public speaking,

offering a compliment, apologizing, saying no, or dealing with teasing and bullying (Rapee et al.,

2008).

While uncomfortable, the final challenge for children learning to conquer social anxiety

is to face their fears directly. While they may be reluctant, the avoidance of anxiety-provoking


situations only serves to reinforce that there is something to be afraid of. Starting with small,

manageable challenges will build the child’s confidence and provide proof they can move

beyond their fear. These small wins are essential because many children with social anxiety

grossly overestimate the negative consequences of social interaction (Rapee et al., 2008). Even

if children struggle to meet their initial goals, they will learn that the consequences were not as

severe as they imagined and realize that even though things may not have gone as smoothly as

planned, the situation was not as terrible as they expected. Meeting manageable goals, learning

to move through disappointment, and encouraging children to cope with their feelings of fear and

inferiority helps remind them that they are strong and capable, which breaks their entrenched

patterns of automatically responding to social situations with anxiousness and worry (Rapee et

al., 2008).

Discussion

Children continually assess their place in the world as they grow and mature. While

developing awareness of one’s level of belonging and acceptance is a normal developmental

milestone, it is not without challenges. For some children, navigating their ever-widening social

environment brings anxiety and excessive fear of humiliation, rejection, and scrutiny that

interrupts their ability to function optimally (APA, 2013). The fear of not measuring up or fitting

in with their peers can lead children to self-protect by any means necessary, including arguing

their way out of social encounters, defying requests to join in, or getting in trouble on purpose as

a way of escaping the feared situation (CAMH, 2019; Ollendick & Benoit, 2012). These

externalizing symptoms of social anxiety are often misidentified by parents and teachers as

defiance and disobedience and result in the child being reprimanded or punished rather than

receiving the support and encouragement they deserve (Sezer, 2017).


The development of childhood anxiety is complex and includes factors such as parenting

behavior, behavioral inhibition, negative interpretation bias, negative self-imagery, shame, an

overactive fight-flight response, and deficits in emotional regulation (Keil et al., 2017; Ollendick

& Benoit, 2012; Vassilopoulos & Moberly, 2013). Regardless of the initial source of the child’s

stress, its substantial impact on the child and their family, siblings, teachers, and classmates

makes early recognition and intervention essential to promoting positive health outcomes. When

left unchecked, childhood social anxiety can wreak havoc on the child’s social and emotional

development and place them at greater risk of lifelong complications including mood disorders,

other anxiety disorders, and substance use disorders (Hollander & Bakalar, 2005).

Individual Psychology and its emphasis on social interest as a measure of health and

well-being provides an excellent foundation to support children at risk of developing social

anxiety. With a focus on the purposefulness of behavior and the impact of inferiority feelings on

the direction of one’s striving, Individual Psychology addresses the core components that

influence the development of social anxiety while also providing a blueprint for its treatment.

By accepting children as more than the sum of their actions and behaviors, parents and teachers

can harness the child’s creative power toward facing social challenges with courage.

Empowering children to recognize their inherent capabilities at facing social challenges rather

than punishing them or bulldozing all obstacles out of their path in a well-meaning effort to

protect them from hardship, parents and teachers help children cultivate a deep sense of

competency and the understanding that they have the power to affect positive change. The

process of supporting the child to face their fears, guided by the skillful use of encouragement,

enables parents and teachers to not only decrease the child’s problematic and disruptive


behaviors but also strengthen the coping, social, and emotional-regulation skills necessary for the

child to confidently engage in a rich and meaningful social life.

Implications for Practice

While the available research provides powerful insight into the successful identification

and treatment of childhood social anxiety, information housed in scientific journals is not readily

accessible to parents and teachers living and working with children at risk. It is unrealistic to

expect key stakeholders to scour the literature each time they encounter a behavioral challenge,

just as it is unrealistic to expect consistent support and treatment when parents and teachers have

little or no guidance on how to assist children exhibiting the externalizing symptoms of social

anxiety. To streamline the identification and treatment process for childhood social anxiety, this

author proposes using the WAVE acronym to guide parents and teachers to (a) consider why the

child is using disruptive behavior, (b) acknowledge the child’s feelings and articulate their

experience, (c) validate and re-script their experience, and (d) encourage exposure opportunities.

The introduction of the WAVE framework to teacher training and parental guidance education

will offer an easily accessible, step-by-step approach for supporting children living with social

anxiety.

W – Why this behavior? Why now? The first step in helping children cope with social

anxiety is to recognize its presence. Children who act out in class or get in trouble on purpose

often behave in such a manner to self-protect from the excruciating pain of social anxiety. By

taking a moment to pause and consider, “What purpose does this behavior serve for the child?,”

“Why now?,” and “What is this behavior allowing the child to avoid?,” parents and teachers are

equipped to identify behavior rooted in social anxiety versus behavior rooted in opposition or

defiance (Rapee et al., 2008). While knee-jerk reactions to disruptive behavior can be hard to


overcome, staying alert and curious to understanding how the child is using their behavior to get

what they want is crucial to creating lasting behavior change. If parents and teachers don’t

acknowledge the root cause of the child’s disruptive behavior, their anxiety will continue to go

unnoticed, their self-protective behaviors will intensify, and the child and everyone in their

immediate environment will suffer.

When assessing the underlying reasons for a child’s externalizing symptoms, it is

important to be aware that their disruptive behavior is not their true personality but a “mask”

causing a distraction from the threatening social experience they wish to avoid. By using the

WAVE framework, beginning with asking “Why?” and staying curious, parents and teachers

show the child it is safe to remove their “mask” and that they will be supported with patience and

understanding. The following clues can be used as a guide to help parents and teachers stay

curious and identify behaviors potentially rooted in social anxiety:

a) Does this behavior occur in a predictable pattern? i.e. Before group work, at recess, or

when asked to speak in front of the class?

b) Does the child show relief at being punished or removed from the situation?

c) Does the child appear to be avoiding the potential for embarrassment, humiliation, or

rejection?

d) Does this behavior occur in the presence of specific students the child may be wishing

to avoid?

e) Is it possible that in the moments preceding the behavior challenge the child felt

inferior, incapable, or incompetent?

A – Acknowledge feelings and articulate experience. Once parents and teachers have

completed the first step of asking why, staying curious, and identifying behaviors potentially


rooted in social anxiety, the next step in the WAVE framework is to acknowledge their feelings

and help them articulate their experience. It is easy to get distracted by the externalizing

symptoms of social anxiety and become focused on the “facts” of the situation (i.e. What

happened? Who did what to whom?) or trying to calm explosive feelings by minimizing the

child’s discomfort. Unfortunately, these approaches do little to support and empower children

struggling with social anxiety. Instead of focusing on placing blame or offering platitudes like

“It’s not that bad,” “You have nothing to be afraid of,” and “It’s only a short speech – what’s the

big deal?,” offering empathetic acknowledgement of the child’s feelings is essential to helping

them manage their emotional peaks and valleys (Siegel & Payne Bryson, 2011). To

acknowledge the child’s experience, parents and teachers need to be aware of specific emotional

responses to social anxiety that may include

a) Blushing-sweating,

b) Confusion-freezing,

c) Difficulty talking out loud,

d) Discomfort at being the center of attention,

e) Refusal to attend social events or participate in group activities,

f) Mumbling,

g) Avoiding eye contact, and

h) Presenting as if they want to disappear (Foa & Wasmer Andrews, 2006).

Upon noticing the child’s emotional response, parent and teachers can empathetically articulate

their observations and acknowledge the child’s lived experience. This can be accomplished

through statements such as, “I noticed you backing toward the wall when it was time to choose

teams,” “It can feel isolating when everyone seems excited for the school dance but you,” or “It


seems like you want to disappear every time we talk about picking roles for Romeo and Juliet.

How are you feeling about the school play?”. Voicing observations in this manner allows the

child to feel heard and their emotions accepted while also giving them the opportunity to correct

any mistaken assumptions or misunderstandings regarding their feelings and behaviors.

In addition to acknowledging the child’s experience, parents and teachers can help

children navigate difficult or uncomfortable feelings by providing them with language to express

themselves. Since the child’s brain is not yet adept at articulating emotions (Siegel & Payne

Bryson, 2011), they need help learning how to express themselves and assign language to their

experiences. This ability helps calm the emotional circuitry of the brain and allows children to

respond less reactively to anxiety-provoking stimuli over time (Siegel & Payne Bryson, 2011). It

is important to note that simply telling children to “use their words” is an ineffective approach

until the child has developed a strong emotional vocabulary. Appendix A contains an example

Emotional Vocabulary template that can be used as a guide.

V – Validate and re-script the child’s experience. After staying open and curious to

the root causes of the child’s disruptive behavior and acknowledging and articulating their

experience, parents and teachers using the WAVE framework can move toward validating the

child’s feelings and exploring alternative coping methods. This step is crucial since children

overwhelmed by social anxiety often feel alone and isolated. Validating their experience helps

them feel accepted and valued and reinforces that their emotional and physical responses to the

threat of embarrassment, humiliation, rejection, and peer victimization are real and that they are

believed (Brown, 2012; Brown, 2015; Siegel & Payne Bryson, 2011). To be effective, parents

and teachers need to both validate the child’s experience as real and true while also encouraging

them to embrace a more positive outlook and attempt alternative coping strategies. Taking the


approach, “Your experience is real and I understand this is hard for you – what can we do to

improve things?” both accepts and validates the child’s experience while opening the door to

introducing empowering options for positive change.

Validating the child’s inflamed emotional response helps calm their emotional storm

while also offering an opportunity to introduce more adaptive self-regulation strategies.

Children who lash out in response to extreme inferiority feelings can learn to recognize the

physical symptoms of their stress and substitute alternative methods for dealing with emotional

overwhelm. Parents and teachers working on this step of the WAVE framework can help

children identify the specific physical sensations they experience when feeling socially anxious.

Symptoms may include, but are not limited to

a) Pounding chest,

b) Sweating,

c) Headache, buzzing in the ears, or dizziness,

d) Upset stomach,

e) Diarrhea,

f) Shortness of breath,

g) Muscle twitching (Shanker, 2016).

Following identification of the child’s physical sensations that precede their emotional outbursts,

parents and teachers can assist the child in identifying alternative options for the next time they

experience similar sensations. In addition to providing examples for the child, it is important to

allow the child to consider and define what they feel would be most helpful in calming their

emotional response to stress. A variety of self-regulation strategies are available in Appendix B

to help initiate this process.


Another critical piece in validating the child’s experience while simultaneously

introducing effective coping mechanisms is teaching them to re-script negative experiences.

Since the information children consolidate to memory becomes their working model for

interpreting future events, negative associations and self-imagery will impact the child’s

developing sense of self and increase their risk of forming a negatively-distorted view of their

performance in social situations (Siegel & Hartzell, 2014). Retrieved memories are vulnerable to

distortion, providing an exceptional opportunity for parents and teachers to help children re-write

the scripts of their painful experiences.

One of the best ways to help children re-script their experiences is through storytelling.

Children who learn to redefine painful past experiences gain a sense of control over their

experiences and emotions (Siegel & Payne Bryson, 2011). No longer helpless bystanders and

victims of social trauma, children learn they are in control of their thoughts and become the

authors of their life story. To begin the process of validating and re-scripting the child’s

experiences and their accompanying negative associations, parents and teachers need to first

validate the child’s lived experience as is. This can be done by asking the child to tell the story

of what happened and what caused them to feel the way they feel. After listening to the child’s

recollection, parents and teachers can work with the child to brainstorm alternative viewpoints or

endings to help children see that their negative view of the event is not the only view of the

event. Finally, the child can be coached to re-tell the story in a more adaptive light and take

action based on their new perspective by, for example, approaching a group of people, speaking

up in class, or going out for recess. Assisting a child to re-script their negative associations can

be summarized as:

a) Allowing the child to tell their story,


b) Brainstorming alternative endings,

c) Re-telling the story based on brainstormed alternatives, and

d) Taking empowered action based on their new perspective.

A sample worksheet outlining the four core steps of helping children re-script their experiences

is provided in Appendix C.

E – Encouragement and exposure. Parents and teachers reaching this step of the

WAVE framework have helped children build a solid foundation for decreasing their destructive

responses to social anxiety. The next step is to put the entirety of the child’s hard work,

reflection, and brainstorming into action through encouragement and exposure. While the

manner and specifics of the encouragement and exposure provided will depend on the individual

needs of each child, one commonality in this step of the framework is the focus on developing

the child’s inner resources and courage toward positive movement (Dinkmeyer & Losoncy,

1996). Using the specific triggers and anxiety-provoking situations the child struggles with,

parents and teachers can help the child strengthen each of the four dimensions of courage,

including a) a positive view of oneself, b) a positive view of others, c) a positive view of life and

remaining open to experience, and d) developing a positive sense of belonging with others

(Evans et al., 1997) through increasing levels of exposure.

The key in providing effective encouragement is to focus on the child’s effort and

accomplishments rather than the adult’s judgement of the child’s actions and performance. For

example, telling a child, “I like how you handled that” implies judgement and takes the focus

away from the child’s inner resources and capabilities and puts it on the adult’s external

assessment of the situation. A more encouraging alternative would be to say, “You worked hard

on speaking in front of the class. You didn’t mumble and maintained eye contact throughout


your presentation. How does it feel to have accomplished such a huge goal?” This response

highlights the child’s ability to face their fears with courage and grace, allowing them to make an

internal assessment of their capabilities without succumbing to external judgement. For

additional examples of encouraging statements, see Appendix D.

Utilizing the WAVE framework. Children living with social anxiety often feel isolated,

alone, and misunderstood. By pausing to consider the root cause of a child’s disruptive behavior,

parents and teachers are in an excellent position to both support children at risk and increase

positive behavioral outcomes. Too often, adults and caregivers are fooled by the protective

“mask” of misbehavior children use to avoid social participation and its associated threats of

rejection, embarrassment, and humiliation. By using the WAVE framework, parents and

teachers not only have a step-by-step guide for the intervention and treatment of childhood social

anxiety, but also a powerful reminder that the first step to supporting children at risk is to accept

them and bring them closer – “waving” them in with kindness and acceptance – rather than

pushing them further away through punishments and reprimands. For a summary of the WAVE

framework, including specific prompts for parents and teachers to use as guidelines for assisting

children at risk of social anxiety, see Figure 1.0.


THE “WAVE” FRAMEWORK

GOAL: “WAVE” the child in closer to understand and support their experience of social anxiety


Recommendations for Future Research

The WAVE framework offers guidance and examples for supporting children at risk of

social anxiety. To offer real benefit to parents, teachers, and the children they support, this

framework must be implemented in a variety of settings and studied rigorously. A critical next-

step in realizing the WAVE framework’s potential is the creation of workshops and educational

opportunities for parents and teachers. Educating key stakeholders on the fundamentals of

childhood social anxiety and providing detailed examples and opportunities to implement the

framework in real-life situations will be crucial in determining the model’s effectiveness. Once

parents and teachers are aware of and educated in the use of the framework, research

investigating its use, including careful examination of the effectiveness of the strategies and

interventions provided, will provide crucial data for updating and expanding the framework.

Conclusion

With appropriate intervention guided by the WAVE framework, the early identification

of anxious behavioral responses in children will decrease problematic and disruptive behaviors at

school and at home. Implementing the discussed interventions with a foundation of kindness,

compassion, and the fundamental Adlerian ideal that all children are capable of change makes

parents and teachers well-positioned to empower children to take control of interfering thoughts

and actions associated with social interactions. Teaching children effective coping and self-

regulation skills places them in a better position to tackle situations that previously caused

distress and mitigates the need to act out, create a distraction, or engage in other disruptive

behaviors that they previously used to distance themselves from the threat of humiliation,

rejection, and social exclusion. In addition to providing children with these crucial skills, parents

and teachers are also introducing powerful life lessons, showcasing that through the power of


encouragement, even seemingly impossible circumstances and severe feelings of inferiority can

be catalysts toward positive change. Resisting the urge to become distracted by a child’s

disruptive or disobedient behavior and focusing instead on their inherent capability and creative

power creates a rich atmosphere for instilling the notion that life’s challenges are opportunities

for learning and growth, and that with focused effort, everything can be different.


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Appendix A

Emotional Vocabulary


Appendix B

Self-Regulation Strategies


Appendix C

Sample Re-Scripting Experience Worksheet


Appendix D

Encouragement Cheat Sheet

Encouragement that focuses on strengthening a child’s inner resources and abilities helps them

feel capable navigating life’s challenges. By encouraging children experiencing social anxiety,

parents and teachers help develop their sense of self-worth and ability to handle stressful

situations with confidence.

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