All Posts Tagged: social anxiety

toddler with social anxiety

Social Anxiety in Toddlers

Toddlerhood is defined as the age range from 12 to 36 months. During this period, a child’s emotional and cognitive development grows by leaps and bounds, as do their social skills. This also coincides with the time when children are likely to go into a daycare environment or head off to preschool. As they engage more often with other children and adults, it may also be the stage when a toddler’s social anxiety begin to emerge.

Just as with adults, some children are comfortable with social interactions while others may not be. Each group of kids will have the social butterfly as well as the “shy” child who quietly observes and doesn’t interact as much. It is one thing to be shy, however, and another to be intensely fearful and anxious in a social setting. Because we know it can show up early in life, a toddler who shows such strong reactions in a social environment is often regarded as having social anxiety.

What causes social anxiety in toddlers?

We aren’t really sure what causes social anxiety in toddlers. Genetics likely plays a role, since it contributes to a child’s temperament and personality. We also know that some genetic traits can influence certain mental health conditions.

A toddler’s environment could also predispose them to social anxiety. For a young child who already has a higher genetic risk, living with trauma or a severe parenting style may be enough to initiate social anxiety. Social anxiety may also be learned from a parent, according to a 2006 study by de Rosnay, et al. Their research focused on indirect expressions of a mother’s social anxiety on their infant. The results showed that, “compared to their responses following their mothers interacting normally with a stranger, following a socially anxious mother-stranger interaction, infants were significantly more fearful and avoidant with the stranger. Infant-stranger avoidance was further modified by infant temperament; high fear infants were more avoidant in the socially anxious condition than low-fear infants.”

Is social anxiety a form of autism?

Studies have shown that social anxiety is not a form of autism, although the two have overlapping indicators, such as separation anxiety and avoiding eye contact. In fact, not only are they two distinct disorders, but the symptoms and diagnostic criteria for each are vastly different.

As the name implies, social anxiety is driven by anxiety. A child who has social anxiety will function within the parameters of their level of unease. For instance, they may simply keep to themselves, avoid other children, or might talk too quietly. Some kids may not talk at all.

On the other hand, a child with autism spectrum disorder doesn’t behave based on their anxiety level. Instead, this child has trouble understanding social cues and the nuances of communication. They might speak too loudly, may push their way into a group of children, or might misinterpret facial expressions or gestures.

Does my kid have social anxiety?

Children who have social anxiety may be branded as difficult kids because their anxiety can show up in forms other than just in social interactions.

Toddlers with social anxiety often show certain signs, such as:

  • Being a picky eater
  • Easily startled by noises
  • Not adapting well to new situations
  • May have a higher sensitivity to tactile sensations
  • Acting shy around new people and fearing strangers
  • Disliking being separated from their parents (separation anxiety) and distraction doesn’t calm them
  • Having strong emotional reactions and difficulty self-soothing
  • Might have sleep issues
  • Seems afraid to interact with peers, both individually or in a group setting
  • Often has other phobias or fears

How to help a child with social anxiety

At home, parents can demonstrate healthy social interactions when their child is with them, so the toddler learns not to be so fearful.

They can also rehearse a new situation with their child before it comes up. For example, a toddler who will be going to daycare for the first time might role-play some of the things they’ll do while they are there. Practicing certain aspects of the day or even dropping by the daycare a couple of times before officially attending can ease fears because the daycare will already be familiar. It would also be helpful to let the teachers or caregivers know about your child’s fears, so they can help build confidence.

Other supportive methods include:

  • Encouraging your toddler, but not forcing them in social interactions
  • Using praise when the child successfully navigates a scary situation
  • Not criticizing them for their fears
  • Being calm and showing the toddler that you are confident
  • Not being overprotective, which only reinforces the idea that the toddler has something to be afraid of
  • Reading books or watching videos that show confident children

Have Further Questions?

If your toddler is experiencing social anxiety, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

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Not All Addicts Are Alike

Not All Addicts Are Alike

Since the cocaine scourge of the ’70s and ’80s and the ongoing tragedy of the opiate epidemic, the American public has become painfully aware of the societal impact of addiction. Because of the prevalence and lethality of fentanyl-laced opiate overdoses almost everyone knows of a family that has lost a loved one. And despite all the time, effort and money invested in eradicating tobacco we now have to confront the growing addiction to nicotine through the expanding use of nicotine vape pens.

So what is this societal menace we call addiction? It’s standard definition requires the presence of four components:

  1. The substance is used to elicit a positive reward state.
  2. Physical dependence develops so that when ongoing use is not possible a withdrawal state ensues.
  3. Tolerance to the substance develops over time so that increasingly higher dosages are required to both impart the “high” as well as avoid the development of active withdrawal.
  4. Ongoing substance abuse occurs despite the dangers present. Most addicts will tell you that they are aware of the risks involved, including arrest, incarceration, the dangers of the environments visited to get the drug, fatal overdose or other non-fatal medical complications (like heart attacks from cocaine, liver disease from alcohol, HIV from intravenous use) and the deleterious impact on family, job, relationships and quality of life. It is as if there is a disconnection between the logical part of the brain and the addicted centers of the brain. More on this later.

On a practical level it is often helpful to restate the problem from another vantage point. Consider the traditional definition of alcoholism. Included in this definition is the need to consume alcoholic beverages upon awakening in ever increasing amounts to avoid alcohol withdrawal, continued imbibing despite the havoc created in one’s life and the rationalization and/or denial employed when loved ones try to talk sense into the alcoholic. This understanding is important but I also contend that one can have an alcohol problem without meeting the alcoholism criteria. Consider the individual who comes home from work every day to consume several beers or a couple of hard liquor drinks. When asked about this custom one will often hear that it is a way to “unwind” and shake off the stress of the day. Why? What about identifying the stressors and attempt to minimize them. Eradicating the source of stress may not always be possible but learning how to more effectively cope with life stress is. Why not substitute time with loved ones/friends, go for a run, meditate, listen to music or see a mental health clinician? All too often in our society we reach for a pill, a drink or an illicit substance to relieve our discomfort. The individual identified here may not meet addict criteria but can be viewed as having a substance related problem. Because of the impact of this problem on one’s life course and life quality, failure to address it becomes unfortunate. Societal acceptance of such maladaptive coping behavior is a big part of the problem, not too different from the common usage of sleeping pills in individuals who should instead directly address their insomnia.

The modern approach to addiction treatment began in the mid 1930’s after meetings between Bill W. and a surgeon now known as Dr. Bob. Dr. Bob recognized alcoholism as a disease process and not merely a social or moral weakness. Out of this came Alcoholics Anonymous whose tenets, Big Book and twelve steps comprise the bulwark of addiction treatment to this day. The twelve step model is an important component in the clinical approach to the addict but it would be unfair to suggest that “one size fits all”.

Classic AA considers the use of any mind-altering medication as taboo to the process of recovery. This is an understandable concept during AA’s early years. However, as addiction science has advanced a more balanced approach is needed. Brain imaging, genetic advances and careful epidemiologic research have all contributed to a more holistic systems approach to recovery. We now know that there are individuals whose addiction has been the direct result of their genetic makeup. As suggested in a previous paper on a systems approach I suggested that there are some individuals whose genetic predisposition only results in clinical pathology when interacting with situational stressors that subsequently activates the biologic psychopathology.

This discussion would not be complete if we did not review the concept of addiction as self-medication. This refers to individuals who discover that the illicit drug or alcoholic beverage serves to reduce or eradicate painful or troublesome mental state symptoms. A classic example is that of social anxiety. Social anxiety disorders can be devastating to say the least and often start in the teenage years. So when a teen discovers at a party that an alcoholic beverage successfully controls the anxiety and for the first time allows the individual to socially interact without emotional constraints, alcohol becomes a necessary ingredient for future social endeavors. Unfortunately, dependence and tolerance ensue and leads to a whole host of new difficulties. Opiates and marijuana similarly modulate social anxiety or panic attacks. Attention Deficit Hyperactivity Disorder (ADHD) represents another example. When the impulsive, terribly restless and hyperactive young person with an inability to focus and control a busy head finds these symptoms almost normalized upon to exposure to recreational cocaine. In fact, cocaine might represent an effective ADHD treatment modality if it were not for its horrendous addiction potential, it’s very short duration of action as well as to say the least, its illegality.

The above discussion introduces the concept of self-medication. Self-medication must be considered in all cases of addiction because once the core psychiatric problem is identified a more definitive treatment becomes possible. By stabilizing the underlying disorder the addictive process has a better chance of entering into an enduring recovery. This does not suggest that the twelve step approach is unnecessary. In fact, the combination of treatment addressing the non-substance abuse psychiatric disorder in conjunction with traditional recovery methods maximizes the outcome.

We now understand that the biology of addiction involves brain regions that get reprogrammed. As a consequence, these brain areas begins to act independently from the healthy rational parts of the brain that under normal circumstances keep us out of harm’s way. These addiction centers are essentially highjacked by the drug and can successfully pathologically influence healthy brain areas. A critical goal of addiction treatment is to help the individual develop coping skills and capabilities that subsequently allow for ability to recover control over previously all powerful addiction centers.

As you can see, successful addiction treatment requires a careful multi-system and bio-psycho-social evaluation and treatment planning that serves as the foundation for a future free of drug abuse. Each person with the scourge of addiction deserves an individualized open-minded approach. Despite all the negative media attention that addiction has garnered, the future has never been brighter for treatment. Prevention remains the ultimate goal and an ongoing challenge.

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Compassion Focused Therapy for Social Anxiety

It’s not unusual for people to get nervous in certain social situations. Preparing to give a speech and meeting a group of people you don’t know are both great examples of situations where it’s perfectly understandable to experience a little anxiety. However, there is a big difference between small amounts of anxiety and social anxiety disorder. Social anxiety disorder develops when those little fears become so intense that you go out of your way to avoid any situations that will trigger them. And, when that avoidance begins to negatively impact your daily life or family it may be time to seek some professional help.

Cognitive Behavioral Therapy

One of the most common treatments for social phobia is cognitive behavioral therapy. This type of systematic desensitization addresses negative patterns and distortions in the way we look at ourselves and the world. There are two main components to this approach:

  • Cognitive therapy examines how your negative thoughts can contribute to your social anxiety.
  • Behavior therapy analyzes the way you behave and react in those situations that trigger your anxiety.

There are three main steps involved in this form of therapy:

  • Identifying your negative thoughts: this can include recognizing what those thoughts include, the specific situations they occur in conjunction with, and recognizing them for the harmful thoughts they are.
  • Challenging your negative thoughts: during this step you’ll question the evidence for your frightening thoughts, weigh the pros and cons associated with them, and conduct experiments to test the validity of these thoughts.
  • Replacing negative thoughts with realistic ones: as you become more adept at recognizing your anxiety-provoking thoughts, you can begin to practice converting those thoughts into positive imaging.

The Compassionate Approach

While cognitive behavioral therapy has become widely recognized as an effective treatment for social anxiety disorder, there are aspects of it that can be difficult for many people. It can be a great challenge to identify positive thoughts or to replace them with realistic ones. Oftentimes people can recognize the benefit of this systematic desensitization approach but understanding the logic doesn’t necessarily make the treatment easier to complete.

This is where compassion focused therapy comes in. People who experience social phobia are apt to be self-critical and filled with thoughts of shame and anger because of how the anxiety affects them. Compassionate-focused therapy helps individuals reverse those thoughts through compassionate engagement. The theory behind this therapy states that we are “at our most flourishing” when we:

  • See evidence that we are cared about and valued
  • Are caring, helping, and valuing others
  • Are mindful and sympathetic of our own feelings

By demonstrating the skills and attributes of compassion, the therapist instils these values in the patient. As a consequence, the patient is aided to develop an internal compassionate relationship with themselves – one that will replace the blaming, condemning and self-critical person they may feel they are.

In other words, by learning to be empathetic and non-judgmental of others it can become easier to give yourself a break, as well. While many might view compassion as a personality trait, the reality is that it is a skill you can be trained in. This therapy helps to foster the attributes of that skill.

 Need More Assistance?

It can be difficult to convert your negative thoughts into a positive mindset when you’re in the midst of social anxiety disorder. If you or someone you know is suffering from social anxiety, seeking professional help can be the most direct path to reclaiming your life.

For more information about compassion-based cognitive behavioral therapy, contact Dr. Andrew Rosen and The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 or email Dr. Rosen and The Center today.

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