The teacher calls to say your son seems withdrawn and never raises his hand. Your daughter gets a stomach ache when you suggest she go play with the neighborhood children. Your son feels short of breath and jittery as you drop him off at an after-school playgroup. Sound familiar? These may be red flags that your child is more than just shy, says Sebastian Zimmerman, M.D., a child and adolescent psychiatrist and an assistant professor of psychiatry and behavioral sciences at the Albert Einstein College of Medicine. When your child’s shyness just doesn’t go away and prevents them from participating in normal childhood activities, it could be social phobia and it may not be something he or she will outgrow. Approximately 5 percent of children suffer from social phobias at some time in their lives, according to the American Psychological Association (APA). That’s the bad news, but the good news is that once identified, social phobia is a highly treatable disorder, Dr. Zimmerman says. “Studies show that when it’s not treated, it can go on for years, putting children at-risk for depression, low self-esteem and alcohol abuse,” he says. “They may choose jobs where they have little contact with others and are less likely to marry than their non-phobic counterparts.”
More than Run-of-the-Mill Shyness “Shyness is common in certain situations, but social phobia is marked by impairment and distress,” Dr. Zimmerman explains. “Social phobia is extreme distress that is pervasive, persistent and interferes with daily life.” It can be generalized or more specific, such as the fear of speaking or reading in public. “These fears often are unreasonable and excessive,” he adds. What’s more, anticipatory anxiety often leads children to avoid doing things. Avoidance is really the key factor, Dr. Zimmerman says, because with ordinary shyness, children may warm up, endure the anxiety and not avoid the situation. If a person with social phobia is exposed to a social situation, they get really anxious, which can bring on symptoms of a panic attack such as trembling, shortness of breath, palpitations and light-headedness. In severe cases, a condition known as selective mutism can develop, in which a child won’t speak to anyone outside his or her family, interfering with both school performance and social interaction.
So What’s a Parent to Do? Don’t push the child into activities that they don’t want to do, but don’t be too over-protective either. Along the same lines, don’t dismiss their fears by calling them a “worry wart” and don’t overindulge their fears. It’s important to strike a balance, Dr. Zimmerman urges. “Let your children experience new challenges at their own pace. Give them the space to meet other children and don’t overwhelm them with your own anxious response,” he says. “Ask him or her what makes them worried, or what they are afraid of.” “If your kid is isolated without any friends, it needs to be looked at,” says psychoanalyst Leon Hoffman, M.D., co-director of the Pacella Parent Child Center, in Manhattan. “To miss a day of school here and there is normal, but children should not be allowed to get into the pattern of ‘I have a stomach ache so I can’t go to school’‚ because that is a very difficult habit to break.” Dr. Hoffman adds: “Parents and mental health professionals need to really try to understand the issues going on within the child and within his or her parent-child interactions that may be provoking these behaviors.” If you notice any of the red flags in your child, he suggests talking to your pediatrician, who can refer your child to the proper mental health professional. Treatment is available and is almost always successful, Dr. Zimmerman says. Cognitive behavior therapy — a type of therapy that involves slowly exposing people to that which they are afraid of and helping them to learn a new way of reacting to it — helps, he says. “Medication is definitely an option, especially when social phobia is severe,” Dr. Zimmerman adds. “It yields good results in a short period of time.” Selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Paxil (paroxetine), have proven effective. “The hypothesis is that there may be too little [of the brain chemical] serotonin in the brain,” Dr. Zimmerman explains. “These medications increase the availability of serotonin and children do become more sociable, outgoing and more talkative within four to six weeks.” While some children improve on medication alone, it’s best to combine medication and therapy, he says. “When the child is more comfortable and has learned new social skills, your doctor can lower the dose of medication and gradually help your child taper off.” For more information, visit the Anxiety Disorders Association of America (ADAA) at www.adaa.org.
An Action Plan for Parents If you notice any warning signs of social phobia:
1. Talk with your child about what he or she fears. 2. Contact your pediatrician and schedule an appointment. 3. Ask about a referral to a trained mental health specialist.
Post-Traumatic Stress — a 21st-Century Reality for Tri-State Families
By Denise Mann
As many New Yorkers know, post-traumatic stress disorder (PTSD) is not just for veterans anymore. New Yorkers of all ages became familiar with this acronym as they struggled to put their lives back together and move forward in the wake of the terrorist attacks on the World Trade Center. More than one in 10 New York-area residents suffered lingering stress and depression in the aftermath of the attacks, according to a study published in the Journal of the American Medical Association. What’s more, PTSD rates are also high in all five boroughs of the city, and in the suburbs of New Jersey and Connecticut. Affecting about 5.2 million Americans yearly, PTSD can develop after surviving or witnessing a violent physical attack or injury, being in a serious accident, seeing someone killed and surviving a terrorist bomb blast or war. Many people with PTSD repeatedly re-experience the ordeal via flashbacks, nightmares or intrusive thoughts. Other symptoms may include sleep disturbances, depression, anxiety and irritability. “The good news about PTSD is that it’s very treatable,” says Randall Marshall, M.D., director of Trauma Studies and Services and the associate director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute, in New York City. “Unfortunately, the vast majority of people don’t get appropriate help because there is a real reluctance to share the experience and the level of the impairment [it caused],” says Dr. Marshall, also an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. “If you have experienced a severe trauma or any experience that has been very disturbing emotionally, and you believe that months or years down the road it is continuing to effect you, talk to your doctor because the ability to recognize and diagnose PTSD has improved dramatically,” Dr. Marshall says. Cognitive behavior therapies in which the patient gradually and repeatedly relives the frightening experience under controlled conditions, and medication including selective serotonin reuptake inhibitors (SSRIs) such as Paxil (paroxetine HCl) and Zoloft (sertraline HCL) have proven extremely successful in treating PTSD. SSRIs help restore the balance of the mood chemical serotonin.
A Long and Winding Road
It was the combination of medication and therapy that ultimately helped former model-turned-screenwriter and seasoned New Yorker Marla Hanson triumph over PTSD. In 1986, Hanson was a promising model, when a pair of attackers hired by her landlord slashed her face with a razor. Doctors were miraculously able to reconstruct her face, but the emotional scars took much longer to heal. People subscribe to the attitude that time heals all wounds, she says, noting that even her own family thought she should be able to move on after her assailants were jailed. That’s not the case with PTSD. Together with a therapist, Hanson began to work through her issues. She finished a degree in film and television at NYU and sold her first screenplay. Things were looking up and she thought she was free and clear of her demons. She wasn’t. They returned as she was ending a relationship and branching out with her career. This time around, however, there were medications available to treat PTSD. A six-month course of therapy combined with medication, and Hanson was functioning once again. “Now I know I have the tools and I know what the triggers are so I am better able to deal with it if it should come back,” she says. She got married and had a daughter, and is working on a book about her experience. “Kids can be a very healing presence in your life,” she says. “They force you to get up, get out and cope, and really open you up.” Hanson admits returning to therapy after 9/11. “If you have been through something terrible, your antennae are way up and are hypersensitive to tragedy,” she says. But one thing she’d never do is leave New York. “There is such a sense of community here,” she says. “Outsiders think it is a big, cold place but it is really just a big, small town.” We can all learn from Hanson’s experience, says social worker Amy Dorin, senior vice president of behavioral health at F.E.G.S., a not-for-profit health-related and human service organization, with offices in downtown Manhattan. Along with therapy and/or medication, “eating right, exercising regularly, and writing or doing art to express their feelings about the trauma can be very helpful,” Dorin says. For more information, call Project Liberty at 1-800-LIFENET. The program provides free crisis counseling services 24 hours a day/7 days a week to persons, families and groups most affected by the September 11 World Trade Center disaster in the five boroughs of New York City and in Delaware, Dutchess, Nassau, Orange, Putnam, Rockland, Suffolk, Sullivan, Ulster, and Westchester counties.
