1. SHYNESS OR SOCIAL ANXIETY? How do you know what is normal?
Dr Emily O’Leary, PhD
Director Anxiety House

2. OVERVIEW How much anxiety is normal? Why talk about social anxiety?
Facts about shyness and social anxiety
Causes
What treatments are there?
When to seek help?
What can parents do?
Question time

3. Anxiety disorders affect one in eight children
WHY TALK ABOUT THIS?
Anxiety disorders affect one in eight children
Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences (impacting on their social and emotional development).
Overall, about half of people with anxiety disorders experience their first symptoms by the AGE OF 11 YEARS and of those diagnosed 75% OF THOSE DO NOT GET HELP

4. WHAT IS NORMAL? AGE FEAR 0-6 months
Loss of support, loud noises, sudden movement
7-12 months
Strangers, sudden appearance of large objects, loud noises
1 year
Separation from parent, strangers, injury, toilet
2 years
Large animals, dark rooms, large objects and machines, loud noises
3 years
Masks, large animals, snakes, separation from parents
4 years
Dark rooms, -noises at nights, large animals
5 years
Wild animals, bodily injury, dark, bad people

5. STAGES OF FEAR (cont’d)
6-7 years
Monsters, storms, lightening, being alone
8-9 years
Dark, people (kidnapper, robber, mugger), guns, weapons
10-11 years
Dark, people, bad dreams punishment, tests grades, being sick
12 years
Being in trouble, being hurt, tests, grades, peers
13 years
Crime, being hurt, war, nuclear war, grades, peers, family

6. IS ANXIETY GOOD OR BAD? When is it a problem
ANXIETY IS NORMAL AND ADAPTIVE
ALERTS US TO DANGER & SERVES AS A NATURAL ALARM SYSTEM
TO KEEP US ALIVE
When is it a problem
When it significantly interferes with your day and you experience distress above same aged peers

7. Most common anxiety disorder is SOCIAL ANXIETY DISORDER

8. SOCIAL ANXIETY DISORDER (SAD)
Criteria
MARKED FEAR OF ONE OR MORE SOCIAL OR PERFORMANCE SITUATIONS IN WHICH THE PERSON IS EXPOSED TO THE POSSIBLE SCRUTINY OF OTHERS AND FEARS HE WILL ACT IN A WAY THAT WILL BE HUMILIATING
Exposure to the feared situation almost invariably provokes anxiety
Anxiety is out of proportion to the actual threat posed by the situation
The anxiety lasts more than 6 months
The feared situation is avoided or endured with distress
The avoidance, fear or distress significantly interferes with their routine or function

9. SOCIAL ANXIETY DISORDER – THE FACTS!
Research suggests that 10 per cent of the Australian population experiences social phobia in a lifetime, with 4.7 per cent experiencing social phobia in a 12-month period.
More women than men appear to develop the disorder.
Develops early childhood/adolescence (13 years), only 25% seek help
Depression is frequently comorbid and most patients describe an insidious onset
36 % of people with SAD report symptoms for 10 or more years before seeking help
Social anxiety disorder is sometimes called a silent disorder because it can affect children for years before it is diagnosed. As children grow and mature, they learn how to avoid being the focus of attention at school or home; as a result, their extreme discomfort in social situations can go unnoticed

10. SPECIFIC AND GENERALIZED SOCIAL ANXIETIES
A specific social anxiety would be the fear of speaking in front of groups (only)
whereas people with generalized social anxiety are anxious, nervous, and uncomfortable in almost all social situations. It is much more common for people with social anxiety to have a generalized type of this disorder.  
is an anxiety disorder in which a person who is normally capable
of speech does not speak in specific situations or to specific people. Selective Mutism usually
co-exists with shyness or social anxiety
Selective Mutism (SM)

11. What are the SIGNS?
Avoiding situations where they may be the centre of attention
Children with possible social anxiety disorder tend to be worried about being embarrassed in front of peers, but not generally in front of adults
Fear of being in situations with strangers (people the sufferer does not know)
Dread over how they will be presented to others
Excessive fear of being teased or criticized
Excessive fear that other people may notice that the sufferer looks anxious
Excessive worry about being anxious, which makes the anxiety worse
Fear of meeting people in authority
Avoiding talking to people because of a fear of embarrassment
The individual worries excessively about being in situations where he/she may be judged
When in a situation that causes anxiety the sufferer's mind may go blank.

12. Q A Is shyness part of SOCIAL anxiety?
No, Shyness and social anxiety disorder are two different things. Shyness is considered a normal personality trait that combines the experience of social anxiety. Many people who are shy do not have the negative emotions and feelings that accompany social anxiety disorder.  They live a normal life, and do not view shyness as a negative trait.
While some people with social anxiety disorder are shy, shyness is not a pre- requisite for social anxiety disorder. In fact some people with social anxiety may not be shy at all. They can be completely at ease with people most of the time, but particular situations, such as walking down an aisle in public or making a speech, can give them intense anxiety.

13. WHAT ARE THE DIFFERENCES BETWEEN SOCIAL ANXIETY DISORDER AND SHYNESS?
People with social anxiety disorder endure high levels of anxiety in daily activities, and this high level of anxiety makes them avoid situations in which they would like to participate.
social anxiety disorder is not considered a “normal” facet of personality, or a personality characteristic, whereas shyness is.
In fact, people who are shy may view this condition as a positive quality, whereas a person with social anxiety disorder would not describe their condition positively.
Only about one half of those diagnosed with social anxiety disorder report having been shy. Looked at another way, being shy can complicate your life.
Having social phobia STOPS YOU,
BEING shy IS A TRAIT.

14. WHAT ARE THE DIFFERENCES BETWEEN SOCIAL ANXIETY DISORDER AND SHYNESS?
People with SAD report a significantly greater number of social fears, avoidance of social situations, negative thoughts, and somatic symptoms than the shy people.
A shy child may take longer to warm up to a situation, but they eventually do.
Also, a shy child engages with other kids, just at a different level of intensity than their peers. In contrast, children with social phobia will get very upset when they have to interact with people.
It is a frightening situation for them, and one they would rather avoid altogether

15. WHAT TYPES OF SAD THOUGHTS?
They will reject me
I will be found out as incompetent
They will think I’m weird
I can’t even do the simplest things
I had better not blow it again
I can’t (don’t know how to) do this
I will tremble and people will judge me
If they see how anxious I am, they will think I’m crazy
I will stumble over my words and be unable to continue
What if the teacher
calls on me?
I always get the
answer wrong!

16. WHAT ARE THE CAUSES?
Scientists currently think that, like heart disease and type 1 diabetes, mental illnesses are complex and probably result from a combination of genetic, environmental, psychological, and developmental factors. 
There are a number of causes of social phobia, including:
If you have a first degree relative with SAD, you may be 2 to 3 times more likely to develop the disorder.
The genetic component of SAD, also known as the “heritability” of the disorder has been estimated at around 30% to 40%, meaning that roughly one-third of the underlying causes of SAD come from your genetics.
Attachment and temperament
Genetics

17. WHAT ARE THE CAUSES?
Scientists currently think that, like heart disease and type 1 diabetes, mental illnesses are complex and probably result from a combination of genetic and environmental factors. 
There are a number of environmental causes of social phobia:
Environmental
Parenting and the family environment - connection between parental over control and parental psychopathology with childhood SAD.
Adverse life events such as sexual abuse, negative peer relationships, bullying and marital discord are also found to contribute to SAD development
Consistently higher rates of female versus male SAD have been traced to the concept of gender roles and to gender differences in child-parent interactions.
Caution practiced in the interpretation of these results, given the limited research in most areas except for parenting. Multifaceted developmental pathway to social anxiety disorder.

18. What are the Treatments?

19. COGNITIVE BEHAVIOURAL TREATMENTS
CBT is an effective treatment for social phobia
It involves teaching people to recognize their anxiety and provides tools to control the anxiety.

20. COGNITIVE BEHAVIOURAL
TREATMENTS
KEY CONCEPTS:
People learn effective skills through relaxation and mindfulness training, role-playing, and social skills training.
Greatest evidence for efficacy of exposure + cognitive restructuring
Cognitive-behavioral therapy is the recommended therapeutic treatment, particularly for mild to moderate cases of SAD. 
In severe cases, SAD can be treated with a combination of CBT and medication with the goal of eventually discontinuing medication over time.

21. WHAT CAN PARENTS LOOK FOR
PARENTS CAN HELP PREVENT SOCIAL PHOBIA FROM TAKING HOLD BY BEING ATTUNED TO WARNING SIGNS AND SYMPTOMS.

22. Questions to ask yourself
Are they unusually uncomfortable speaking to teachers or peers?
Does he or she avoid eye contact, mumble or speak quietly when addressed by other people?
Does a child blush or tremble around other people?
Does a young child cry or throw a tantrum when confronted with new people?
Does a child express worry excessively about doing or saying something “stupid”?
Does a child or teen complain of stomach aches and want to stay home from school, field trips or parties?
Is he or she withdrawing from activities and wanting to spend more time at home?

23. What Can Parents Do?

24. WHAT CAN PARENTS DO
Reinforce that anxiety is a normal feeling and lots of other kids have the same difficulties (normalize, normalize, normalize!)
Reward Brave, Non-anxious Behavior. Whenever you see the child doing something brave, make a big fuss.
Empathize and Understand. Ensure the child knows that you understand their anxiety (you’ve felt anxiety before!) and how hard facing your fear can be (provide an example from your own life).
Encourage Constructive Coping. (Skill Building Opportunity) Encourage the child to come up with their own helpful coping options in a scary situation (rather than telling them how to cope) is a great way to foster self-esteem in your child.
Model Non-Anxious Behavior. Your child watches you face challenging situations. Ensure you are modeling brave coping whenever you enter a situations that scary for you.
Talk to a professional

25. Shyness vs. Social Anxiety?Q U E S T I O N
Shyness vs. Social Anxiety?

26. CONTACT DETAILS Anxiety House Hawthorne Medical Centre
Suite 2, 171 Riding Road
Hawthorne, QLD 4171
PO Box 297
Morningside, QLD 4171