To Help a Shy Child, Listen

By Perri Klass, M.D., The New York Times, 9/16/13

Shyness is part of the great and glorious range of the human normal.

Toward the end of the summer, I was seeing a middle-school girl for a physical. The notes from a clinic visit said she was a good student but didn’t talk enough in class. So I asked her: “Is this still a problem for you?”

“I’m shy,” she said. “I’m just shy.”

Should I have turned to her mother and suggested — a counselor? An academic evaluation? Should I have probed further? “How do you feel in school, do you have some friends, is anybody bullying you?”

Or should I have said: “Lots of people are shy. It’s one of the healthy, normal styles of being human.”

All of these responses, together, would have been correct. A child who is being bullied or bothered may be anxious about drawing attention to herself; a child who doesn’t talk in class may be holding back because some learning problem is…making her self-conscious. So you need to listen…and find ways to ask questions. “Are you happy, anxious, afraid?”

Shyness is part of the great and glorious range of the human normal. Kathleen Merikangas (National Institute of Mental Health)…published a study of 10,000 older children, ranging from 13 to 18 years old. “We found that about half of kids in America describe themselves as shy,” she told me.

Common though it may be, our schools…do not always celebrate the reserved…. “Children who are shy, who don’t raise their hand,…are really penalized in this society,” Dr. Merikangas said….

Shyness reflects a child’s place on the temperamental continuum, the part of it that involves dealing with new and unfamiliar circumstances…. What most children need is time to settle in, support from parents and teachers, and sometimes help making connections….

If a child is not more comfortable after a month or so,…more help [from outside may be] needed….

I’m struck by the parallels between the ways we discuss shyness and the ways we discuss impulsivity and hyperactivity. In both cases, there is concern about the risk of “pathologizing” children who are well within the range of normal and worry that we are too likely to medicate outliers. By this thinking, children who would once have been considered shy and quiet too often get antidepressants, just as children who would once have been considered lively and rambunctious too often get A.D.H.D. medications.

The most important question is whether children are in distress. Dr. Merikangas’s study distinguished between the common trait of shyness and the psychiatric diagnosis of social phobia. Over all, about 5% of the adolescents in the study were severely restricted by social anxiety; they included some who described themselves as shy and some who did not. The authors questioned whether the debate about the “medicalization” of shyness might be obscuring the detection of the distinct signs of social phobia….

To help a shy child cope with, for example, a brand new classroom full of brand new people, consider rehearsing, scripting encounters and interactions. “Do a role play and behavioral rehearsal ahead of time,” said Steven Kurtz, a senior clinician at the Child Mind Institute in Manhattan….

But don’t take over. “The danger point is rescuing too soon, too often, too much, so the kids don’t develop coping mechanisms,” said Dr. Kurtz.

Cognitive behavioral therapy relies on “successive approximations,” in which children slowly close in on the behaviors they are hoping to achieve. In that spirit,…a teacher might look for the right partner to pair up with a shy child for cooperative activities in the classroom.

“Probably the worst thing to do is to say, ‘Don’t be shy. Don’t be quiet,’ ” Dr. Merikangas told me. This is not about trying to change the child’s temperament. It’s about respecting…temperament and variation, and helping children navigate the world with their own instruments.

Perri Klass is professor of journalism & pediatrics at New York University.

http://well.blogs.nytimes.com/2013/09/16/to-help-a-shy-child-listen/?_r=0

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