running head: anxiety, children, and behavior 1 ......thank you, ali and jenny, for encouraging me...
TRANSCRIPT
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
ANXIETY, CHILDREN, AND BEHAVIOR 3
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
ANXIETY, CHILDREN, AND BEHAVIOR 4
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!
ANXIETY, CHILDREN, AND BEHAVIOR 5
Dedication
To the parents and teachers who see the light in every child.
ANXIETY, CHILDREN, AND BEHAVIOR 6
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, CHILDREN, AND BEHAVIOR 7
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
ANXIETY, CHILDREN, AND BEHAVIOR 8
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.
ANXIETY, CHILDREN, AND BEHAVIOR 9
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
ANXIETY, CHILDREN, AND BEHAVIOR 10
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,
ANXIETY, CHILDREN, AND BEHAVIOR 11
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
ANXIETY, CHILDREN, AND BEHAVIOR 12
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
ANXIETY, CHILDREN, AND BEHAVIOR 13
(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
ANXIETY, CHILDREN, AND BEHAVIOR 14
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
ANXIETY, CHILDREN, AND BEHAVIOR 15
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
ANXIETY, CHILDREN, AND BEHAVIOR 16
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
ANXIETY, CHILDREN, AND BEHAVIOR 17
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).
ANXIETY, CHILDREN, AND BEHAVIOR 18
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.
ANXIETY, CHILDREN, AND BEHAVIOR 19
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
ANXIETY, CHILDREN, AND BEHAVIOR 20
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
ANXIETY, CHILDREN, AND BEHAVIOR 21
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
ANXIETY, CHILDREN, AND BEHAVIOR 22
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
ANXIETY, CHILDREN, AND BEHAVIOR 23
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,
ANXIETY, CHILDREN, AND BEHAVIOR 24
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
ANXIETY, CHILDREN, AND BEHAVIOR 25
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).
ANXIETY, CHILDREN, AND BEHAVIOR 26
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).
ANXIETY, CHILDREN, AND BEHAVIOR 27
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
ANXIETY, CHILDREN, AND BEHAVIOR 28
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
ANXIETY, CHILDREN, AND BEHAVIOR 29
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,
ANXIETY, CHILDREN, AND BEHAVIOR 30
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).
ANXIETY, CHILDREN, AND BEHAVIOR 31
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.
ANXIETY, CHILDREN, AND BEHAVIOR 32
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
ANXIETY, CHILDREN, AND BEHAVIOR 33
(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
ANXIETY, CHILDREN, AND BEHAVIOR 34
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
ANXIETY, CHILDREN, AND BEHAVIOR 35
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.
ANXIETY, CHILDREN, AND BEHAVIOR 36
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
ANXIETY, CHILDREN, AND BEHAVIOR 37
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
ANXIETY, CHILDREN, AND BEHAVIOR 38
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.
ANXIETY, CHILDREN, AND BEHAVIOR 39
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
ANXIETY, CHILDREN, AND BEHAVIOR 40
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
ANXIETY, CHILDREN, AND BEHAVIOR 41
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).
ANXIETY, CHILDREN, AND BEHAVIOR 42
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
ANXIETY, CHILDREN, AND BEHAVIOR 43
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
ANXIETY, CHILDREN, AND BEHAVIOR 44
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
ANXIETY, CHILDREN, AND BEHAVIOR 45
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
ANXIETY, CHILDREN, AND BEHAVIOR 46
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
ANXIETY, CHILDREN, AND BEHAVIOR 47
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.
ANXIETY, CHILDREN, AND BEHAVIOR 48
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,
ANXIETY, CHILDREN, AND BEHAVIOR 49
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
ANXIETY, CHILDREN, AND BEHAVIOR 50
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.
ANXIETY, CHILDREN, AND BEHAVIOR 51
THE “WAVE” FRAMEWORK
GOAL: “WAVE” the child in closer to understand and support their experience of social anxiety
ANXIETY, CHILDREN, AND BEHAVIOR 52
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
ANXIETY, CHILDREN, AND BEHAVIOR 53
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.
ANXIETY, CHILDREN, AND BEHAVIOR 54
References
Abrahams, L., Pancorbo, G., Primi, R., Santos, D., Kyllonen, P., John, O. P., & De Fruyt, F.
(2019). Social-emotional skill assessment in children and adolescents: Advances and
challenges in personality, clinical, and educational contexts. Psychological Assessment,
31(4), 460-473. Retrieved from https://10.1037/pas0000591
Adler, A. (1946). Understanding human nature. New York, NY: Greenburg.
Ainsworth, M. D. (1989). Attachments beyond infancy. American Psychologist, 44, 709-716.
Retrieved from http://dx.doi.org/10.1037/0003-066X.44.4.709
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: American Psychiatric Publishing.
Ansbacher, H. L. (1992). Alfred Adler’s concepts of community feelings and of social interest
and the relevance of community feeling for old age. Individual Psychology: The Journal
of Adlerian Theory, Research and Practice, 48(4), 402-412.
Ansbacher, H. L., & Ansbacher, R. R. (1956). The Individual Psychology of Alfred Adler: A
systematic presentation in selections from his writings. New York: NY: Harper Perennial.
Ansbacher, R. (2011). The life tasks: Opening convocation, Meredith College, August 27, 1979.
The Journal of Individual Psychology, 67(1), 9-12.
Ayduk, O., Mendoza-Denton, R., Mischel, W., Downey, G., Peake, P. K., & Rodriguez, M.
(2000). Regulating the interpersonal self: Strategic self-regulation for coping with
rejection sensitivity. Journal of Personality and Social Psychology, 79, 776-792.
Retrieved from https://doi.org/10.1037/0022-3514.79.5.776
Bandelow, B., Torrente, C. A., Wedekind, D., Broocks, A., Hajak, G., & Rüther, E. (2004). Early
ANXIETY, CHILDREN, AND BEHAVIOR 55
traumatic life events, parental rearing styles, family history of mental disorders, and birth
risk factors in patients with social disorder. European Archives of Psychiatry and Clinical
Neuroscience, 254, 397-405.
Barret, P. M., Fox, T., Farell, L. J. (2005). Parent-child interactions with anxious children and
with their siblings: An observational study. Behaviour Change, 22(4), 220-235.
Beidel, D. C., Turner, S. M., & Morris, T. L. (1999). Psychopathology of childhood social
phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 38 643-
650.
Bernstein, G. A., Layne, A. E., Egan, E. A., & Nelson, L. P. (2005). Maternal phobic anxiety and
child anxiety. Journal of Anxiety Disorders, 19, 658-672.
Blöte, A., Miers, A., & Westenberg, P. (2015). The role of social performance and physical
attractiveness in peer rejection of socially anxious adolescents. Journal of Research of
Adolescence, 25(1), 189-200.
Britzman, M. J., & Henkin, A. L. (1992). Wellness and personality priorities: The utilization of
Adlerian encouragement strategies. Individual Psychology: The Journal of Adlerian
Theory, Research & Practice, 48(2), 194.
Brown, B. (2012). Daring greatly: How the courage to be vulnerable transforms the way we live,
love, parent and lead. New York, NY: Avery.
Brown, B. (2015). Rising strong: The reckoning. The rumble. The revolution. New York, NY:
Spiegel & Grau.
Bruce, L., Heimberg, R., Goldin, P., & Gross, J. (2013). Childhood maltreatment and response to
cognitive behavioral therapy among individuals with social anxiety disorder. Depression
and Anxiety, 30, 662-669.
ANXIETY, CHILDREN, AND BEHAVIOR 56
Carleton, R., Pelso, D., Collimore, K., & Asmundson, G. (2011). Social anxiety and
posttraumatic stress symptoms: The impact of distressing social events. Journal of
Anxiety Disorders, 25, 49-57.
Carlson, J., & Maniacci, M. (Eds.). (2012). Alfred Adler revisited. New York, NY: Routledge.
Carns, M. R., & Carns, A. W. (1998). A review of the professional literature concerning the
consistency of the definition and application of Adlerian encouragement. Journal of
Individual Psychology, 54(1), 72-89.
Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and
research strategies. Journal of Child Psychology and Psychiatry, 32(7), 1063-1080.
Centre for Addiction and Mental Health. (2019). Social anxiety disorder. Retrieved from
https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/social-anxiety-
disorder
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M.
Liebowitz, D., A. Hope, & F. R. Schneider (Eds.), Social phobia: Diagnosis, assessment,
and treatment. (pp. 69-92). New York, NY: Guilford Press.
Cougle, J., Timpano, K., Sachs-Ericsson, N., Keough, M., & Riccardi, C. (2010). Examining the
unique relationships between anxiety disorders and childhood physical and sexual abuse
in the National Comorbidity Survey-Replication. Psychiatry Research, 177, 150-155.
Déry, M., Lapalme, M., Jagiellowicz, J., Poirier, M., Temcheff, C., & Toupin, J. (2017).
Predicting depression and anxiety from oppositional defiant disorder symptoms in
elementary school-age girls and boys with conduct problems. Child Psychiatry & Human
Development, 48(1), 53-62. Retrieved from https://doi.org/10.1007/s10578-016-0652-5
Dia, D. A., & Harrington, D., (2006). What about me? Siblings of children with an anxiety
ANXIETY, CHILDREN, AND BEHAVIOR 57
disorder. Social Work Research, 30(3), 183-188. Retrieved from
https://doi.org/10.1093/swr/30.3.183
Dinkmeyer, D., & Losoncy, L. (1996). The skills of encouragement: Bringing out the best in
yourself and others. Delray Beach, FL: St. Lucie Press.
Drabick, D. A. G., Ollendick, T. H., & Bubier, J. L. (2010). Co-occurrence of ODD and anxiety:
Shared risk processes and evidence for a dual-pathway model. Clinical Psychology:
Science and Practice, 17, 307-318. Retrieved from
https://doi.org/10.1016/j.cpr.2009.08.005
Dreikurs Ferguson, E., & Page, L. J. (2014). Work as a life task in contemporary times. Journal
of Individual Psychology, 70(3), 245-250.
Dunn, J. (2000). State of the art: Siblings. Psychologist, 13, 144-148.
Eisen, A., & Kearney, C. (1995). Practitioner’s guide to treating fear and anxiety in children
and adolescents: A cognitive-behavioral approach. Northvale, NJ: Jason Aronson.
Erwin, B., Heimberg, R., Marx, B., & Franklin, M. (2006). Traumatic and socially stressful life
events among persons with social anxiety disorder. Anxiety Disorders, 20, 896-914.
Evans, T. D., Dedrick, R. F., & Epstein, M. J. (1997). Development and initial validation of the
encouragement scale (educator form). Journal of Humanistic Education and
Development, 35, 163-174. Retrieved from https://doi.org/10.1002/j.2164-
4683.1997.tb00366.x
Foa, E. B., & Wasmer Andrews, L. (2006). If your adolescent has an anxiety disorder. New
York, NY: Oxford University Press.
Fox, T., Barrett, P., & Shortt, A. (2002). Sibling relationships of anxious children: A preliminary
investigation. Journal of Clinical Child and Adolescent Psychology, 31, 375-383.
ANXIETY, CHILDREN, AND BEHAVIOR 58
Griffith, J., & Powers, R. L. (2007). The lexicon of Adlerian psychology (2nd ed.). Port
Townsend, WA: Adlerian Psychology Associates Ltd.
Groh, A. M., Fearon, R. P., Bakermans-Kranenburg, M. J., van Ijzendoorn, M. H., Steele, R. D.,
& Roisman, G. I. (2014). The significance of attachment security for children’s social
competence with peers: A meta-analytic study. Attachment and Human Development, 16,
103-136. Retrieved from https://dx.doi.org/10.1080/14616734.2014883636
Hinshaw, S. P. (2005). The stigmatization of mental illness in children and parents:
Developmental issues, family concerns, and research needs. Journal of Child Psychology
and Psychiatry, 46(7), 714-734.
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive
model and its treatment implications. Cognitive Behaviour Therapy, 36, 193-209.
Hollander, E., & Bakalar, N. (2005). Coping with social anxiety: The definitive guide to effective
treatment options. New York, NY: Henry Holt and Company.
Jongerden, L., Simon, E., Bodden, D. H. M., Dirksen, C. D., & Bögels, S. M. (2015). Factors
associated with the referral of anxious children to mental health care: The influence of
family functioning, parenting, parental anxiety and child impairment. International
Journal of Methods in Psychiatric Research, 24(1), 46-57. Retrieved from
https://doi.org/10.1002/mpr.1457
Keil, V., Asbrand, J., Tuschen-Caffier, B., & Schmitz, J. (2017). Children with social anxiety
and other anxiety disorders show similar deficits in habitual emotional regulation:
Evidence for a transdiagnostic phenomenon. European Child & Adolescent Psychiatry,
26(7), 749-757. Retrieved from https://doi.org/10.1007/s00787-017-0942-x
Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity and adult psychiatric
ANXIETY, CHILDREN, AND BEHAVIOR 59
disorder in the US National Comorbidity Survey. Psychological Medicine, 27, 1101-
1119.
Krans, J., de Bree, J., & Bryant, R. A. (2014). Autobiographical memory bias in social anxiety.
Memory, 22(8), 890-897. Retrieved from https://doi.org/10.1080/09658211.2013.844261
Kross, E., Berman, M., Mischel, W., Smith, E. E., & Wagner, T. (2011). Social rejection shares
somatosensory representations with physical pain. Proceedings of the National Academy
of Sciences, 108(15), 6270-6275.
Kunimatusu, M., & Marsee, M. (2012). Examining the presence of anxiety in aggressive
individuals: The illuminating role of flight-or-flight mechanisms. Child & Youth Care
Forum, 41(3), 247-258. Retrieved from https://doi.org/10/1007/s10566-012-9178-6
Lewis-Morrarty, E., Degnan, K. A., Chronis-Tuscano, A., Henderson, H. A., Pine, D., & Fox,
N.A. (2015). Infant attachment security and early childhood behavioral inhibition interact
to predict adolescent social anxiety symptoms. Child Development, 86(2), 598-613.
Retrieved from https://doi.org/10.1111/cdev.12336
Lewis-Morrarty, E., Degnan, K. A., Chronis-Tuscano, A., Rubin, K., Cheah, C., Pine, D., …
Fox, N. (2012). Maternal over-control moderates the association between early childhood
behavioral inhibition and adolescent social anxiety symptoms. Journal of Abnormal
Child Psychology, 40(8), 1363-1373.
Manassis, K., & Hood, J. (1998). Individual and family predictors of impairment in childhood
anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry,
37, 428-434.
Meltzer, H., Ford, T., Goodman, R., & Vostanis, P. (2011). The burden of caring for children
ANXIETY, CHILDREN, AND BEHAVIOR 60
with emotional or conduct disorders. International Journal of Family Medicine, 1-8.
Retrieved from https://doi.org/10.1155/2011/801203
Mosak, H., & Maniacci, M. (1999). A primer of Adlerian psychology: The analytic-behavioral-
cognitive psychology of Alfred Adler. New York, NY: Routledge.
Ng, A., & Abbott, M. (2016). The effect of negative, positive, and neutral self-imagery on
symptoms and processes in social anxiety disorder. Cognitive Therapy & Research,
40(4), 479-495. Retrieved from https://doi.org/10.1007/10608-015-9751-z
Norton, A. R., & Abbott, M. J. (2017). Bridging the gap between aetiological and maintaining
factors in social anxiety disorder: The impact of socially traumatic experiences on beliefs,
imagery and symptomology. Clinical Psychology & Psychotherapy, 24(3), 747-765.
Retrieved from https://doi.org/10.1002/cpp.2044
Oberst, U. E., & Stewart, A. E. (2003). Adlerian psychotherapy: An advanced approach to
Individual Psychology. New York, NY: Routledge.
Ollendick, T. H., & Benoit, K. E. (2012). A parent-child interactional model of social anxiety
disorder in youth. Clinical Child & Family Psychology Review, 15(1), 81-91. Retrieved
from https://doi.org/10.1007/s10567-011-0108-1
Ollendick, T. H., & Hirshfeld-Becker, D. (2002). The developmental and psychopathology of
social anxiety disorder. Biological Psychiatry, 51(1), 44-58.
Ollendick, T. H., & Horsch, L. M. (2007). Fears in children and adolescents: Relations with child
anxiety sensitivity, maternal overprotection, and maternal phobic anxiety. Behavior
Therapy, 38, 402-411.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social
phobia. Behaviour Research and Therapy, 35, 741-756.
ANXIETY, CHILDREN, AND BEHAVIOR 61
Rapee, R. M., & Spence, S. (2004). The etiology of social phobia: Empirical evidence and an
initial model. Clinical Psychology Review, 24, 737-767.
Rapee, R. M., Wignall, A., Spence, S. H., Cobham, V., & Lyneham, H. (2008). Helping your
anxious child (2nd ed.). Oakland, CA: New Harbinger Publications, Inc.
Rasmussen, P. R., & Dover, G. J. (2006). The purposefulness of anxiety and depression:
Adlerian and evolutionary views. Journal of Individual Psychology, 62(4), 366-396.
Sezer, S. (2017). Novice teachers’ opinions on students’ disruptive behaviours: A case study.
Eurasian Journal of Educational Research, (69), 199-219.
Shanker, S. (2016). Self-reg: How to help your child (and you) break the stress cycle and
successfully engage with life. New York, NY: Penguin Press.
Short, R. M. L., Sonuga-Barke, E. J. S., Adams, W. J., & Fairchild, G. (2016). Does comorbid
anxiety counteract emotion recognition deficits in conduct disorder? Journal of Child
Psychology & Psychiatry, 57(8), 917-926. Retrieved from
https://doi.org/10.1111/jcpp.12544
Siegel, D. J., & Hartzell, M. (2014). Parenting from the inside out: How a deeper self-
understanding can help you raise children who thrive. New York, NY: TarcherPerigee.
Siegel, D. J., & Payne Bryson, T. (2011). The whole-brain child: 12 revolutionary strategies to
nurture your child’s developing mind. New York, NY: Bantam Books.
Siegel, R., La Greca, A., & Harrison, H. (2009). Peer victimization and social anxiety in
adolescents: Prospective and reciprocal relationships. Journal of Youth and Adolescence,
38, 1096-1109.
Silverman, W. K., Kurtines, W. M., Pina, A. A., Jaccard, J. (2009). Directionality of change in
ANXIETY, CHILDREN, AND BEHAVIOR 62
youth anxiety treatment involving parents: An initial examination. Journal of Consulting
and Clinical Psychology, 77(2), 474-485.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2015). Counseling and psychotherapy theories
in context and practice (2nd ed.). Hoboken, NJ: John Wiley & Sons, Inc.
Sperry, L., Carlson, J., Duba Sauerheber, J., & Sperry, J. (Eds.). (2015). Psychopathology and
psychotherapy: DSM-5 diagnosis, case conceptualization, and treatment (3rd ed.). New
York, NY: Routledge.
Stein, H. (2008). Adler’s legacy: Past, present, and future. Journal of Individual Psychology,
64(1), 4-20.
Stein, H. (2012, April 19). Birth order: Sense and nonsense – An Adlerian view. [Video].
Retrieved from https://youtube.com/watch?v=UhXE1AT3nN4&feature=youtu.be
Sweeney, T. J. (2009). Adlerian counseling and psychotherapy: A practitioner’s approach. New
York, NY: Taylor & Francis.
Towe-Goodman, N. R., Franz, L., Copeland, W., Angold, A., & Egger, H. (2014). Perceived
family impact of preschool anxiety disorders. Journal of the American Academy of Child
and Adolescent Psychiatry, 53(4), 437-446. Retrieved from
https://doi.org/10.1016/j.jaac.2013.12.017
Vassilopoulos, S. P., & Moberly, N. J. (2013). Cognitive bias modification in pre-adolescent
children: Inducting an interpretation bias affects self-imagery. Cognitive Therapy &
Research, 37(3), 547-556. Retrieved from https://doi.org/10.1007/s10608-012-9481-4
Watts, R. E., & Ergüner-Tekinalp, B. (2017). Positive psychology: A neo-Adlerian perspective.
Journal of Individual Psychology, 73(4), 328-337.
Weymouth, B. B. & Buehler, C. (2018). Early adolescents’ relationships with parents, teachers,
ANXIETY, CHILDREN, AND BEHAVIOR 63
and peers and increases in social anxiety symptoms. Journal of Family Psychology,
32(4), 496-506. Retrieved from https://doi.org/10.1037/fam0000396
Wong, Q., & Rapee, R. (2015). The developmental psychopathology of social anxiety and
phobia in adolescents. In Ranta, K., La Greca, A., & Garcia-Lopz, L. (Eds.), Social
anxiety and phobia in adolescents: Development, manifestation and intervention
strategies. Switzerland: Springer International Publishing.
Yeh, H., & Lempers, J. (2004). Perceived sibling relationships and adolescent development.
Journal of Youth and Adolescence, 33, 133-147.
ANXIETY, CHILDREN, AND BEHAVIOR 64
Appendix A
Emotional Vocabulary
ANXIETY, CHILDREN, AND BEHAVIOR 65
Appendix B
Self-Regulation Strategies
ANXIETY, CHILDREN, AND BEHAVIOR 66
Appendix C
Sample Re-Scripting Experience Worksheet
ANXIETY, CHILDREN, AND BEHAVIOR 67
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.