Ask An Expert / Anxiety

Our 6-year-old is too anxious to participate in school activities. What should we do?

Behavioral therapy helps children overcome anxiety by building tolerance

Jerry Bubrick, PhD
Jerry Bubrick, PhD

Senior Clinical Psychologist, Anxiety Disorders Center

Child Mind Institute

Our daughter is 6 years old, adopted at 1 year old from China. From the beginning she has been shy and cautious. In school events, activities, sports she will not participate, despite the fact that she is quite agile physically. She stands in the middle, not doing whatever activity the other kids are doing. When asked why she does not participate she reports that it is because she looks weird, though she looks the same as others (this has happened in Canada and China, too). She thinks that people stare at her, which is usually not the case, unless it's because she's not participating. She has friends but has a hard time talking to adults. She is reluctant to discuss these issues with us to try to find a solution. It is impacting her quality of life almost daily. The school counselor did not have any suggestions. We have considered seeing an art therapist since she likes drawing. Thank you for your time.

You’re right to seek evaluation and treatment for your daughter, whose anxiety seems clearly to be clearly getting in the way of her healthy development. Anxiety gets harder to counteract as children get older and develop an identity around avoiding things that make them uncomfortable.

It’s possible that she has selective mutism, a disorder in which a child who speaks freely at home is unable to speak in some social situations, such as school. Children with SM typically have a hard time speaking to adults, and they are sometimes frozen with anxiety when other kids are active and rowdy. Social anxiety, and what we call performance anxiety rarely appear in children under 10 — they usually develop in the teen years.

But whatever the specific diagnosis, your daughter could probably benefit from cognitive behavioral therapy, which would help her learn gradually to tolerate being uncomfortable without letting it interfere with her participation in school and other social activities. A behavioral therapist would also give you pointers on what to do and not to do to encourage her to push through her discomfort.

Sometimes, by the way, when a child has a misperception about how other children are behaving or reacting to her, as a part of the behavioral therapy we actually videotape a play date or birthday party and show the video to the child, as a kind of reality check.

Although it might seem tempting to try a therapy that coincides with your daughter’s interests, we don’t recommend either art or play therapy because there is no evidence that they are effective. In fact, for some kinds of anxiety they may exacerbate the problem.