Dear Readers and Parents of Children with Selective Mutism, Social Anxiety, and with other symptoms of anxiety:

A very good study was just published in the Journal of the American Academy of Child and Adolescent Psychiatry about the many factors that contribute for the development and maintenance of social anxiety and other types of anxiety in young children. The authors were able to follow up children from the age of 4 to the age of 6, and they looked at the “variables” (factors) that had an important role in keeping or increasing the anxiety in these children. It is already known that children with “Behavioral Inhibition” are more likely to develop anxiety. Behavioral Inhibition is a type of temperament that children show that is basically when children show significant signs of being uncomfortable and they do whatever they can to avoid unfamiliar situations. Behavioral Inhibition is something that all children show, but some have more intense (and more impairing) signs, such as hiding behind their parents’ bodies when entering a new place, becoming upset and anxious whenever he/she meets a new person, and not interacting with new peers or adults. The authors reviewed other factors that contributed to the child’s lack of progress in Behavioral Inhibition and with anxiety, and they came to the conclusion that mothers’ anxieties, mothers’ high levels of “overinvolvement” were also important risk factors in keeping and increasing the child’s social anxiety and generalized anxiety. Two very important conclusions can be taken from this very good and empirically-based study: First, it is very important to work with parents (fathers were not included in the study reviewed, but we know that they need to be involved as well) of children who show behavioral inhibition and/or anxiety early in life, as young as possible. In working with parents early enough, the clinician would work with the interaction between the parents and the child, and in that way facilitating the decrease of anxiety in all members of the family. When parents work with such symptoms early in life, they are actually working in preventing their child from developing more chronic levels of anxiety later in life. The second very important conclusion of the study is that it is not enough to work with children alone when facing symptoms of social anxiety, separation anxiety, generalized anxiety in their children. “The apple does not fall far from the tree”, i.e., parents are very likely to be anxious as well, and therapists working with children with anxiety need to not neglect working with parents with their own anxiety about their children’s anxieties to help parents not “rescue” children from their own anxiety, and thus reinforce even more the vicious cycle of anxiety. It is well known that anxiety has strong genetic links, and these are combined with an environmental influence in keeping generations with anxiety if child psychologists and other mental health providers do not recognize that the ideal treatment should include parents and children, and their interaction as well. Note that although the authors did not mention “Selective Mutism”, it is well known that Selective Mutism is directly related to Social Anxiety as it is a Social Communication Anxiety Disorder, and it may be placed in that category when the DSM-V is completed. Please, do not hesitate to write or call if you have any questions or comments.