My 10-year-old niece is so sensitive that she is afraid to ask for anything at school. She cries if she needs to ask a question or for something as simple as needing a piece of paper. She has friends but the other children are beginning to ignore her. What can her parents do?

Dr. Pat responds:

She is suffering from extreme shyness or anxiety. At her age it is unlikely to just disappear on its own.

There are some things that your niece and her parents can do. Maybe you can help too.

She can learn ways to calm her body, such as deep breathing and muscle relaxation.
Changing the way she thinks can help her calm her mind.

Deep breathing is a good way to relax the body. Most people who are anxious have very shallow breathing. We call deep breathing "belly breathing" because it makes you fill up your lungs so your belly sticks out a bit. If she practices belly breathing, she will calm her body. If she gets dizzy when deep breathing, she should breathe slower.

She may think that horrible things will happen if she speaks up. But she may not even know what she is thinking. She needs to learn to say things to herself that will calm her down. She might say things like "Everything will be OK if I ask the teacher," or "Nothing bad will happen if I ask a question."

Learning what to do won't work if she doesn't ask the teacher. Facing fear is the only way to overcome it.

She can practice asking her teacher by pretending with her mom. Doing it many times will help.

She can use her imagination. She can imagine herself feeling afraid in the classroom. Then she can relax her body and her mind. And imagine asking questions.

It would be helpful for her mom to talk to her teacher as well. Maybe they can practice a few times without other kids around. Her teacher can make it a bit easier for her to speak up. But she has to speak up to overcome her fear.

This sounds easy but it is hard. She and her parents will need your support. A psychologist could help your niece and her parents.

Selective serotonin reuptake inhibitors (SSRIs) can sometimes be helpful in various forms of anxiety, even in children. Some of the newer anti-depressants have also been used.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. He is also the CEO of the Strongest Families Institute, which provides mental health care to families across Canada.