Question: My daughter gets extremely anxious when it comes to performing in front of people. This has affected her ability to perform in the school plays that she has been interested in and to take part in school projects in which she needs to speak in front of the class.

I want to help build her confidence and help her be less anxious. What do you recommend?

Answer: Many girls at this age begin to report social anxiety, performance fears and fear of rejection. They may have had anxious feelings before, but they were described as "a little shy" rather than "having anxiety." Whether her behavior is isolated to performance, or is more generalized to include poor peer relationships, oversensitivity to criticism and low self-esteem, the treatment is similar.

The tools used for anxiety reduction will be helpful throughout her life. A common approach is to ask a person to notice her body's reactions and then rate the severity of the experience on a scale of one to five. If she can stop and feel her body's response, she can start the process of relaxing, before the anxiety takes over. Children can learn to calm themselves by muscle tightening and relaxing, slow breathing and visualization.

Helping children link their body's sensations to their negative thoughts also helps children slow their automatic reactions down. This process allows them to accept the feelings and begin to replace the scary thoughts with positive coping statements.

A school counselor, child therapist or behavioral pediatrician can help determine the severity of your daughter's anxiety and offer further help and guidance. Two very popular books with practical "how to" information are: Freeing Your Child From Anxiety by Tamar E. Chansky and Helping Your Anxious Child by Ronald M Rapee, Susan H. Spence, Vanessa Cobham and Ann Wignall.

Debra Collins is a licensed marriage and family therapist. Debra has worked in both primary and middle schools as a school counselor. She gives workshops to teachers and students on a variety of topics concerning youth and families and offers parenting classes and parent coaching throughout the Bay Area. Debra is also a mental health assessor for the San Francisco Unified School District.

Advice from our experts is not a substitute for medical or other professional advice and services from a qualified health-care provider familiar with your unique situation. We recommend consulting a qualified professional if you have concerns about your child's medical or emotional condition.

February 2008