Social/ School Avoidance 




Prematurity and Its Impact on Psychosocial and Emotional Development in Children

Phyllis Zelkowitz, EdD, McGill University, Canada

Teenagers born at extremely low birth weight

Michael F Whitfield, MD FRCPC FRCPE1 and Ruth E Grunau, PhD RPsych2

“In general, during late adolescence, ELBW teenagers (born in the mid-1980s) tended to be a bit smaller than their peers, did not have a major impairment and had struggled with some aspects of schooling, but, by determination and application and support of their families, had or would likely achieve high school graduation. They were tentative in seeking work, were averse to physical activity, and seemed less mature socially and emotionally, and more connected to the family than were peers. Although this generalization may be true, the predominant impression of an ELBW teen is that he or she is very much the product of his or her family, reflecting the great importance of genetic, sociodemographic and parenting factors on the ultimate outcome of the highest risk survivors.”

Social development of children born very preterm: a systematic review

Kirsten Ritchie Samudragupta Bora Lianne J Woodward

‘Children born VPT have poorer social competence. These difficulties emerge early and persist throughout childhood.’


If you are a parent of a shy adolescent, it is common to wonder whether your teenager’s behaviour is holding them back and impacting them negatively. What is the right way to address this issue without making things worse?

Being shy or feeling socially uncomfortable is not uncommon, most teenagers feel shy at least occasionally, but can eventually adjust and enjoy participating in social activities with their peers. But if the teenager’s shyness leads to avoiding new experiences or limiting interactions with new people it’s helpful to look into this before this becomes more than just shyness.

Here are some symptoms to watch for:

  • Avoiding situations where the teen may be judged by others
  • Feeling anxiety when around unfamiliar people
  • Avoidance of social situations
  • Feeling of making a social mistake
  • Apprehension of social events that begins days or weeks in advance
  • Severe test anxiety
  • Irritability or anger before a social event
  • Hyper-sensitivity to criticism
  • Poor school performance

Possible Physical Symptoms

  • Blushing, flushed skin
  • Difficulty speaking, shaky voice
  • Rapid heart beat

If your teenager exhibits the symptoms above and these symptoms are creating impairment in their functioning, there are several ways a parent can help improve the situation.

Some teenagers that are excessively shy or have an ongoing problem with social interactions, for example, teens that are vulnerable to feeling socially awkward can often create a way of life that alleviates their fears, often by using avoidance as their main coping skill. This avoidance strategy can create a lost opportunity to establish healthy social skills that typically develop during the transition from adolescence to adulthood.


Some tips you can try with your teenager:

  • Discuss the origins of anxiety. Talk through the “fight or flight” response that was once essential in keeping humans alive, but now can create unnecessary stress responses to fearful situations. Helping a teenager understand the reasons for physical changes during periods of stress can be beneficial in normalizing their responses.
  • Teach calming techniques. When anxiety does trigger physical changes, one of the most noticeable responses is rapid breathing. Breathing quickly can lead to an imbalance in oxygen and carbon dioxide, which may lead to increased heart rate, muscle tension, and dizziness. This vicious cycle can be easily broken by using calming breath techniques.
  • Talking with your teenager talk with your teen and find out which social situations are the most challenging. make a list of their most distressing situations. Use this list to set up specific strategies to alleviate their symptoms.
  • Realistic Expectations. Talk with your teenager about how mistakes are part of the growth process.
  • Problem Solving. Help your adolescent find ways to face fears, rather than avoid them. Help them make a plan for future social situations that they see as stressful.
  • Conquering negative thoughts. Help them develop alternative thoughts to these negative ideas. Practicing this activity together.
  • Model Social Behaviour. Allowing your teenager to see you nervous about a situation, and then see you confront that situation anyway, is one of your most powerful tools in helping them through their social challenges.

 Parent skills to focus on:

  • Avoid labelling as shy
  • Avoid blaming: There are many possible contributing factors that lead to the development of these symptoms.
  • Accommodating Avoidance: Allowing your teen to stay home from school or avoid all social events will reinforce their fears. Provide gentle support and guidance while encouraging participation.

 If these challenges persists for more than 6 months it might be helpful to talk to the school guidance counsellor, school year advisor or your family doctor.

International Friendship Day July 30th   A day to promote friendships in positive ways.

“Whatever emotional state you’re in while you’re parenting, this will convey more to your child than the content of what you're doing with them, no matter how perfect your intervention looks "on paper." In other words, to paraphrase Marshall McLuhan, "your emotional state is the message.”
Michael Y. Simon, The Approximate Parent: Discovering the Strategies that Work for Your Teenager

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Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances.To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].