I feel that she is almost there, but she is also very stubborn. She speaks everywhere else but not in school. What else can her teacher or I do to encourage her or to give her the confidence she needs to speak up?

Answer: I would recommend having your daughter evaluated by a child psychologist who specializes in the treatment of childhood anxiety. A psychologist could help determine whether your daughter's refusal to speak in the classroom is related to anxiety or some other cause.

To make this determination, a psychologist will have to speak with you, your daughter and your daughter's teacher to get a better sense of the nature of the problem. If a psychologist does determine that your daughter is suffering from anxiety, there are very effective treatments available for helping her. Specifically, cognitive-behavioral treatment (CBT) is a short-term and highly effective treatment for childhood anxiety. CBT involves teaching children skills for coping with anxiety and giving them the opportunity to practice these skills through exposure to feared situations

Dr. Lisa Hunter is an assistant professor in the department of child psychiatry at Columbia University and the director of school-based mental health programs at Columbia University's Center for the Advancement of Children's Mental Health. Her research focuses on the development, implementation, and evaluation of school-based mental health and prevention programs. In addition she is a licensed clinical psychologist in private practice in New York City. She specializes in cognitive behavioral treatment for children and adolescents.

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.

August 2006