Overcoming social appearance anxiety among children affected by congenital physical differences

Purpose of reviewHow can we effectively help children with congenital physical differences and their parents in adapting to their situation and overcome social appearance anxiety? How can we improve their self-efficacy in social situations and relationships, as well as increase their self-esteem and self-confidence, which are foundations of assertiveness? Recent findingsSeveral studies have examined the coping skills variability between children. Researchers have attempted to identify the discriminating factors of these differences. Standardized programmes combining Cognitive Behavioural Therapy (CBT) and Social Skills Training (SST) have been developed, but recent studies question their effectiveness. Research is now focusing on third-wave CBT that is promoted actively despite insufficient evidence. Close examination of the mechanisms by which children develop social appearance anxiety shows that exposure and assertiveness training are key therapeutic tools. As with any other type of social anxiety, exposure allows these children to experience and learn positive, value-enhancing social relationships, in spite of their differences. SST creates a well tolerated exposure environment for whichever kind of curiosity the child may encounter. Therapeutic support requires continued individualized readjustment and a complete understanding of the child's personal history, the complex system in which they are developing, and the mechanisms involved. We suggest to formulate for each child a personalized 'Global Theory', which integrates history and detailed functional analyses.