My Child’s Fears are Getting Out of Hand!

By: Rachel Christensen & Suzi Naguib, Psy.D.                                                                                                                                               Blog PDF

phobia anxiety children“My son, Alex, has been afraid of bugs for as long as I can remember. Lately, it seems like this is all that he is able to think about. His teachers have told me that he refuses to go outside to play with the other children, and I am sure that it is because he is afraid of insects. Even when we are walking to our car in the garage, Alex is clinging to me. Everyone tells me that he is just “going through a phase” and to “give it time,” but I don’t think it’s just a regular childhood fear. I’m really worried about him. His fear is controlling his life.”

Most people have experienced fear at some point in their lives. In most cases, our fear response is natural and adaptive because it helps us to prepare when something could be a threat.

Most children have something that scares them. Not only is experiencing fear or anxiety common, it is also part of normal development. Although fears are typically transient for most children, for some kids, this fear response may seem excessive or out of proportion to the actual danger. Like with Alex, the fear may be so extreme that the child may actively avoid the feared object or situation, and in turn, this may affect his or her ability to enjoy and participate in daily childhood activities.

What is a specific phobia?
A specific phobia is an intense manifestation of fear in the absence of imminent danger. A child with a specific phobia experiences marked fear or anxiety about a specific object or situation, which significantly influences and interferes with the child’s usual daily activities 1. Because many children are afraid of something growing up, a child’s fear must impair his or her functioning for at least six months in order for it to be considered a specific phobia 1. The fear or anxiety may elicit physiological arousal like trembling, dizziness, or sweating and may lead to somatic complaints such as head and stomachaches. The fear may also be expressed by crying, tantruming, freezing, clinging or avoiding 1. Therefore, a child who always refuses to stay at grandma’s house because grandma has a dog or becomes panicky if made to sleep in his or her own bedroom because of fear that someone may break into their home may be suffering from a specific phobia. For a child who is afraid of bugs, the mere anticipation of having to go outside for recess may be so distressing that he or she tries to avoid going to school altogether. Conversely, a child who is sometimes worried that there may be monsters under their bed and wants a parent to quickly check for them before they go to sleep may not warrant a specific phobia.

There are a number of specific phobias that one may experience. Animal phobias are the most common. Someone with an animal phobia may be scared of dogs, mice, snakes, birds, spiders, or other insects. Situational phobias include the fear of flying, riding in public transportation, driving, going over bridges or in tunnels, or being in a closed space like an elevator. Individuals who experience natural environment phobias are often afraid of water, heights or thunderstorms, and someone who is afraid of needles or who may fear the sight of blood may be experiencing a blood-injection-injury phobia 1.

What causes phobias?
The causes of specific phobias are complex, and research shows that it probably involves a combination of different factors. There is evidence that specific phobias sometimes run in families and that genetics and environmental factors such as learned behavior from a family member or exposure to a negative experience may play a role. 

Will my child grow out of it?
According to the DSM-5, approximately 5% of children and 16% of 13 to 17 year olds have a specific phobia that affects their daily functioning. In addition, most individuals who develop a specific phobia do so before the age of ten 1. Studies have shown that specific phobias can last a lifetime without therapy and may lead to anxiety disorders, mood disorders, and substance use disorders in adulthood 2. Therefore, the prevention and treatment of specific phobias in children is very important for their current as well as future well-being.

Is it okay to allow my child to avoid what they are afraid of?
Helping your child avoid the feared situation will certainly temporarily relieve their anxiety. However, consistently avoiding the object or situation will not help him or her to overcome their fear and will likely lead to increased fear and impaired functioning 3. 

What does treatment entail?
Fortunately, there are effective treatments for individuals suffering from specific phobia. One of the evidence-based treatments that has been found to be particularly effective is graded exposure therapy 4. With this treatment, the child is gradually introduced to circumstances that provoke their particular anxiety but in a supportive and controlled environment 4. In other words, for a child like Alex, who is afraid of bugs, therapy may start off with the child viewing pictures of bugs while talking through the experience with the therapist. The therapist may then model how to interact with different insects in a calm manner 4. In addition, the child is taught how to cope with the anxiety-provoking situation and associated thoughts in a new way. With further encouragement and exposure, eventually the child will become desensitized to the stressor, will progress to feeling more comfortable, and will experience minimal anxiety around insects. In some cases of extreme anxiety, medication can be useful, but it is rarely necessary for overcoming a phobia unless the clinician believes it would assist the child in participating in the behavioral treatment.

Sunfield Center psychologists are available to help identify and treat specific phobias in children and adolescents as well as other challenges faced by families whose children have mental health needs. To schedule an appointment, please call us at (734) 222-9277. To access the links in this blog, visit our website at sunfieldcenter.com/for-families/blog/. For more information about Sunfield Center, and our Anxiety Disorders Service, please visit our website at sunfieldcenter.com.

References
1 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
2 Ollendick, T. H. & March, J. S. (2003). Phobic and Anxiety Disorders in Children and Adolescents: A Clinician’s Guide to Effective Psychosocial and Pharmacological Interventions. Oxford University Press, USA.
3 Choy, Y., Fyer, A, J., & Lipsitz, J, D (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27, (3), pp 266-286.
4 Mineka, S.,  Mystkowski, J. L., Hladek, D., & Rodriguez, B. I. (2009). The Effects of Changing Contexts on Return of Fear Following Exposure Therapy for Spider Fear. Northwestern University Journal of Consulting and Clinical Psychology, 67, (4), pp. 599-604.