Fear is an intense aversion to or apprehension of a person, place, activity, event, or object that causes emotional distress and often avoidance behavior. Fears are common in childhood.
Description
More than 50 percent of children experience normal phobias, which is the fear of a specific object, or more general worries, called anxieties, before they are 18 years old. For adults it may be helpful to distinguish between rational fears, such as fear of snakes or guns, which are survival mechanisms and serve to protect a person from danger; and irrational fears, or phobias, which cannot be traced to any reasonable cause.
Most children have some fears. Fears are normal, and can be a good thing. For example, children need to know they should not run into a street. They need to know not to play with knives. A little fear is good, but too much fear is a problem. So is too little fear. A child with too much fear may not want to leave the house. A child with not enough fear may get into a stranger's car. Children's personalities also will influence their fears. One child may be scared of more things than another child. Some children are braver, while others are more shy and fearful.
Many childhood fears fall somewhere between the rational and irrational, occurring in phases as the child or adolescent is exposed to new experiences and as both cognitive reasoning and the capacity for imagination develop. Whether a child's fear is considered normal generally depends on his or her age, background, and most importantly on how much it interferes with his or her normal daily activities. Fear of water may be considered normal in a child who has never learned how to swim, but it might be considered abnormal in the adolescent son of a coastal fisherman.
The most significant factors in overcoming fear are identifying the fear, developing a sense of control over the feared environment, and envisioning alternatives to the feared negative outcomes. Forcing children to perform activities they are afraid to do destroys, rather than builds, autonomy and self-confidence. If a child refuses to do something or explicitly voices fear, those feelings should be taken seriously and explored through questions and discussion. Parents can ask the child or adolescent what change can be made to accommodate the fear in order to make him or her feel more in control.
Some research suggests that reading scary picture books functions as a courage-building tool for children and helps them face their fears in a controlled environment; they are free to turn the page or to remind themselves that the monster is not real. Horror stories or movies may serve the same purpose for teens but not for children who cannot exercise the same level of choice by leaving the theater and should not be exposed to disturbing movies.
Infancy
Babies fear falling, being dropped, and loud noises. A fear of strangers is also common in infants starting at the age of seven to nine months and lasting until about 18 months, when it begins to decrease. Fear symptoms in infants are primarily crying, stiffening, and sometimes shaking.
Toddlerhood
Fears among toddlers include strangers, animals, bugs, storms, sirens, large objects, dark colors, darkness, people with masks, monsters, and "bad" people, such as burglars. Children at this age also commonly fear being separated from their parents. Fear symptoms in toddlers include crying and avoidance of the feared person or object.
Preschool
Preschoolers fear being separated from parents, being left alone or sleeping alone, and imaginary figures, such as ghosts, monsters, and supernatural beings. Symptoms may be physical, such as a stomachache or headache.
School age
In younger school-age children, fears include separation anxiety; death; violence, such as in war or murder; kidnapping and physical injury; natural disasters such as floods, earthquakes, and tornados; and anxiety about academic achievement and other forms of school performance. Children at age seven often have a fear of not being liked while children ages eight and nine may worry about personal inabilities.
In older adolescents, common fears include anxiety about school achievement, social rejection and related worries, and sexual anxieties, including dating and sexually transmitted diseases, especially human immunodeficiency virus (HIV).
Symptoms in adolescents and teens include anger, avoidance, and denial of the fear, and panic reactions, such as sweating, trembling, fast heartbeat, and rapid breathing.
Nearly all fears have a scientific name, such as triskaidekaphobia, the fear of the number 13. In the classic Christmas television special, "A Charlie Brown Christmas," Charlie Brown had pantophobia, the fear of everything. Other common fears include:
Research shows that most children report having several fears at any given age. Some research shows that 90 percent of children ages two to 14 have at least one specific fear. If the fear does not interfere with the child's daily life, such as sleeping, going to school, and engaging in social activities, then professional help is generally not needed.
Phobias belong to a large group of mental problems known as anxiety disorders and can be divided into three specific types: specific phobias (formerly called simple phobias), social phobias, and agoraphobia.
A specific phobia is the fear of a particular situation or object, including anything from airplane travel to dentists. Found in one out of every ten Americans, specific phobias seem to run in families and are roughly twice as likely to appear in women. If the person rarely encounters the feared object, the phobia does not cause much harm. However, if the feared object or situation is common, it can seriously disrupt everyday life. Common examples of specific phobias, which can begin at any age, are fear of snakes, flying, dogs, escalators, elevators, high places, or open spaces.
People with social phobia have deep fears of being watched or judged by others and of being embarrassed in public. Common social phobias in children include reading aloud in front of a class; participating in a musical, drama, or athletic event; starting or joining in a conversation; talking to adults; attending social events, such as dances and parties; taking tests; attending physical education class; using school or public bathrooms; and asking a teacher for help.
Social phobia is not the same as shyness. Shy people may feel uncomfortable with others, but they do not experience severe anxiety, they do not worry excessively about social situations beforehand, and they do not avoid events that make them feel self-conscious. On the other hand, people with social phobia may not be shy; they may feel perfectly comfortable with people except in a public place. This feeling usually begins about age 15 and affects three times as many women as men.
An episode of spontaneous panic is usually the initial trigger for the development of agoraphobia. After an initial panic attack, the person becomes afraid of experiencing a second one. Patients literally "fear the fear," and worry incessantly about when and where the next attack may occur. As they begin to avoid the places or situations in which the panic attack occurred, their fear generalizes. Eventually the person completely avoids public places. In severe cases, people with agoraphobia can no longer leave their homes for fear of experiencing a panic attack.
Agoraphobia is the intense fear of feeling trapped and having a panic attack in specific situations. Social phobias may be only mildly irritating, or they may significantly interfere with daily life. It is not unusual for people with social phobia to turn down job offers or avoid relationships because of their fears.
Parental concerns
While normal fears tend to be experienced in phases and tend to be outgrown by adulthood, abnormal fears are those that are persistent and recurrent or fears that interfere with daily activities for at least a month. Abnormal fears, including extreme separation anxiety, being afraid to go to school, or extreme social fears, may indicate an anxiety disorder.
When to call the doctor
When children's fears persist beyond the age when they are appropriate, they can begin to interfere with their daily lives. Typically, children who experience this type of irrational fear, or phobia, should get treatment from a psychologist.
The most popular and effective treatment for phobias is behavior therapy, which approaches the phobia as an undesirable behavior to be unlearned. Most often it takes the form of desensitization, a technique by which the fearful person is exposed to the feared stimulus in an extremely mild form and then with gradually increasing degrees of intensity. For example, a child who fears dogs may first be asked to look at pictures of dogs, then perhaps play with a stuffed dog or view a dog from afar, ultimately getting to the point when she is able to pet and play with dogs.
Phobias also respond to treatment by medication, including anti-anxiety drugs such as Xanax and BuSpar and selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft. Medication is especially helpful for social phobia, where it can help the child overcome her aversion to social interaction sufficiently to work with a therapist. When agoraphobia accompanies panic attacks, it also responds to cognitive-behavioral treatment for panic disorder, often in conjunction with anti-anxiety and antidepressant medications similar to those prescribed for other phobias.
Before, during, and after exposure to the source of fear, the child can begin to imagine controlling the environment and his own reactions in other ways. Creative visualization, for example, imagining a switch the child can use to control his fear when visiting the doctor or dentist, can sometimes be effective. A comforting ritual, a familiar object, or thoughts of a beloved person can be used as a good luck charm before embarking on a scary trip or performing a task such as speaking in class or sleeping alone. Relaxation techniques can also be taught to older children.
KEY TERMS
Agoraphobia—Abnormal anxiety regarding public places or situations from which the person may wish to flee or in which he or she would be helpless in the event of a panic attack.
Ailurophobia—Fear of cats.
Cognitive—The ability (or lack of) to think, learn, and memorize.
Didaskaleinophobia—Fear of going to school.
Entomophobia—Fear of insects.
Glossophobia—Fear of speaking.
Myctophobia—Fear of darkness.
Ophidiaphobia—Fear of snakes.
Pantophobia—Fear of everything.
Phobia—An intense and irrational fear of a specific object, activity, or situation that leads to avoidance.
Selective serotonin reuptake inhibitors (SSRIs)—A class of antidepressants that work by blocking the reabsorption of serotonin in the brain, thus raising the levels of serotonin. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).
Triskaidekaphobia—Fear of the number thirteen.
Xenophobia—Fear of strangers or foreigners.
Zoophobia—Fear of animals.
BOOKS
Chansky, Tamar E. Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child'sFears, Worries, and Phobias. New York: Broadway Books, 2004.
Foxman, Paul. The Worried Child: Recognizing Anxiety in Children and Helping Them Heal. Alameda, CA: Hunter House, 2004.
Ollendick, Thomas H., and John S. March. Phobic and Anxiety Disorders in Children and Adolescents: A Clinician's Guide to Effective Psychosocial and Pharmacological Interventions. Oxford, UK: Oxford University Press, 2003.
Spencer, Elizabeth DuPont, et al. The Anxiety Cure for Kids: A Guide for Parents. Hoboken, NJ: Wiley, 2003.
PERIODICALS
Dragon, Natalie. "Behind the Headlines: Could TB Pill Help Banish Phobias?" GP (December 15, 2003): 39.
Epstein, Randi Hutter. "Experts Try Fast-Track Fix for Children with Phobias." The New York Times (January 20, 2004): F5.
London, Robert T. "Conquering Phobias." Clinical Psychiatry News (May 2004): 43.
Purvis, Patty. "Fear of Talking (Selective Mutism)." Clinical Reference Systems (Annual 2002): 1261.
Travis, John. "Fear Not: Scientists Are Learning How People Can Unlearn Fear." Science News (January 17, 2004): 42–4.
Tucker, Libby. "Fear Factors: Everyone Reacts to Fear Differently. Scientists Are Beginning to Understand Why." Science World (February 7, 2003): 14–15.
ORGANIZATIONS
Anxiety Disorders Association of America. 8730 Georgia Ave., Suite 600, Silver Spring, MD 20910. Web site: <www.adaa.org>.
Mood and Anxiety Disorders Institute. Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114. Web site: <www.mghmadi.org>.
WEB SITES
"The Anxious Child." American Academy of Child & Adolescent Psychiatry, December 2000. Available online at <www.aacap.org/publications/factsFam/anxious.htm> (accessed December 10, 2004).
"Helping Your Child Deal with Fears & Phobias." Child Development Institute, March 25, 2004. Available online at <www.childdevelopmentinfo.com/disorders/fears.htm> (accessed December 10, 2004).
