ChildrensFears: DevelopmentalorDisorder?

WhatEducatorsShouldKnow

SachaN.Matthews UniversityofPittsburgh,SchoolofEducation Matthews,2010 20 1

TableofContents
1.WhatisNormalFear? Normal&CommonFears AgesandStagesofFear GenderDifferences 3 4 5 7 8 9 10 11 12 13 14 15 16 17 18
RobinsonIII,E.H.,Rotter,J.C.,(1991).Childrensfears:Towardapreventive model.SchoolCounselor,38(3),187.Retrievedfromhttp: search.ebscohost.comlogin.aspxdirect=rue&db=aph&AN=9607292174 &site=ehostlive

2.AbnormalFearPhobias DSMDefinition CaseStudy Assessment Prevalence&ComorbidityofPhobias WhatCausesPhobias? CommonSymptomManifestations Treatment

3.StrategiesforTeachers FurtherResources

4.References

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References
King,N.J.,Muris,P.,&Ollendick,T.H.(2004).Specificphobia.InT.L.Morris& J.S.March(Eds.),Anxietydisordersinchildrenandadolescents(2nd ed.,pp.263279).NewYork:GuilfordPress. King,N.J.,Muris,P.,&Ollendick,T.H.(2005).Childhoodfearsandphobias: Assessmentandtreatment.ChildandAdolescentMentalHealth,10(2), 5056.doi:10.1111/j.14753588.2005.00118.x

WhatisNormalFear?
Alsoreferredtoasnormativefear,fearisanaturalpartof childdevelopment.Asuncomfortableasitcanbeto experiencefeelingsoffear,itisanessentialdevelopmental processthatprepareschildrentonavigatedifficultsituations. Fearcancreateapositive,motivationalexperience,resulting inasenseofconfidenceandempowerment.Infact, experiencingfearmayeveninfluencechildrentobehavein saferways.Forexample,achildwhoisafraidofheightsmay avoidclimbingonobjectsthatheorshemayfalloffof(2010, Matthews). AccordingtoRobinson&Rotter(1991),thenotionofpower isasignificantfactorindetermininghowwellachildcan copewithfearinducingobjectsandsituations.Essentially,a childsfeelingsofpower,orlackthereof,areassociatedwith thewaysinwhichachildmayrespondtofear.Furthermore, theideaofpowerincludesthreeconcepts:security,self worth,andcontrol.Therefore,childrenwhofeelsecure, valued,andhaveacertainlevelofcontrolovertheirlives tendtohandlefearsmoreeffectively(Robinson&Rotter, 1991. Fromthis,itisoftheutmostimportanceforparentsand educatorstofocusonassistingchildrenindevelopinghealthy copingskillsbyinstillingfeelingsconfidenceandvalue. Moreover,inlearningtomanagefearfulsituations,children mustbegivenalevelofautonomyandindependence.That is,childrenneedtobegiventhefreedomtoexperimentwith variouscopingstrategies(2010,Matthews). 3

King,N.J.,Muris,P.,&Ollendick,T.H.(2004).Specificphobia.InT.L.Morris &J.S.March(Eds.),Anxietydisordersinchildrenandadolescents(2nd ed.,pp.263279).NewYork:GuilfordPress.

Muris,P.,Merckelbach,H.,&Collaris,R.(1997).Commonchildhoodfearsand theirorigins.BehaviorResearchandTherapy,35(10),929937. doi.org/10.1016/S007967(97)000508

Muris,P.,Merckelback,H.,Mayer,B.,&Prins,E.(2000).Howseriousarecom monchildhoodfears?BehaviorResearchandTherapy,38(3),217228. doi.org/10.1016/S00057967(98)002046

Ollendick,T.,King,N.,&Muris,P.(2002).Fearsandphobiasinchildren: Phnomenology,epidemiology,andaetiology.ChildandAdolescent MentalHealth,7(3),98106.Retrievedfromhttp:/search.ebscohost.com/l ogin.aspx?direct=true&db=aph&AN=10454613&site=ehostlive

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Normal&CommonFears
Thetenmostcommonchildhoodfears,asperthe administrationoftheFearSurveyScheduleforChildren Revised(Muris,Merckelback,&Collaris,1997): 1. Notbeingabletobreathe 2. Gettingaseriousillness 3. Bombingattacks 4. Gettinghitbyacar 5. Fire/gettingburned Interestingly,commonchildhoodfearscanchange.Fearsare afunctionofthediagnostictoolusedforassessment.Theten mostcommonfearsuponaskingthefreeoptionquestion, Whatdoyoufearmost?(Murisetal.,1997). 1. Spiders 6.Snakes 6.Burglarbreakingin 7.Gettinglost 8.Fallingfromahighplace 9.Death/deadpeople 10.Spiders

FurtherResources
Worrywisekids.org
http://www.worrywisekids.org/anxiety/ specific_phobias.html

AnxietyDisordersAssociationofAmerica
http://www.adaa.org/livingwithanxiety/children

Healthychildren.org
http://www.healthychildren.org/English/healthissues/ conditions/emotionalproblems/Pages/Understanding ChildhoodFearsandAnxieties.aspx http://www.healthychildren.org/English/healthissues/ conditions/emotionalproblems/Pages/Phobias.aspx

2. Beingkidnapped 3. Predators 4. Thedark 5. Frighteningmovies

7.Beinghitbyacar 8.Fallingfromahighplace 9.Parentsdying 10.Burglarbreakingin

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StrategiesThatHelp
Tobesuccessfulinassistingchildrendealingwiththe developmentprocessoffears,educators,clinicians,and parentsmustbecomeeducatedinthedevelopmentalaspects ofchildrensfears.Itisvitaltoknowwhatfearsareageand stageappropriate(2010,Matthews). Activitiesinthehomeandschoolmustfocusonthe developmentoftheconceptsofpower,control,security,and selfworth,whicharethenecessaryconstructsforhealthy fearcopingskills(Robinson&Rotter,1991). Robinson&Rotter(1991)suggestthateducatorsshould integrateclassroomactivitiesthatexploreageappropriate, developmentalfearsthroughtheuseofstories,civics lessons,andspecialprojectsthatutilizethesubjectsofart, history,geography,math,science,reading,andspelling. Educatorsandparentsmustrememberthefollowing: Neveruseachildsfearasaformofdiscipline. Nevermakefunofachildsfears. Alwayslistenandtrytobeassupportiveandsympathetic aspossible. Helpthechildexplorestrategiestoovercometheirfears. Encouragethechildtotalkabouttheirfeelings. 16

AgesandStagesofFear
Fearschangeacrossagesandstagesofdevelopment. Typically,fearsvaryinfrequency,intensity,andduration,yet tendtobemild,agespecific,andtransitory(Ollendick,King, &Muris,2002). Age 06months Fear Lossofsupport,loudnoises,sudden movement

712months Strangers,suddenappearanceoflargeobjects, loudnoises 1year 2years Separationfromparent,strangers,injury, toilet Largeanimals,darkrooms,largeobjectsand machines,loudnoises,suddenchangesin Darkrooms,masks,largeanimals,snakes, separationfromparent Darkrooms,noisesatnight,largeanimals, snakes,separationfromparent Wildanimals,bodilyinjury,dark,badpeople, separationfromparent

3years 4years 5years

Source:RobinsonIII,E.,&Rotter,J.(1991).Childrensfears: Towardapreventitivemodel.SchoolCounselor,38(3),187.

AgesandStagesofFearContinued
Age 6years 7years 8years 9years 10years 11years 12years Fear Ghosts,monsters,witches,dark,beingalone, thunderandlightening Dark,monsters,storms,beinglost, kidnapping,beingalone Dark,people(kidnapper,robber,mugger), gunsorweapons,beingalone,animals Dark,beinglost,baddreams,bodilyharmor accident,beingalone Dark,people,baddreams,punishment, strangers Dark,beingalone,baddream,beinghurtby someone,beingsick,tests,grades Dark,punishment(beingintrouble,bad grades),beingalone,beinghurtortaken away,tests,grades Crime,beinghurtorkidnapped,beingalone, warandnuclearwar,badgrades,tests, punishment Failureatschool,personalrelations,war, tests,sexissues(pregnancy,AIDS),being alone,familyconcerns

Treatment
Themostsuccessfultreatmentprotocolsforphobiasinvolve exposingthechildtofearedobjectsandsituations.Thisisa keycomponentinbreakingtheassociationbetweenthefeared objectandtheexperienceoffeelingafraid(Matthews,2010). AccordingtoKingetal.(2005),...exposureisanecessary ingredientofinterventionprogramsforchildren(p.51). Furthermore,theauthorsstresstheneedforintensiveparental involvement inthetreatmentofphobicchildren(Kingetal., 2005). ThreeCategoriesofTreatment: 1. BehavioralProcedures: Systematicdesensitization Modeling ContingencyManagement 2. CognitiveBehavioralInterventions 3.BehavioralFamilyInterventions

13years

14+years

Source:RobinsonIII,E.,&Rotter,J.(1991).Childrensfears: Towardapreventitivemodel.SchoolCounselor,38(3),187. 6

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CommonSymptomManifestations
King,Muris,andOllendick(2004)state,Childhoodfearsand phobiascanbeconceptualizedintermsofthreeresponse systems:cognitive,physiological,andovert/behavioral(p. 264).Thatis,childrenexhibitamyriadofsymptomswhen experiencingfearedobjectsandsituations.Typically,children showthattheyareafraidoranxiousthroughthefollowing responses: 1. Cognitive:Commonresponsesincludestatements regardingfeelingsoffear(Ifeelscared),negativeself statements(Icantgoschool),andanticipatingencounters withthefearedobjectthatwillbringaboutharmtoones self(Thebirdwillscratchme). 2. Physiological:Increasedheartrate,sweating,drymouth, nausea,trembling,shaking,headaches,stomachaches,and changesinrespiration. 3. Overt/behavioral:Avoidanceorescapeofthefeared objectorsituation.Whenavoidanceisnotpossible, childrenmayexhibittantrums,freezeorholdarigidbody posture,thumbsuck,cry,andclingtoparents.Sleep disturbancessuchasinabilitytofallasleepandexcessive sleepcanoccur.

GenderDifferences
Boysandgirlstendtobeafraidofdifferentobjectsand situations,andtheyranktheirfearsdifferently(Murisetal., 1997).Additionally,girlstendtoexhibithigherlevelsoffear andanxietyincomparisontoboys(Muris,2007). BoysFearsFreeOption 1.Spiders 2.Predators 3.Beinghitbyacar 4.Snakes 5.Burglar 6.Frighteningmovies 7.Thedark 8.Beingteased 9.Frighteningdreams 10.Medicaloperations GirlsFearsFreeOption 1.Spiders 2.Beingkidnapped 3.Parentsdying 4.Thedark 5.Frighteningmovies 6.Thunderstorms 7.Beingteased 8.Bats 9.Bats/Ghosts/Spookythings 10.Sleepinginthedark/ Makingmistakes

Source:Muris,P.,Merckelbach,H.,&Collaris,R.(1997). Commonchildhoodfearsandtheirorigins.BehaviorResearch andTherapy,35(10),929937.

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AbnormalFearPhobias
Forsomechildren,theprocessofdevelopmentalfearsgoes awaytherebycausingthedevelopmentofineffectivefear copingstrategies(Robinson&Rotter,1991).Forsuch children,encounterswithfearedobjectsandsituationsbecome severelydebilitatingandinterferewithnormaldaily functioning(Robinson&Rotter,1991).Suchchildrenmayor maynotunderstandthattheirfearisexcessiveor unreasonable. TheresearchofMarx(ascitedbyOllendicketal.,2002), definedaphobiaas: 1. Outofproportiontothedemandsofthesituation 2. Cannotbeexplainedorreasonedaway 3. Beyondvoluntarycontrol 4. Leadstoavoidanceofthefearedsituation However,theworkofMiller,BarrettandHampe(ascitedby Ollendicketal.,2002)expandeduponthatandspecified childhoodphobiaas: 5. Persistsoveranextendedperiodoftime 6. Unadaptive 7. Notageorstagespecific

WhatcausesPhobias?
Theetiologyofchildhoodphobiasisnotfullyunderstood. Itwasoriginallythoughtthatallchildhoodfearswereacquired throughRachmanspathwaysoffearacquisition: 1.Directconditioning 2.Vicariousconditioning 3.Information/instruction(Ollendick,etal.,2002).

Currentresearchhasdiscoveredthattherearemanypossible pathwaysforthedevelopmentoffearsandspecificphobias, duetotheinconsistenciesthatexistwhenaphobiadevelopsin theabsenceofRachmanspathways(Ollendicketal,2002). AccordingtoOllendicketal.(2002),...causesmaybemulti plydetermined,ifnotoverdetermined(p.101). Additionaldevelopmentalpathways: 1. Heredity 2. Biology 3. Childtemperament 4. Environment 5. Parentalinfluencesonachild

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Prevalence&ComorbidityofPhobias
Clinicaldiagnosesofspecificphobiahaveaprevalencerateof approximately5%ofchildrenandadolescentsincommunity settingscomparedtoarateofabout15%ofchildrenand adolescentsinclinicalsettings(Ollendicketal.,2002). Anxietydisordersandchildhoodphobiasappeartohaveahigh rateofcomorbidity.Muris(2007)states,generalized anxietydisorder,separationanxietydisorder,specificphobia, andtoasomewhatlesserextent,socialphobiafrequentlyco occur(p.25).Inaddition,depressionhasthehighest comorbidityand,tolesserextents,oppositionaldefiant disorder,conductdisorder,attentiondeficithyperactivity disorder,andsubstanceabusefrequentlycoexistwithphobias andotheranxietydisorders(Muris,2007). Fromthis,childrensfearscanbesignificantlymoresevere thantheyappeartobeonthesurface.Althoughchildhood fearsareanormaldevelopmentalprocess,thisprocesscanvery easilychangefromnormaltodisordered(2010,Matthews).

DSMIVTRCriteriaSpecificPhobia
ThefourtheditionoftheDiagnosticandStatisticalManualof MentalDisorders(DSMIVTR)liststhefollowingcriteriafor specificphobia:

1) Markedandpersistentfearthatisexcessiveor unreasonable,cuedbythepresenceoranticipationofa specificobjectorsituation 2) Exposuretothephobicstimulusalmostinvariably provokesanimmediateanxietyresponse,whichmaytake theformofasituationallyboundorsituationally predisposedpanicattack 3) Thepersonrecognizesthatthefearisexcessiveor unreasonable 4) Thephobicsituationisavoided,orelseenduredwith intenseanxietyordistress 5) Theavoidance,anxiousanticipation,ordistressinthe fearedsituation(s)interferessignificantlywiththe personsnormalroutine,occupationoracademic functioning,orsocialactivitiesorrelationships,orthereis markeddistressabouthavingthephobia 6) inindividualsunder18years,thedurationisatleast6 months. Source:AmericanPsychiatricAssociation(2000). Diagnosticandstatisticalmanualofmentaldisorder,four edition,textrevision.Washington,DC:American PsychiatricAssociation

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CaseStudy
NormalFear Ben,age6,getsintobedwithhisfavoritestuffedanimals, TeddyandMr.Elephant,andgetsreadytolistentoabedtime story.Ashismomfinishesthelastlinesofhisfavoritebook, heaskshismomtocheckinhisclosetandunderhisbedfor monsters.Hismothergladlyindulgeshisrequestsandreplies, Allclear,Ben!Nomonstersinhere!ShethenremindsBen thathisnightlightwillbeonandthatsheandDaddyarejust downthehall.Shealsosays,Ben,ifyoufeelafraidofthe dark,squeezeTeddyandMr.Elephantextratight.Withthat, BenrollsoverandsoftlyremindsTeddyandMr.Elephantthat thereisnothingtobeafraidofwhileslowlyfallingasleep. AbnormalFear Jake,age10,laysinbedlisteningtohisfatherreadinghima storybeforebed.Ashisfatherreads,Jakekeepsinterrupting andinquiringifhehastosleepwithallthelightsoff.His fatherreplies,Jake,thenightlightwillbeon.Itsokay. Thereisnothingtobeafraidof.Jaketightlyclutchesa belovedstuffedanimalwhilehisentirebodybeginstotense. Afterhisfatherkisseshimgoodnight,Jakelaysinbedtrying totellhimselfthatthereisnothingtobeafraidof.Asthe minutestickby,hefeelsincreasinglyanxious.Hispalms begintosweat,andhisstomachstartstohurt.Finally,heleaps outofbedandturnsonallthelights.Jakeeventuallyfalls asleep,butfrequentlywakesupinthemiddleofthenight paranoidofthedarkandrunstohisparentsroom.Thiscycle occursnightly,disruptingthesleepoftheentirefamily(2010, Matthews). 10

Assessment
Bestpracticeassessmentofphobicchildrenshouldbemulti informant(child,parent,andteacher)andmultimethod(i.e. relyingonmorethanonedatagatheringprocedure).Further, theassessmenttoolsusedshouldbepsychometricallysound andalsobeageappropriate,takingintoaccountthechilds leveloffunctioningandcognitiveverbalskills(King,Muris, &Ollendick,2005,p.50). Kingetal.(2005)recommendthefollowingdiagnostictools:
1. ChildVersionoftheAnxietyDisordersInterview

ScheduleforDSMIV
2. FearSurveyScheduleforChildrenRevised 3. SpiderPhobiaQuestionnaireforChildren 4. MultidimensionalAnxietyScaleforChildren 5. ScreenforChildAnxietyRelatedEmotionalDisorders 6. SpenceChildrensAnxietyScale

Ultimately,acomprehensive,yetcaring,sensitiveapproach involvingparents,teachers,andthechildshouldbetaken whenassessingchildrensfears.Whileitisimportantto utilizeresearchbaseddiagnostictools,itisevenmore paramounttotalktothechildtoobtainamorepersonalized, detailedviewoftheirindividualfears(2010,Matthews).

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