Phobias

Is your child:

• Saying, “There’s a monster under my bed?”
• Suffering from a fear of being alone?
• Becoming extremely worried when parents go to the basement?
• Struggling to sleep in his own bedroom at night?
• Complaining of the dark and unable to sleep?
• Fearing dogs so much that that she will not go to the park?
• Seeming to be unable to stop talking about spiders?
• Showing intense fear of being bitten by a bug or stung by a bee?
• Fearing riding the elevator, making you climb eight flights of stairs at the doctor’s office?
• Becoming inconsolable before receiving an immunization?
• Refusing to go outside if it is windy or raining? Deathly fear of tornados or storms?

Your child may suffer from excessive fears or phobias. For example, your child may be afraid of dogs, the dark, germs, or monsters.

The fears mentioned in this article are overwhelming and atypical, meaning that the fear is out of proportion or is developmentally inappropriate for the child’s age. Specific fears are only a problem if they significantly impact daily functioning and the ability to enjoy life.

Fears that seem debilitating, persistent, or even exhausting may represent a true psychological symptom worthy of diagnosis and treatment. In the case of a phobia, a child is not generally anxious, just overwhelmingly afraid of something. This phobia often feels to parents like unreasonable fear that does not extend to other areas of life.

Your child may be so afraid of shots that everyone in the house dreads the annual doctor’s appointment. This child worries for months about the flu shot and often cries for hours or cannot sleep for fear of the shot. The fear leads to refusal to go into the doctor’s office, a panic attack or a meltdown at the thought.

This child may avoid sharing symptoms of illness for fear that the doctor will be called. Lots of kids are afraid of shots, but a phobia would extend to significantly impact your child’s life. After the shots are done, as painful and awful as it may be for everyone, you would see a substantial decrease in anxiety until it becomes fall again, and you begin to get close to the annual physical.

Excessive worry and phobias are types of specific anxiety. It is important to consider what kind of anxiety your child may be experiencing. Fears that are more generalized across a number of different situations and variables are not phobias. Questions you may pose are as follows:

Is this a specific phobia? Specific phobias are intense fears about specific situations, objects, or animals.

Is this separation anxiety? Children with separation anxiety become extremely upset when they are apart from parents. Is the anxiety related to social situations? Social anxiety is fears of being around people, being embarrassed, or having to be ‘on stage’ in a large crowd.

Is anxiety more general in nature? Generalized anxiety is worry that occurs across settings (school, home, community). It is important to consider the level of impairment from the anxiety. Anxiety can be clinical and significant. In this case, the child avoids participation at school or in social settings, likely has some physical symptoms such as tummy-aches, and may have panic attacks.

Alternately, a child can have subclinical anxiety, that is, just regular worries. Some level of anxiety is okay, but excessive anxiety can cause major problems in a person’s day-to-day life.

If anxiety centers on only a certain situation in a child’s life, like school, consider other factors like academic struggles. If a child is only anxious around test performance, the real concern may be an underlying learning disability. If a child is anxious only in social situations, the problem may be an underlying deficit in social skills and abilities. In this case, it would be important to consider an autism spectrum disorder or ADHD. If your child is fearful of the dark, dogs, heights, storms, shots or bugs, and this fear has a significant impact on day-to-day functioning, a specific phobia may be present.

Clinically, phobias are common in children. If you find yourself reorganizing your life to avoid flying because your child refuses to go on an airplane, your child may have a phobia.

If you get the nasal spray flu shot even though it doesn’t work, to save peace of mind, your child may have a phobia of injections. If you walk away from the park because there will be fewer dogs, and dogs mean your child will run away shrieking and running, then maybe your child has a phobia.

A child who has a phobia will have an extreme reaction, a tantrum, panic symptoms like hyperventilating, sweating, or nausea. You will likely be able to see the fear visibly in your child. Anxious children often have wide eyes, cold, clammy hands, foot tapping, hand wringing, and stiff posture.

Treatment for these extreme fears will include gradual exposure paired with coping strategies, relaxation and anxiety reduction. Having the help of a professional is often recommended, and research shows that phobias are relatively easy to treat, so that is the good news!

If your child has a phobia that is impacting day-to-day functioning, it may help to gradually expose your child to the feared stimuli and to allow anxiety to remit, thus fighting that need to escape and avoid. This gradual exposure is best completed with the help of a professional counselor or psychologist, particularly if the fear is severe and significant.

If your child fears dogs, first you could read books about dogs and look at pictures while noticing your child’s anxiety level. Do this over several weeks spacing out the books until your child can read the books without worrying. Then, watch a familiar dog from a distance without contact. Gradually move to getting closer and closer, making sure the “exposure” is safe and will not traumatize your child.

Work to be able to let a familiar dog sniff your child and to have them feel comfortable petting the animal. In public, you do not want your child approaching unfamiliar dogs, but it is nice to be able to walk down the street without screaming and crying at the sight of an animal.

By exposing your child gradually to the feared object or animal, you may be able to alleviate mild anxiety before it becomes more serious. This regular exposure to the feared object without allowing for escape tends to alleviate anxiety over time. If, however, the child is already experiencing extreme distress, seek out the services of a psychologist right away.

Approach a fear of the dark similarly, with gradual exposure until your child is quite comfortable with the lights on, just a lamp, the night light, and so on. As we noted, working with a clinician who has expertise in this area can help guide the speed and nature of these “exposures” with “response prevention,” meaning the child does not try to escape the scary thing. If your child experiences fear and avoids the stimulus, it reinforces the phobia because getting away alleviates anxiety. You want to see anxiety decrease in the presence of something feared or in a simulated situation in which the feared thing is introduced in books or pictures. Phobias are relatively easy to treat, as noted above, with a little support.

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

• General anxiety: anxiety that occurs in many contexts; not necessarily just in the presence of one or a few feared stimuli
• Self-esteem: anxiety that occurs in more than a few situations and is related to the judgments of others. Prolonged anxiety and perception of failure leads to decreased self-esteem and can lead to depression
• Socializing problems (Socializing) or Social anxiety: anxiety related to social deficits and trouble reading social cues

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this information does not serve as a diagnosis in any way. See the ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

• Specific Phobia (Anxiety Disorders): anxiety related to a specific fear that causes clinically significant distress like the dark, dogs, or spiders
• Generalized Anxiety Disorder (Anxiety Disorders): excessive worry that has an impact on day-to-day functioning; look at anxiety across settings to see what diagnosis fits best
• Separation Anxiety Disorder (Anxiety Disorders): anxiety that is related to being separated from a primary caregiver, usually in young children
• Social Anxiety Disorder (Anxiety Disorders): anxiety related to feeling incapable in social situations but not necessarily in others; may stay away from birthday parties but feel okay on tests
• Autism Spectrum Disorder: anxiety related to deficits in social communication and restricted interests or behaviors that may lead to a preference for routine and repetitive interests; challenges in reading other’s social cues
• Depression: anxiety and depression are on a continuum; low self-esteem may lead to anxiety at first, but depression can result later

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

• CLEAR Child Psychology: to obtain a customized profile of concerns for your child or to consult ‘live’ with a psychologist
• Psychotherapist or Play Therapist: to treat anxiety using exposure treatment in-vivo or practiced
• School Psychologist: to treat anxiety in the school setting, particularly if the fear is of something like storms that could crop up at school; to look at ways to adjust the setting to lessen anxiety like an extra support person during tornado drills
• Psychologist or Neuropsychologist: to conduct a full assessment to look at symptoms in mental health context

These professionals may recommend or administer the following tests for this symptom:

• Roberts, BASC-3, Clinical Interview, RCMAS, CDI-2, Human Figure Drawing, Brief Projective Measures: social-emotional assessment (Neuropsychological or psychological evaluation)
• TOL-II, CTMT, TOVA: attention and executive functioning assessment as anxiety can lead to challenges sustaining attention and possibly academic failures (Neuropsychological evaluation)
• WISC-V: cognitive assessment to determine what interventions may work best (Psychological, or School Psychological evaluation)
• ADOS-2: social-emotional assessment for concerns indicating an autism diagnosis should be considered; many children with autism have a number of unusual and extreme fears that go along with social communication challenges and restricted interests or repetitive behavior

[1] Huebner, Dawn & Matthews, Bonnie (2008). What to Do When You Dread Your Bed: A Kid’s Guide to Overcoming Problems With Sleep (What to Do Guides for Kids).

Amazon: https://www.amazon.com/What-When-You-Dread-Your/dp/1433803186/

[2] Huebner, D. (2005). What to do when you worry too much: A kid’s guide to overcoming anxiety.

Amazon: https://www.amazon.com/What-When-You-Worry-Much/dp/1591473144/

[3] Peters, D.B. (2013). From worrier to warrior: A guide to conquering your fears.

Amazon: https://www.amazon.com/Worrier-Warrior-Guide-Conquering-Fears/dp/1935067249/

[4] Culbert, Timothy &  Kajander, Rebecca. (2007) Be the Boss of Your Stress (Be The Boss Of Your Body®).

Amazon: https://www.amazon.com/Be-Boss-Your-Stress-Body/dp/1575422565/

[5] Meiners, Cheri J. (2003). When I Feel Afraid (Learning to Get Along).

Amazon: https://www.amazon.com/When-Feel-Afraid-Learning-Along/dp/1575421380/

[6] Green, Andi (2011) Don’t Feed The WorryBug.

Amazon: https://www.amazon.com/Dont-Feed-WorryBug-Soft-Cover/dp/0979286077/

Image Credit:
Description: childhood fears. sand therapy. the child plays with the sand. burying insects in the sand. the fight against childhood fears. the fear of insects
Stock Photo ID: #425856199 (Shutterstock)
By: Tatyana Dzemileva
Child-phobia-treatment
Previously Licensed on: May 21, 2017
Stylized by Katie Harwood exclusively for Clear Child Psychology

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