Overview of fears and phobias in children and adolescents
- Marilyn Augustyn, MD
Marilyn Augustyn, MD
- Section Editor — Developmental and Behavioral Pediatrics
- Associate Professor
- Boston University School of Medicine
All children have fears at some point in their lives . Children are particularly susceptible to learning fear from their parents. Most childhood fears are normal, temporary, and eventually outgrown. Some fears, however, may be symptoms of an anxiety disorder. Studies show that anxiety disorders are among the most common psychiatric disorders in childhood/adolescence.
Fears and anxiety are on a continuum, with phobias at the more severe end of the spectrum where symptoms are accompanied by functional impairment. Children with this presentation warrant additional evaluation for specific phobia or other anxiety disorders.
This topic describes the pathogenesis, clinical presentation, course, differential diagnosis, and initial management of fears in children and adolescents. The epidemiology, clinical manifestations, course, assessment, and diagnosis of anxiety disorders in children are discussed separately. Pharmacotherapy and psychotherapy for anxiety disorders in children are also discussed separately. (See "Anxiety disorders in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, and course" and "Anxiety disorders in children and adolescents: Assessment and diagnosis" and "Psychotherapy for anxiety disorders in children and adolescents" and "Pharmacotherapy for anxiety disorders in children and adolescents".)
- Ollendick TH, Yang B, King NJ, et al. Fears in American, Australian, Chinese, and Nigerian children and adolescents: a cross-cultural study. J Child Psychol Psychiatry 1996; 37:213.
- Ollendick, T. Fears and phobias in children: Phenomenology, epidemiology, and aetiology. Child Adolesc Ment Health 2002; 7:98.
- Schowalter JE. Fears and phobias. Pediatr Rev 1994; 15:384.
- Brent, D, Rabinovich, H, Birmaher, B, Campo, J. Major psychiatric disorders in childhood and adolescence. In: Developmental Behavioral Pediatrics, 3rd ed, Levine, MD, Carey, WB, Crocker, AC (Eds), WB Saunders, Philadelphia 1999. p.632.
- Muris P, Merckelbach H, de Jong P, Ollendick TH. The etiology of specific fears and phobias in children: a critique of the non-associative account. Behav Res Ther 2002; 40:185.
- Rachman S. The passing of the two-stage theory of fear and avoidance: fresh possibilities. Behav Res Ther 1976; 14:125.
- Rachman S. The conditioning theory of fear-acquisition: a critical examination. Behav Res Ther 1977; 15:375.
- Kendler KS, Gardner CO, Annas P, et al. A longitudinal twin study of fears from middle childhood to early adulthood: evidence for a developmentally dynamic genome. Arch Gen Psychiatry 2008; 65:421.
- Merckelbach H, Muris P, Schouten E. Pathways to fear in spider phobic children. Behav Res Ther 1996; 34:935.
- King NJ, Eleonora G, Ollendick TH. Etiology of childhood phobias: current status of Rachman's three pathways theory. Behav Res Ther 1998; 36:297.
- Menzies RG, Clarke JC. The etiology of childhood water phobia. Behav Res Ther 1993; 31:499.
- McNally RJ, Steketee GS. The etiology and maintenance of severe animal phobias. Behav Res Ther 1985; 23:431.
- Bauer DH. An exploratory study of developmental changes in children's fears. J Child Psychol Psychiatry 1976; 17:69.
- Ferrari M. Fears and phobias in childhood: some clinical and developmental considerations. Child Psychiatry Hum Dev 1986; 17:75.
- Anxious symptoms. In: The Classification of Child and Adolescent Mental Diagnoses in Primary Care. Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version. Wolraich, ML (Ed). American Academy of Pediatrics, Elk Grove Village, IL 1996.
- Gordon J, King NJ, Gullone E, et al. Treatment of children's nighttime fears: the need for a modern randomised controlled trial. Clin Psychol Rev 2007; 27:98.
- King N, Ollendick TH, Tonge BJ. Children's nighttime fears. Clin Psychol Rev 1997; 17:431.
- Kendler KS, Gardner CO, Annas P, Lichtenstein P. The development of fears from early adolesence to young adulthood: a multivariate study. Psychol Med 2008; 38:1759.
- Connolly SD, Bernstein GA, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 2007; 46:267.
- Meltzer H, Vostanis P, Dogra N, et al. Children's specific fears. Child Care Health Dev 2009; 35:781.
- Muris P, Steerneman P, Merckelbach H, Meesters C. The role of parental fearfulness and modeling in children's fear. Behav Res Ther 1996; 34:265.
- Christophersen, ER, VanScoyoc, SM. Stormy weather. Advise parents on how to handle weather-related fears among children. AAP News 2006; 27:1.
- Van Houtem CM, Laine ML, Boomsma DI, et al. A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears. J Anxiety Disord 2013; 27:379.
- Biel MG, Klein RG, Mannuzza S, et al. Does major depressive disorder in parents predict specific fears and phobias in offspring? Depress Anxiety 2008; 25:379.
- Dunne G, Askew C. Vicarious learning and unlearning of fear in childhood via mother and stranger models. Emotion 2013; 13:974.
- Taylor S. The hierarchic structure of fears. Behav Res Ther 1998; 36:205.
- Anxiety Disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR®). American Psychiatric Association, Washington, DC 2000. p.429.
- Le Roux, P, McCann, CM. Phobias. In: Primary Pediatric Care, 4th ed. Hoekelman, RA (Ed), Mosby, St. Louis 2001. p.848.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
- Evans DW, Gray FL, Leckman JF. The rituals, fears and phobias of young children: insights from development, psychopathology and neurobiology. Child Psychiatry Hum Dev 1999; 29:261.
- Marks I. The development of normal fear: a review. J Child Psychol Psychiatry 1987; 28:667.
- Muris P, Merckelbach H, Gadet B, Moulaert V. Fears, worries, and scary dreams in 4- to 12-year-old children: their content, developmental pattern, and origins. J Clin Child Psychol 2000; 29:43.
- Agras WS, Chapin HN, Oliveau DC. The natural history of phobia. Course and prognosis. Arch Gen Psychiatry 1972; 26:315.
- Ollendick, TH, King, NJ, Yule, W (Eds). International handbook of phobic and anxiety disorders in children and adolescents, Plenum Press, New York 1994.
- Dadds MR, Spence SH, Holland DE, et al. Prevention and early intervention for anxiety disorders: a controlled trial. J Consult Clin Psychol 1997; 65:627.
- Manassis K, Hood J. Individual and familial predictors of impairment in childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 1998; 37:428.
- Warren SL, Ollendick TH, Simmens SJ. Reliability and validity of the Fear Survey Schedule for Infants-Preschoolers. Depress Anxiety 2008; 25:E205.
- Spence SH, Rapee R, McDonald C, Ingram M. The structure of anxiety symptoms among preschoolers. Behav Res Ther 2001; 39:1293.
- Edwards SL. Temperament and environmental risk factors contributing to anxiety symptoms in preschool-aged children. Sydney, Australia: Macquarie University. 2007.
- Drotar D. Detecting and managing developmental and behavioral problems in infants and young children: The potential role of the DSM PC. InfantsYoung Child 2004; 17:114.
- American Academy of Pediatrics. The Classification of Child and Adolescent Mental Disorders in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent Version, American Academy of Pediatrics, Elk Grove Village, IL 1996.
- Bennet Johnson, S, Melamed, BG. The assessment and treatment of children's fears. In: Advances in child psychology, Lahey, BB, Kazdin, A (Eds), Plenum Press, New York 1979. p.107.
- Kashani JH, Orvaschel H. A community study of anxiety in children and adolescents. Am J Psychiatry 1990; 147:313.
- Levine, ML. Middle childhood. In: Developmental Behavioral Pediatrics, 3rd ed, Levine MD, Carey, WB, Crocker, AC (Eds), WB Saunders, Philadelphia 1999. p.51.
- Ollendick TH, Hagopian LP, Huntzinger RM. Cognitive-behavior therapy with nighttime fearful children. J Behav Ther Exp Psychiatry 1991; 22:113.
- American Academy of Pediatrics. Fears and Phobias. In: Caring for Your School-Age Child Ages 5 to 12. The Complete and Authoritative Guide. Schor, EL (Ed), American Academy of Pediatrics, Elk Grove Vill, IL 1995. p.263.
- Compton SN, March JS, Brent D, et al. Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J Am Acad Child Adolesc Psychiatry 2004; 43:930.
- Roberts CM, Kane R, Bishop B, et al. The prevention of anxiety and depression in children from disadvantaged schools. Behav Res Ther 2010; 48:68.
- Pina AA, Zerr AA, Villalta IK, Gonzales NA. Indicated prevention and early intervention for childhood anxiety: a randomized trial with Caucasian and Hispanic/Latino youth. J Consult Clin Psychol 2012; 80:940.
- Developmental factors
- Familial factors
- Environmental triggers
- CLINICAL PRESENTATION
- Fears versus phobias
- Assessment instruments
- DIFFERENTIAL DIAGNOSIS
- Normal fears
- Anxiety disorders
- Medical conditions
- MANAGEMENT STRATEGIES
- Parental education
- Support strategies
- Mental health care
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS