Phobias in Children and Adolescents

A phobia is a major fear of a specific object or situation that is excessive or unreasonable.  Exposure to the feared object or situation almost always results in immediate symptoms of anxiety. Common phobias include fear of animals, insects, blood, heights, injections or flying. The feared object or situation is avoided, anticipated with fear, or endured with extreme anxiety to the extent that it interferes with normal routines and activities. In children, the fear or anxiety may be expressed by crying, tantrums, freezing or clinging to others.

A specific phobia must be differentiated from other anxiety disorders that are often seen in children and adolescents:

• Social anxiety disorder. Fear or anxiety of one or more social or performance situations in which the child is exposed to possible evaluation by others (for example, talking on the phone, ordering in a restaurant, reading aloud, giving a book report in front of the class). 
• Separation anxiety disorder. Recurrent and severe distress when expecting or experiencing separation from home or from attachment figures.
• Selective mutism. The inability to speak in specific social situations in a child or adolescent who can and does speak in some settings and to some people.
• Panic disorder. Repeated, unpredictable anxiety attacks that can lead a child or adolescent to fear that they are dying, “going crazy,” or have a severe health problem. People having panic attacks often experience heart palpitations, shortness of breath, dizziness, sweating, other physical symptoms, and an intense urge to flee the situation.

All children and adolescents experience some anxiety. It is a normal part of growing up. However, when worries and fears do not go away and interfere with a child or adolescent's usual activities (like school, friends, family functioning), an anxiety disorder may be present. Children of parents with an anxiety disorder are more likely to develop an anxiety disorder.

Causes and Risk Factors

As with many behavioral or mental health conditions, the causes of phobias are not fully understood. Researchers believe that they may involve naturally occurring chemicals in the brain called neurotransmitters. However, it is likely that phobias have a complex set of causes that may include the body's biological processes, genetics, environment, and life experiences.

Diagnosis and Tests

A child psychologist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive diagnostic evaluation. Parents who note symptoms of severe anxiety in their child or teen can help by seeking an evaluation and treatment as soon as possible. Early treatment may help prevent future problems.

A diagnosis of a specific phobia requires that the child’s excessive fear and anxiety last at least 6 months and cause significant distress or impairment in important life areas (such as at school, with friends, or at home).

Treatment

Studies that have been done with children and adolescents have shown that cognitive- behavioral therapy (CBT) can be a very effective treatment for anxiety. CBT is a short-term, problem-focused approach. Children and parents are educated about the role of anxiety in the specific symptoms the child is experiencing. The goal of CBT is to help the child manage emotional distress, physical symptoms, negative thoughts and problematic behaviors that often accompany anxiety in ways that promote bravery. With CBT, children with phobias are taught to learn to recognize the physiological symptoms of anxiety, to use realistic “self-talk” rather than negative self-talk, and to “face their fears” in a stepwise manner. Parents are included to provide reinforcement and rewards for children’s success, and to learn to implement and practice the skills with their children at home and in the community.