Childhood Phobias And Anxieties
Childhood Phobias And Anxieties
Charles Sophy (Private Practice in Adult, Child and Adolescent Psychiatry) gives expert video advice on: How prevalent are anxieties and phobias in children?; What is the professional treatment for a child with phobias and anxieties?; What can I do to prevent my child from developing an anxiety? and more...
What is "anxiety"?
Anxiety is a general feeling that all people feel. Things that trigger anxiety in everybody are different from me to you; it may be the weather for me, it may be the finances for you, it may be not sleeping well, but there are different variables that will trigger anxiety in an individual that will manifest itself in different ways. Some people have higher tolerances for their anxiety and it doesn't come out until it spills to another range; other people have lower tolerance and it comes out more often and more frequently. It commonly manifests itself as what people know as worry, and how that worry translates for everybody is different. A child doesn't know it's worry; it may come out as frustration, anger, rage, or a tantrum. An adult may know it's worry, and they may not eat for a day or so, they may ruminate and think about it, they may not want to leave their home, or they may not be able to fall asleep. So, how anxiety will be manifested depends on the individual, their age, and the kinds of coping skills they instil within themselves.
What is a "phobia"?
A phobia is a fear-based manifestation of the fear. So, it may be a phobia of spiders, heights or crossing the street, but it is anxiety-based manifestations of fear. There are certain criteria that you have to meet to have a phobia. Fear and anxiety get to a certain level that then spills into the phobic range. And the phobic range is diagnosed through criteria, again by the American Psychiatric Association, and then the format that that fear will take will either be bridges, spiders or anything else.
When does my child's fear become a phobia?
A fear and a phobia differ in the fact that a fear starts off with, “I'm afraid of walking through the door.” Whereas it spills into the phobic range when it becomes “I'm afraid to walk by the door, and I can't wear this shirt when I go to touch the door, and I've got to step back, and I can only walk on this block, I can't walk on that”. As it adds up, and the things and the elements that prevent the ability to go through the fear build up, that's when you're in the phobic range.
How prevalent are anxieties and phobias in children?
Anxieties, fears, and phobias in children are not as significant as you would think. There's a lot of normal or age appropriate fears and anxieties in children that have to be worked through and allowed to develop on their own and then dissipate. So as far as diagnosing those anxieties, fears and phobias, there are usually three to five percent of the general population. Other than that it's the age appropriate stuff that a child should have that a parent needs to just foster and work through.
When do children begin to develop anxieties or phobias?
Any age of a child can exhibit an anxiety or a phobia, some of them are just genetic. So if you have a anxious mom or dad often times that's genetic. It can be exhibited as young as two or three months of age with stranger anxiety, when your child can't really tolerate seeing somebody and they really don't work themselves through that process. You can see it at the age of two or three or four when it's time to seperate to go to a program, a mommy and me program or a DK or whatever the program will be in your area, to be able to seperate you will see separation anxiety come up, transition anxiety come up. Going from eating to watching television or playing an activity and getting ready for bed. So identifying those kinds of spots for your child that are rough and allowing them transition times giving them the knowledge that this is what's going to happen, empowers them and they are really able to get their arms around it and move forward.
What are common, age-appropriate childhood fears?
Age-appropriate childhood fears include separation anxiety from early childhood, such as leaving your child with somebody and your child feels that you feel it. This includes those days of pre-kindergarten when you have to leave you child and both of you are feeling that pull of transition into higher levels of school. Stranger anxieties apply as well, such as when your child is 2 to 3 months of age and they scream when they see somebody that they don't know because they are used to seeing your face. There is also general anxiety for sleeping. It all depends, but they're all within the age-appropriate expectations and spectrum and its up to a parent to decide if those symptoms or the severity of those anxieties become significant and meet the criteria of a diagnosable mental health disorder. If so then you're in a different range and the treatment may be different.
Are age-inappropriate fears considered phobias?
There are some age-inappropriate anxieties such as a 10 year old who can't separate, or a 9 year old who can't tolerate a stranger, or a 6 year old who should be able to go off to kindergarten or first grade and be appropriate. So, there are age-inappropriate fears that are considered phobias. However, that doesn't mean it's necessarily diagnosable and will meet the criteria. It means that reassurance needs to be put in place and some family dynamic work may dissipate that for a child.
What are the most common symptoms of anxieties and phobias in children?
Some common signs and symptoms you would see in a child that may have anxieties or fears will be: crying, tantruming at certain times or certains episodes of their life when it's time to get ready to go or you're leaving for the evening and your nanny or babysitter are there and your child starts to break down or they don't want to separate and they hold on, or they don't want to share necessarily, or they're not integrating into a peer group. You'll start to see the bumps in the road that typically you woundn't have seen with your other children, or other children in the peer group. That should start to raise your level of suspicion to say: "maybe my child is a little anxious". You'll also maybe see a sleep issue where they'll be having some sleep anxiety. Where getting ready for bed is a little anxious. It's dark out, they're feeling alone, they're feeling scared and they're clinging a little bit - whether that's clinging physically and/or clinging emotionally, that's a huge sign as well.
What is the professional treatment for a child with phobias and anxieties?
The treatment for a child with phobias or anxieties is to firstly identify it; notice where it's happening. And when you go in, if you want to get treatment, go to your primary care provider for a referral. Be able to give them as many specifics as you can. The phobia or anxiety happens then, it happens now, this is what I see triggers the phobia or anxiety. And all of that information allows them to be better able to diagnose it for you. Then they will give you a treatment plan for the phobia or anxiety. The treatment plan may be just some simple changes to the family dynamics, transition times. Make sure you give Johnny ten minutes before we're going to eat, five minutes before we're going to eat, three minutes before we're going to eat, it's time to clean up. Whatever will give them control and the knowledge to know that their life ahead is planned, and they know it. That empowerment will allow them to go. That's usually the kinds of treatment we look at, unless we're looking at a medical piece, which is the medications because the symptoms are really inhibiting their ability to function. That's not often that we do that. Mostly we don't have to go to that extreme, we just usually do the behavioral stuff and the education for the parents, and the empowerment of their child.
What can I do to prevent my child from developing an anxiety?
As a parent, you must realize that your child is an individual, and if they have the predisposition to have an anxiety, they will have it. As a parent, the best thing to do is to be able to have an open mind; know yourself well enough that if you have anxieties, you are not putting them onto your child, and that you're not modelling ways to behave when you worry or you double-check things. So self-awareness for a parent can prevent children developing anxieties. And then being able to have open communication with your child, to say or show you that they feel anxious or scared, and that they will get some guidance from you if they do open up about anxiety.