The Development of Children's Phobias - Essay Example

The Development of Phobias in Children Fears and phobias All children experience different degrees of fear at some point in their childhood. However,these are usually transient and are either are lost or resolved with time. When a certain fear regularly interferes in the child’s functioning, it may be necessary to evaluate the fear, and to classify this as phobia. Strictly speaking, fear and phobia are two different entities (Augustyn, 2009). Fear is an emotionally unpleasant reaction to a perceived danger source; whether this danger is real or imaginary does not matter, although fear can also precisely assess the future occurrence of real harm. It is considered an adaptive response which is necessary for survival. Fears are normally age-specific with the nature and content of these fears change as the children grow older (King & Ollendick, 1989). Fear, when excessive and persistent, becomes phobia. Phobias are characterized by a compulsive and persistent dread with an object of fear. Most of the time though, the child realizes that the danger is small in proportion to the dread, but there is no feeling of reassurance and thus, avoidance of the object or situation is foremost always on his mind (Augustyn, 2009). However, in this essay, the words phobia and fear are interchanged loosely. Infants’ and toddlers’ fears are multitude, and are related to separation from parents, animals, loud noises and the dark. From age 6 to 11 years of, fear of bodily injury and low school achievement persist. Although the number of children with age-specific fears are high, and there are significantly less children with phobic disorders, the data on school phobias is nil (King & Ollendick, 1989). It is also possible that anxiety disorders and phobias are not recognized earlier and could be undiagnosed in children (Emslie, 2008). Different phobias in children The Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV-TR) classifies phobias under anxiety disorders. The DSM-IV-TR identifies and describes three phobia types: specific phobia or simple phobia, social phobia, and agoraphobia (American Psychiatric Association, 2000). The three general classifications of phobias are all observed in children, albeit at significantly different levels as they go through the different stages of childhood (Kendler, Gardner, Annas, Neale, Eaves, & Lichtenstein, 2008). Social phobia, according to the DSM-IV-TR, is a form of an anxiety disorder manifested by an intense and persistent fear of social or performance wherein an individual perceives that he will be subjected to embarrassment, such as speaking in front of an audience. Also known as social anxiety disorder, it is a serious mental health problem that affects 3.7% of the American population aged 18-54 years (Social Phobia, 2009). The onset of social phobia always occurs during childhood, resulting in impairment in many areas of children’s development and functioning (Gisburg & Grover, 2005). Among the most prevalent psychiatric disorder in the youth (Gisburg & Grover, 2005), social phobia affects 5%-15% of children at some point in their teen years (Heimberg, Stein, Hiripi, & Kessler, 2000). However, this disorder is usually unidentified and untreated because it has always been dismissed as simple "childhood shyness.” Cognitive-behavioral and pharmacological treatments are recommended. Agoraphobia is an anxiety disorder manifested by strong fear of places and situations where escape is perceived to be difficult. Individuals with agoraphobia are afraid of being dizzy, fainting, or going crazy (American Psychiatric Association, 2000). Agoraphobias may be accompanied by panic disorders. In children, panic attacks are common with agoraphobics; panic attacks are usually manifested public places. The panic attacks are characterized by unexpected and recurring periods of fear and discomfort. It is usually accompanied by feelings of shortness of breath, rapid heartbeat, dizziness, trembling, dread, and the feeling of impending death (American Academy of Child and Adolescent Psychiatry, 2004). Panic disorders are common and can be treated with drugs. Medications proven effective in adults can also be used to treat agoraphobic children (Ballenger, Carek, Steele, & Cornish-McTighe, 1989). Specific phobias in children are many. These include intense fear of heights, dark places, enclosed spaces, animals, spiders, visits to the dentists and many more. Some of these phobias may occur at certain ages only and are overcome later in their development, while other phobias are retained into adulthood. In a study in Britain, approximately 35% of children were assessed to have at least one of twelve fears (Meltzer, Vostanis,  Dogra,  Doos, Ford, Goodman, 2009). The most common were fears of animals, injections and blood, and the dark. Fears of imaginary supernatural beings, loud noises and the dark were common in younger children, while girls mostly fear animals. Ethnic groupings also affected the nature of the fears, an observation that was verified in another study (Ollendick, Yang, King, Dong, & Akande, 1996). Cultures, traditions and values also affect the nature of feared objects. The origin and development of phobias Many studies have delved into the origins and development of the different phobias in children, adolescents, and adults. Since phobias develop or originate from ordinary fear, it is worthwhile to understand how fears of any degree develop. Five factors were revealed to contribute significantly to the etiology of phobic fears. These are separation, nature, social, mutilation, and animal fears (Torgersen, 1979). Other factors important in the development of phobias were environmental factors, and social and emotional adjustment. In addition, based on results obtained from twin studies, genetic factors were found to contribute to the content and intensity of phobic fears. The most early and famous explanation of the etiology of fear is the conditioning theory, which was published by Rachman in 1977. This theory focuses more on the effects of environment on development of phobias. The conditioning theory was the result of many fear induction experiments on laboratory animals, combat soldiers, children, and clinical situations. According to this theory, fear and phobia are acquired via three ways: direct conditioning, vicarious learning and instruction or information (Rachman, 1977). The acquisition process in itself is already a form of conditioning. With direct conditioning, the strength of fear is directly associated with the number of times and the intensity that the stimulus causing pain or fear is experienced. Direct conditioning also results in ready aversion even in the absence of the stimulus. Similarly, vicarious exposure and transmission of information can produce fear even in the absence of actual stimuli. In vicarious exposure, the observed experience of others produces fear in an individual. Transmission or information, without actually and vicariously experiencing fear and aversion can lead to phobias. Rachman’s theory of fear acquisition have been evaluated, accepted, and challenged many times. In Australian and American children, fears were attributed to the vicarious and instructional pathways, although direct conditioning was also found to play a role (Ollendick & King, 1991). Gender effects, but not nationality, was shown to be significant, with boys reporting more direct and vicarious experiences. However, age may also play a factor in fear acquisition (Sayfan & Lagattuta, 2008). Other studies also provide support for the theory of fear acquisition in the development pathways of childhood phobias. However, the original three pathways proposed by Rachman have been expanded to five: (1) a first-hand experience of a traumatic event; (2) observation of the traumatic experience of others; (3) observation of fears in others; (4) fear was taught and, (5) absent memory of fear stimulus (Kendler, Myers, & Prescott, 2002). The observation of traumatic experiences and fear in others is a component of the social learning theory of phobia acquisition (Kendler, Karkowski, & Prescott, 1999). A second major factor that affects the development of children’s phobias is genetics or innate traits in an individual that are dictated by his unique and inherited genome sequence. The role of genetics in phobia development is not compatible with the classical conditioning and social learning theories, which are environmental effects. The genetics model is similar to the nonassociative models, which theorize that being prone to phobias is mostly innate and is not due to personal environmental experiences (Kendler, Myers, & Prescott, 2002). The role of genetics was elucidated by a multitude of studies on identical and fraternal twins. Torgersen, in his twins study in 1979, concluded that the strength and content of phobias are highly influenced by genetic factors, although environmental effects are also important. In another study which spanned eight years, twins studies showed that phobias are heritable. Panic disorder, anxiety disorder and phobias were all found to be substantially common in families. (Hettema, Neale, & Kendler, 2001). However, the interaction between individual and its specific environment contributed more significantly to phobia development compared to familial-environmental factors (Kendler, Karkowski, & Prescott, 1999). The genetic effects were found to be developmentally dynamic. This means that the genetic factors that influence the intensity of phobia and fears at ages 8-9 years may lose their importance with the onset of the expression of new genetic factors from early adolescence to early adulthood (Kendler, Gardner, Annas, Neale, Eaves, & Lichtenstein, 2008). During the period of adolescence, heritable genetic factors and environmental factors such as experienced trauma, vicarious information all contribute to variations in phobias (Lichtenstein & Annas, 2000). However, as the ages of the children increase, the environmental factors affecting a specific phobia lose their significance and only genetic factors are contributing to fear intensity (Kendler, Gardner, Annas, Neale, Eaves, & Lichtenstein, 2008). This is consistent with the conclusion that the strongest regulation of the genetic differences occurs when the fear stimulus is strongest (Eaves & Silberg, 2008). Cultural background and race also contribute to the development of fears and phobias in children and adolescents. A study of the fears of children from different countries showed that youth from Nigeria were more likely to acquire fears more than children and adolescents from America, China, and Australia (Ollendick, Yang, King, Dong, & Akande, 1996). From a cultural context, fear levels are increased in cultures where inhibition and compliance are favored. However, results of this particular study should be carefully interpreted because of the limitations in the conduct of the research. What still needs to be done In the past twenty-five years, there was an increase in the number of publications on childhood anxiety disorders (Muris & Broeren, 2009). Although more than 50% of the studies delved into childhood anxiety disorders, there was significantly less research on development, assessment, and intervention of these childhood disorders. The importance of understanding the development of phobias and fears in childhood cannot be understated because most phobias begin during childhood, and can cause social, psychological and psychiatric adult problems if left untreated. The identification of the key etiological elements will lead to design of treatments and interventions that can alleviate the effects of the phobias, and the betterment of the adulthood of phobic children. Works Cited American Academy of Child and Adolescent Psychiatry. (2004, November). Panic Disorder In Children And Adolescents. Retrieved December 1, 2009, from American Academy of Child and Adolescent Psychiatry: http://www.aacap.org/cs/root/facts_for_families/panic_disorder_in_children_and_adolescents American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision). Washington: American Pychiatric Association. Augustyn, M. (2009). Overview of fears and specific phobias in children. Retrieved November 26, 2009, from UpToDate Patient Preview: http://www.uptodate.com/patients/content/topic.do?topicKey=~4h7ahQH.SrX/LRa Ballenger, J., Carek, D., Steele, J., & Cornish-McTighe, D. (1989). Three cases of panic disorder with agoraphobia in children. American Journal of Psychiatry, 146, 922-924. Eaves, L., & Silberg, J. (2008). Developmental-genetic effects on level and change in childhood fears of twins during adolescence. Journal of Child Psychology and Psychiatry, 49 (11), 1201-1210. Emslie, G. (2008). Pediatric anxiety-unrecognized and undertreated. The New England Journal of Medicine, 359, 2835-2836. Gisburg, G., & Grover, R. (2005). Assessing and treating social phobia in children and adolescents. Pediatric Annals, 34 (2), 119-127. Heimberg, R., Stein, M., Hiripi, E., & Kessler, R. (2000). Trends in the prevalence of social phobia in the United States: A synthetic cohort analysis of changes over four decades. European Psychiatry, 15 (1), 27-37. Hettema, J., Neale, M., & Kendler, K. (2001). A review and meta­-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry , 158, 1568-1578. Kendler, K., Gardner, C., Annas, P., Neale, M., Eaves, L., & Lichtenstein, P. (2008). A longitudinal twin study of fears from middle childhood to early adulthood: evidence for a developmentally dynamic genome. Archives of General Psychiatry, 65 (4), 421-429. Kendler, K., Karkowski, L., & Prescott, C. (1999). Fears and phobias: reliability and heritability. Psychological Medicine, 29, 539-553. Kendler, K., Myers, J., & Prescott, C. (2002). The etiology of phobias: an evaluation of the stress-diathesis model. Archives of General Psychiatry, 59, 242-248. King, N., & Ollendick, T. (1989). Childrens anxiety and phobc disorders in school settings: classification, assessment, and intervention issues. Review of Educational Research, 59 (4), 431-470. Lichtenstein, P., & Annas, P. (2000). Heritability and prevalence of specific fears and phobias in childhood. Journal of Child Psychology and Psychiatry, 41 (7), 927-937. Meltzer, H., Vostanis, P., Dogra, N., Doos, L., Ford, T., & Goodman, R. (2009). Childrens specific fears. Child Care, Health, and Development, 35(6), 781.  Muris, P., & Broeren, S. (2009). Twenty-five years of research on childhood anxiety disorders: publication trends between 1982 and 2006 and a selective review of the literature. Journal of Child and Family Studies, 18 (4), 388–395. Ollendick, T., & King, N. (1991). Origins of childhood fears: an evaluation of Rachmans theory of fear acquisition. Behavioral Researc and Therapy, 29 (2), 117-123. Ollendick, T., Yang, B., King, N., Dong, Q., & Akande, A. (1996). Fears in American, Australian, Chinese, and Nigerian children and adolescents: a cross-cultural study. Journal of Child Psychology and Psychiatry, 37 (2), 213-220. Rachman, S. (1977). The conditioning theory of fear-acquisition: a critical examination. Behavioral Research and Therapy, 15, 375-387. Sayfan, L., & Lagattuta, K. (2008). Grown-ups are not afraid of scary stuff, but kids are: young childrens and adults reasoning about childrens, infants, and adults fears. Child Development, 79 (4), 821-835. Social Phobia. (2009). Retrieved November 25, 2009, from Encyclopedia of Mental Disorders: http://www.minddisorders.com/Py-Z/Social-phobia.html Tiet, Q., Bird, H., Hoven, C., Moore, R., Wu, P., Wicks, J., et al. (2001). Relationship between specific adverse life events and psychiatric disorders. Journal of Abnormal Child Psychology, 29 (2), 153-164. Torgersen, S. (1979). The nature and origin of common phobic fears. British Journal of Pstchiatry, 134, 343-351. Read More