Childhood fears and phobias

806
Egbert Haynes
Childhood fears and phobias

During childhood and adolescence there is greater vulnerability to fear and consequently to the development of phobias.

Fears of separation, strangers, animals, and the dark are rather characteristic of childhood. Those related to social evaluation (criticism, performance, competence, etc.) are more typical of preadolescence and adolescence. Fears related to harm and physical dangers (not being able to breathe, getting burned, a car accident, war…) tend to occur in both children and adolescents. The animal phobias that we find in adults are generated almost entirely in childhood, usually before the age of 5 or 6. Fears / phobias of the blood-injection-wound type usually appear before the age of 7 and continue over the years.

Contents

  • Assessment of childhood fears
    • General fear inventories
  • Treatment of childhood phobia
  • Specific phobias
  • Criteria for the diagnosis of social phobia

Assessment of childhood fears

General fear inventories

General fear inventories are usually made up of two elements:

  • An extensive list of phobic stimuli, approximately between 50 and 100 items.
  • A scale of estimation of the intensity of the phobia, of three or five points, where the lower end is equivalent to "not at all afraid" and the upper one to "very or very afraid"

In Spanish we have the Fear Inventory, of which there is a 103-item version (Pelechano, 1981) and a very similar one with 100 items (Pelechano 1984), both with a three-point scale for parents to evaluate their children's fears. . We also have the Inventory of Fears of Sosa, Capafons, Conesa-Peraíeja, Martorell, Silva and Navarro (1993); This7, unlike the previous one, is answered by the children. It uses a three-point scale and comprises 74 items plus a final open question: Is there anything else that scares you? We also find the Ollendick fear survey shedule for children-revised questionnaire in Spanish, adapted by Chorot and Sandín.

Specific fear inventories They have the same format as general inventories, but focus on stimuli related to a specific topic such as school or hospital, so they are shorter. Inventory of School Fears (IME) by Méndez (1988). In Spanish, it contains 49 items and an open-ended one: "other school-related fears". It is designed for the school to answer, but it can also be filled out by teachers and parents. Applies from preschool to Baccalaureate (from three to twenty years).

Scales for estimating fear ("miedometers") They consist of graduated scales, for example from zero (no fear) to ten (maximum fear), so that the properly trained child can evaluate their level of anxiety- They are used when the child is In the dreaded situation, for example, to evaluate the anxiety produced by the surgery, the child is asked how much fear he feels at different times: the day before the operation, when going down to the operating room, before the anesthesia, etc. They are also used during the application of other evaluation techniques. Like separation anxiety, etc. As children, especially the youngest ones, often have difficulty giving a numerical value to their anxiety level, we usually use gestures or drawings (such as traffic lights, bar diagrams), an effective method when children cannot express their levels in values. scary is to paint faces on a cardboard with gestures of liking to dislike and from behind we give it a numerical value, by means of a piece that moves horizontally the child points to the face that corresponds to what we ask and we can see from behind the corresponding value and at the same time write it down.

Observation in a natural environment It is difficult for these situations to be observed since the child tends to avoid phobic stimuli. Méndez and Maciá made a class attendance record. Ortigosa and Méndez made another for the answers in hospitalization situations.

Behavioral Approach Tests The child is asked to gradually approach the phobic stimulus to observe his anxiety responses. There are two ways:

  1. Active approach: the child gets closer and closer to the phobic stimulus.
  2. Passive exposure: the child remains in the same place while the phobic stimulus approaches, or intensifies.

We have two types of measurements:

  1. Measurements of physical variables: distance that separates the child from the phobic stimulus and what is approaching (centimeters or meters), time in seconds or minutes, light intensity, etc..
  2. Measures of psychological variables: the intensity of the phobic response is evaluated by means of a scale, which can be:
  • Zero points: null execution
  • One point: partial and / or fearful execution (initiates one of the approaches but interrupts it, delays in the beginning, ends it showing fear)
  • Two points: total and safe execution; and! child completes one of the approximations without signs of anxiety.

Treatment of childhood phobia

Separation anxiety disorder: We usually find this disorder associated with school phobia. The use of modeling, contingency management, exposure and cognitive strategies is quite successful. After the evaluation, we began to create an intervention program that we mainly have to base it on promoting activities that involve separation from parents and home. Usually these activities are going to school, going to friends' houses, going out to play with other children, etc. We begin by applying contingency management, for this, in the evaluation we will have obtained the antecedents and consequences of the occurrence of separation anxiety, mainly with a record by the parents of one or two weeks' duration. It is important that with these records we can identify what may be causing this behavior in the child. What really interests us is what consequences the child gets after emitting the behaviors. Once these are identified, we then have parents apply extinction to negatively reinforcing consequences, such as avoiding going to school, or positively, such as paying attention. That is, parents are often negatively reinforcing the child by letting him not go to school and stay at home, and then there it is normal for the child to spend the day with his toys or doing reinforcing things for him. They also tend to pay close attention to it if it has not been to school or even in the moments immediately after the behavior is issued. We always have to combine this with differential reinforcement of incompatible behaviors such as reinforcement when separated from parents, when attending school, etc. We also have to develop a hierarchy with the child of the situations that generate separation anxiety. Then we will move on to the graded exhibition, which is done in the same way as all exhibitions.

Specific phobias

We have four types of specific phobias:

  • Animal type
  • Environmental type
  • Blood-injection-damage type
  • Situational type

Before deciding any type of intervention on specific phobias we have to make sure that they are inappropriate fears for the age, as long as they are not causing a major family disturbance. Many times it is not necessary to intervene and just explaining to the parents that it consists of a normal evolutionary phenomenon and that they usually tend to disappear with age, is usually enough. We will use the graded exposure through a hierarchy of the phobic stimulus, in this way we get the child to gain confidence and reduce fear progressively as the hierarchy is completed. In the phobia of the dark, for example, we will graduate the exposure time, the place and the safety signs (such as being accompanied by different people). For all the specific phobias we will use the same, graded exposure combined with self instructions, incompatible responses such as imagining what you are doing and modeling is a feat. Social Phobia Children with social anxiety are usually withdrawn, they are not "problematic", their phobia often goes unnoticed by their parents and teachers. There is usually a tendency to think shyness and social anxiety are normal phenomena during childhood and adolescence and that they overcome or disappear spontaneously with age, when the reality is that social phobia is possibly the anxiety disorder that remits with the most difficulty.

Criteria for the diagnosis of social phobia

  • Marked and persistent fear of one or more social or performance situations in which the person is exposed to strangers or to the possible evaluation of others. The individual fears acting in a way (or showing symptoms of anxiety) that would be humiliating or embarrassing. Children must have age-appropriate social relationships with family members, and anxiety must occur in relationships with other children, not just in interactions with adults..
  • Exposure to the feared social situation almost invariably causes anxiety. which may consist of a situational or situationally predisposed panic attack. In children, anxiety can manifest itself through crying, tantrums, immobilization or cowering in social situations with strangers.
  • The person recognizes that the fear is excessive or irrational (this characteristic is not necessary for children).
  • The feared situations (social or acting situations) are avoided, or they are endured with intense anxiety or discomfort.
  • The avoidance, anxious anticipation, or dexterity (discomfort) associated with the situations significantly interfere with the person's normal activity, with their work or academic tasks, or with their activities or social relationships, or there is an intense dexterity associated with the fact of having the phobia.
  • For people under 18 years of age the duration of symptoms should be at least six months.

Situations or activities that are often avoided by teens with social phobia.

  • Eating in public, especially in the school cafeteria
  • Give an oral lesson
  • Take exams or contests
  • Call a classmate about school issues
  • Ask the teacher for help or clarification at school
  • Walk through the lobby
  • Work on a group project
  • Fitness classes, music lessons, and other performance-based activities
  • Talking to people in authority, including shop assistants or adult friends of parents
  • Call or invite a friend to do something
  • Answer the phone or doorbell
  • Attend after-school activities, club meetings, dances, sporting events
  • Initiate or join conversations with peers
  • Situations that require assertiveness, such as telling someone to stop teasing you or preventing them from copying your homework
  • Dating (meeting someone)
  • Having to take a picture, especially for the school album
  • Order food at a restaurant

For the treatment of this disorder we will use exposures, contingency management, modeling and cognitive strategies. Modeling will allow us to design therapeutic programs that improve possible deficits in social skills that are usually associated with social phobia; it also provides us with corrective information on erroneous expectations and beliefs related to social interaction. Thanks to modeling, we will improve social skills, reduce symptoms of anxiety or social withdrawal and enhance social contact behaviors in children (verbal contact with other children, frequency of social interaction, physical proximity ...) Both in social phobia and in Other social anxiety problems (assessment or test anxiety) are common self-statements such as "everyone's noticing me," "I'm stupid," and maladaptive negative expectations like "I'm going to make a fool of myself." For all this we will use cognitive restructuring aimed at modifying maladaptive thoughts that can interfere with task-oriented problem-solving behaviors. Given the importance that the use of social skills plays in social phobia, and since many children have difficulties in this regard, we usually use social skills training programs that normally involve an education phase to teach appropriate communication behaviors, such as smile, talk, look; a modeling phase and an operational phase (giving corrective feedback and reinforcement).


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