A phobia is a persistent, abnormal and often irrational fear of particular activity, thing, situation or even person. Phobias are not uncommon in children and can be managed. However, critical attention has to be paid to a child so as to determine the cause of the phobia and to assist in the selection of the most appropriate method of treatment to partake. Misdiagnosis or the lack of any diagnosis has proven to be quite disastrous. For most children who have their conditions untreated, their fears culminate into full blown psychological issues that mar their development and haunt them in their adult life.
Many studies have been conducted on prevalence of phobias. A current study conducted in the United States observed that approximately 1 person in every 23 people suffer from phobia. This statistic translates to about 4.25% of the population. The same study was done in the United Kingdom and it was found that 25 million people were struggling with various phobias. Of these phobias, only about 20% disappear by their own in adults. In children and adolescents, the occurrence of phobias is estimated to range from 1% to as high as 9.2%. This statistics indicate that the phobias are a serious issue and should be dealt with accordingly and promptly once discovered so as to improve the quality of life of the people affected.
Fears in children are natural and occur at different stages in the child’s life. Research has shown that children have varying phobias depending on their age. For example, children between the ages of 2 and 4 years may fear animals, loud noises and disabled people while children between the ages of 4 and 6 fear darkness and imaginary creatures.
There are four different types of phobia that are most common among children and adolescents. These include; specific phobia, panic disorder, social phobia and selective mutism. Specific phobia is associated with a specific situation or thing. Panic disorder is an unexpected period of intense fear that is characterized by shortness of breath, dizziness, increased heart beat rate, lightheadedness and shaking. Social phobia is the fear of social situations for example in a school setting. Selective mutism is the inability to speak at public forums in a child or an adolescent when the individual can speak in other situations.
Research is currently ongoing on the factors that trigger the onset of phobias. However, the research conducted so far suggests that genetic components and environmental factors predispose an individual to phobia. Specific phobias have been associated with a fearful first encounter with the phobic object or situation. The question still exists, however, whether this conditioning exposure is necessary or if phobias can develop in genetically predisposed individuals.
This information has caused the author to formulate a question for further research; how has past research on the psychological causes and effects of phobia in children been useful in the treatment of children dealing with phobias and is there need for further research?
Children are very sensitive individuals and as a result, any research that is conducted on them has to be of very high standards. The process of collection of data needs to be unobtrusive. This process can be aided by the use of concealed video cameras and tape recorders, well-designed and economic recording sheets and stopwatches. Observing a child in his or her natural environment will produce the best results. Therefore, a well-designed observational study will give the researcher an opportunity to take a record of real life events as they occur.
Many problems are associated with research involving children. These problems include; the absence of a common language in matters of case definition, diagnostic criteria and classification of data; the lack of agreed, standardized, widely-acceptable assessment tools and the lack of common analytical techniques and uniform ways of data presentation. These are as outlined by Jabesky (1986a).
Typically, studies on children gather information from not only the children but also from the parents and the teachers. Questions have been raised regarding how information gathered should be combined so as to ensure that the data is combined effectively (Costello 1989). However, the applicability of adult diagnoses to children as well as the relationship between certain adult and children diagnoses still remains unclear.
There are different ways to collect information. The researcher can use the method of administering of questionnaires or the conducting of interviews. Interviews are an effective method of conducting research. This is because interviews allow the researcher to obtain information on the child’s perspective on issues. Willing participants allow the researcher to access dimensions of information that would otherwise not be available, such as non-verbal cues on feelings, since this procedure is interactive. The relatively free-flow interaction allows the researcher to pick up on important and emotive issues by general probing and to discover what matters most to the participants from the topics they raise themselves.
The use of standardized questionnaires can be very useful to a researcher who is working with children. Standardized questionnaires have the advantage of providing triangulation by allowing comparable information to be collected from different sources such as parents, children and teachers. The results are standardized on a mixed age group, say age 8 to age 17. An example of a questionnaire on social skills is; “I listen to other people’s point of view during arguments” and “I control my temper when I lose in a game or in a competition” with the possible ratings as “not true”, “sometimes true” and “mostly true”.
Many theories have been put forward on factors that contribute to the acquisition of phobias. Rachman (1976a, 1977) suggested three possible pathways to fear; direct conditioning, observational acquisition and learning, and instruction. Direct conditioning refers to firsthand conditional experiences. For instance, involvement in a car accident may develop the fear of cars in a child. The other two methods have indirect involvement. In addition, Rachman acknowledged the role of biological constraints and other factors that might mediate the development of fear such as trait anxiety and preparedness.
Numerous studies have been conducted to examine the frequency with which the development of phobias can be accounted for by these three methods. A large number of studies have provided support for this model by showing that direct and indirect forms of phobia acquisition occur frequently across a wide range of phobia types. It is important to note that for most of the cases studied, but not all, direct conditioning experiences are the most frequently cited factors in the causes of development of phobias.
There is still some disagreement regarding the role of direct conditioning, observational acquisition and informational learning in the development of phobias. Although it is clear that these pathways are important in the development of phobias, it is noted with deep concern that these pathways do not account for all phobias. The question of why some people and not others develop phobias and not others after these experiences still remains unanswered. Several possible answers have been proposed to this question (Antony & Barlow, 1997) but they are yet to be verified through research. These include variables such as; previous exposure to the feared situation (before the learning event), subsequent exposure to the situation (after the learning event), the context of the event (for example, stress at the time of the event, the availability of social support, the individual’s perception of control over the event). (Bouton et al. 2001) elaborates these ideas.
Much research has been conducted on the possibility that genetic components increase the chances of a child developing a specific phobia. There are a number of methods to examine genetic influences on the development of anxiety in children. These include twin studies, genetic linkage studies and adoptive studies. Torgesen (1993) provides an excellent summary of these methods. Twin studies examine the rate of concordance in monozygotic twins who share identical genes and dizygotic twins who are no more similar genetically than non-twin siblings. Genetic linkage studies attempt to use genetic markers to pinpoint the chromosomal location of the gene that may carry a particular disorder. Adoptive studies examine twins who have been brought up in different homes therefore eliminating the possibility that high concordance rates for a disorder between twins simply reflects the fact that they were raised in the same environment.
A research conducted on temperamental variables produced significant findings related to the construct of behaviuoral inhibition. (Kagan, Resnick, & Snidman, 1987). Behavioral inhibition is a temperament style that is characterized by various behavioral and emotional markers that are reminiscent of anxiety namely, avoidance, withdrawal, dependence on attachment figures, fearfulness and arousability. This study observed that for children whose parents present with anxiety, they are far more likely to develop anxiety as compared to children whose parents did not present with this condition (Rosenbaum et al., 1988).
In another study on behavioral temperaments, it was found that behaviorally-inhibited temperament acts as a risk factor for the development of anxiety disorders later on in childhood. In one study, when compared to uninhibited and healthy controls, only inhibited children met the criteria for four or more anxiety disorders at a later stage in their development (Biederman et al., 1990). However, this risk is not perfect because a high percentage of the children (70%) did not go on to develop problems with anxiety. Despite many questions that remain about the nature of the relation between behavioral inhibition and anxiety, there appears to be consensus among the researchers in the field of childhood anxiety that additional study of this may lead to important insights into the onset of childhood anxiety.
In the treatment of phobias in children, the first thing to consider is whether or not, the phobia has a strong influence on the child. If the phobia does not interfere with the day to day operations of the child, then it might be worth considering letting nature take its course. This is because some of the phobias facing children will fizzle out with time. If the situation is contrary and the phobia does affect the child’s normal operations, then it is prudent to seek professional advice.
Although persistent fears in children can be treated the same way as in adults, it is necessary to consider a child’s previous record with the phobia before launching into an elaborate treatment programme. This is because phobias in children are volatile and transitory.
Ordinarily, parents can help children cope with fears by supporting and encouraging bravery while gently discouraging avoidance. (Kelley, 1995). It is very important for parents to provide children with opportunities for graduated exposure to the feared object and situation. A parent should acknowledge a child’s fear while providing accurate information regarding why the child should not be afraid. Parents can also set ‘bravery’ goals and reward children for accomplishing them.
Research has indicated that, of the cases of phobia that are severe and need professional assistance, behavioral and cognitive therapy is the most widespread technique used in the treatment of these cases. This technique incorporates the exposure to the feared stimulus in graduated steps, modeling of good coping methods and rewards for completing the exposure training.
Supported treatments for children with phobias can be divided into four different categories. These include; Systematic Desensitization, Modelling, Contingency Management and Cognitive-Behavioral Therapy.
Systematic desensitization involves the presentation of fear-producing stimuli in the presence of other responses that are incompatible with fear, such as relaxation. First, a fear hierarchy is established ranking feared objects from the least feared gradually progressing to the most feared objects. Then the child progresses through the hierarchy, first being exposed to the least feared objects and gradually progressing to the most feared objects. Systematic desensitization requires assistance of a therapist trained in this technique.
Modeling involves having the child observe another person adaptively coping with exposure to an anxiety-producing situation or event. In participant modeling, the child assists another child, who is not afraid, with the exposure task. In other words, the child who is fearful actually participates in the activity that he or she fears. In filmed modeling, the child observes a film of a person being exposed to the feared stimulus. Reinforced practice involves the gradual exposure of the participant to the fear -inducing object followed by reinforcement.
The Cognitive-Behavioral Technique (CBT) involves techniques to alter a child’s maladaptive thoughts. For example, positive phrases may be repeated by the child to help the child change unhelpful thoughts about a fear-evoking stimulus.
Treatments with the best research support are considered ‘well-established’ and include participant modeling and renforced practice. Treatments with good research support are considered ‘probably efficacious’ and include modeling, systematic desensitization and Cognitive-Behavioral Technique.
Society must develop ways and means to recognize and protect the rights of children (United Nations Declaration of Human Rights and United Nations Convention on the Rights of the Child, 1989). Individual states should enact proper legislation to this regard. For instance, in United States, the Individuals with Disability Education Act (IDEA): public law 101-476 mandates free and appropriate public education to any child with special needs.