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Childhood phobias are no laughing matter, The National, 24.02.2009

Discovering the trigger can help unlock the reason behind a child’s fear. Jo Wadham examines the ways to find the key.

Most children have a fear of something, perhaps of the dark, of dogs or even something as innocuous as zips. For some children the fear they experience can affect the normal functioning of their daily lives. In extreme cases, they can be dangerous. Recently in the UK, an inquest was carried out into the death in 2005 of the eight-year-old schoolgirl Sophie Waller who refused to eat or drink after developing a severe dental phobia. But how can you tell if your child’s fear is a phobia and what can you do to help them if it is?

Fear is a common phenomenon amongst children, as Dr Melanie Schlatter, a consultant health psychologist based in Dubai, explains, “90 per cent of two to 14-year-olds have one specific fear, but if it does not interfere with their schooling, home life or their sleep, for example, then it is OK not to be overly concerned”. The difference between a fear and a phobia is a question of degree. Dr Schlatter explains that there is a level of normal fear – of thunderstorms for example – but that when a fear becomes excessive it can provoke a physical “fight or flight” response in the child. At this stage, the fear is one which needs controlling to bring it back to a manageable level. If this level of fear persists for more than six months, it is diagnosed as a phobia.

Stephanie Hunter’s daughter, Megan, had always loved dogs as a baby, but by the age of two, her love had turned to terror. “If we saw a dog approaching us in the distance, she would start cowering. I would feel her tension rising as the dog got closer and then she’d start to scream ‘Mummy! Mummy!’. If I didn’t pick her up quickly enough, she’d start to climb up me to get away from the dog.”

Hunter suspected the cause of Megan’s fears might have been a bull mastiff which used to bark ferociously at them as they walked through their village in the UK. Megan’s terror of dogs continued until she was five years old. “I tried the ‘it’s fine – don’t worry’ and also the ‘don’t be so silly’ approach, but neither was terribly effective,” says Hunter. The real turn-around came when Megan started going to school. Peer pressure made her want to fit in, and then her new best friend was given a puppy. Megan desperately wanted to continue playing with her friend despite this new arrival, and also wanted to be like her, to go up close and stroke the dog. Gradually, she did start to play with the puppy.

Megan now loves dogs, although she still displays a certain apprehension and will wait for another child to approach the dog first. “That level of caution is fine,” Hunter says.

According to Schlatter, children’s phobias usually arise either through learned behaviours, or after what psychologists term a “trigger event”. Knowing what the trigger event is can be key, but the particular difficulty with children is that they may be too immature to articulate what the trigger event was. This is the problem Claire Carré has encountered in trying to deal with her daughter’s phobia of clowns.

Coulrophobia is surprisingly common. Carré’s five-year-old daughter, Jossienne, is utterly terrified of them. “Her most violent reaction to a clown was at a birthday party six months ago. A clown came in to entertain the children and Jossi ran away,” Carré explains, “It took 15 minutes to find her. When we did, she was curled up in a ball in a corner, shaking and she had wet herself.”

Carré says that even the memory of her fear haunts Jossienne. “There are certain party venues I can’t take her to now as she remembers there was a clown there last time she went.” Carré has tried to talk to Jossienne to discover why she is so scared, and has discussed her phobia with a psychologist, but Jossienne is still too young to articulate her fears. “We’ve shown her there is a person inside, but this makes no difference. We do face painting, dressing up, but she’s still terrified.”

In the meantime, Carré is trying to manage Jossienne’s fear, pre-empting trigger situations, or just making sure she is on hand to comfort her.  “Part of me doesn’t want to stifle her natural reaction to what she perceives is a danger,” Carré says. But at the same time she acknowledges the challenges ahead, “My real fear is that one day I won’t be able to get to her in time and she will run across a busy road to get away.”

Dr Schlatter recommends that parents talk to their children about their fears, explaining that being scared is not always a bad thing. “It is very helpful to explain that it is OK to be anxious sometimes, for example about exams or busy roads.” But, she warns, parents should never punish the child for their phobia. For the same reasons, homemade aversion therapy sessions are best avoided. They are likely to terrify children and may cause them to hide their fears from you, denying the opportunity for treatment later.

Parents should also talk to their children about the physical sensations they experience when they are frightened. Children often don’t understand their own physical reaction which can add to their level of fear and compound the phobia. “The feeling of fear can be very overwhelming. When the panic response occurs, the child can feel confused and bewildered”, says Schlatter. Explaining their fears is an important part of the treatment of a phobia “We start with basic level education,” explains Schlatter, “we talk to them about it, explore the basis of their fear, and normalise it for them.”

There are a variety of different therapies medical professionals can use to treat phobias. From basic cognitive behavioural therapy, where, essentially, the patient is taught how to modify any unhelpful thoughts and behaviours, to systematic desensitisation, where the child is gradually exposed to the object of their phobia, to play therapy. The psychologist will select the appropriate therapy and tailor it to the individual child.

Parents should be reassured that manageable levels of fear are all part of a developmental stage children go through. Clearly, if it becomes unmanageable, professional help is needed. But otherwise, take heart, some fear is good. Fear can help children protect themselves; but sometimes they just need help to realise that the object in question isn’t dangerous, or at least, not as dangerous as they think it is.

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