CHILDREN FEARS & PHOBIAS -Including School Phobia (School Refusal)

 

Young children have more fears and phobias than adults, and experience them more intensely. Novelty, unpredictability and sudden changes can also induce fear in children, and illness might 'put them back', reviving old fears that they had put behind them at an earlier age. Adults also teach children to fear certain things before the child has even come across them, through their words or actions. Children may also 'pick up' the fears of adults in their family.    
 

The objects and situations that children fear vary a good deal. When very young children show fear it can be hard to judge exactly what is causing it, and many parents underestimate the number of things that frighten their children.  The following is a general list of normal fears: 

Age 2-4: Fear of animals, loud noises, being left alone, inconsistent discipline, toilet training, bath, bedtime, monsters and ghosts, bed wetting, disabled people, death and injury.

Age 4-6: Fear of darkness and imaginary creatures. Also animals, bedtime, monsters and ghosts. Other fears, such as of strangers, seem to be persistent. 'Stranger fear' would probably be called 'shyness', while fear of snakes tends not to decrease much, if at all, during this period. Children at this age may also fear loss of a parent, death, injury and divorce.
Beyond these ages, irrational fears tend to decline rapidly, though there may be further peaks to do with other situations, e.g. age 9-11: fear of school; fear of blood and injury.  
Older children tend to worry more about death and related topics such as nuclear war. Up to

age 11 boys and girls tend to be equally represented in the 'fear tables'; after 11 years boys lose their fears more rapidly than girls. 

8 year-olds will probably have fragments of earlier fears but additional ones will tend to be more rationally based and will possibly include fear being late for school, social rejection, criticism, new situations, adoption, burglars, personal danger and war.

9 and 10 year-olds are also likely to fear divorce, personal danger and war and these three are very likely to continue as fear problems into the mid teens.  This age group might also fear blood and injury.

11 and 12 year-olds might fear animals, kidnapping, being alone in the dark and injections. 

Research showed that beyond this age boys lose their fears more readily than girls.

13 year-olds seem to fear heights as well as the three mentioned above.

14-16 year-olds will tend to have a wide range of rational or almost rational fears which might include: injury, kidnapping, being alone in the dark, injections, heights, terrorism, plane or car crashes, sexual relations, drug use, public speaking, school performance, crowds, gossip and divorce.  

As will be noted from the above, many childhood problems wax and wane as a normal part of development and a sensitivity in a certain area might be aggravated by a current problem so that this particular child temporarily ‘falls back’ into an earlier level of fear when faced with a trauma or severe family or school problems.

WHAT ARE THE SYMPTOMS OF PHOBIA?
 

Phobias produce all the unpleasant physical symptoms of  'normal' fear:

* heart palpitations
* feeling sick
* chest pains    
* difficulty breathing
* dizziness 
* 'jelly legs'
* feeling 'unreal'
* intense sweating
* feeling faint    
* dry throat
* restricted or 'fuzzy' vision or hearing.

In severe cases, young people may feel certain that they are about to die, go mad, or lose control of themselves and injure someone, or do something disgusting and humiliating. Most of all they feel an overpowering urge to 'escape' from the situation they are in. Children are more likely to cry, shout or scream, or simply run away when confronted by the things they fear, though they may also be sick or go rigid. Paleness, perspiration and trembling are also signs of severe anxiety.

The level of symptoms that children with phobias experience varies a great deal, from very mild anxiety to very severe panic and terror. A mild degree of nervousness in particular situations is not usually a problem, but it is only a matter of degree, and at the other end of the scale there are children who have full-scale panic attacks when in the dreaded situation, and soon refuse to enter it altogether because of the terror that grips them at such times. 
Phobias aren't just severe anxiety: the anxiety is turned into a phobia by avoidance. In the early stages of a phobia the child's parents sometimes try to tackle his or her fears head on by forcing him or her to enter the feared situation. If this works, the phobia can be overcome.  If it doesn't, this is only likely to strengthen the fears and make the child want to avoid the phobic situation even more. It also risks destroying the child's confidence in its parents. 
Avoidance is attractive because it brings a reduction of the tension; thus it rapidly becomes a habit.

 

HOW CAN CHILDREN'S FEARS BE TREATED?
Persistent fears in children and interfering with day-to-day functioning  would require professional help  to consider a treatment  program. Children in particular seem to respond best to being helped to increase their skill and competence, and being encouraged to take part in activities that will involve the thing they fear. With young children especially, practical activities that involve exposure could also be turned into a game, since most children respond better to play than to work.

SCHOOL PHOBIA (SCHOOL REFUSING)
The number of children who dislike school and avoid it whenever possible is probably more than 5% of the school-age population, but less than 1% could genuinely be called 'school phobic'. School phobia, also called 'school refusal' is commoner among boys, and the peak onset in Britain is at the age of 11-12 years. This is perhaps not surprising, since this is the age when most children move from primary to secondary school, and therefore experience great changes in their lives. 

There are also smaller peaks at the age of 5-7 years old, where separation from the mother may be a primary cause ; and at 14, where it is more likely to be associated with a psychiatric disorder such as depression.
Some older adolescents and young adults may experience fears of college or work that resemble school phobia; most of these will have been school refusers when children.

Sometimes school refusal begins suddenly, for instance after a prolonged absence from school due to illness; following an abrupt change of school or class; after school holidays - or even after a weekend. However, the actual event immediately before school refusal is unlikely to be the sole cause of the problem, though it might have been the last straw on top of a lot of other things.  These additional situations could include family problems; difficulties at school; anxiety about puberty;  other sexual matters; general difficulty with social situations; anxiety about being separated from the parents (mainly the mother); bereavement; or depression. 
However, most cases of school refusal seem to develop slowly. Reluctance to attend gradually increases, with visible signs of anxiety that grow more obvious as the child is pressured to go. Sometimes the child will deny that he or she is afraid, but signs such as paleness, trembling and frequent urination may be very obvious to the parent. Typically the child will complain of bodily pains, stomach trouble or nausea in the early morning. These problems usually cease abruptly if the child is allowed to stay at home, and re-appear when he or she is once again pressured to go to school.
Some children will simply refuse to go to school, offering no reason. Others might complain of bullying, or of being unable to get on with teachers or do the school work. Some may express fears about undressing in front of other children, or of making a spectacle of themselves by fainting, vomiting or losing control of their bowels. Less often they may mention fears of something happening to one or both of their parents while they are at school, or simply of feeling 'unsafe' when far from home.

Children deal with their fear of attending school in many ways. Some may go through the morning ritual almost normally, but are then unable to leave the house, or turn back before reaching school. Others may flatly refuse to get out of bed, or lock themselves in somewhere, or run off until they feel it is safe to return home. Some will gladly put up with punishment as the price of not going, and many will promise (and mean it at the time) to go 'this afternoon' or 'tomorrow' if they are only allowed to stay at home now. Some children have been known

to threaten, or even attempt, suicide when they felt totally trapped by the situation. 

PHOBIA OR TRUANCY?
School phobia is sometimes confused with truancy - even by teachers and educational workers. However, truants do not usually express or display such high levels of anxiety, and nor do they flatly refuse to attend school. It is just that there are other things they would rather be doing. They are more likely to pretend to set off for school, and then disappear on the way, or during the day, returning home at the normal time, so that parents are often the last to find out what is happening. Truants also tend to become involved in other delinquent behaviour.  They may also come from disadvantaged areas and homes where there is not enough discipline, caring, or simple parental interest. Their school work is likely to be rather poor and they will probably show little interest in what the school thinks of them.

This is in sharp contrast to the typical school refuser, who comes from a stable home with both parents present and caring (if sometimes over-protective) and who is often described as "always such a good boy/girl - never any trouble before this". Typical refusers may also be sensitive to the point of timidity, being unduly wounded by adverse comments from teachers, and have unrealistically high goals for themselves; they may then become excessively upset at their perceived failures.
   

Dr. Akeel Abdulla  A.Abdul Wahab

Fellow & Member of The Royal College of Psychiatrists (UK)

FRCPsych. (UK), MRCPsych. (UK), Board NeuroPsych. (London University,UK)

Dip.Psych. (London University, UK), MB.ChB.(Basra University, Iraq )

Formerly Senior Consultant Psychiatrist  & Clinical professor

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References:

Fears, Phobias and Rituals by Professor I M Marks, published by Oxford University Press (1987), and
Handbook of Parent Training: Parents as Co-Therapists for Children's Behaviour Problems (C.E. Schaeffer (Ed.)) Section 111, Chapter 3; Prof. W. Yule, Ph.D, New York; John Wiley

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Mental health public Awareness /children fear & phobia/AAW  Jan 2022 Copyright