Childrens Anxieties & Phobias
Today many children develop Anxiety Disorders. It is always wise to see your Doctor and get the help of trained people who specialize in treating children. We have, however put a leaflet together which may help parents or carers.
A phobia is actually a “fear of fear” because sufferers are not really frightened of any particular place, situation’ object or animal although, children tend to believe that there really is something to be frightened of. Sufferers are really frightened of the feelings of fear that they experience when faced with their “trigger” situation. They know that there is no real danger but are unable to fully convince themselves that everything will be perfectly safe. There is always a feeling that “something” might just happen. This is known as the “what if” factor and consequently sufferers avoid more and more situations just in case “what if” happens. Needless to say it never does and never will occur but sufferers cannot bring themselves to take that risk. This equally applies to children and often when faced with their “trigger” situation, e.g. the perceived need to have a parent or carer stay with them, when going to bed, because of a fear of the dark.
The beginning of a phobia usually follows periods of stress and often starts after a final trauma, “The last straw, which breaks the camel’s back” or after a first panic attack which appears to come out of the blue. In the early stages of a phobia, sufferers feel frightened when in a particular place or situation, without knowing exactly why. Whenever they go into the particular place or situation they experience an overwhelming feeling of impending disaster and feel a compulsive urge to escape from it. Sufferers do not know why they are afraid but the feelings of fear that they experience are very real. These feelings start a spiral of fear and sufferers begin to think that they will get these awful feelings wherever they go. As a result, an agoraphobic stays at home; a claustrophobic avoids all lifts, a sufferer from monophobia is afraid of being alone and a space phobic avoids going outside into the garden. A child does not wish to attend school.
School phobia is a common childhood behaviour problem that refers to a child’s refusal to attend school. It is often accompanied by irrational fears, physical complaints, temper tantrums and panic or anxiety related to school attendance. It is essential that school phobia is not confused with truancy and so a visit to the doctor, who can give a definite diagnosis, is necessary.
Many children with school phobia display traits of unusual conscientiousness, eagerness to please and a tendency towards conformity. Frequently, they are shy and introverted, behaviourally inhibited, uncomfortable away from parents and home and not very interactive with others and they may well be anxious about other things besides school. Unfortunately today school phobia may be related to bullying at school or the internet.
Statistics on the frequency of school phobia vary a great deal. The number of children who actively dislike school and avoid it whenever possible is probably about 5% of the school population but those who could be classed as school phobic would probably make up about 1% of the school population of the U.K. or about 90 thousand. Well over half the numbers are boys and the peak onset is about 11 to 12 years of age. This is, to some extent, is understandable being the age at which most children change from primary school to secondary school and are consequently faced with numerous large changes in their lives. Research indicates that the final peak age is about 14 years of age and may well be associated with depression.
Sometimes refusing begins suddenly and often happens after a prolonged absence from school through illness or following an abrupt change of class or even after the normal long summer school holiday. The actual event, immediately prior to school refusing, is unlikely to be the sole cause of the problem and is usually the “last straw” effect added to an accumulation of other things. These might include family problems, difficulties at school, anxiety about puberty or allied sexual matters, general problems in social situations or anxiety about being separated from a parent. Most cases of school phobia seem to develop slowly and reluctance to attend gradually increases, with the visible signs of anxiety growing more noticeable, as pressure is put on the child to go to school.
Often, the child will deny that they are afraid but symptoms may be very obvious to a parent, e.g. paleness, stomach trouble, trembling, frequent visits to the toilet, nausea just before it is time to leave the house and unexplained bodily pains. These symptoms will suddenly disappear if the child is allowed to stay at home only to reappear when the child is pressurized to attend school.
Children deal with their fears and their need to attend school in many ways. Some may go through the “morning ritual” but then be unable to leave home or turn back after completing part of the school journey. Others may just refuse to get up, lock themselves in somewhere or run off until it is safe to return home. Some may even endure punishment as the price of not going to school. Many will swear, and mean it at the time, to go this afternoon or tomorrow if they are allowed to stay at home at the present time.
Effects On Parents
The effects on parents can be very distressing because it is so difficult for a child to talk about and explain their problem in such a way that a parent can understand. Very often parents do not know where to turn to for help and even when help is found, they find it very hard to put their child through a recovery programme. After all what caring parent wants to see their child suffer and yet, this is what has got to happen if a recovery is to be achieved. It is a frightening and distressing experience for the child which surely must pull at the heartstrings of parents. However, comfort can be gained by the knowledge that it is the child’s best long term interest.
We are very aware of this hardship and parents are encouraged to use our help-line for their own support. A problem shared is a problem halved so please let us try and help you.
Do Anxiety Disorders Fade Away Naturally With Time?
It is fair to say that many children will grow out of their fears and worries. However, this is not always the case and treatment may be appropriate in some cases.
Overcoming Anxiety Disorders (Children)
There is no doubt that anxiety disorders can be overcome and cognitive/behaviour therapy brings about the highest, proven success rates. Some of the newer antidepressants may also help and your doctor will be able to advise you on which one is most likely to prove helpful to your child. However, even if drugs are used your child will almost certainly have to undergo a course of cognitive/behaviour therapy.
No Panic is based on self-help cognitive behaviour therapy but this does not mean we have the only solution to anxiety disorders. We readily accept that other methods have worked for some sufferers and should you wish to try other methods, please ensure that the person you are intending to consult has the necessary qualifications and knowledge to do the job properly. Too many people have been “ripped off” by charlatans. We cannot offer an overnight miracle cure, we do not believe it exists, but we do know that methods, which we use, be they long and drawn out offer the best likelihood of a complete recovery. We give no promises or guarantees of success but ask to be judged by the many thousands of anxiety disorder sufferers who have overcome their problems using methods similar to ours.
Cognitive/behaviour therapy involves changing the way a sufferer thinks and changing the way a sufferer behaves and this, we believe, is the way forward and can be provided by a self-help group like No Panic or a suitably qualified therapist. Research would indicate that cognitive/behaviour therapy is more effective in the treatment of anxiety disorders in children than traditional psychotherapy as it helps the child to learn how to quell anxiety both in O.C.D. and phobias. A big part of helping your child to get better is to help restore self confidence and this happens by facing fears gradually at the child’s own pace.
Treatment For School Phobia
To children suffering from school phobia the symptoms which they experience, e.g. headaches, stomach aches, nausea, poor appetite and weakness are very real. They actually feel ill and only find relief when the fear of school has gone. As a result, many parents get the impression that the child is malingering because, the symptoms pass once the threat of school has disappeared. However, like most phobias once the “trigger” has been avoided the symptoms of fear dramatically reduce very quickly.
Common treatments approaches may well include individual cognitive/behaviour therapy and also family counselling in order to help the parents as well as the child come to terms with and overcome the problem. Treatment of school phobia, as with most children’s anxiety disorders, is best conducted by a professional psychologist who has been trained to deal specifically with children. Whilst the treatment is basically the same as an adult it needs to be put over in a way which a child can comprehend.
Parents should insist on regular school attendance regardless of the child’s excuses, pleas, fears and tears. We accept that this is not a view shared by everyone and, in some cases, it is not possible but we feel the child should be encouraged to attend school as often as possible. Parents also need to consistently and positively reinforce any designed treatment plan prepared by the appropriate professional and give praise as and when the child makes an improvement. If a child does miss school, parents could, perhaps, try making home less appealing, e.g. by limiting or excluding television or by cutting down on entertainment and treats. The child’s intake of caffeine, sugar and other stimulants should be restricted and regular physical exercise encouraged in order to reduce the child’s overall anxiety. Family counselling can help parents to better understand and deal with the school phobic child by providing behavioural guidance and emotional support.
Reports from parents of school phobics tell of anxiety and confusion and many indicate a feeling of guilt. They have been told or read somewhere that it is their entire fault for molly coddling their child. Parents often react to this by developing a deep sense of shame and then closing ranks. In most cases the parents have behaved in a perfectly normal and acceptable manner and no blame can really be laid at their door. You do not have to have bad parents to be a school phobic. In most cases the complete opposite is true. So we urge parents not to hide the problem away as this will not help the child. The best thing to do is seek help.
Many current treatments for school phobics are carried out around the home and in the school. They involve some element of helping the child deal with the anxiety symptoms in the situation where they developed whilst getting the child back to school as quickly as possible. Some people, not usually clinicians, favour taking a school phobic out of the school system entirely, temporarily or permanently.
However, research indicates that temporary home tuition whilst attractive to some parents is not useful as part of a recovery programme and works against the child’s early return to school. With permanent withdrawal, some children might do better academically with home tuition or be more content outside the school system but this has profound dangers in that the child may never resolve the problem that generated, or was part of, the school phobia. Consequently the child may be a prime candidate for a similar anxiety disorder when faced, as an adult, with college or work. Should the child be taken out of the school system permanently then, besides the possibility of more anxiety problems in the future, he/she may also be handicapped by the lack of the social and “peer” learning obtained at school. Character traits such as timidity, over-sensitivity, having unrealistic expectations of other people and of personal achievement may become a permanent barrier between the young adult and the rest of the world. When return to school is agreed on as a goal, it is difficult to put an actual time limit on it. The therapist’s personal belief and the extent of the problem will be the controlling factors in the equation. However, whether this is a short or long period all therapists will have a series of priorities. They will work at establishing a good, trusting relationship with the child and family, will clarify situations that actually stimulate the anxiety and will then desensitize the child to these situations by using imagination, (getting the child to face the dreaded events in their mind), relaxation techniques and simply talking about the situations. Finally, the therapist will help the child to confront the situations for real.
As with all phobias exposure therapy is done in small steps at a time to build up self confidence by proving to the child in time nothing terrible will happen and they will manage to sit through a lesson, through the morning and then the whole day. One mum told us with her child she went into school constantly to take her child for one hour at a time. This worked because an hour isn’t long but the whole day can seem too much at first. Then gradually this was extended to two hours until the whole day was achieved. The child should be given a lot of praise because facing this situation can be extremely difficult and needs a lot of patience on parent’s part and also understanding from the school.
Where To Seek Help
- Your doctor.
- Teacher or headmaster/headmistress.
- School nurse.
- Local education authority (ask for the child psychology dept.)
- Local family health services authority.
The following are extracts from the experiences of a mother who has a son who tackled his school phobia.
School phobia: There is no research which indicates a definite cause of school phobia and, in my opinion; the examples given in this leaflet are theories only. The physical symptoms of the phobia do not disappear once the child is at school and “their mind is taken off it”. Children hide the symptoms to avoid embarrassment, and this compounds the problem.
Home tuition: Although this leaflet says home tuition is not a good idea there are exceptions. My son’s tutor has been a Godsend but she has not taught him at home! He has gradually been reintegrated into a small school environment, which has built up both his confidence and attendance at school. Initially he was only able to attend, comfortably, for the first 15 minutes of each day. Home tuition varies a great deal depending on the needs of the child and the tutor involved. I would not hesitate to recommend this option.
My Son’s Road to Recovery
School: I found that although it was eventually acknowledged that there “might” be a problem, not enough was known about school phobia for it to be recognized in the early stages. Support from teachers is essential in reintegrating a school phobic. Ideally the child should be gently encouraged whilst their attendance increases. After all, one day’s attendance, by a phobic, is far more of a personal achievement than a full week’s attendance by a child who enjoys school!
Education Welfare Officer: When events came to a head, I contacted the Welfare Department and found that an objective view from someone not directly involved, was very helpful. This support has been long-term.
General Practitioner: After one appointment my son was referred to a clinical psychologist and the G.P. provided support, on the telephone, if any problems arose which needed immediate attention.
Clinical Psychologist: Although it was difficult at first, the psychologist was invaluable as he helped my son to think about “school” calmly, then to progress to the point we have now reached, i.e. regularly attending school.
Hypnotherapist: Helped to break the circle of guilt, tension and frustration involved.
Home tutor: Has helped my son to become interested in learning again, built up his confidence, given him trust in people outside the family, and still supports him for two of his sessions in school.
Remember your child can get better. It is important that the problem is acknowledged and professional help sought at the earliest opportunity.
No Panic gratefully acknowledges the support given by N.P.A.D. of America and their kind permission for the use of extracts from their own literature.
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