Three manifestations of Anxiety in Children:
School Refusal, Selective Mutism, Emetophobia
School Refusal
School refusal occurs in nearly five percent of children ages seven to eleven, and between one and two percent of children age 14 to 16. The incidence is highest in children age five to seven and eleven to fourteen. School refusal usually develops after a child has been home from school because of an illness or vacation, after a stressful event or at the time of a move to a new school.
Children whose parents have anxiety disorders have a higher rate of anxiety disorders than those children whose parents do not have these disorders. Young children may exhibit behaviors which indicate a predisposition to developing school refusal. Some warning signs include a clinging attachment, fear of staying in a room alone or in the dark, trouble sleeping or nightmares, and very intense worries about something awful happening when away from home or separated from parent or attachment figures.
Parents can make attempts to prevent school refusal by giving the child appropriate opportunities to separate from them during the preschool years by exposing them to playgroups, daycare, preschool and babysitters.
If a child begins to exhibit school refusal behavior, parents need to make the school administration aware of the situation, and work with them to identify and resolve any bullying or situations that may be contributing to the anxiety. Parents should not encourage school refusal by allowing the child to stay home. Missing school only increases the academic and social difficulties, which reinforces the school refusal.
Children who refuse to attend school usually try to convince the parent to let them stay home. Frequently there are genuine physical symptoms which improve if the child is allowed to avoid school. Common complaints are headaches, nausea, stomach aches and dizziness. Symptoms can include vomiting, diarrhea, sweating, trembling and a fast heart rate. Sometimes the child will cry or have an angry outburst.
About a quarter of the children who refuse to attend school have an underlying anxiety problem, usually separation anxiety or social phobia. Early intervention is very important because research shows that individuals who experience anxiety disorders in childhood are at risk for continued psychiatric problems, as well as, substance abuse.
Treatment for school refusal is cognitive behavioral therapy for an average period of six months. Cognitive therapy teaches the child to redirect their thoughts and actions into more effective coping patterns. The behavior therapy involves teaching the parents and the child strategies for overcoming certain stressful events and may include desensitization. Cognitive behavioral therapy does produce successful results with more than 80 percent of children attending school normally one year after treatment.
Selective Mutism
Selective Mutism is typified by the inability to speak in certain social situations due to fear around others. The first symptoms of selective mutism often appear between the ages of 1-3 as shyness and a reluctance to speak in some settings. It is most common among children under age 5, but left untreated can persist for years and develop into a generalized anxiety disorder or social phobia. Most children are diagnosed between the ages of 3-8.
Children who are selectively mute understand language and have the ability to speak. Some may be mute only at school and others may be mute everywhere except home. Children who are selectively mute have difficulty initiating communication, but may participate fully in social interactions in non-verbal ways. Some will point or respond via nodding., while others remain motionless and will not respond to others at all. Selective mutism is troubling to the child, as much as it is troubling to those around them.
Treatment for selective mutism uses a variety of behavioral techniques, play therapy and community based interventions. The first goal is to lower the child’s anxiety.
Engagement via play therapy is often the first intervention, and is used to introduce social skills and cognitive strategies to manage anxiety. Parents and teachers are coached regarding how to decrease the pressure on the child. The child is initially reinforced for bravery and small amounts of interaction, often in safe places and with safe others. Behavioral interventions build on successes and then gradually increase expectations. Finally, over time the child is gradually desensitized to anxiety provoking social settings by “fading” out the safe individuals.
Emetophobia
Reportedly the fifth most common phobia, it’s the fear of vomiting. It is often the “core fear” behind other phobias like flying, claustrophobia, and even social phobia. A fear of food (specific foods, being too full, food poisoning) is common, as is agoraphobia (fear of being out in public). Avoidance behavior can include avoidance of words and things associated with being sick in that person’s mind (clothing, movies, etc.) Most people with emetophobia fear that they will vomit. Some may only fear vomiting in front of others; few are fearful only of seeing someone else vomit.
Treatment is cognitive-behavioral, and relies heavily on gradual exposure and desensitization. Learning relaxation techniques can be helpful; erroneous thoughts about vomiting and bodily sensations can be corrected. The goal of treatment is anxiety reduction, not having the person vomit.
Emetophobia affects mostly females (2-3% of males, 6-7% of females) and usually first emerges in childhood. Left untreated the phobia tends to be reinforced. There is some evidence that children of emetophobes are more likely to develop the phobia than children of parents who do not have an intense fear of vomiting.
School Refusal
School refusal occurs in nearly five percent of children ages seven to eleven, and between one and two percent of children age 14 to 16. The incidence is highest in children age five to seven and eleven to fourteen. School refusal usually develops after a child has been home from school because of an illness or vacation, after a stressful event or at the time of a move to a new school.
Children whose parents have anxiety disorders have a higher rate of anxiety disorders than those children whose parents do not have these disorders. Young children may exhibit behaviors which indicate a predisposition to developing school refusal. Some warning signs include a clinging attachment, fear of staying in a room alone or in the dark, trouble sleeping or nightmares, and very intense worries about something awful happening when away from home or separated from parent or attachment figures.
Parents can make attempts to prevent school refusal by giving the child appropriate opportunities to separate from them during the preschool years by exposing them to playgroups, daycare, preschool and babysitters.
If a child begins to exhibit school refusal behavior, parents need to make the school administration aware of the situation, and work with them to identify and resolve any bullying or situations that may be contributing to the anxiety. Parents should not encourage school refusal by allowing the child to stay home. Missing school only increases the academic and social difficulties, which reinforces the school refusal.
Children who refuse to attend school usually try to convince the parent to let them stay home. Frequently there are genuine physical symptoms which improve if the child is allowed to avoid school. Common complaints are headaches, nausea, stomach aches and dizziness. Symptoms can include vomiting, diarrhea, sweating, trembling and a fast heart rate. Sometimes the child will cry or have an angry outburst.
About a quarter of the children who refuse to attend school have an underlying anxiety problem, usually separation anxiety or social phobia. Early intervention is very important because research shows that individuals who experience anxiety disorders in childhood are at risk for continued psychiatric problems, as well as, substance abuse.
Treatment for school refusal is cognitive behavioral therapy for an average period of six months. Cognitive therapy teaches the child to redirect their thoughts and actions into more effective coping patterns. The behavior therapy involves teaching the parents and the child strategies for overcoming certain stressful events and may include desensitization. Cognitive behavioral therapy does produce successful results with more than 80 percent of children attending school normally one year after treatment.
Selective Mutism
Selective Mutism is typified by the inability to speak in certain social situations due to fear around others. The first symptoms of selective mutism often appear between the ages of 1-3 as shyness and a reluctance to speak in some settings. It is most common among children under age 5, but left untreated can persist for years and develop into a generalized anxiety disorder or social phobia. Most children are diagnosed between the ages of 3-8.
Children who are selectively mute understand language and have the ability to speak. Some may be mute only at school and others may be mute everywhere except home. Children who are selectively mute have difficulty initiating communication, but may participate fully in social interactions in non-verbal ways. Some will point or respond via nodding., while others remain motionless and will not respond to others at all. Selective mutism is troubling to the child, as much as it is troubling to those around them.
Treatment for selective mutism uses a variety of behavioral techniques, play therapy and community based interventions. The first goal is to lower the child’s anxiety.
Engagement via play therapy is often the first intervention, and is used to introduce social skills and cognitive strategies to manage anxiety. Parents and teachers are coached regarding how to decrease the pressure on the child. The child is initially reinforced for bravery and small amounts of interaction, often in safe places and with safe others. Behavioral interventions build on successes and then gradually increase expectations. Finally, over time the child is gradually desensitized to anxiety provoking social settings by “fading” out the safe individuals.
Emetophobia
Reportedly the fifth most common phobia, it’s the fear of vomiting. It is often the “core fear” behind other phobias like flying, claustrophobia, and even social phobia. A fear of food (specific foods, being too full, food poisoning) is common, as is agoraphobia (fear of being out in public). Avoidance behavior can include avoidance of words and things associated with being sick in that person’s mind (clothing, movies, etc.) Most people with emetophobia fear that they will vomit. Some may only fear vomiting in front of others; few are fearful only of seeing someone else vomit.
Treatment is cognitive-behavioral, and relies heavily on gradual exposure and desensitization. Learning relaxation techniques can be helpful; erroneous thoughts about vomiting and bodily sensations can be corrected. The goal of treatment is anxiety reduction, not having the person vomit.
Emetophobia affects mostly females (2-3% of males, 6-7% of females) and usually first emerges in childhood. Left untreated the phobia tends to be reinforced. There is some evidence that children of emetophobes are more likely to develop the phobia than children of parents who do not have an intense fear of vomiting.
