Children's specific fears

Nighttime coping response in children: Development and validation of a new scale

Coping strategies can play an important role in dealing with nighttime fears and related anxiety problems in school-aged children, but well-established self-reporting tools are lacking, and research in this area is limited. The aim of this study was to develop a new self-report instrument assessing coping strategies in school-aged children when facing nighttime fears, the Nighttime Coping Response Scale (NCRS), and to examine its psychometric properties. Participants were 786 children (48.7% boys) aged 8-12 years, who completed the NCRS and other measures related to anxiety and behavioral problems. The construction of the NCRS was based on relevant prior literature and experts' criteria. Exploratory and confirmatory analyses supported a three-factor structure, comprising 15 items measuring coping strategies related to self-control, social support seeking, and avoidance. The NCRS was shown to have good internal consistency, test-retest reliability, and convergent and divergent validity. This research found preliminary support for the use of the NCRS, suggesting the potential suitability of this brief tool to be used by clinicians and researchers to identify and address the use of children's maladaptive coping strategies when dealing with nighttime fears. The NCRS could also be important to enable the development of further research in this field.

Girls' Stuff? Maternal Gender Stereotypes and Their Daughters' Fear

One of the most robust findings in psychopathology is the fact that specific phobias are more prevalent in women than in men. Although there are several theoretical accounts for biological and social contributions to this gender difference, empirical data are surprisingly limited. Interestingly, there is evidence that individuals with stereotypical feminine characteristics are more fearful than those with stereotypical masculine characteristics; this is beyond biological sex. Because gender role stereotypes are reinforced by parental behavior, we aimed to examine the relationship of maternal gender stereotypes and children’s fear. Dyads of 38 mothers and their daughters (between ages 6 and 10) were included. We assessed maternal implicit and explicit gender stereotypes as well as their daughters’ self-reported general fearfulness, specific fear of snakes, and approach behavior toward a living snake. First, mothers’ fear of snakes significantly correlated with their daughters’ fear of snakes. Second, mothers’ gender stereotypes significantly correlated with their daughters’ self-reported fear. Specifically, maternal implicit gender stereotypes were associated with daughters’ fear of snakes and fear ratings in response to the snake. Moreover, in children, self-reported fear correlated with avoidance of the fear-relevant animal. Together, these results provide first evidence for a potential role of parental gender stereotypes in the development and maintenance of fear in their offspring.

A Sorrow Shared Is a Sorrow Halved? Patient and Parental Anxiety Associated with Venipuncture in Children before and after Liver Transplantation

Taking blood via venipuncture is part of the necessary surveillance before and after liver transplantation. The spectrum of response from children and their parents is variable, ranging from a short and limited aversion to paralyzing phobia. The aim of this retrospective, cross-sectional study was to determine the level of anxiety amongst children during venipuncture, to compare the anxiety reported by children and parents, and to identify the factors affecting the children’s and parents’ anxiety in order to develop therapeutic strategies. In total, 147 children (aged 0–17 years, 78 female) and their parents completed questionnaires. Statistical analysis was performed using qualitative and quantitative methods. Results showed that the majority of children reported anxiety and pain during venipuncture. Younger children had more anxiety (self-reported or assessed by parents). Children and parental reports of anxiety were highly correlated. However, the child’s anxiety was often reported as higher by parents than by the children themselves. The child’s general anxiety as well as the parents’ perceived stress from surgical interventions (but not the number of surgical interventions) prompted parental report of child anxiety. For children, the main stressors that correlated with anxiety and pain were factors during the blood collection itself (e.g., feeling the puncture, seeing the syringe). Parental anxiety was mainly related to circumstances before the blood collection (e.g., approaching the clinic, sitting in the waiting room). The main stressors mentioned by parents were the child’s discomfort and their inability to calm the child. Results indicate that the children’s fear of factors during the blood collection, along with the parents’ perceived stress and helplessness as well as their anticipatory anxiety are important starting points for facilitating the drawing of blood from children before and after liver transplantation, thereby supporting a better disease course in the future.

A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms

Atypical behavioral responses to environmental sounds are common in autistic children and adults, with 50-70 % of this population exhibiting decreased sound tolerance (DST) at some point in their lives. This symptom is a source of significant distress and impairment across the lifespan, contributing to anxiety, challenging behaviors, reduced community participation, and school/workplace difficulties. However, relatively little is known about its phenomenology or neurocognitive underpinnings. The present article synthesizes a large body of literature on the phenomenology and pathophysiology of DST-related conditions to generate a comprehensive theoretical account of DST in autism. Notably, we argue against conceptualizing DST as a unified construct, suggesting that it be separated into three phenomenologically distinct conditions: hyperacusis (the perception of everyday sounds as excessively loud or painful), misophonia (an acquired aversive reaction to specific sounds), and phonophobia (a specific phobia of sound), each responsible for a portion of observed DST behaviors. We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.

Children's self-reports of fear and pain levels during needle procedures

Aim

The objective was to determine the levels of and potential relationships between, procedure-related fear and pain in children.

Design

Clinical based cross-sectional.

Methods

Ninety children aged between 7-18 years were included consecutively and self-reported levels of pain and fear on a 0-100 mm visual analogue scales (VAS) when undergoing routine needle insertion into a subcutaneously implanted intravenous port following topical anaesthesia.

Results

The needle-related fear level was reported to be as high as the needle-related pain level (mean VAS: 14 mm and 12 mm, respectively, N = 90). With fear as the dependent variable, age and pain were significantly associated and explained 16% of the variance. With pain as the dependent variable, fear was significantly associated and explained 11% of the variance. A post hoc analysis indicated that younger children reported their fear levels to be higher than their pain levels.

Clinical holding: ethical guidance for children's nurses working in the UK

This article explores ethical decision-making surrounding clinical holding of children and young people in healthcare environments with the aim of enhancing autonomy and engagement on their behalf. A considerable body of evidence, published over the last 20 years, suggests that this complex and challenging area of practice is not always well managed, with mixed messages about the nature of consent, choice and negotiated practice countered by best interests decisions taking precedence ahead of the child's wishes. An ethical framework is proposed comprising four levels of value-based interventions and how they may be applied in clinical practice, allowing for increased engagement, empowerment and support on behalf of children and young people in relation to clinical holding decisions.

Challenging anxious cognitions or accepting them? Exploring the efficacy of the cognitive elements of cognitive behaviour therapy and acceptance and commitment therapy in the reduction of children's fear of the dark

Anxiety is highly prevalent in pre‐adolescent children. Distorted cognitions are characteristic for dysfunctional levels of anxiety. However, applying cognitive elements in pre‐adolescent children cannot be fully ascertained, as it is not until adolescence before children can apply logical and abstract reasoning in a sophisticated manner. Cognitive behaviour therapy (CBT) and acceptance and commitment therapy (ACT) both target distorted cognitions. Whereas CBT encourages children to change the content of negative cognitions by applying cognitive restructuring, ACT stimulates youth to have a more accepting attitude towards these thoughts by applying cognitive defusion. The current study examined the efficacy of applying cognitive elements and compared the cognitive elements of CBT and ACT in pre‐adolescent children. We included no behavioural elements to specifically study the developmental appropriateness of the cognitive elements in this age group. Highly anxious children, aged 8–12 years were randomised to a 30‐minute cognitive restructuring (n = 21) or cognitive defusion intervention (n = 22). Subjective fear of the dark levels, behavioural darkness toleration, and comprehension and fun associated with the interventions were assessed. Both interventions had a significantly positive impact on children's fear of the dark. Cognitive restructuring led to more favourable results on subjective fear than cognitive defusion, no differences were found for darkness toleration.

The association between car accident fatalities and children's fears: A study in seven EU countries

Children's fear of a car accident occurring to parents or themselves has been used as a concrete example to illustrate one of the symptoms of anxiety disorders such as separation anxiety and generalized anxiety. However, its usage across countries may be questionable where the prevalence of this specific type of injury differs. This cross-sectional study compares samples from seven diverse European countries (Bulgaria, Germany, Italy, Lithuania, Netherlands, Romania, Turkey) to see if an environmental exposure, car accident death rate per 100,000 people (country-wide from WHO data), is associated with children's self-report of car accident fears. In this study, 6-11 year-old children were surveyed by a diagnostic instrument (Dominic Interactive) about several situations and asked if they believed they were similar to a fictional child depicted in said situations. Mothers were surveyed for additional sociodemographic information. Multivariable logistic regression was used to adjust for covariates including mother's age, mother's education, single parenting, and mother's professional inactivity. We report a monotonic relationship between higher car accident death rates and the prevalence of children reporting fear of parent's or own accident. Relative to a reference of 3.9 deaths per 100,000 people, children's odds of reporting fear of parent's accident ranged from 1.99 (95% CI 1.51-2.61) times to 4.84 (95% CI 3.68-6.37) times as the risk of death by car accident increased across countries. A similar result arose from fear of child's own accident, with significant ORs ranging from 1.91 (95% CI 1.53-2.40) to 2.68 (95% CI 2.07-3.47) alongside increased death rates. Given that reporting of these fears accompanies correspondingly high accident death rates, the pertinence of using fear of car accidents as an illustration for some diagnostic item for mental disorders cross-nationally appears to be an issue.

Parents' perspectives on supporting children during needle-related medical procedures

When children endure needle-related medical procedures (NRMPs), different emotions arise for the child and his/her parents. Despite the parents’ own feelings, they have a key role in supporting their child through these procedures. The aim of this study is to describe the meanings of supporting children during NRMPs from the perspective of the parents. Twenty-one parents participated in this study. A reflective lifeworld research (RLR) approach was used and phenomenological analysis was applied. The essential meaning of the phenomenon—supporting children during an NRMP—is characterized as “keeping the child under the protection of one’s wings,” sometimes very close and sometimes a little further out under the wingtips. The essential meaning is additionally described through its constituents: paying attention to the child’s way of expressing itself, striving to maintain control, facilitating the child’s understanding, focusing the child’s attention, seeking additional support, and rewarding the child. The conclusion is that parents’ ability to be supportive can be affected when seeing their child undergo an NRMP. To regain the role as the child’s protector and to be able to keep the child “under the protection of one’s wings,” parents need support from the staff.

Undergoing an immunization is effortlessly, manageable or difficult according to five-year-old children

BACKGROUND

To prevent diseases among children they regularly undergo immunizations. Previous research show different approaches available to facilitate immunization-procedures for children to protect them from harm. To complement this research and provide care suited for children, research recognizing their perceptions of undergoing such a procedure is needed.

AIM

The aim of this study was to describe 5-year-old children's perceptions of undergoing an immunization.

METHOD

A phenomenographic approach and analysis was used to describe the children's (n = 21) various perceptions. The data-collection was accomplished directly after the immunization to grasp the children's immediate perceptions. Drawings and reflective talks were used as they are considered as suitable methods when involving young children in research. The right to conduct research with children was approved by the appropriate research ethics committee and also by each child and the parents.

RESULTS

The findings show that children's perceptions of an immunization-procedure may vary from effortlessly, to manageable or difficult. Regardless of how the child perceive the immunization-procedure each perception embrace the children's descriptions of actors and articles in the situation, their feelings in the situation and also their actions to deal with the immunization. Nevertheless, these descriptions vary according to how the children perceive the immunization as effortlessly, manageable or difficult.

CONCLUSION

Children's and adults' perceptions of medical procedures may differ and children need guidance, time and space to deal with them. Recognizing children's perceptions of undergoing an immunization contributes to the promotion of their right to be involved in their own health care and towards the development of child-centred care.

Nurses' perspectives on supporting children during needle-related medical procedures

Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents' ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as "balancing on a tightrope" in an unpredictable situation.

Growing pains and pleasures: how emotional learning guides development

The nervous system promotes adaptive responding to myriad environmental stimuli by ascribing emotion to specific stimulus domains. This affects the salience of different stimuli, facilitates learning, and likely involves the amygdala. Recent studies suggest a strong homology between adaptive responses that result from learning and those that emerge during development. As in motivated learning, developmental studies have found the salience of different classes of stimulus (e.g., peers) undergoes marked fluctuation across maturation and may involve differential amygdala engagement. In this review, by highlighting the importance of particular stimulus categories during sensitive periods of development, we suggest that variability in amygdala response to different stimulus domains has an active and functional role in shaping emerging cortical circuits across development.

Examining the cultural validity of fear survey schedule for children: the contemporary fears of Turkish children and adolescents

The authors examined the cultural validity of Fear Survey Schedule for Children (FSSC-AM) developed by J. J. Burnham (2005) with Turkish children. The relationships between demographic variables and the level of fear were also tested. Three independent data sets were used. The first data set comprised 676 participants (321 women and 355 men) and was used for examining factor structure and internal reliability of FSSC. The second data set comprised 639 participants (321 women and 318 men) and was used for testing internal reliability and to confirm the factor structure of FSCC. The third data set comprised 355 participants (173 women and 182 men) and used for analyses of test-retest reliability, inter-item reliability, and convergent validity for the scores of FSSC. The sum of the first and second samples (1,315 participants; 642 women and 673 men) was used for testing the relationships between demographic variables and the level of fear. Results indicated that FSSC is a valid and reliable instrument to examine Turkish children's and adolescents' fears between the ages of 8 and 18 years. The younger, female, children of low-income parents reported a higher level of fear. The findings are discussed in light of the existing literature.

Evaluating and approaching a strange animal: children's trust in informant testimony

This study examined 3- to 7-year-old children's reliance on informant testimony to learn about a novel animal. Sixty participants were given positive or negative information about an Australian marsupial from an informant described as a maternal figure or a zookeeper. Children were asked which informant was correct and were invited to touch the animal, which was a stuffed toy hidden in a crate. Overall, younger children endorsed the zookeeper's testimony about the animal, but touched the animal more readily when the maternal figure provided positive information. Older children endorsed the informant who provided positive information, but showed some sensitivity to zookeeper expertise. Age differences were obtained in the association between participant characteristics and informant selection and animal approach behavior.

The Common Fears and Their Origins Among Turkish Children and Adolescents

The present study aimed to investigate the common fears and their origins among children and adolescents from different age, gender, and socioeconomic levels (SES). The sample was comprised of 642 females (48.8%) and 673 males (51.2%) with a total of 1,315 participants aged between 8 and 18 (M = 13.15; SD = 3.18). The Fear interview was utilised to examine the common fears and the role of conditioning, modelling and negative information in the development of children's fears. The result showed that the most common fear in Turkey was ‘God’, followed by ‘losing my friends’ and ‘going to Hell’. In addition, the findings revealed that Turkish students are more likely to learn fears by modelling rather than negative information transmission and conditioning. The results also indicated that negative information transmission had a more intensifying effect on the children and adolescents’ existing fear rather than modelling and conditioning. Furthermore, multinomial logistic regression was conducted to examine the effects of age, gender and SES on the origins of fear. Results showed that age and gender were significant predictors of origins of fear.

Young (3–5 year-old) children’s ways of engagement in care procedures involving venepuncture

A fear of medical examination and of pain in care procedures is common among children. Young children are particularly sensitive to the way a procedure is carried out. The children will engage and act in the way they understand the situation and what is meaningful for them, which will depend on their experiences, interests and motivation. This study describes the qualitative differences in the complexity of how young children, aged 3–5 years, demonstrated the way they engaged in care procedures involving venepuncture. Video observation captured the young children as social actors in the procedure, and interpretive descriptive analysis was used to seek an understanding of the children’s demonstrated expressions and actions. The identified ways of engagement among the children were as follows: watchful engagement, curious engagement and adaptive engagement, as well as avoidance, forced engagement and resigned engagement. The children could fluctuate between the different ways of engagement during the course of the procedure. The results call attention to the sensitivity and responsiveness shown by the adults, nurses and parents in guiding the young children’s engagement and their ability to become integrated and act through active participation in a sometimes frightening care procedure.

Cross-cultural variations in the prevalence and presentation of anxiety disorders

Considerable cross-cultural variation exists in the prevalence and presentation of the anxiety disorders as defined by the fourth edition of the Diagnostic and Statistical Manual. Researchers debate whether this variation represents cultural differences in the phenomenology of universal disorders or the existence of unique culturally constructed disorders. This article reviews recent literature on the prevalence and presentation of five anxiety disorders: generalized anxiety disorder, social anxiety disorder, panic disorder, specific phobia and post-traumatic stress disorder, both across countries and within the USA. This article indicates that certain anxiety disorders (e.g., generalized anxiety disorder and panic disorder) may vary greatly in rate across cultural groups. It indicates that the clinical presentation of anxiety disorders, with respect to symptom presentation and the interpretation of symptoms, varies across cultures. A difference in catastrophic cognitions about anxiety symptoms across cultures is hypothesized to be a key aspect of cross-cultural variation in the anxiety disorders. Future research directions are suggested.