|  Age of  Onset 4
Age of  Onset
Frequent and varied fears are a normal part of childhood. As children have increased
exposure to the world, and develop cognitively, they tend to “age out” of their fears
as they learn that particular stimuli are not dangerous. For some children, this kind
of learning fails to occur. This can be due to family avoidance of the stimuli, learn-
ing to fear the stimuli from other family members, or (albeit less likely) a negative
experience with the stimuli. In these cases, a phobia can develop. The hallmark of a
phobia (in contrast to a normal, transient fear) is the expression of extreme distress
when exposed to the feared stimuli and/or impairment in functioning.
A recent literature review suggests that the age of onset for animal phobias, natu-
ral environment phobias (fear of heights, storms, and water), and blood-injection-
injury (BII) phobias are remarkably similar (LeBeau et al., 2010). These subtypes
of phobias tend to emerge between 5 and 13 years of age. In contrast, situational
phobias (fear of flying, driving, enclosed places) tend to emerge later, between the
ages of 13 and 21. It is important to note that most studies on age of onset of pho-
bias are based on retrospective data (i.e., adults looking back on their childhoods),
suggesting that these data should be viewed with some caution.
In a clinical setting, the youngest patients with phobias tend to fear specific ani-
mals and insects. Very young children (ages 3–5) also present for treatment fearing
imaginary creatures (e.g., ghosts, witches) and the dark. Later in childhood (ages
6–9), we continue to see children with the aforementioned fears and we also begin
to see children with fears pertaining to their physical health. At this age, children
retain memories of going to the doctor for yearly immunizations or blood tests.
They might remember a negative experience of being ill or of seeing a friend or
family member being ill, or they might learn about illnesses from school or the
media. For some children, these experiences lead to the onset of a full-blown pho-
bia of BII and other bodily concerns (including vomit).
In the later elementary school years and through middle school (ages 9–13), pho-
bias shift more into the realm of general worries (doing well at school) and social
concerns. This makes sense because at this time, life revolves around school and
peers. Even at this young age, there can already be a great deal of pressure to per-
form well in school and extracurricular activities. For youth who are predisposed
to anxiety, messages communicated by schools and parents can be strongly inter-
nalized and translated into overwork, expectations that are impossible to meet, and
negative thoughts about the self when performance is anything less than perfect.
Other anxious children who receive these messages sometimes underperform. The
standards that they set for themselves (and which they perceive are set for them
by others) can seem so difficult to attain that they end up procrastinating and not
being able to complete work in a timely manner, resulting in poor grades. Socially,
this is the age where peer relations become more complex, leading some anxious
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