Pediatric Specific Phobia Workup

Updated: Aug 09, 2018
  • Author: William R Yates, MD, MS; Chief Editor: Caroly Pataki, MD  more...
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Workup

Approach Considerations

Fears and phobias are common in young children; thus, preschool children are rarely referred and diagnosed as phobic. Common fears of childhood need to be distinguished from specific phobia, as the latter is irrational, interferes more with daily routines, and leads to maladaptive behaviors.

Assessments generally consist of structured or semistructured interviews by the practitioner with the child and his or her parents. Various rating scales are also available to assess anxiety disorders.

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Diagnostic Criteria

Diagnostic criteria for specific phobia is found in the Diagnostic and Statistical Manual of Mental Disorders,FifthEdition (DSM-5). [8] This revision made no significant criteria changes for the diagnosis of pediatric specific phobia.

The specific DSM-5 criteria for specific phobia are as follows: [8]

  • Marked fear or anxiety about a specific object or situation (eg, flying, heights, animals, receiving an injection, or seeing blood); in children, this fear or anxiety may be expressed by crying, tantrums, freezing or clinging
  • The phobic object or situation almost always provokes immediate fear or anxiety
  • The phobic object or situation is actively avoided or endured with intense fear or anxiety
  • The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context
  • The fear, anxiety, or avoidance persists, typically for 6 months or longer
  • The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The disturbance cannot be better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with paniclike symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder [OCD]); reminders of traumatic events (as in posttraumatic stress disorder [PTSD]); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder)

The following specifiers are used, according to the phobic stimulus present: [8]

  • Animal - Fear of dogs (cynophobia), cats (ailurophobia), bees (apiphobia), spiders (arachnophobia), snakes (ophidiophobia), or other animals
  • Natural environment - Fear of heights (acrophobia), water (hydrophobia), or thunderstorms (astraphobia)
  • Blood-injection-injury - Fear of needles or invasive medical procedures
  • Situational - Fear of flying, elevators, or enclosed spaces
  • Other - Fear of situations that may lead to choking or vomiting; in children, loud sounds or costumed characters
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