January 20, 2004Experts Try Fast-Track Fix for Children With PhobiasJanuary 20, 2004Experts Try Fast-Track Fix for Children With PhobiasBy RANDI HUTTER EPSTEINBugs ruled Brandon Howard's life as long as he could remember. One glimpse of a beetleflitting by was enough to send Brandon racing away from his buddies to the safety of home.But no more. A single three-hour treatment session turned Brandon, who was 10 then, into a friend of beetles. In this intensive exposure session, a therapist helped Brandon bond with a red-striped beetle and conquer his fears. So far he's been phobia-free for ninemonths.Brandon, who is now 11 and lives in Dublin, Va., is one of 120 children participating in a trial sponsored by the National Institute of Mental Health that is testing a speedy cure for childhood phobias. So far, investigators, from Virginia Tech and Stockholm University in Sweden, claim a 75 percent cure rate — with follow-up of about a year.The concept is a CliffsNotes version of traditional exposure therapy: the people with phobias are exposed to their worst nightmares until their bodies are too weary to respond with stress. But in this trial with children, the lessons typically experienced over several sessions are conducted in three hours.Brandon said he looked at the beetle in the jar for 20 seconds and needed a break. "It was awful at first," he said. And then, in the course of a few hours, he got closer and closer until the bug was creeping up his arm. "It was just amazing how you can really heal and not even know it."Children's phobias include fear of strangers among infants, fear of monsters and fierce animals in toddlers and fear of thunderstorms and bodily injury among older children. While some experts believe most children will grow out of these phobias without treatment, others see the need for intervention.For parents, it is best to be calm and not allow children to avoid particular phobias totally,many experts say, because that can reinforce the child's worries. And what can seem like an inconvenience often creates havoc in a household when youngsters refuse to go to school, play with friends or go on family outings.Parents talk about children who obsess over weather reports, lose sleep over the possibility of a fire alarm, or refuse to walk to school for fear of encountering a dog.Ann Goettman, a mother of three in McLlean, Va., said her formerly outgoing 8-year-old suddenly became terrified of thunderstorms."It completely changed her personality and disrupted family life," Ms. Goettman said. "She didn't want play dates in case it rained. I'd get calls from the school nurse saying mydaughter has stomach pains and I'd have to ask, `Did you hear thunder?' She was constantly checking the weather map to see if there was a lightning bolt in the picture. It consumed her life." Ms. Goettman's daughter, who did not want her name used, suffered from a common phobia. Her fears faded within five months without professional help, but with a lot of reassurance from her parents. What type of treatment will work often depends on the child. Some experts question whether children have the courage or stamina to withstand a single intense session, as Brandon did. "One treatment session might be good for the highly motivated child," said Dr. Tamar Chansky, director of the Children's Center for O.C.D. and Anxiety in PlymouthMeeting, Pa. "But I think the message for parents is that you have to know your child. Is your child a microwave or a crockpot? Some kids need more time to stew and simmer. And that's O.K." Most therapists prefer a more relaxed pace, teaching a child to behave differently or thinkdifferently over several weeks or months. Still, the institute study's focus on phobic children is helping pave the way for a biologically based concept of emotional development. Some scientists speculate that phobias are set off by faulty brain chemistry, creating an exaggerated response to, say, a loud noise or a big dog. But instead of a fix-it-all pill, some authorities are looking to cognitive and behavior therapy to fix faulty circuitry and help children cope with stress better when they grow into adults. Kim Howard, Brandon's mother, said her son had been "creeped out by everything since he was 3.""We live in a rural community with all kinds of weird bugs," she said, "but when all the kids were playing, he'd just wind up coming home and doing stuff by himself because of a bee, spider, insect, whatever." By the end of his treatment at Virginia Tech, Brandon's former nemesis, a bean-size box elder bug, became his new pet. "The really weird thing about the whole deal," Mrs. Howard said, "is that he used to be petrified of the dark and thunderstorms. I don't know how it all ties together but he is a different, more confident kid. And there was no hypnosis, no medication."Dr. Thomas Ollendick, one of the investigators and a professor of psychology at Virginia Tech, said the "notion is that a phobia persists because a person has certain catastrophic thoughts about what will happen.""We expose them to the fear and help them realize what they dread will happen does not truly happen," Dr. Ollendick said. He and his collaborator, Dr. Lars-Goran Ost, a professor of psychology at Stockholm University, presented preliminary findings on Nov.23 at the meeting of the Association for the Advancement of Behavior Therapy in Boston.Therapists say the phobia often has nothing to do with the triggering event. Any crisis for the child, like the birth of a baby sister or moving to a new home, can bring on a fear that may seem to have nothing to do with the initial situation.In Freud's day, no surprise, psychotherapists believed the fears of toddlers and young children represented unconscious sexual urges. Little Hans, one of Freud's patients in 1909, developed anxiety over horses after a bad fall. According to Freud's analysis, the horse phobia was a reflection of repressed sexual urges for his mother and aggression against his father, said Dr. Allan Compton, a Los Angeles psychiatrist.In the 1920's, Dr. John Watson, a professor of psychology at Johns Hopkins University, argued a radical new theory that phobias could be taught. Dr. Watson based his notion on a flawed study of one boy, Little Albert, who was conditioned to fear rabbits. The researcher claimed he startled Albert by clanging on an iron rod every time he handed theboy a white rat. Like a Pavlovian response Albert would be startled by any white
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