Phobias | Diagnosis & Treatments

As one of the largest pediatric psychiatric services in New England, our team at Boston Children's Hospital is made up of expert psychiatrists, psychologists, and social workers ready to help your child and family cope with a phobia.

How do we diagnose phobias?

A Boston Children’s mental health clinician (typically a child and adolescent psychiatrist, child psychologist, or psychiatric social worker) determines if your child has a phobia after making a comprehensive psychiatric assessment with you and your child. During the assessment, you talk about your child’s fears and any panic attack symptoms. You also are also asked to provide an overview of your child’s family history, medical history, academic life, and social interactions.

If my child is diagnosed with a phobia, what happens next?

Your mental health clinician will explain the diagnosis and answer any questions you or your child may have. The next step is developing a mutually agreed-upon treatment plan that works for you, your child, and your family.

How do we treat phobias?

At Boston Children's Hospital, we typically treat phobias with:

  • psychotherapy
  • in some cases, a combination of therapy and anti-anxiety medication

Psychotherapy

Psychotherapy, or “talk therapy,” is designed to help the child learn new ways of controlling his fear, anxiety, and panic attacks, if and when they occur. A clinician teaches your child to address his phobia (and the feelings it causes) by using such techniques as:

  • recognizing that the sense of danger associated with the object of the phobia is out of proportion (for example, if a child has a phobia of birds, recognizing that birds rarely come into direct contact with people and can't cause significant injury if they do)
  • realizing that the imagined outcomes of encountering the feared object or situation are impossible or highly unlikely (for example, being alone in a dark bedroom won't cause the child to be attacked by monsters)
  • practicing “self-talk” to remember what is real and what is imagined (for example, “I'm OK. I might feel like I'm going to die because I'm so scared, but that's just my brain creating panic. I am not in any real danger. If I take deep breaths and think calmly, this feeling will go away.”)
  • relaxation exercises to control breathing and lessen muscle tension when feeling anxious
  • role-playing with the clinician and/or a parent to “practice” worst-case scenarios related to the phobia (for example, “Imagine you are about to give a speech in front of your class and you mix up your notes”), use newly learned coping and problem-solving skills to lessen anxiety, and eventually accept that the fear is not based in reality
  • gradually increasing exposure to situations that “trigger” the phobia (for example, getting up on a stage or being near a spider), so that over time, as the child realizes a dreaded outcome is unlikely to happen, the feelings of fear go away

Anti-anxiety medications

If your child's phobia doesn't adequately respond to therapy, your clinician may add an anti-anxiety medication to his treatment plan. These medications can be very beneficial in helping your child feel more relaxed while working on problem-solving and coping skills in therapy.

Medication is never a “standalone” treatment here; we consider it part of a two-prong approach, with psychotherapy as a necessary component. Our Psychopharmacology Clinic is devoted to helping children, families, and clinicians decide whether medication might be a useful part of treatment.

Occasionally prescribed anti-anxiety medications include:

  • alprazolam (Xanax)
  • lorazepam (Ativan)
  • diazepam (Valium)
  • clonazepam (Klonopin)
  • diphenhydramine (Benadryl)
  • hydroxizine (Vistaril)

Less commonly prescribed medications that can also treat fear and anxiety include:

  • buspirone (BuSpar)
  • zolpidem (Ambien)

For persistent problems with anxiety treatment, an anti-anxiety/antidepressant drug may be recommended. These medications include:

  • prozac
  • zoloft
  • effexor
  • celexa
  • lexapro

Learn more about psychiatric medications.

Coping and support

The ups and downs experienced by a child — and family — living with a phobia can feel overwhelming. In addition to the information provided here, you may find comfort and support from the following resources:

Patient and family resources at Boston Children's

The Hale Family Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families, and health professionals are welcome to use the center's services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.

The Advocating Success for Kids (ASK) Program provides multidisciplinary evaluation, referral, and advocacy services for children under age 14 with behavioral, emotional, learning, or developmental problems, either at home or at school. ASK works with children who receive their primary care either at Boston's Bowdoin Street Community Health Center, Boston Children's at Martha Eliot, or Joseph M. Smith Community Health Center, or at the Children's Hospital Primary Care Center. For more information about ASK, please call 617-355-4690.

The Experience Journal was designed by Boston Children's psychiatrist-in-chief David DeMaso, MD, and members of his team. This online collection features thoughts, reflections, and advice from kids and caregivers dealing not only with physical illnesses like asthma and diabetes, but also with such mental health conditions as ADHD and depression.

Our Integrative Therapies Team provides a number of services for hospitalized children, their families, and their caregivers, including:

  • massage therapy
  • acupuncture
  • yoga
  • therapeutic touch

Why are my friendships changing? How can I convince my parents that being a vegetarian is heathy and right for me? What types of birth control are available to me, and how do I use them? Young men and young women may have some concerns specific to their gender, and some that they share. The Center for Young Women's Health and Young Men's Health Site offer the latest general and gender-specific information about issues including fitness and nutrition, sexuality and health, health and development, and emotional health.

Helpful links

Please note that neither Boston Children's Hospital nor the Department of Psychiatry and Behavioral Sciences unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

Helpful links for parents and families

Helpful links for teens

Helpful links for younger children