Unusual Fears and Phobias in Children with Autism - West Palm Beach Autism & Education | Examiner.com

Unusual Fears and Phobias in Children with Autism - West Palm Beach Autism & Education | Examiner.com

Anxiety Disorders are a frequent co-occurring (comorbid) problem for children and youth with ASD.
Although prevalence rates vary from 11% to 84%, most studies indicate
that approximately one-half of children with ASD meet criteria for at
least one anxiety disorder. Of all types of anxiety disorders, specific
phobia is the most common, with prevalence estimates ranging from 31% to
64%. In contrast, estimates of phobias in children in the general population range from 5% to 18%.

Unusual fears have long been recognized as a feature of autism.
In fact, 70 years ago, Leo Kanner wrote in his initial account of
autism that “loud noises and moving objects” are “reacted to with
horror” and things like “tricycles, swings, elevators, vacuum cleaners,
running water, gas burners, mechanical toys, egg beaters, even the wind
could on occasions bring about a major panic.” We now know that children
with autism perceive, experience, and respond to the world very
differently than children without autism. Experiences that may be
tolerable for most typical children might be frightening, disturbing, or
irritating for a child with ASD. Children with autism may also be
unresponsive to other experiences (e.g., insensitive to pain), may not
show stranger or separation anxiety, and may be seemingly unaware of
obvious dangers (e.g., running into traffic).


Previous research examining the types and frequencies of fears in
children with autism have found odd and intense fears in approximately
40% of children with autism, whereas unusual fears were present in only
0–5% of children without autism, including children with a learning
disability, language disorder, ADHD, intellectual disability, and
typical development. Studies also indicate that while some of the most
common fears for children with autism and typical development overlap,
children with autism have frequent fears that were not amongst the most
frequently reported for typical children. These include fear of
thunderstorms, large crowds, and closed spaces.

A large scale study reported in Research in Autism Spectrum Disorders
investigated unusual fears in a sample of 1033 children ages 1-16 with
autism. The purpose of the study was to categorize and determine
specific types of unusual fears in children with autism as well as
identify variables related to the presence or absence of these fears.
Unusual fears were reported in 421 (40.8%) of the 1033 children with
autism. A total of 487 unusual fears were reported, representing 92
different fears. The most common unusual fear was fear of toilets,
accounting for 11.7% of the unusual fears. For children with unusual
fears, 60.0% had one fear, 27.6% had two, 10.2% had three, 1.9% had
four, and one child had five fears. Unusual fears fell into 14
categories. More than half of the 421 children with unusual fears had
fears of mechanical things, heights, and/or weather. The most common
category was fear of mechanical things, which accounted for 23.8% of the
types of fears reported. For children with unusual fears, 71.1% had
fears in only one category, 21.9% in two categories, 6.7% in three
categories, and 0.3% in four categories. Many children also had common
childhood fears and phobias (including fear of dogs, bugs, spiders,
snakes, the dark, doctors, barbers, monsters, people in costumes,
mechanical toys, sleeping alone, fire, and swimming), which increased
the overall proportion of children with autism who had intense fears and
phobias to more than 50%.

Categories and Frequency of Unusual Fears

The most frequently reported categories of unusual fears were:

  • Mechanical things (Blenders, can openers,
    cassette players, ceiling fans, clothes, dryers, drills, electric
    toothbrushes, exhaust fans, hair dryers, hand dryers, leaf blowers,
    toilets, vacuum cleaners, washing machines, water fountains,
    wheelchairs, windshield wipers)
  • Heights (Elevators, escalators, heights, steps)
  • Weather (Cloudy weather, natural disasters such as floods, droughts, hurricanes, tornadoes), rain, thunderstorms, wind)
  • Non-mechanical things (Balloons, black
    television screen, buttons, clam shells, crayons, dolls, drains,
    electrical outlets, eyes on toys garden hose, glass tabletops, glow in
    dark stars, gum under table, hair in bathtub, lights, mole on person’s
    face, moon, shadows, strings, stuffed animals, swinging or rocking
    things, tall things, things on ceiling, vent on house)
  • Places (Bathroom, bedroom, certain house
    or restaurant, closed or small spaces, garage, large or open space, room
    with doors unlocked or open)
  • Worries Dying (e.g., bone breaking through
    chest, car accident, drowned, eaten by fleas, heart attack, murdered,
    natural disaster, poisoned, spleen exploding, world ending), germs or
    contamination, running out of certain foods, running out of gas,
    something falling over, swallowing something when did not, toilet
    overflowing, tree falling on house)
  • Visual media (Characters in or segments of movies, television shows, commercials, computer games)
Types and Frequency of Unusual Fears

Unusual fears reported by parents fell into two categories: (1)
uncommon fears not typically reported in children in the general
population or in children with specific phobias and (2) fears that have
been reported in studies of children without autism but which were
considered unusual by parents because of their intensity, obsessiveness,
irrationality, or interference with functioning. Of the total number
reported, the most common unusual fears in three or more children with
autism were:

  • Toilets
  • Elevators
  • Vacuum cleaners
  • Thunderstorms
  • Tornadoes
  • Heights
  • Worry dying (e.g., bone breaking through chest, car
    accident, drowned, eaten by fleas, heart attack, murdered, natural
    disaster, poisoned, sick, spleen exploding, or world ending)
  • Visual media (characters in or segments of movies, television shows, commercials, or computer games)
Associated variables

Children with and without unusual fears did not differ in age, IQ
level, mental age, autism severity, race or parent occupation. Of all
the demographic variables, only female gender was associated with the
presence or absence of unusual fears. More girls had unusual fears
(48.8%) than did boys (39.1%). This is consistent with the earlier
studies indicating that girls with autism had more fears than boys and
with general population studies showing that girls had more fears and
higher fear survey scores than boys. The finding that children with and
without unusual fears did not differ in age suggests that unlike most
typical children, those with autism may not outgrow unusual fears.
Likewise, the findings regarding autism severity and parent occupation
suggest that the presence of unusual and intense fears may be present
across SES and the entire autism spectrum. The authors note that the
lack of demographic differences in the study may suggest a
neurobiological basis for fears overriding developmental and
environmental influences.

Conclusion and Implications

Research suggests that it is critical to assess for unusual and
intense fears in children with ASD because they are common in this
population and can interfere significantly with functioning. Specific
fears and phobias have been cited as frequent anxiety triggers/stressors
for children with ASD. The impact of anxiety includes personal distress
in children, parents, and siblings, increase in challenging behavior
and stereotyped behaviors, restriction of activities/opportunities and
negative impact on quality of life for child and family. For example,
children with autism may avoid necessary life situations (e.g., refusing
to go to school because there may be a fire drill) or be in a constant
state of anxiety and unable to function optimally because of their

Identification of specific fears and phobias in children with ASD can
help educators and interventionists improve programs and services for
this group of students. This information may be especially useful for
clinicians, particularly those utilizing CBT as a treatment approach for
children and youth with ASD. There is evidence to suggest that the
interventions used to treat intense fears and phobias in children
without autism (exposure, desensitization, modeling, shaping, and
reinforcement) might also be effective for children who have autism.
Lastly, further research is needed to investigate why some specific
unusual fears are common to autism but not the general population. As
more individuals with ASD communicate about their fears and reasons for
their idiosyncrasies, we may come to a better understanding of autism
and its symptoms.


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