Nighttime fears of children and adolescents: Frequency, content, severity, harm expectations, disclosure, and coping behaviours

Abstract

The present school-based study investigated the nighttime fears of 511 children and adolescents, aged 8–16 years. Participants were assessed using a structured interview about the frequency, content, severity, harm expectations, coping strategies, and disclosure of nighttime fears. Results indicated that nighttime fears are a common experience, with nearly two-thirds (64.2%) of children and adolescents reporting nighttime fears. Fear of intruders/home invasion was the most frequently reported nighttime fear. Females more frequently reported nighttime fears than males (72.9% and 54.6%, respectively) and a greater number of children reported nighttime fears compared to adolescents (79.4% and 48.8%, respectively). Nighttime fears were given moderate severity ratings, and harm expectations were most strongly associated with ‘personal security’ fears. Respondents reported a variety of coping strategies to manage their nighttime fears with self-control/distraction techniques being the most common. Most respondents reported disclosing their nighttime fear(s) to another person. The clinical implications of these findings and the methodological limitations are discussed.

Introduction

Nighttime fears are normal reactions to real or imagined threats at night, and have been cited in the medical, psychiatric, and normative fear literature since the time of Hippocrates in 460–370 BC (Gordon, 2004; Treffers & Silverman, 2001). Described as a ‘heterogeneous class of fears’, such nocturnal fears comprise a broader content than simply a fear of darkness, including fears of bad dreams, nightmares, noises, shadows, monsters, intruders, burglars, kidnappers, and of being left alone at night (Gordon, King, Gullone, Muris, & Ollendick, 2007; King, Ollendick, & Tonge, 1997). Although there has been much research on the fears of children and adolescents (Craske, 1997; Gullone, 2000; Westenberg, Drewes, Goedhart, Siebelink, & Treffers, 2004), surprisingly little work has addressed the fears of children at night, particularly for adolescents.

Most children and adolescents appear to overcome or outgrow nighttime fears, however, others experience persistent and severe nighttime fears that interfere with their daily functioning, and cause much discomfort for both the child/adolescent and family (Gordon & King, 2002). For example, in a community survey of parent-reported sleep problems of 989 elementary school children, Blader, Koplewicz, Abikoff, and Foley (1997) found that sleep onset problems were correlated with more nighttime fears, night waking, psychiatric and medical conditions, the need for reassurance and caregiver proximity, and a history of sleep problems. In an epidemiologic study of 776 young people, Pine, Cohen, and Brook (2001) reported that fear of the dark specifically and overall level of fears in adolescence more generally were predictive of future risk for major depression. Clearly, nighttime fears are not trivial and require further research investigation (Gordon & King, 2002).

In a sample of 54 unselected normal American children between 4 and 12 years of age, Bauer (1976) found that 74% of 4–6 year olds, 53% of 6–8 year olds, and 55% of 10–12 year olds reported fears of ghosts and monsters. ‘Bedtime fears’ were reported by 53%, 67%, and 35% of the three age groups, while ‘frightening dreams’ were endorsed by 74%, 80%, and 45% of three groups, respectively. Such developmental progression of ‘normal’ fears is thought to reflect the emerging cognitive and representational capabilities of the child (Gullone, 2000; King et al., 1997; King, Hamilton, & Ollendick, 1988). With regard to gender differences, Bauer (1976) noted that girls more frequently reported nighttime fears (i.e., frightening dreams, bedtime fears) than boys. This was especially so for 10–12 year olds.

More recently, Muris and colleagues investigated nighttime fears in 176 normal school aged 4–12 years in the Netherlands (Muris, Merckelbach, Ollendick, King, & Bogie, 2001). Children and parents were interviewed about the frequency, content, origins, coping behaviours, and severity of children's nighttime fears. Results showed that 73.3% of children reported nighttime fears confirming the suspected high prevalence of such fears. Developmental patterns were also evident, with 58.8% of 4–6 year olds, 84.7% of 7–9 year olds, and 79.6% of 10–12 year olds reporting nighttime fears. Fears of scary dreams and imaginary creatures decreased with age, while fears of frightening thoughts and personal harm increased with age. However, significant gender differences were not found. In relation to origins, nearly 80% of children attributed their fears to negative information: conditioning and modelling were endorsed less frequently (25.6% and 13.2%, respectively). Children reported a variety of coping strategies and generally rated these strategies as helpful in reducing anxiety. Moreover, in about 10% of the children, nighttime fears were related to one or more anxiety disorders following criteria of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. DSM-III-R; American Psychiatric Association, 1987): separation anxiety disorder (6.3%), over-anxious disorder (4.4%), animal phobias (1.9%), and environmental phobias (1.3%). Finally, parent reports substantially deviated from children's reports. In particular, parents provided a marked underestimation of nighttime fears (see also Muris, Merckelbach, Gadet, & Moulaert, 2000).

Although advances are apparent in the study of nighttime fears in children, the methodological limitations of past research need acknowledgement (Gordon et al., 2007). These include relatively small sample sizes, a limited age range of participants, as well as the most recent studies being restricted to the Netherlands (e.g., Muris et al., 2001). In particular, there has been no investigation comparing the frequency and content of nighttime fears in children and adolescents. The present Australian investigation addresses these limitations and examines developmental and gender-related patterns of normal nighttime fear prevalence, content, severity, and coping behaviours in a large school-based sample of children and adolescents. Not yet previously explored, this investigation also examines harm expectations of the children and adolescents, and disclosure patterns of nocturnal fears.

Consistent with the Muris et al. (2001) study, information was collected via a structured interview rather than traditional fear survey schedules which define how children and adolescents respond through a predetermined factor structure (Essau & Barrett, 2001). The “response freedom” of the interview is ideal for the exploration of nighttime fears in children and youth and using the same methodology allows for valid comparison of findings with the Muris et al. (2001) Netherlands study. The broad age range of children and adolescents (i.e., 8–16 years), investigated in this study is unique. This is the first large, systematic study of nighttime fears in children and adolescents to be carried out in Australia.