SF: Discussion: Fears, Phobias, and Anxiety

ORIGINAL PAPER

The Relation Between Fears and Anxiety in Children with Specific Phobia and Parental Fears and Anxiety

Lisa Clefberg Liberman1 • Lars-Göran Öst2

Published online: 2 June 2015

� Springer Science+Business Media New York 2015

Abstract The purpose of the present study was to

investigate if fearfulness and anxiety in children with a

specific phobia are related to parental fearfulness and

anxiety. Sixty-five 7–18 year-old children that were

included in a treatment study completed the State-Trait

Anxiety Inventory for Children (STAIC), and the revised

version of the Fear Survey Schedule for Children (FSSC-

R). The parents of the children answered the adult versions

of STAI and FSS; rated to what extent they generally

expressed fears in the presence of their children, and

answered whether they suffered from any emotional or

mental disorders. Analyses showed that there were no

correlations between parental fearfulness or anxiety and

fearfulness or anxiety in the children, or between parents’

expressed fears and children’s reported fears. However,

there was a positive correlation between mothers’ expres-

sed fears and level of trait anxiety in the children. More-

over, age and trait anxiety of the children were significant

predictors of their fearfulness. Regarding the question

about parental emotional or mental disorder, 54 % of the

children had at least one parent suffering from an emo-

tional or mental disorder. In 46 % a parent had an anxiety

disorder, and in 32 % this was a specific phobia.

Keywords Anxiety � Fear � Parents � Phobic children � Expression of fear

Introduction

Several researchers have studied the children of anxiety

disordered patients (e.g. Aktar et al. 2014; Beidel and

Turner 1997; Biederman et al. 1991; Mancini et al. 1996;

Murray et al. 2008; Turner et al. 1987; Unnewehr et al.

1998; Warner et al. 1995), and all of these researchers have

agreed that parental anxiety disorders increase the risk of

children developing anxiety disorders.

Nevertheless, only a few studies have investigated the

parents of children suffering from anxiety or phobias

(Cooper et al. 2006; Last et al. 1987a, b; Muris et al. 1996;

Silverman et al. 2009). These studies, looking at children

with different anxiety disorders of the generalized kind

(e.g. separation anxiety disorder, generalized anxiety dis-

order, overanxious disorder, etc.), depression and exter-

nalizing disorders have found that child anxiety is

associated with a larger presence of anxiety disorders in the

parents. Since specific phobia is a circumscribed disorder,

with a fear reaction that appears only when subjectively or

objectively confronted with the phobic stimuli, it would be

interesting to examine if the same relationship exists as in

the case with children who suffer from more generalized

disorders.

A large number of researchers have found that fearful-

ness of children decreases as they grow older (Burnham

and Gullone 1997; Muris et al. 1999; Ollendick and King

1994; Poulton et al. 1997). Although the number and

intensity of fears have been found to decrease with age, the

number of anxiety symptoms has been found to increase

(Costello et al. 1988; Kashani and Orvaschel 1990).

Most literature suggests that there is a relationship

between fearfulness and gender in children. Girls have

been found to report more intense, and a larger number of,

fears than boys (Anderson et al. 1987; King et al. 1988;

& Lisa Clefberg Liberman lclefberg@gmail.com

1 Institute for Cognitive Behavior Therapy, Santiago, Chile

2 Section of Psychology, Department of Clinical Neuroscience,

Karolinska Institute, Stockholm, Sweden

123

J Child Fam Stud (2016) 25:598–606

DOI 10.1007/s10826-015-0222-7

McGee et al. 1990). Morris and Kratochwill (1991)

reported one study of Eme and Schmidt (1978), where

these differences between the genders had not been found

for some age groups. Despite this, overall they found girls

to be more fearful than boys, and according to them, girls

report different kinds of fears in their teens. These differ-

ences have led some researchers to consider being a girl as

a risk factor for the development of anxiety disorders

(Costello and Angold 1995).

A large number of studies have found that children of

parents suffering from anxiety disorders are much more

likely than children of parents with no diagnosis or other

disorders to suffer from anxiety disorders (Biederman et al.

1991; Mancini et al. 1996; Turner et al. 1987; Unnewehr

et al. 1998). Beidel and Turner (1997), on the other hand,

concluded that parental anxiety disorder (panic disorder,

OCD, and social phobia) did not increase the risk of mental

disorders in children above that of parental depression or

mixed parental anxiety/depression. However, they did find

a possible familiality of anxiety disorders as children of

anxious parents suffered from anxiety disorders, whereas

children of parents in the other two diagnostic groups had

more varied disorders (anxiety, depression, and external-

izing disorders). In the study by Unnewehr et al. (1998),

children of panic disordered patients suffered from more

internalizing anxiety disorders whereas children of animal

phobics suffered from more externalizing anxiety disor-

ders, suggesting the presence of a possible transmission of

disorders with common features (Unnewehr et al. 1998). A

more recent study, examining how infants of socially-

anxious mothers interacted with a stranger, found that

infants’ avoidance was predicted by expressed maternal

anxiety and low levels of encouragement to interact with

the stranger (Murray et al. 2008). In another study (Aktar

et al. 2014) toddlers of parents with a lifetime social anx-

iety disorder (both alone and comorbid with other anxiety

disorders) showed more fear/avoidance in novel social

situations than toddlers of parents without an anxiety

disorder.

Two studies of Last et al. (1987a, b) investigated the

mothers of children with anxiety disorders. In one of these

studies (1987a) lifetime prevalence of anxiety disorder

among mothers was investigated, and it was found that

83 % of the mothers had a lifetime history of anxiety

disorder. Moreover, 57 % of them suffered from anxiety at

the time of the interview. These results were significantly

different from those of the control group. In the other study

(Last et al. 1987b), mothers were asked about childhood

history of SAD and OAD. Significant differences were

found between mothers of OAD children and the other two

groups. Mothers of OAD children reported having suffered

from OAD to a higher degree than mothers of SAD and

control children. Almost a decade later, Muris et al. (1996)

investigated forty 9–12 year old children suffering from

disruptive behavior disorder; oppositional-defiant disorder;

anxiety disorder not otherwise specified; generalized anx-

iety disorder; PTSD; obsessive–compulsive disorder; and

depressive disorder. Twenty-four of the children suffered

from an anxiety disorder of some sort, whereas the rest of

the children belonged to the other diagnostic groups. The

parents answered questionnaires assessing parental fear-

fulness and anxiety, and they rated how much they

expressed fear in the presence of their children on a 3-point

scale. According to their findings, 67.5 % of the mothers

reported that they expressed fear in the presence of their

child, whereas the same number for the fathers was 40 %.

Moreover, fearfulness in children was related to fearfulness

of the mother, and a relationship was found between the

amount of fear that the mothers showed and the fearfulness

of the children. They also found that trait anxiety in chil-

dren was positively related to trait anxiety of both parents.

According to epidemiological studies, lifetime preva-

lence of anxiety disorders ranges between 16.1 and 28.8 %

(Kessler et al. 2005a; Somers et al. 2006). In a review of a

number of epidemiological studies of psychological dis-

orders, Anderson (1994) found that the prevalence of

specific phobias varied between 2.4 and 9.2 % of the

studied children. For specific phobias in adults, even higher

figures have been obtained (12.5 %) and this diagnosis has

been reported as the most prevalent anxiety disorder among

adults (Eaton et al. 1991; Kessler et al. 2005b). In a study

by Cooper et al. (2006), the presence of affective disorders

among parents of anxious children was examined and

compared with a control group. According to their findings,

the rate of current and lifetime anxiety disorder in mothers

was significantly higher among anxious children (68.2 and

72.9 %, respectively) than among control children (37.8

and 27.5 %, respectively). For fathers, the lifetime rate of

anxiety disorder was significantly higher among the fathers

of the anxious children (45.1 %) than the fathers of the

control group (20.6 %), whereas no difference between the

groups was found for current anxiety disorder. In a treat-

ment study with children suffering from anxiety disorders,

Silverman et al. (2009) found that 39.7 % of the mothers

were found to meet DSM–IV criteria of an anxiety

disorder.

Considering the high prevalence of anxiety disorders,

and the fact that specific phobia has been reported as the

most prevalent anxiety disorder among adults, it ought to

be of interest to study the relationship between anxiety and

fears in phobic children and their parents. Since specific

phobia is a circumscribed disorder, with a fear reaction that

appears only when subjectively or objectively confronted

with the phobic stimuli, it would be interesting to examine

if the same relationship exists between parents’ and their

children’s feelings of fear and anxiety in children with

J Child Fam Stud (2016) 25:598–606 599

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specific phobias, as with more generalized disorders. The

only study so far that has looked specifically into the

relationship between children’s and their parents’ fearful-

ness is that of Muris et al. (1996). Therefore, we decided to

use that study as a basis and inspiration for this study with a

sample of children suffering from a more circumscribed

disorder, to examine whether parental fearfulness, level of

anxiety and reported expression of fear were related to

fearfulness and anxiety in a clinical sample of children

referred to treatment for specific phobia. A secondary

purpose was to look for predictors of fearfulness in the

children, looking separately at mothers’ and fathers’

influence. Identifying potential predictors of fearfulness

might help guide both prevention and treatment

interventions.

Based on the earlier findings reviewed above, the

hypotheses that we posed in our study were that:

1. Younger children will show higher scores on the fear

questionnaire than older ones, but the opposite will be

found on the anxiety questionnaire.

2. Girls will show higher scores on the fear and anxiety

questionnaires than boys.

Inspired by Muris et al.’s (1996) findings, the following

two hypotheses were also formulated:

3. The children’s fear ratings are positively correlated

with the mothers’ fear ratings.

4. Children whose mothers have high scores on the fear-

expression item have higher scores on the fear

questionnaire than do children whose mothers have

low scores.

As the above-mentioned studies have studied parents of

children with anxiety diosrders, but not focused solely on

those of children with specific phobias, we also formulated

a research question:

Do the parents of the anxious children have higher rates

of mental disorders, and specifically anxiety disorders, than

what has previously been found in epidemiological studies

with adults?

Method

Participants

The sample consisted of 65 children who were referred for

a treatment study at the Department of Psychology,

University of Stockholm, Sweden. The children were

referred by psychiatric clinics, school nurses and psychol-

ogists in the county of Stockholm in order to participate in

a treatment study of specific phobia. The children who

were included in the study were between 7 and 17 years of

age, and suffered from specific phobias according to DSM-

IV (APA 1994). In total, 185 subjects were included: 65

children, 63 mothers and 57 fathers. The mean age of the

children was 11.8 years (SD = 2.8) and 60 % of them

were girls. They suffered from various specific phobias,

with injection phobia (n = 12), claustrophobia (n = 11),

dog phobia (n = 10) and spider phobia (n = 9) being the

most common ones. The mean severity (0–8 scale) of the

children’s primary diagnoses at the time of filling out the

questionnaires was 6.1. Although specific phobia was the

primary disorder in all of the children, 42 % of them had at

least one comorbid disorder. The most common secondary

diagnoses were an additional specific phobia (n = 12),

major depression (n = 4), social phobia (n = 4) and sep-

aration anxiety (n = 3).

Procedure

To ascertain that the children fulfilled the DSM-IV (APA

1994) criteria for specific phobia, two screening interviews

were carried out. First, the child was interviewed with the

Anxiety Disorders Interview Schedule for DSM-IV: Child

version (ADIS-C; Albano and Silverman 1996) and then

one of the child’s parents was interviewed with the Anxiety

Disorders Interview Schedule for DSM-IV: Parent version

(ADIS-P; Albano and Silverman 1996), and based on the

combined information it was decided whether the child

fulfilled the criteria. If this was the case, the child and

parent were given full information about the project and an

informed consent form was signed by the parent and co-

signed by the child. The children and parents were then

given the questionnaires to fill out independently at home

and bring back for the child’s behavioral test a week later.

To assess reliability of the diagnoses and severity ratings,

25 % of the videotaped interviews were randomly selected

and watched by an independent assessor. Using Cohen’s

kappa, agreements were 0.90 and 0.85 on primary and

secondary diagnoses, respectively. The parents were asked

if they suffered from any emotional or mental disorders at

the end of the ADIS-C interview. An affirmative answer

was further explored by the clinical psychologist doing the

interview and questions were asked regarding treatments

and formal diagnoses, but no determination was made

regarding diagnostic severity.

Measures

Fear Survey Schedule for Children-Revised (FSSC-R;

Ollendick 1978) is a questionnaire that consists of 80 items,

and the children are instructed to report their level of fear

of these items on a 3-point scale (none, some, and a lot).

The children’s answers are rated as 1, 2, or 3, and the total

score can vary between 80 and 240. This is the most widely

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used scale to assess fears in children and adolescents

(Burkhardt et al. 2012) and it has been reported, across a

large number of studies, to have good psychometric prop-

erties such as internal consistency, test–retest reliability

and validity (Ollendick 1983; Weems et al. 1999).

State-Trait Anxiety Inventory for Children (STAIC;

Spielberger et al. 1973) is a questionnaire that consists of

two independent scales, each with 20 items. The State-

scale is intended to measure situation-bound anxiety and

the Trait-scale is intended to measure stable anxiety that is

not situation-bound. The children’s answers are rated as 1,

2, or 3, and the total score can vary between 20 and 60. The

Trait scale has been found to have higher test–retest reli-

ability than the State scale, whereas the internal consis-

tency is acceptable for both scales. Barrios et al. (1981)

recommended using the scale as a general screening

instrument.

Fear Survey Schedule (FSS-III; Wolpe and Lang 1964)

is a questionnaire that consists of 76 items, and the adults

are told to rate the amount of fear of the described situa-

tions on a 5-point scale ranging from 1 (not at all) to 5

(very much). The total fear score can vary between 76 and

380. This survey has been used with both clinical and non-

clinical samples and for international comparisons (Abdel-

Khalek 1988; Johnsen and Hugdahl 1990).

Expression-of-fear item (Muris et al. 1996) was added to

FSS-III. Parents were instructed to rate to what extent they

generally expressed fear in the presence of their children on

a 5-point scale ranging from ‘‘never’’ to ‘‘often’’. Muris

et al. (1996) used a 3-point scale for this item (almost

never; sometimes; and often) while the present study used a

5-point scale in order to permit a larger variation. This is

the only one of the assessment items that does not count

with solid empirical support. However, it was used in a

previous study that found correlations between the parents’

answers to this question and the children’s results on the

questionnaires of interest, and we therefore decided to

include it, increasing the response scale, instead of creating

an item of our own.

State-Trait Anxiety Inventory (STAI; Spielberger et al.

1970), as STAIC, is a questionnaire that consists of two

independent scales, each with 20 items. Adults are

instructed to rate how they feel on a 4-point scale, and the

total score on the two scales ranges from 20 to 80. The

STAI has been subjected to a number of psychometric

assessments, and has been found to be a reliable and valid

measure of state anxiety (Bernstein et al. 2005).

One question from the Anxiety Disorders Interview

Schedule for DSM-IV—parent version (ADIS-C/P; Albano

and Silverman 1996): Do you or the child’s father/mother

suffer from any emotional or psychiatric disorder? Answers

were rated according to three groups: emotional or psy-

chiatric disorder, anxiety disorder, and specific phobia.

Data Analyses

Statistical analyses were conducted in the PASW Statistics

version 22.0 (SPSS Corp, Chicago, IL, USA). To start with,

internalconsistencywascalculatedforallofthe questionnaires

in the study, through Cronbach’s alpha. In order to test our first

two hypotheses, regarding age and gender differences, t tests

were carried out comparing girls’ and boys’ scores on FSSC-R

andSTAIC andthe two age groups of children (7–12 year olds

vs 13–17 year olds). Pearson product-moment correlations

were also calculated to assess the relationship between the

scores on the questionnaires and the age of the children. In

order to test our third hypothesis regarding the relationship

between mothers’ and children’s fears, and to explore the

relationships between fearfulness in children and their fathers,

we carried out Pearson product-moment correlations to com-

pare the children’s results on FSSC-R and STAIC with the

parents’ scores on the respective questionnaires. For the fourth

hypothesis, Spearman correlations were used to compare the

parents’ reports of expressing fear in the presence of the chil-

dren with the children’s scores on FSSC-R and STAIC. A t test

wasalsoconductedtocomparemothers’andfathers’reportsof

expressing fear in the presence of the children. Finally, to meet

our secondary purpose, two regression analyses were con-

ducted to identify predictors of fearfulness in the phobic chil-

dren. For these regressions, separate analyses were carried out

for mothers and fathers.

Results

First of all, all questionnaires showed satisfactory reliability

(Cronbach’s alphas ranging from 0.80 on the fathers’ STAI-

T to 0.96 on the mothers’ FSS-III; see Table 1). According to

our first hypothesis, a significant negative correlation was

found between age and total score on FSSC-R

[r(63) = -0.33, p \ .01] and a positive correlation was found between age and state anxiety [r(63) = 0.40,

p \ .001]. Due to the significant correlations between the scales and the age of the children, t tests were carried out

between two age groups of children (7–12 years and

13–17 years). According to this division, the younger chil-

dren were found to report significantly more fear than the

older children (see Table 2), as per our first hypothesis.

Contrary to our second hypothesis, no significant dif-

ference was found between girls and boys on the measures,

although a clear tendency towards a higher score for girls

was found on STAIC-T [t(64) = 1.97, p = .053]. The

children with at least one comorbid disorder reported a

significantly higher level of trait anxiety than those suf-

fering only from specific phobia [t(62) = 3.39, p \ .001]. No differences were found between the groups on the other

two measures (FSSC and STAICS; see Table 2).

J Child Fam Stud (2016) 25:598–606 601

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As can be seen in Table 1, substantial positive correla-

tions were found between trait anxiety and fearfulness, and

between trait and state anxiety in both children and parents.

State anxiety was also positively correlated with fearful-

ness in both parental groups.

In order to test our third hypothesis, Pearson product-

moment correlations were calculated to compare the chil-

dren’s results on FSSC-R and STAIC with the parents’

scores on the respective questionnaires. Analyses showed

that there were no significant correlations between the

children’s scores on FSSC-R and the parents’ scores on

FSS-III [children–mothers: r(61) = 0.03, children–fathers:

r(55) = -0.01], nor between the children’s scores on

STAIC and the parents’ scores on STAI [state: children–

mothers: r(61) = 0.13, children–fathers: r(54) = -0.03;

trait: children–mothers: r(60) = 0.21, children–fathers:

r(53) = 0.10].

As we used a larger age range in the present study than that

of Muris et al. (1996), we divided our sample in two, and

carried out separate correlation analyses for these two age

groups. That division made our younger age group (7–12 year

olds) more comparable to that of Muris et al., whereas the

older group consists of adolescents. Based on those analyses,

fearfulness in the younger children was found to correlate

positively with the score on STAICT [r(36) = 0.63,

p \ .001]. The only significant correlation that was found betweenthechildren’sandtheirparents’scoreswasanegative

one between the children’s score on STAICS and mothers’

score on FSS-III [r(37) = -0.42, p \ .01]. For the older group, however, significant positive correlations were found

between the children and their mothers on a number of mea-

sures: STAICS–FSS-III mother: r(22) = 0.42, p \ .05; STAICS–STAIT mother: r(22) = 0.41, p \ .05; STAICT– FSS-III mother: r(22) = 0.43, p \ .05; and STAICT–STAIT mother: r(22) = 0.65, p \ .001.

No significant correlation was found between parents’

expressed fears and children’s reported fears [children–

mothers: r(60) = 0.06, children–fathers: r(54) = 0.04].

However, mothers’ expression of fear in the presence of the

children was positively correlated with level of trait anxiety

in children [r(59) = 0.32, p \ .05], but no correlation was found between the fathers’s expression of fear and the

children’s trait anxiety [r(53) = 0.06]. When the two age

groups were analyzed separately, this correlation between

trait anxiety in children and expressed fear in mothers was

found in the older age group [r(22) = 0.42, p \ .05], but not among the younger children [r(35) = 0.24]. Mothers

reported that they expressed fear in the presence of their

children to a significantly higher degree than fathers did

[t(54) = 3.33, p \ .01]. The percentages of mothers who ‘‘Never’’, ‘‘Seldom’’, ‘‘Sometimes’’ or ‘‘Pretty often’’

expressed fear in the presence of their children were 3.2

(n = 2), 50.0 (n = 31), 45.2 (n = 28) and 1.6 (n = 1),

respectively. For the fathers the same numbers were 21.4

(n = 12), 51.8 (n = 29), 25.0 (n = 14), and 1.8 (n = 1).

In order to examine what factors contribute to the

fearfulness in children, two stepwise regression analyses

were carried out with fathers and mothers being analyzed

separately, the score on FSSC being the dependent variable

Table 1 Means (SDs), Cronbach’s alphas of the

questionnaires and Pearson

product-moment correlations

between the children’s

respective measures of fear and

anxiety

M (SD) a FSS STAIS FSSC STAICS STAICT

Children

FSSC 121.0 (21.2) 0.94

STAICS 29.0 (4.9) 0.85 0.17

STAICT 31.2 (7.4) 0.89 0.55** 0.52**

Mothers

FSS 133.1 (33.2) 0.96 0.03 0.08 0.10

STAIS 30.7 (7.7) 0.92 0.30* 0.01 0.13 0.14

STAIT 34.9 (8.2) 0.91 0.55** 0.73** 0.04 0.09 0.21

Fathers

FSS 133.3 (19.1) 0.92 -0.01 0.02 -0.00

STAIS 29.9 (6.7) 0.89 0.44** -0.01 -0.03 0.06

STAIT 30.8 (5.3) 0.80 0.42** 0.69** 0.11 -0.08 0.10

* p \ .05; ** p \ .01

Table 2 Means (SD) on the three questionnaires for age and diag- nostic groups (comorbid versus non-comorbid)

FSSC STAICS STAICT

7–12 (n = 37) 126.8 (22.4) 27.7 (4.5) 31.5 (7.5)

13–17 (n = 28) 112.2 (15.1) 31.0 (4.8) 30.5 (7.3)

t value 3.12* 2.88* 0.52

Non-comorbid (n = 38) 118.5 (18.9) 28.9 (5.1) 28.9 (6.3)

Comorbid (n = 27) 125.1 (23.9) 29.3 (4.5) 34.9 (7.7)

t value 1.23 0.29 3.39*

* p \ .05

602 J Child Fam Stud (2016) 25:598–606

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in both analyses. The predictors of both analyses were the

parents’ score on FSS, STAI and the expression of fear-

item, together with the age, sex, comorbidity and STAIC of

the child. Exactly the same variables were included in the

same order in both regression equations and only the child

variables explained a significant proportion of the variance

in both analyses, with no parental variable contributing

significant variance. Thus, only the results of the mothers

are presented (see Table 3). Trait anxiety of the child and

two demographic variables were entered on the first step

and these variables were found to significantly predict

fearfulness, F(2, 56) = 17.21, p \ .001, explaining 46.5 % of the variance. However, the two variables to contribute

significant variance were age of the children and the

STAICT score, with a tendency to significance for gender

(b = -.201, p = .051). In Step 2, the five additional variables (comorbidity of the child, maternal fearfulness,

maternal STAIS score, maternal STAIT score and expres-

sion of fear) did not contribute significant, unique variance.

The question regarding emotional or psychiatric disor-

ders among parents revealed that 54 % of the children had

a parent (mother and/or father) suffering from at least one

psychiatric disorder. According to the reports, 46 % of the

total sample had a parent suffering from an anxiety disor-

der, and in 32 % this was a specific phobia.

Discussion

In line with earlier findings, and in accordance with the first

hypothesis, the phobic children of the present study

reported a decreasing fearfulness with increasing age, and

state anxiety was found to increase with increasing age. No

difference was found for trait anxiety, providing us with

partial support for our first hypothesis. Opposed to the

second hypothesis, but in line with the results of an earlier

study on fear in Swedish children (Svensson and Öst 1999),

no significant difference in fear and anxiety was found

between girls and boys. Fearfulness and state anxiety were

not found to be related with comorbidity, although trait

anxiety was found to be significantly higher in those chil-

dren suffering from comorbid disorders. Contrary to the

third hypothesis, no significant correlations were found

between parental fearfulness and fearfulness in the phobic

children, nor between parental anxiety and anxiety in the

children. Moreover, contrary to the fourth hypothesis, no

correlation was found between parents’ expressed fears and

children’s reported fears. However, a significant positive

correlation was found between mothers’ expressed fears

and children’s trait anxiety, and mothers reported that they

expressed fear more than fathers did. In our prediction

analysis, the two predictors of child fearfulness that con-

tributed significant variance were age of the children and

trait anxiety. As regards our research question, we found

that more than half our children (54 %) had a parent with at

least one psychiatric disorder, 46 % of them having a

parent with an anxiety disorder. In as many as 32 % of the

children, this psychiatric disorder was a specific phobia.

Considering that epidemiological studies have indicated

that this figure for the general adult population ranges

between 2.4 and 9.2 %, this number is clearly higher. Our

finding is in accordance with previous studies examining

the parents of children suffering from anxiety disorders

(Cooper et al. 2006; Silverman et al. 2009).

Due to the large age range, and in order to make the

younger group more comparable to the sample studied by

Muris et al. (1996), separate correlation analyses were

carried out for younger and older children, and these

Table 3 A multiple regression analysis with child fearfulness

as the dependent variable

Variable B SE B b p R2 DR2 DF (dfs)

Step 1 .494 .494 17.21** (2.56)

Gender -8.63 4.32 -.201 .051

Age -3.08 .74 -.409 .000

STAICT 1.59 .29 .544 .000

Step 2 .502 .008 .16 (5.51)

Gender -8.58 4.52 -.200 .064

Age -3.21 .81 -.425 .000

STAICT 1.72 .36 .589 .000

Comorbidity -2.93 4.91 -.069 .554

FSS-III mother .05 .09 .074 .615

STAIS mother .11 .42 .042 .789

STAIT mother -.30 .55 -.110 .592

Expressed fear mother .47 4.04 .013 .908

** p \ .001

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findings were rather surprising. Several studies have

reported that children tend to become less influenced by

their parents, as they grow older. Therefore, it would be

expected for younger children to show higher correlations

with their parents than older children. However, we found

fearfulness and trait anxiety of the mother to be positively

correlated with both state and trait anxiety in the older

children while the only significant correlation that was

found between mothers and the younger children was a

negative one between fearfulness of the mothers and state

anxiety of the children. Maybe, as these children were part

of a clinical sample of children, they were less independent

than other non-clincal children their age, and therefore,

more aware of their mothers’ fears and anxieties.

A fact that distinguishes the present study from the

Muris et al. (1996) study is that the current probands had a

primary specific phobia, whereas the Dutch children had

more generalized disorders as their primary diagnoses, and

only 40 % of the children of that study had an anxiety

disorder at all. Thus, different clinical groups were studied

and this may explain why the present study did not repli-

cate the results of the Dutch study. Another explanation

might be that the age range of the children in the current

study was larger (7–17) than that of the children in the

Dutch study (9–12). The majority of the children in the

Dutch sample were boys, whereas the majority of the

Swedish participants were girls. Comorbidity was not

assessed in the Dutch study and can therefore not be

examined as a plausible explanation. In the Dutch study,

67.5 % of the mothers reported that they expressed fear in

the presence of their child whereas the same number for the

fathers was 40 %. These figures are clearly higher than the

Swedish ones (44.6 % for the mothers and 23 % for the

fathers). This difference in expressed fear may be another

important factor when attempting to explain the different

findings.

Another issue that differentiates Muris et al. investiga-

tion (1996) from the present study is that in their study a

3-point scale was used to assess parental expression of fear,

while the present study used a 5-point scale in order to

permit a larger variation. However, very few parents in the

Swedish sample endorsed the ‘‘pretty often’’ rating, and no

parent endorsed the ‘‘often’’ rating. This indicates that the

parents of the phobic Swedish children reported that they

expressed fear in their children’s presence to a significantly

lower degree than the parents of the Dutch children did. It

would be interesting to further explore this in a future study

with parents of children suffering from more generalized

anxiety and/or emotional problems. The parents of the

current study might have had more circumscribed disorders

themselves, due to the familiality observed in previous

findings (e.g. Murray et al. 2008; Unnewehr et al. 1998). If

parents of children suffering from more generalized

problems would suffer from more generalized problems

themselves, they might then express more fear than the

current parents of children with specific phobias.

In line with this, when interpreting the results, it is

important to consider that even though the current study

focused on clinical children referred for treatment, these

children did not score higher on FSSC-R and STAIC than

the general population of their age (Svensson and Öst

1999) which means that there is a low variance in the

sample. This restriction of range in the questionnaire

scores, together with the restricted range of the parental

reports on the expressed-fear item, makes it difficult to

obtain significant correlations, and may be considered a

statistical artifact. Earlier studies have shown that child

self-report measures of anxiety have poor discriminative

validity (Manassis et al. 1997; Perrin and Last 1992),

something that might be confirmed by this study. A

potential weakness of the present study is the use of the

self-reported expressed fear in parents. However, since this

study purported to carry out a replication of Muris et al.

study (1996) with a different clinical sample, the same

assessment instruments were used, although the range was

increased from a 3-point scale to a 5-point scale in order to

avoid having a restricted range of ratings. Even though

fearfulness in the parents was not found to correlate with

fearfulness in the children, and anxiety in the parents was

not correlated with anxiety in children, the results in the

present study may still point to the importance of

addressing parental anxiety when treating children. The

fact that an elevated fear expression among mothers was

found to be related to more trait anxiety in the children

might be of importance when treating children’s phobias,

as the children’s level of trait anxiety was found to be the

principal variable to explain their fearfulness, according to

the regression analysis.

According to our secondary purpose, to find predictors

of fearfulness in the phobic children, the fact that trait

anxiety was the most significant predictor is important to

consider when planning prevention and treatment inter-

ventions for children and adolescents. This might suggest

that children with a higher anxiety baseline might be at

larger risk of developing specific anxiety diagnoses, and

might therefore be important candidates for prevention

interventions. If we take this even one step further, the

significant correlation that was found between mothers’

expressed fearfulness and children’s trait anxiety might

suggest that it would be beneficial to direct attention to

mothers (or parents in general) in awareness campaigns, in

terms of expressing fear in their children’s presence. This

would also be relevant in light of previous findings

regarding the benefit of adding a parent anxiety manage-

ment component to cognitive behavior therapy when

treating anxiety disorders in children (Cobham et al. 2010).

604 J Child Fam Stud (2016) 25:598–606

123

Another caveat is that the diagnoses of the parents are only

self-reported, and no diagnostic interview was performed

with them. Since no diagnostic interviews were done, some

parents may have had more or fewer diagnoses than were

actually reported. However, since there was no criterion

saying that the parents must have a disorder for the child to

participate in the treatment study, it may be plausible to

assume that they under-reported rather than over-reported

their personal problems, due to the social desirability factor.

Since the question came at the end of the interview, they had

already heard all the descriptions of the disorders within 2 h

before that particular question, why we might assume that

they were aware of what they were answering.

This study indicates that although parents and children

might score differently on self-report measures, specific

phobias and anxiety disorders are more common among

parents of phobic children than in the population in gen-

eral. Therefore, in order to examine the relation between

parents’ fears and anxiety and their children’s fears and

anxiety, diagnostic interviews should be carried out with

both, together with family interaction tests, according to

Wei and Kendall’s recommendation (2014). Moreover, to

make such a study even more interesting and relevant,

siblings of the phobic or anxious children should also be

included, in order to evaluate a possible differential influ-

ence, possibly associated with age of the children, gender,

order in the sibling group, etc.

Acknowledgments This study was supported by Grant 12681 from the Swedish Medical Research Council and a grant from the Söder-

ström–König Foundation.

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