Fantasy-reality confusion a primary cause of childhood nighttime fears

November 13, 2012

From monsters under the bed to bogeymen in the closet, most children experience nighttime fears at some point in their development. And while most grow out of them without any professional intervention, others contend with persistent and extended periods of these fears, with a risk of developing anxiety problems later in life.

As part of a large-scale project on nighttime fears funded by the Israeli Science Foundation, Prof. Avi Sadeh of Tel Aviv University's School of Psychological Sciences is exploring how these fears fit into the normal developmental process -- and when they become a problem. Together with Dr. Jonathan Kushnir, who completed his Ph.D. studies in the field in Prof. Sadeh's lab, MA student Tamar Zisenwine, and Ph.D. student Michal Kaplan, he discovered that a child's ability to differentiate fact from fiction has a huge impact on overcoming terror of things that go bump in the night.

In their study, published in Child Psychiatry and Human Development, the researchers found that preschoolers with persistent nighttime fears were far less able to distinguish reality from fantasy compared to their peers. The research will help clinicians and parents alike to develop interventions that can better soothe fretful children, he says, noting that a strong imagination can ultimately be used to the child's psychological advantage.

Separating fact and fiction

For young children undergoing significant development in their ability to differentiate reality from fantasy, bedtime can be a major challenge. In many cases, it is the only time of the day when they're left to face their thoughts, feelings, and fears alone, explains Prof. Sadeh. This is when imagination can run wild.

To test their hypothesis that fantasy-reality confusion has a strong impact on nighttime fears, researchers evaluated four-to-six-year-old children -- 80 of them diagnosed with severe nighttime fears and 32 with more normal development -- on their ability to separate fact from fiction based on parental reports and a standardized interview. For example, children were presented with the character of a fairy, then asked a series of questions to determine whether or not the fairy was fictional, including whether or not they could call the fairy by phone or the fairy could visit them at home.

Children with more intense nighttime fears were significantly less able to differentiate reality from fantasy. As expected, younger children of the group also scored lower on these evaluations than their elders, a result attributable to the children's developmental stage. The lower the score, the more severe the child's nighttime fears.

The power of imagination

According to Prof. Sadeh, the fantasy-reality confusion that causes nighttime fears can also be used to help children to overcome these fears. Parents and clinicians can use this affinity for the imaginary to the child's benefit.

"We send children mixed signals by telling them that monsters aren't real while we tell them stories about the tooth fairy," he explains. Simply telling a child that their fear isn't realistic doesn't solve the problem, he says. Prof. Sadeh recommends using the child's strong imagination as a treatment. For instance, parents might help their children view an imaginary monster as a non-threatening entity, perhaps by writing it a letter to extend an offer of friendship or reading the child a book in which a threatening figure turns out to be friendly.

One treatment that Prof. Sadeh has found highly effective is a toy called a "huggy puppy." In this therapy, children are presented with a stuffed dog and told that the once happy puppy is now sad. They are given the responsibility of being the puppy's friend, caring for him, and ensuring that he is not afraid at night. Because this intervention depends on the child's willingness to believe the huggy puppy's story and embrace their new compassionate role, it works best for children with stronger imaginations, he says.
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