200 Anxiety Disorders
watching someone drown), an unexpected panic attack in the to be feared situation (e.g.,
an unexpected panic attack while on the subway), or informational transmission (e.g., ex-
tensive media coverage of a plane crash). However, many individuals with specific phobia
are unable to recall the specific reason for the onset of their phobias. Specific phobia usu-
ally develops in early childho od, with the majority of case s developing prior to age 10
years. The median age at onset is between 7 and 11 years, with the mean at about 10 years.
Situational specific phobias tend to have a later age at onset than natural environment, an-
imal, or blood-injection-injury specific phob ias. Specific phobias that develop in child-
hood and adolescence are likely to wax and wane during that period. However, phobias
that do persist into adulthood are unlikely to remit for the majority of individuals. 
When specific phobia is being diagnosed in children, two issues sh ould be considered.
First, young children may express their fear and anxiety by crying, tantrums, freezing,
or clinging. Second, young children typically are not able to understand the concept of
avoidance. Therefore, the clinician should assemble additional information from parents,
teachers, or others who know  the child well. Excessive fears are quite common in young
children but are usually transitory and only m ildly impairing and thus considered devel-
opmentally appropriate. In such cases a diag nosis of specific phobia would not be made.
When the diagnosis of specific phobia is being considered in a child, it is important to
assess the degree of im pairment and the duration of the fear, anxiety, or avoidance, and