For children with nighttime fears, help is at hand

Nighttime fears are a normal part of childhood development. Fear of the dark, of monsters, of burglars, and of separation from loved ones are among the more common fears that impact up to 85% of children aged 7-12.

But according to a new study from Black Dog Institute, for some children, these fears can be more than just a phase. The research found that 79% of children with persistent nighttime fears met criteria for a psychiatric diagnosis, including separation anxiety disorder (24%) and specific phobia (18%). Seventy per cent experienced clinically significant sleep disturbances.

“For some children, ongoing nighttime fears can interfere with day-to-day functioning and substantially impact family life,” says lead researcher Dr Melissa Aji, Postdoctoral Fellow and Clinical Psychologist at Black Dog Institute.

“We want to be able to help these children by providing support, because we know that nighttime fears can be an early marker of other clinical problems.”

Despite the prevalence of nighttime fears, there are currently no evidence-based interventions available to treat them. In response, Dr Aji and her team are launching  an Australian-first pilot study designed specifically to overcome nighttime fears in children and improve their sleep using a digital program.

Support for childhood anxiety and sleep problems in children

Dr Aji is quick to caution parents that nighttime fears aren’t necessarily cause for concern. Many children with mild nighttime fears won’t experience any impacts on their functioning, which means they’re unlikely to need intervention.

“Nighttime fear in itself isn’t a clinical diagnosis. It’s very normal; it’s a developmental stage,” she says.

However, for children with persistent, moderate to severe symptoms, the Black Dog Institute research offers a pathway to better care: by identifying those who may benefit from additional support, parents and professionals can intervene early in an aspect of childhood wellbeing that has been largely under-researched.

It’s good news for families, who often experience exhaustion, guilt, frustration and relationship strain as a result of children’s nighttime fears. Earlier Black Dog Institute research found that emotional outbursts, bedtime conflict, and demands for co-sleeping and repeated reassurances are common, leading to knock-on effects both inside and beyond the home.

“Families can find that nighttime fears are really disruptive to their work, schooling and family routines—they impact the dynamic with siblings and between parents. There’s also a lot of guilt, with parents wondering whether they’re responsible for their child developing these fears,” Dr Aji says.

“It’s important for parents to know that they are not to blame. These fears are a normal part of development; they’re just what the brain does. It also doesn’t really matter in terms of treatment how these fears came about. Our focus is on how we can help them now.”

Evidence-based tools for nighttime fears

Black Dog Institute’s Nighttime Fears and Worries program is a free, 8–10-week digital program designed for children aged 7–12 targeted whose nighttime fears impact their functioning and family life.

The program focuses on two evidence-based techniques: exposure and bedtime fading. Exposure therapy encourages children to gradually face their fears in a structured way, while bedtime fading optimises children’s sleep and wake times to help them fall and stay asleep.

“We know that exposure, which is a component of cognitive behavioural therapy, is the most powerful tool we have for anxiety and nighttime fears. There’s a lot of evidence to show that it works,” Dr Aji says.

Over the first eight weeks, parents and children learn about and practise a series of structured exposure techniques. An additional two weeks focused on bedtime fading are available for children whose sleep issues persist. Families also receive up to three support sessions with a therapist over the life of the program.

Content has been developed in collaboration with clinicians and co-designed with families who have lived experience of nighttime fears. Treasure hunts and other playful activities that gently expose children to their fears are key to getting families working together, while structured modules help guide parents through the learning experience.

“That’s what came out of our co-design work in terms of what families with lived experience want to see in the program. What we’re really interested in, because this is a pilot study, is whether it’s acceptable and feasible. Do parents like using it? Does it make sense in their context? Does it fit into their lives?” Dr Aji says.

“We also want families to gain more of an understanding of nighttime fears for parents to feel more confident supporting their children. For children, we hope there will be a reduction in nighttime fears and the extent to which they interfere in both the child’s life and their family’s.”