Applying Cognitive-Behavioral Therapy for Anxiety to the Younger Child

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The need to treat anxiety in younger children

Anxiety disorders in older children and adolescents have long been recognized as common,1 impairing,2, 3 persistent, and predictive of subsequent anxiety and mood disorders.4 By contrast, anxiety symptoms in preschoolers and younger children have until recently been regarded as transient difficulties falling within developmentally normative parameters. Mounting evidence suggests, however, that anxiety disorders in younger children are as common, impairing, and persistent as those in older

Cognitive-behavioral therapy for childhood anxiety disorders

The number of cognitive-behavioral interventions for anxiety disorders in older children and adolescents has grown dramatically over the past two decades,14, 15, 16, 17 and cognitive-behavioral therapy (CBT) has demonstrated efficacy for childhood anxiety disorders, including obsessive-compulsive disorder (OCD)17, 18 and posttraumatic stress disorder (PTSD),19, 20 whether offered in individual or group format.16 CBT shows benefit whether offered to the child only or family,21 or alone or in

Adapting CBT for younger children

CBT protocols for anxiety disorders in older children tend to combine coping skills with hierarchical exposure to feared situations (with response prevention in the case of OCD). Coping skills include relaxation methods, strategies for addressing anxious cognitions, and tools for quantifying anxiety and observing its decrease. The coping skills serve to facilitate participation in exposure, which is considered the most essential element of treatment. Other treatment components may include

Training in Coping Skills

Early studies addressing specific fears and phobia analogs in young children are important “proofs-of-concept” demonstrating how coping techniques, such as relaxation and self-instruction, may fruitfully be applied with young children. In one study,29 42 preschoolers aged 3 to 5 years with no previous dental treatment were randomly assigned to 1 of 3 treatment conditions administered half an hour before having a cavity filled. Children in the coping skills condition were taught general

New developmentally appropriate CBT protocols for young children

If the approaches discussed can address specific fears and phobias in young children, they should also be applicable to more severe anxiety disorders. Table 1 summarizes chronologically the published research reports to date. In addition to the open trials reported here, the authors know of at least 6 others that are under development. Seven groups to date have published randomized clinical trials (RCTs). The various approaches have included parent training in the implementation of CBT; CBT

Future directions

The growing number of studies addressing the developmental adaptation of CBT for anxiety disorders in children younger than 8 years is very encouraging, given the great need in this previously neglected population. In particular, 2 treatments for PTSD,68, 69 1 for OCD,45 and 4 for anxiety disorders in general9, 10, 52, 57 (including 2 preventive studies10, 52) have demonstrated efficacy in RCTs. Parents, pediatricians, preschool teachers, and other caregivers seeking to refer young children for

Financial disclosures

Drs Hirshfeld-Becker and Henin have received honoraria from Reed Medical Education (a logistics collaborator for the MGH Psychiatry Academy). The education programs conducted by the MGH Psychiatry Academy were supported, in part, through independent medical education grants from pharmaceutical companies, including AstraZeneca, Bristol-Myers Squibb, Forest Laboratories Inc, Janssen, Lilly, McNeil Pediatrics, Pfizer, Pharmacia, the Prechter Foundation, Sanofi Aventis, Shire, the Stanley

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  • Cited by (30)

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      Citation Excerpt :

      Most of these adaptations gave more emphasis to behavioral components and included play therapy techniques and involved parents in the treatment protocol. Parental participation is of great importance since parents may unintentionally reinforce anxiety by being overprotective, modeling maladaptive responses, or facilitating avoidant behaviors [5,23]. Due to their high influence and involvement in the child's daily routine, they could be regarded as active collaborators, responsible for the implementation of therapeutic procedures such as exposure exercises [22].

    • Recent advances in intervention for early childhood anxiety

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    Financial disclosures: See last page of article.

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