Conditioned anxiety in response to recurrent medical procedures poses a significant problem in the adjustment of children with cancer. Though there is evidence that behavioral approaches can play a role in reducing anxiety, research in this area is hampered by the lack of objective measures of situationspecific anxiety. In the present study, an observational behavior rating scale was developed that enabled us to reliably measure anxiety responses to bone marrow aspirations in 115 children with cancer and to differentiate between low-and high-anxious children, as measured by independent nurses' ratings. Anxiety in response to bone marrow aspirations was virtually ubiquitous in this sample, suggesting the need for clinical intervention. No stable pattern of habituation to this procedure was found. A significant relationship was found between age and both quantity and type of anxious behavior, with younger children tending to emit a greater variety of anxious behaviors over a longer period of time than older children. A developmental trend toward behavioral withdrawal and increased muscle tension with advancing age was also found. Females tended to display higher levels of anxiety than did males, across age groups, and to express this with comfort-seeking, as opposed to uncooperative, behaviors. Age by sex interactions were absent. Results are discussed in terms of the need to consider age and sex when designing treatment and research strategies. A behavioral observation methodology appears promising in terms of its use in a medical setting, from both scientific and pragmatic points of view.Conditioned anxiety related to recurrent both temporal and sensory stimuli (sounds, diagnostic and treatment procedures for sights, and smells), and other stimulus pediatric cancer is a major source of distress discriminants. in children with malignant disease (Katz, Behavioral approaches toward the in press; Zeltzer, Kellerman, Ellenberg, amelioration of acute pain and anxiety in Dash, & Rigler, in press). Such anxiety is children with cancer have included hypnosis often anticipatory (occurring prior to the (Dash, in press; Gardner, 1976; La Baw, administration of medical procedures) and Holton, Lewell, & Eccles, 1975), promanifests itself in a variety of symptoms: cedural preparation (McCue, in press), and nausea and vomiting, anorexia, insomnia, parental relaxation training, along with nightmares, withdrawal, and depression, operant reinforcement of appropriate Though the medical procedures themselves, behavior (Kellerman, 1979). Evaluation of comprised of bone marrow aspirations, the efficacy of such treatment is hampered, lumbar punctures, intravenous and intra-however, by a lack of valid, reliable measmuscular injections of chemotherapeutic urement techniques. agents, are the primary stimuli that evokeIn a recent study, Glennon and Weisz anxiety, substantial stimulus generalization (1978) reviewed the various approaches that occurs, so that children may exhibit anxiety have been used to measure anxiety in young in response ...
