Cognitive-Behavioral Intervention with Young Anxious Children

Abstract

Despite evidence that preschool and early elementary school-age children can present with anxiety disorders that may put them at risk for later psychopathology and dysfunction, the cognitive-behavioral protocols available for treating anxiety in children have been tested almost exclusively in older children. However, there could be benefits to treating children earlier, before anxiety disorders begin to impair their social and academic development. This report discusses the adaptations necessary in providing cognitive-behavioral therapy to young anxious children and describes a manualized, cognitive-behavioral intervention, with child and parent components, that was piloted openly in nine families with children aged 4 to 7 years - each of whom had multiple risk factors for developing anxiety disorders, and most of whom had already presented with anxiety disorders. Eight of the nine children were judged "much" or "very much improved" at postintervention on number of anxiety diagnoses, number of DSM-IV anxiety symptoms, and ability to cope with feared situations. Cases are presented to illustrate the way that cognitive-behavioral therapy can be conducted with youngsters in this age range. Whereas randomized, controlled trials are needed to confirm the efficacy of this manualized treatment, our experience suggests that cognitive-behavioral protocols for anxiety can be adapted and successfully implemented with young children.

Anxiety and depressive disorders in offspring at high risk for anxiety: A meta-analysis

“…This information has clinical implications in that it may inform the selection of children for preventive or early intervention efforts, such as those developed by Rapee, Kennedy, Ingram, Edwards, and Sweeney (2005) and Hirshfeld-Becker, Masek, et al (2008) for childhood anxiety disorders, and those developed by Beardslee et al (1997) and Beardslee, Gladstone, Wright, and Coope (2003) and Clarke et al (2001) for major depressive disorder. It also highlights the importance, when evaluating children for anxiety disorders, of examining parental lifetime history of anxiety and mood disorders in understanding the child's prognosis.…”

Behavioral inhibition

“…It is possible that children with more extreme BI or children with BI who also had parents with anxiety disorders might have been more likely to maintain their BI status over time and therefore provided a better test of this research question. Subsequent studies currently under way in our laboratory [Hirshfeld-Becker et al, 2006, 2008a and others may shed further light on this question.…”

Social Phobia and Selective Mutism

“…A clear relationship between BI and SOP has been established empirically. 42,43 In one study, children classified as BI at age 21 months and 31 months were significantly more likely to have SOP diagnosed at age 13 (61%) compared with those who had not been classified as BI (27%). 22 Another study found that 17% of 2-, 4-, and 6-year-olds classified as BI also met criteria for SOP, whereas there was no relationship between BI and other mood or anxiety disorders.…”