Very early family-based intervention for anxiety: two case studies with toddlers

Abstract

Anxiety disorders represent the most common category of psychiatric disorder in children and adolescents and contribute to distress, impairment and dysfunction. Anxiety disorders or their temperamental precursors are often evident in early childhood, and anxiety can impair functioning, even during preschool age and in toddlerhood. A growing number of investigators have shown that anxiety in preschoolers can be treated efficaciously using cognitive–behavioural therapy (CBT) administered either by training the parents to apply CBT strategies with their children or through direct intervention with parents and children. To date, most investigators have drawn the line at offering direct CBT to children under the age of 4. However, since toddlers can also present with impairing symptoms, and since behaviour strategies can be applied in older preschoolers with poor language ability successfully, it ought to be possible to apply CBT for anxiety to younger children as well. We therefore present two cases of very young children with impairing anxiety (ages 26 and 35 months) and illustrate the combination of parent-only and parent–child CBT sessions that comprised their treatment. The treatment was well tolerated by parents and children and showed promise for reducing anxiety symptoms and improving coping skills.

The Need to Develop an Individualized Intervention for Mathematics Anxiety

“…Here it is potentially important to include parents in treatment. Some research has shown that parents can assist their children recover from anxiety in general (Hirshfeld-Becker et al, 2019), although we are not aware of any family-based interventions for mathematics anxiety.…”

Cognitive Behavior Therapy for Young Children with Anxiety: A Focused Review

“…Hirshfield Becker et al [56] showed that anxiety in pre-schoolers aged below 4 years can also be treated using a modified form of CBT which obviously involved training the parents to be the co-therapists. The program involved teaching parents how to monitor anxious responses, restructure their own thoughts, identify what responses are unhelpful to their child's anxiety, model adaptive coping, engage in nondirective play with the child, use praise to reinforce better coping responses and also plan and implement graded exposure exercises.…”

In This Issue

“…In another article, Hirshfeld-Becker and colleagues report on two case studies that tested the feasibility and potential efficacy of family-based cognitive-behavioral therapy (CBT) for anxiety in toddlers 11. The authors note that anxiety in young children tends to be persistent and interferes with cognitive and social development.…”