A Family-based CT approach to Anxiety Disorders in Children and Adolescents

In the online newsletter of the Osborne Division of General Practice (at http://www.odgp.com.au), Dr Sue Martin summarizes a workshop she attended titled "Treatment of Anxiety Disorders in Children and Adolescents: A Family Based Cognitive Therapy Approach" by Suzanne Kennedy and Ann Wignall from the Child and Adolescent Clinic at the Royal North Shore Hospital (somewhere in Australia). The following is a slightly edited version of Dr. Martin's summary of the workshop:

A main part of their programme is exposure, of which there are 3 main principles:

1.Facing fears gradually, working from slightly difficult to the hardest fears.
2.The child must stay in the feared situation long enough to learn that the bad things they fear will not happen.
3.Practice and repetitions are the keys to success.

Suggested ways of helping parents of children with anxiety disorders:

1.Attention – help the parents realise the role they have in reinforcing their child’s behaviour. They should praise ‘brave’ behaviour, give ‘rewards’ or ignore the negative behaviour. They should also stop reassuring reassurance seeking children.
2.Independence – teach parents to encourage and allow children to be independent. Talk with parents about their anxieties about being too firm or ‘tough’. Help parents give support to their children rather than be over protective. Teach them how to ‘rescue’ their child, to use anxiety management skills and age appropriate problem solving strategies.
3.Modelling – children model their parents own anxieties and avoidance behaviours. Educate parents about how children learn behaviours that parents do not really mean to teach them e.g. there are helpful and unhelpful coping skills.
4.Consistency – lack of consistency is the most common reason for failure of childhood management of anxiety. Therefore parents should watch out for empty threats, accidental rewards, vague instructions and inconsistencies between parents.
5.Non-physical punishment – punishment is occasionally needed. The anxious child is usually excessively anxious to please and often very sensitive to punishment or criticism. Time-out or removal of privileges could be used.

Dealing with difficulties.

If a child’s behaviour gets worse, check the consistency of management step by step. The child may also be pushing new limits.

You may need to decide the priorities for treatment as other problems may need to be addressed first e.g. marital
problems or family conflict.

Further reading:

Treating Anxious Children and Adolescents – an evidence based approach. Dr R Rapee, A Wignall et al. New
Harbinger Publications.

Helping Your Anxious Child – a step-by-step guide. Dr R Rapee, S Spence et al. New Harbinger Publications.

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