Treatment of childhood anxiety: Developmental aspects

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Abstract

This review focuses on research on the cognitive-behavioral treatment of childhood anxiety disorders. Early forms of therapy for childhood anxiety were borrowed from adult treatment models. More recently, there has been a recognition of the need to design treatment from a child-based perspective. Consequently, several cognitive-behavioral programs designed specifically for children and youth have been both developed and evaluated. The importance of parental involvement has also been recognised in these treatment innovations. However, a number of developmental factors have yet to be given adequate consideration in both the research and practice of childhood anxiety treatment. The article highlights some of these factors including issues of individual, family and cultural variation.

Section snippets

Brief overview of childhood anxiety treatment

TREATMENT OF CHILDHOOD and adolescent anxiety has garnered increasing attention over the last decade. For the majority of children, anxiety is a common, functional, and transitory experience (Last, Perrin, Hersen, & Kazdin, 1996), the nature and intensity of which varies, at least in part, according to the child's developmental stage. For example, young children often experience anxiety when separated from main attachment figures or if exposed to dark, unfamiliar places. In comparison, the

Developmental guidelines for treatment

The call to acknowledge developmental issues in the conceptualisation of childhood psychological disorder is not a new thing (Treadwell, Flannery-Schroeder, & Kendall, 1995). However, the impact of this recognition has been slow to filter down to the treatment literature. An appreciation of general patterns of development can provide important direction for the design and implementation of childhood anxiety treatment. Examination of these patterns gives insight into potential vulnerabilities,

Treatment of generalised anxiety

The few randomised controlled studies in the area of childhood anxiety have mainly evaluated a variety of cognitive behavioral techniques (CBT). Particular attention has been directed towards psychological education about the nature of anxiety, cognitive restructuring, and behavioral exposure Albano & Barlow 1996, Kendall 1994, Ollendick & King 1994.

In a recent review of studies, Ollendick and King (1998) examined the relative effectiveness of a variety of behavioral and cognitive-behavioral

Treatment of specific anxiety disorders

In spite of the difficulties with comorbidity, some studies have applied cognitive-behavioral principles to the treatment of specific anxiety disorders, using the primary diagnosis as their target in most cases.

Issues of individual difference in treatment

Although most of the focus until this point has been on global comparisons, clinicians are well aware that individual differences play a large role in treatment outcome. Whilst every child and family experiences life stressors, it is clear that not all children develop disorders. A greater understanding of the influence of life events and prior functioning on the development of severe anxiety problems is thus essential. It is suspected that multiple factors (i.e., risk factors) may operate to

Future directions for treatment research

The current discussion has attempted to emphasize the relevance of developmental factors to the treatment of childhood anxiety disorders. In so doing, it has identified several areas that are under-researched at present, and others that provide avenues for new research. The argument has been that programs of treatment for childhood anxiety need to be especially sensitive to developmental factors. Examination of developmental patterns in normal fear experiences indicate that fears in early

Conclusions

Generally speaking, standardised treatment programs for childhood anxiety have only been designed and evaluated over the past 10 years. Research in this area has grown in accuracy and sophistication, with positive consequences for families and clinicians. However, in common with other areas of child and adult psychopathology, several conceptual and methodological limitations still remain. The current discussion has sought to highlight some of these, with particular emphasis on the developmental

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