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Best Practices for the Treatment of Child Anxiety

Best Practices for the Treatment of Child Anxiety. Kimberly Becker, Ph.D. Johns Hopkins Child and Adolescent Psychiatry. Objectives. Gain knowledge about the prevalence and course of child anxiety Understand how to recognize symptoms and manifestations of anxiety

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Best Practices for the Treatment of Child Anxiety

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  1. Best Practices for the Treatment of Child Anxiety Kimberly Becker, Ph.D. Johns Hopkins Child and Adolescent Psychiatry

  2. Objectives • Gain knowledge about the prevalence and course of child anxiety • Understand how to recognize symptoms and manifestations of anxiety • Learn how CBT addresses anxiety symptoms

  3. Facts about Anxiety Disorders • Prevalence of anxiety disorder: 10%, but often unidentified and misdiagnosed • Mean age of onset: 7-15 years old • Impairment: academics, attendance, peers, families • Course: • Waxes and wanes • 1/3 of kids with anxiety improve without treatment • Most adult anxiety disorders have pediatric onset • Comorbidity: very common

  4. Comorbidity • Having more than one disorder • Additional anxiety disorder: 30-80% • Mood disorder: 12-60% • Externalizing disorder (ADHD, CD, ODD): 3-60%

  5. Symptoms of Anxiety

  6. Physical Feelings I have a headache and stomachache. Teacher, can I go see the nurse? • Muscle tension • Heart palpitations • Abdominal pain • Nausea • Flushed face • Headaches • Perspiration • Anxious youth EXPERIENCE more physical difficulties/complaints • Anxious youth are MORE SENSITIVE to physical sensations

  7. Thoughts • Catastrophizing: blowing things out of proportion • Overestimating: expecting the worst will happen • “What if…??” What if the teacher calls on me? I always get the answer wrong!

  8. Behavior • Avoidance/escape • Reassurance-seeking • Tantrums/disruptive behavior/school refusal

  9. Is anxiety good or bad? Anxiety is normal and adaptive. It serves as a natural alarm system to alert us to danger. • Excessive • Persistent • Developmentally inappropriate • Results in accommodation by others • Causes impairment When is anxiety a problem?

  10. Evidence-based Assessment • Multiple informants (e.g., child, parent, teachers, clinicians, etc.) • Multiple methods • Questionnaires • Interviews (e.g., ADIS-IV-C) • Behavioral observation • Repeated, ongoing assessment throughout treatment • Frequency, duration, intensity, interference

  11. Evidence-Based Treatments for Anxiety Disorders in Children • Medication (SSRIs) • Cognitive Behavioral Therapy (CBT) • Child Anxiety Multisite Study (CAMS) • Medication effective • CBT effective • Combination most effective

  12. Empirical Evidence Summary • > 20 controlled trials • Response: CBT 55-80% • Treatment gains maintained – 5-7 years • Parent symptoms = poorer outcomes

  13. Goals of CBT for Anxiety • Reduce anxiety, but not eliminate it • Increase ability to manage and cope with anxiety by teaching skills • Identify and change anxious behaviors (avoidance) and thoughts

  14. Anxiety Symptoms and CBT Skills Psychoeducation

  15. Psychoeducation • Goal: To provide basic facts about anxiety and its treatment, instill hope • When: Session 1, and thereafter • Key Points: • Define anxiety: find common language • Normalize anxiety: everyone experiences it sometimes • Externalize anxiety: it is a reaction to situations…an alarm (true alarm vs. false alarm) • Propose treatment: (1) CBT model, (2) How do you know the difference between true alarm and false alarm? Test it out!

  16. Goal! Step 5 Step 4 Step 3 Step 2 Step 1 Exposure/Practice: Facing Fears • The key component of CBT for anxiety • Rationale • Anxiety is partly learned and can be unlearned • Learn that feared consequences do not occur • Fear Ladder • Gradually build from easy to hard situations to practice

  17. Sample Fear Hierarchy Situation Rating • Giving speech in front of class 10 • Giving answer aloud in class 8 • Asking question aloud in class 6 • Writing on blackboard in class 4 • Throwing trash away in class 2

  18. Item Selection • Start exposure/practice by collaboratively choosing an item that the child will not refuse and that the child will successfully complete • Move up the ladder as the child masters each item • A “good item” is one that provokes anxiety and that the child habituates or gets used to over time • Be creative!

  19. Summary Anxiety : • Normal and adaptive • Affects: thoughts, feelings, behaviors Anxiety disorders are: • Common • Misidentified and under-treated • Amenable to treatment CBT is: • Time-limited • Skill-based • Effective for treating anxiety (50-80% improvement rate)

  20. Additional Resources • ABCT. ORG • ACADEMYOFCT.ORG • ADAA.ORG: convention March 2010, Baltimore • Chorpita, B. F. (2007). Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders. NY: Guilford. • DuPont Spencer, E. DuPont, R., & DuPont, C. (2003). The Anxiety Cure for Kids. New Jersey: Wiley. • Manassis, K. (1996). Keys to Parenting Your Anxious Child. Hauppauge, NY: Barron’s Education Series. • Rapee, R. M., Spence, S. H., Cobham, V., & Wignall, A. (2000). Helping Your Anxious Child. Oakland: New Harbinger Press.

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