Depression
Depression affects as many as one in ten children between the ages of six and twelve. Children with depression can experience classic symptoms of sadness/hopelessness, changes in eating or sleeping patterns, fatigue, and loss of interest in activities or less recognized behavioral changes such as a sudden drop in school performance, shouting or irritability, refusals to cooperate, aggression and alcohol or drug use. Treatment for depression helps children to:

• Recognize and modify irrational and self-deprecating thoughts.
• Adopt more appropriate and/or positive responses to their own and others’ thoughts and feelings.
• Improve listening, social, and problem-solving skills.
• Plan positive/pleasant individual and social activities.

Anxiety
Mild anxieties or fears in childhood are common and considered to be part of normal development. However, fears can become excessive and produce significant distress for a child. These more severe anxiety disorders include Social Phobia (anxiety about or refusal to go to school), Separation Anxiety (from a parent), or more Specific Phobias (fear of animals, darkness, thunderstorms or sleeping alone). Excessive worries for children often develop around school, health, and home-related events (test-taking, rejection by peers, physical illness or injury, medical procedures, and parental conflicts/punishments). Treatment consists of:

• Cognitive restructuring of the feared event so the child can view it as less threatening and manage the situation more effectively without avoiding it.
• Training in relaxation and imagery.
• Exposure to situations that elicit increasing levels of anxiety until the child can remain relatively calm in the face of the feared stimulus.
• Demonstrating or modeling more adaptive responses for the child.

Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is a neurobehavioral disorder that affects approximately 0.5% to 1% of children and adolescents at any given time. A child may experience either obsessions (recurring thoughts, images or impulses that are intrusive and distressing) or compulsions (repetitive behaviors, such as washing, or thoughts, such as counting). A child may try to neutralize his or her anxiety or prevent some feared event from occurring by using rituals (i.e., repeatedly jumping over cracks in the sidewalk to keep a parent safe) or checking behaviors (i.e., repeatedly turning on and off a light switch "to be sure" it is really off). Symptoms are time consuming, cause marked distress, and often interfere with the child's ability to function at home, school and socially. Cognitive-behavioral therapy, alone or in combination with medication, is an effective treatment for OCD consisting of:

• Learning anxiety management skills such as deep muscle relaxation, imagery and controlled breathing.
• Cognitive restructuring of unpleasant anxiety symptoms as physiological arousal rather than a cue that something bad is going to happen.
• Gradual exposure with response prevention which guides the child through the process of confronting his/her fear (e.g., touching a dirty doorknob) without having to perform the usual anxiety-reducing behavior (e.g., washing hands or holding the knob with a tissue).
• Story metaphors that demonstrate to the child that he or she has a choice about including or excluding OCD from his/her life.

Attention-Deficit/Hyperactivity Disorder
Children with Attention-Deficit/Hyperactivity Disorder often experience discipline problems at home and school, poor school grades and difficulty making or maintaining friendships. Limited ability to concentrate, low frustration tolerance for long or routine tasks, shifting from one incomplete task to another, inability to delay and think through a problem situation adequately or to regulate behavior as a situation demands, persistent restlessness, trouble following through on directions given, inconsistencies in the quality, accuracy and speed of completing assigned work are the hallmarks of this disorder. Children and their parents are seen individually and together during different phases of treatment. Treatment for the child includes:

• Learning and rehearsing a set of self-directed instructions to guide them when completing a task or responding to a social situation (helping them to slow down and consider all their choices before problematic behavior begins). These skills can help improve school performance, daily conduct, friendships, and reduce the need for constant supervision or excessive punishment.
• Self-control and calming techniques that help the child to reduce his/her frustration or anger and think things through in difficult situations limiting conflicts with parents, siblings and friends.
• Using structured feedback from the child’s teachers and/or parents to monitor, correct and reward more appropriate classroom behaviors.
• Training in independent study skills to improve organizational skills and school performance.

Essential behavior management training for parents of ADD and ADHD children includes:

• Simple and highly effective behavioral management techniques that help restore order and control to a conflict ridden home environment.
• Paying attention to your child’s good behavior and giving positive feedback and approval.
• Giving effective commands rather than negotiating with your child.
• Rewarding, punishing and ignoring various behaviors appropriately.
• Proactive problem-solving strategies.
• Directed readings allow parents to develop more realistic expectations of their child.

When working with adolescents, treatment is modified to include mutual problem-solving skills, communication training and behavioral contracting. Strong-willed or noncompliant children and their parents can benefit from a similar course of treatment as that outlined for ADHD. Anger control training is emphasized in this treatment program; combining cognitive restructuring and inhibition of impulsive or aggressive behaviors with social skills training.

Eating Disorders
Eating Disorders generally develop during adolescence. Binge-eating, common in bulimia and compulsive overeating, often involves an excessive intake of food, usually high calorie foods, in a short period of time. It can be understood as an attempt to dull or escape anxious thoughts and feelings by creating a “trance-like” or “mindless” state. These periods of overeating are usually preceded by a period of fasting, producing excessive cravings for food, and often followed by purging through excessive exercise, self-induced vomiting or laxative misuse. Many bulimics hold perfectionistic standards for themselves which produce excessive self-criticism (e.g., “ I’m disgusting”, “No one will ever want me”). Treatment involves:

• Establishing an appropriate eating plan (three meals and snacks) to reduce the risk of excessive cravings that often lead to bingeing. A consultation with a licensed nutritionist is strongly recommended.
• Detailed self-monitoring of the frequency, amount, situations, thoughts and emotions associated with bingeing.
• Using response delays (allowing some predetermined amount of time to pass or engaging in an alternate activity - choosing to wait 20 minutes before bingeing, calling a friend, washing laundry, etc.) or response prevention (trying to tolerate the urge to binge without bingeing).
• Cognitive thought monitoring to identify and challenge the unpleasant thoughts and feelings you become aware of as binge-eating decreases (e.g., “I can’t stand feeling so bloated”, “I have to get rid of this feeling immediately”).
• Relaxation and positive body imagery training.
• Assertiveness, communication and problem-solving strategies as needed.

Bed Wetting
Ten percent of all children are enuretic at six years of age, and some remain so as teenagers. Research demonstrates that when enuresis is eliminated, the child’s self-esteem and emotional adjustment are improved. Rapid and highly effective treatment is available through a new procedure known as “dry-bed training” which includes:

One night of intensive training (guided by a parent) followed by use of a urine-alarm apparatus for as little as one week.

• Training in inhibiting urination.
• Positive reinforcement for correct urination (on the toilet).
• Training in rapid awakening.
• Increased fluid intake.
• Self-correction of accidents and practice in toileting.

The therapist instructs /coaches parents on how to implement these procedures with their child and modifies the program as needed.  Consultations with school personnel on behalf of your child are also available.

Child and Adolescent Therapy
American Institute for Cognitive Therapy
136 East 57th Street, Suite 1101
308 2440
AICT@AOL.COM

For more information on children and adolescents please see the following chapters that you can download below:

Connor: Prevalence of aggression, anti-social behavior and suicide

Campbell: Behavior Problems in Preschool Children: Second Edition: Clinical and Developmental Issues

Bipolar Disorder in Childhood and Early Adolescence
-Edited by Barbara Geller and Melissa P. DelBello

Child Psychopathology: Second Edition
-Edited by Eric J. Mash and Russell A. Barkley Attention deficit hyperactivity disorder

Defiant Children: Second Edition: A Clinician's Manual for Assessment and Parent Training
-Russell A. Barkley

Your Defiant Child: Eight Steps to Better Behavior -Russell A. Barkley

Behavioral and Emotional Disordes in Adolscents: Nature, Assessment and Treatment - David A. Wolfe and Eric J. Mash.

Separation Anxiety in Children and Adolescents: An Individualized Approach to Assessment and Treatment - Andrew R. Eisen and Charles E. Schaefer.

Recommended Reading:
Relationship Matters: How to Teach Children Compassion - Offra Gerstein

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