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Parent and Child Psychological Services PLLC 
941.357.4090 (Office)/ 727.304.3619 (Fax)
​Instagram: @childtherapysrq

What is CBT? How does it help children with anxiety? By Tara Motzenbecker, MS, NCSP

2/22/2019

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CBT stands for Cognitive-Behavioral Therapy. In CBT, a therapist helps the patient see how they may be thinking (cognitive) about things in a way that is not helpful, and helps them see things that they are doing (behavioral) that may be holding them back. The goal of the treatment is to (1) help the person understand their own patterns, (2) think more accurately about their situations, and then (3) plan actions that will help them reach their goals. In the course of the therapy, the therapist should help them practice their new “skills” in real-world situations.

For anxiety, CBT must include one important component – exposure. Exposure just means practice doing things that have been avoided, in small steps, in real-world situations, with the help and guidance of the therapist. If you are working with a CBT therapist for help with anxiety, this should be a major part of the treatment.

CBT typically involves 16-20 sessions and it is very goal-oriented - the goal being to reduce symptoms and improve functioning in the target areas. If there are multiple problems (like depression and anxiety) or the symptoms of anxiety are very severe and it has been going on for many years, it may take more sessions, but you should be able to start seeing positive changes within the first couple of months.

In CBT for anxiety in kids, parents are very much part of the team. Parents are shown how to encourage practice and not give-in to avoidance or reassurance at home. In this example, if parents were asking the teacher for accommodation to write the report instead of read it in front of class, or let the child miss school on presentation day, the therapist would help them encourage practice of small steps (like have them practice in front of them a few times, then ask the teacher if they can practice 1:1 first before doing it in front of the class) instead of avoidance. Although avoidance helps people feel better quickly it does not help them overcome their anxiety (and actually makes the anxiety stronger). Anxiety can be overcome, and CBT is a great tool to help people do just that.

childmind.org/article/behavioral-treatment-kids-anxiety/

effectivechildtherapy.org/concerns-symptoms-disorders/disorders/fear-worry-and-anxiety/​​

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Anxiety and Children by rachel funnell, LMFT

2/14/2019

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​What is Anxiety?:
The definition of anxiety is: a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. Anxiety is there to keep us from danger. It is a built-in self-protection mechanism that every human has.There is nothing wrong with experiencing the feeling of anxiety; it is how we react to those feelings that can lead to harm or unhealthy behaviors.


What does anxiety look like in children?
These are some examples but anxiety can present in many, many other ways.
  • Clinging/separation anxiety
  • tantrums
  • crying
  • hypervigilance
  • avoidance of people/places or things (which can often look like refusing to go/do what is expected)
  • regression (bedwetting, thumb sucking, baby-talk)
  • tics, or unusual kinetic movements
  • increased sensory seeking behaviors
  • shutting down
  • rapid talk/increased inquisitiveness, or reassurance seeking
  • selective mutism
  • lack of concentration/inattentiveness 
  • increased somatic complaints
  • agitation
  • restlessness
  • difficulties with transitions
  • sleep disruptions

What is a protective level of anxiety and what is a problematic level?
The anxiety is considered to be a problem when it affects the child’s daily functioning. There will be many times throughout a child’s life that anxiety will increase due to life events and this is not to be a concern unless it becomes chronic. Some diagnoses require at least 4 weeks of ongoing symptoms and others at least 6 months.

Causes of anxiety
  • Trauma: disasters, accidents, abuse etc but also medical procedures, community violence, death of a loved one-person or pet, a move, witnessing violence
  • Learned behaviors: children pick up cues from the adults in their lives and learn how to manage their feelings by modeling what they see 
  • Genetic predisposition; including sensory sensitivities

When do you know that your child needs professional help?  
When the anxiety is affecting the daily functioning of the child and/or the family for a few weeks and is not the result of a situation that one would expect anxiety to increase. In addition, if the heightened anxiety continues after the situation has resolved, professional attention may be warranted.



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Identifying Attention Deficit Hyperactivity Disorder (ADHD) in Young Children by kirsten ellingsen, ph.d.

2/2/2019

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Attention Deficit Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed behavioral disorders in childhood. Rates have been increasing over the past few decades and there are different reasons suggested for this increase, including better screening for ADHD.  According to the DSM-5, the childhood rate of ADHD in the United States is estimated at five percent. Community population samples and parent report of children in some studies have found higher estimates (up to 11%).
 
ADHD can profoundly affect children’s educational performance, wellbeing, and social interactions (American Academy of Pediatrics, 2011). Common referral concerns for ADHD include exhibiting behaviors such as high activity level, impulsivity, and poor attention. Accurate diagnosis, particularly when children are young, requires informed clinical judgment, the use of multiple assessment measures (often through formal neuropsychological evaluations), and information about how a child is functioning across different settings over time. Children can be diagnosed as young as 4 years of age (although most children are not diagnosed with ADHD until age 7). While symptoms may be observed in early childhood, accurate diagnosis is incredibly difficult – because many of the “problem behaviors” associated with ADHD fall in the range of typical or age-expected behavior for young children. 
 
Early signs of possible ADHD that have been identified include:
  • Acts before thinking
  • Changes activities frequently
  • Has a short attention span
  • Fails to focus and follow directions
  • Distracts easily
  • Has difficulty staying on task (Fewell & Deutscher, 2002, p27)
According to Dr. Mark Mahone, early signs of ADHD risk for preschool children include:
  • Dislikes or avoids activities that require paying attention for more than a few minutes
  • Loses interest and moves on to another activity after engaging in an activity quickly
  • Talks more and makes more noise compared to same age peers
  • Climbs on things even when told not to
  • Not able to hop on one foot by age 4
  • Almost restless
  • Fearlessness results in getting into dangerous situations
  • Warms up too fast to strangers
  • Aggressive to peers and preschool expulsion
  • Injures him or herself by running or moving fast even when told not to do so
(http://www.kennedykrieger.org/overview/news/it-adhd-or-typical-toddler-behavior-ten-early-signs-adhd-risk-preschool-age-children)
 
Characteristics of ADHD - Predominantly Inattentive Presentation
  • Fails to give close attention to details or makes careless mistakes
  • Has difficulty sustaining attention
  • Does not appear to listen
  • Struggles to follow through on instructions
  • Has difficulty with organization
  • Avoids or dislikes tasks requiring sustained mental effort
  • Loses things
  • Is easily distracted
  • Is forgetful in daily activities
 
Characteristics of ADHD - Predominantly Hyperactive/Impulsive Presentation
  • Fidgets with hands or feet or squirms in chair
  • Has difficulty remaining seated
  • Runs about or climbs excessively in children; extreme restlessness in adults
  • Difficulty engaging in activities quietly
  • Acts as if driven by a motor; adults will often feel internally as if they were driven by a motor
  • Talks excessively
  • Blurts out answers before questions have been completed
  • Difficulty waiting or taking turns
  • Interrupts or intrudes upon others
 
(See more at: http://www.chadd.org/Understanding-ADHD/Parents-Caregivers-of-Children-with-ADHD/Symptoms-and-Causes/Symptoms-and-Diagnostic-Criteria.aspx#sthash.fz8ZbS23.dpuf)
 
Impulsivity, inattention, high activity levels and distractibility are all commonly observed in young children.  Problems with self-control or hyperactivity occur with many preschool children and are expected -to a degree. Therefore, it is important to consult with a knowledgeable and informed professional who can help differentiate between developmentally appropriate (or age appropriate) behaviors and when behaviors fall outside of the expected range. Problematic behaviors need to be more frequent, severe, and persistent compared to same age peers. It is also the combination of these behaviors and how they affect functioning in different environments that might suggest a possible underlying disability. If you have concerns about your child’s behavior or questions about ADHD talk with your pediatrician, a psychologist, or a neuropsychologist. 
 
 Resources:
 
Preschoolers and ADHD (National Research Center on ADHD) https://chadd.org/wp-content/uploads/2018/05/preschoolers.pdf
 
Is it ADHD or Typical Toddler Behavior? Ten Early Signs of ADHD Risk in Preschool Children: 
http://www.kennedykrieger.org/overview/news/it-adhd-or-typical-toddler-behavior-ten-early-signs-adhd-risk-preschool-age-children
  
ADHD: https://kidshealth.org/en/parents/adhd.html


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    Parent and Child Psychological Services is a private practice serving children and families in the Sarasota, Florida area. The practice is owned and operated by Dr. Gibson, a Licensed Psychologist who is Board Certified in Clinical Child and Adolescent Psychology. ​

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Parent and Child Psychological Services PLLC 
info@childtherapysrq.com
941.357.4090 (Office)
727.304.3619 (Fax)                                                                                                                                                               
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