Childhood Anxiety Disorders: A Guide to Research and Treatment

370 Pages·2005·2.37 MB·English

by  Deborah C. Beidel

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Childhood
Anxiety
Disorders
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RT7979 title page 5/24/05 8:32 AM Page 1
Childhood
Anxiety
Disorders
A Guide to Research and Treatment
DEBORAH C. BEIDEL & SAMUEL M. TURNER
NEW YORK AND HOVE
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Published in 2005 by Published in Great Britain by
Routledge Routledge
Taylor & Francis Group Taylor & Francis Group
270 Madison Avenue 27 Church Road
New York, NY 10016 Hove, East Sussex BN3 2FA
© 2005 by Taylor & Francis Group, LLC
Routledge is an imprint of Taylor & Francis Group
Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number-10: 0-415-94797-9 (Hardcover)
International Standard Book Number-13: 978-0-415-94797-8 (Hardcover)
Library of Congress Card Number 2004030818
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic,
mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and
recording, or in any information storage or retrieval system, without written permission from the publishers.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only
for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Beidel, Deborah C.
Childhood anxiety disorders : a guide to research and treatment / Deborah C. Beidel and Samuel
M. Turner.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-415-94797-9
1. Anxiety in children.
[DNLM: 1. Anxiety Disorders—Adolescent. 2. Anxiety Disorders—Child.]
I. Turner, Samuel M., 1944– II. Title.
RJ506.A58B45 2005
618.92'8522—dc22 2004030818
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
Taylor & Francis Group and the Routledge Web site at
is the Academic Division of T&F Informa plc. http://www.routledge-ny.com
Contents
About the Authors vii
Preface ix
Part I Overview of Childhood Development
Chapter 1 An Introduction to Children’s Fears 3
Chapter 2 An Introduction to Childhood Anxiety Disorders 17
Chapter 3 Developmental Considerations 35
Chapter 4 Etiological Factors in the Development
of Anxiety Disorders 51
Part II Anxiety Disorders in Children
Chapter 5 Dental Fears, Medical Fears, and
Chronic Medical Illnesses 75
Chapter 6 Excessive Worry and Generalized Anxiety Disorder 101
Chapter 7 Specifi c Phobia 127
Chapter 8 School Refusal 159
Chapter 9 Separation Anxiety Disorder 187
Chapter 10 Social Phobia and Selective Mutism 203
Chapter 11 Obsessive-Compulsive Disorder and Trichotillomania 241
Chapter 12 Panic Disorder 273
Chapter 13 Posttraumatic Stress Disorder 291
References 313
Index 351
v
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Th ere are very few people in this world whose life so positively impacts
the lives of many others, be they patients, colleagues, students, or
friends. Although we will always miss his gentleness, grace, courage,
and laughter, his legacy will continue to enrich those of us who were
fortunate enough to have truly known him. Th is book is dedicated to
my co-author, colleague, and very best friend, Samuel M. Turner, who
passed away during its fi nal production.
Deborah C. Beidel
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About the Authors
Deborah C. Beidel received her Ph.D. in 1986 from the University of Pitts-
burgh. Aft er serving as faculty at the University of Pittsburgh and the Medical
University of South Carolina, she joined the Clinical Psychology Program at
the University of Maryland in 1998. In addition to her appointment as Profes-
sor of Psychology, she is the Co-Director of the Maryland Center for Anxiety
Disorders (MCAD). She was the 1990 recipient of the Association for Advance-
ment of Behavior Th erapy’s New Researcher Award and the 1995 recipient of
the Distinguished Educator Award from the Association of Medical School
Psychologists. Dr. Beidel holds the American Board of Professional Psychology
(ABPP) Diplomate in Clinical Psychology and Behavioral Psychology and is
a Fellow of the American Psychological Association and a past-president of
the Society for a Science of Clinical Psychology. She serves on the editorial
board of a number of scientifi c journals. Her academic, research, and clinical
interests focus on child and adult anxiety disorders, including their etiology,
psychopathology, and behavioral treatment. Her research is characterized by
a developmental focus, and includes high risk and longitudinal designs, psy-
chophysiological assessment, treatment outcome, and treatment development.
Along with her colleague, Dr. Samuel M. Turner, she is the recipient of NIMH
grants addressing the development and effi cacy of behavioral interventions for
adults and children with anxiety disorders.
Samuel M. Turner received his Ph.D. in Clinical Psychology in 1975 from the
University of Georgia. Following faculty tenures at the University of Pittsburgh
and the Medical University of South Carolina, he joined the University of Mary-
land, College Park, in 1998. He is Professor of Psychology and Co-Director of
the Maryland Center for Anxiety Disorders (MCAD), a clinical research center
for the study of anxiety in adults and children. Dr. Turner is a Diplomate of the
American Board of Professional Psychology (ABPP) in Clinical Psychology and
in Behavioral Psychology and a Fellow of the American Psychological Associa-
tion and the American Psychological Society. In 1997, he was the recipient of the
American Psychological Association Award for Distinguished Contributions to
Professional Knowledge and the 1998 recipient of the Distinguished Scientist
Award from the Association of Medical School Psychologists. He served as
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viii About the Authors
Associate Editor-in-Chief of Th e American Psychologist and is on the editorial
board of numerous scientifi c journals. Dr. Turner’s primary academic, research,
and clinical interests are in the anxiety disorders, and behavioral theories,
behavioral assessment, and behavioral treatment. His program of research
includes studies designed to delineate the phenomenology of anxiety states,
etiological and developmental parameters of anxiety disorders, and develop-
ment and evaluation of treatments for anxiety disorders. In addition to these
primary areas of focus, he has interest in clinical methodology, measurement,
scale development, and racial, ethnic, and cultural factors in the etiology and
treatment of anxiety disorders.
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Preface
Once thought to be primarily disorders of adulthood, it is increasingly recog-
nized that maladaptive anxiety states are common and debilitating disorders
of childhood. Research aimed at understanding their manifestations continues
to emerge and effi cacious treatment programs are being developed and tested.
However, much of this literature has yet to make its way into the hands of the
numerous health and mental health professionals who, every day, attempt to
manage and treat children with these conditions.
Over the years, we have provided many workshops on treating childhood
anxiety disorders and we oft en are asked for clinical materials (e.g., treatment
plans, treatment manuals, sample fear hierarchies, self-monitoring forms) that
we use in our clinical practice and in our ongoing treatment protocols. Th us,
in this book, we discuss the research eff orts of many investigators and also
describe our clinical experience in treating children with anxiety disorders.
We hope that by including these clinical materials we can make more vivid
the scientifi c descriptions and illustrate the range, severity, and functional
impairment that childhood anxiety disorder can impart. In addition, we hope
these clinical materials will illustrate the creative process of fi tting appropriate
treatments to individual cases, the necessity for understanding the nature of
the condition and how they aff ect those who are affl icted, and the necessity
for an understanding of the scientifi c literature. Indeed, it is unlikely, in our
view, that these conditions can be eff ectively and appropriately treated if any of
these components are missing. Hence, one objective was to discuss the material
presented in such a manner that this would be unabashedly clear. We trust we
were successful in this regard.
Because fears are so common in children, we felt that it was important
that this book include not only anxiety disorders but also the developmental
background necessary to place childhood anxiety disorders in their proper
context. Th erefore, we have divided this book into two parts. Part I, consisting
of the fi rst four chapters, provides an overview of children’s fears, children’s
anxiety disorders, developmental considerations, and etiological factors that
cut across specifi c disorders. Many of the interventions used to treat anxiety
disorders in children emerged from the literature on adult disorders, and as
such, sometimes are neither developmentally sensitive nor appropriate for
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