Assessing and Treating Anxiety Disorders in Young Children: The Taming Sneaky Fears Program

228 Pages·2018·3.12 MB·English

by  Suneeta Monga

Suneeta Monga · Diane Benoit
Assessing and
Treating Anxiety
Disorders in
Young Children
The Taming Sneaky Fears Program
Assessing and Treating Anxiety Disorders in Young
Children
Suneeta Monga Diane Benoit
(cid:129)
Assessing and Treating
Anxiety Disorders in Young
Children
The Taming Sneaky Fears Program
123
Suneeta Monga Diane Benoit
Department ofPsychiatry Department ofPsychiatry
Hospital for SickChildren Hospital for SickChildren
Toronto, ON,Canada Toronto, ON,Canada
and and
Department ofPsychiatry Department ofPsychiatry
University of Toronto University of Toronto
Toronto, ON,Canada Toronto, ON,Canada
ISBN978-3-030-04938-6 ISBN978-3-030-04939-3 (eBook)
https://doi.org/10.1007/978-3-030-04939-3
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Acknowledgements
WethankthePsychiatryEndowmentFundattheHospitalforSickChildrenforthe
early seed funding nearly two decades ago to develop the Taming Sneaky Fears
program and for their financial support for the ongoing refinement of the Taming
SneakyFearsprogram.WearegratefultotheOntarioMentalHealthFoundationfor
funding research activities that provided the empirical evidence documenting the
efficacy of the Taming Sneaky Fears program. We also thank clinicians from
various community mental health agencies in Northern Ontario, Canada, with a
special mention of clinicians from Algoma Family Services in Sault Ste. Marie,
Ontario, who have gained an expertise in implementing the Taming Sneaky Fears
programand provided us with insights on how toeffectivelyteach this programto
various professionals. We are also grateful to colleagues, trainees, parents, and
childrenwhohaveparticipatedintheTamingSneakyFearsprogramattheHospital
forSickChildren,Toronto,overtheyearsforalloftheirinvaluablefeedbackonthe
various iterations of the program.
v
Contents
1 Anxiety Disorders in Young Children. . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Anxiety Versus Anxiety Disorder. . . . . . . . . . . . . . . . . . . . . . 1
1.2 Classification and Phenomenology . . . . . . . . . . . . . . . . . . . . . 2
1.3 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.4 Comorbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.4.1 Comorbidity Between Anxiety Disorders . . . . . . . . . . 7
1.4.2 Comorbidity Between Anxiety Disorders
and Non-anxiety Disorders . . . . . . . . . . . . . . . . . . . . 7
1.4.3 Comorbidity Between Selective Mutism
and Social Anxiety Disorder . . . . . . . . . . . . . . . . . . . 8
1.5 Etiological Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.5.1 Genetics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5.2 Behavioral Inhibition . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5.3 Parenting Styles and Parental Anxiety . . . . . . . . . . . . 10
1.5.4 Additional Risk Factors Associated with Selective
Mutism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.6 Impact on Family Functioning . . . . . . . . . . . . . . . . . . . . . . . . 11
1.7 Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2 Screening and Assessment Tools for Young Anxious Children . . . . 17
2.1 Anxiety-Specific Screening Tools for Four- to Seven-Year-
Old Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2.1.1 Preschool Anxiety Scale . . . . . . . . . . . . . . . . . . . . . . 17
2.1.2 Picture Anxiety Test. . . . . . . . . . . . . . . . . . . . . . . . . 19
2.2 Questionnaires Specific to Selective Mutism. . . . . . . . . . . . . . 20
2.2.1 Selective Mutism Questionnaire. . . . . . . . . . . . . . . . . 20
2.2.2 School Speech Questionnaire. . . . . . . . . . . . . . . . . . . 23
2.3 Diagnostic Assessment Tools for Young Anxious
Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
vii
viii Contents
2.3.1 Anxiety Disorders Interview Schedule
for DSM-IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.3.2 Preschool Age Psychiatric Assessment. . . . . . . . . . . . 25
2.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3 Innovative Assessment Approaches for Young Anxious
Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1 Anxiety-Specific Screening Tools for Four- to Seven-Year-
Old Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1.1 Preschool Screen for Child Anxiety Related
Emotional Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.2 Tools to Assess Selective Mutism and Social Anxiety
Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.2.1 Mutism Accommodation Scale . . . . . . . . . . . . . . . . . 31
3.2.2 Talking Behavior Assessment Tool . . . . . . . . . . . . . . 32
3.2.3 Selective Mutism Versus Social Anxiety
Disorder Criteria Checklist . . . . . . . . . . . . . . . . . . . . 33
3.2.4 Steps to Talking. . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.3 Future Directions and Goals . . . . . . . . . . . . . . . . . . . . . . . . . 37
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
4 Current Evidence-Based Management . . . . . . . . . . . . . . . . . . . . . . 47
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.2 Parent-Child Interaction Therapy . . . . . . . . . . . . . . . . . . . . . . 48
4.2.1 Bravery-Directed Interaction . . . . . . . . . . . . . . . . . . . 48
4.2.2 Coaching Approach Behavior and Leading
by Modeling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.3 Cognitive Behavior Therapy . . . . . . . . . . . . . . . . . . . . . . . . . 51
4.3.1 Parent-Child Dyadic Approach . . . . . . . . . . . . . . . . . 52
4.3.2 Child Group Approaches. . . . . . . . . . . . . . . . . . . . . . 53
4.4 Management of Selective Mutism . . . . . . . . . . . . . . . . . . . . . 56
4.4.1 Defocused Communication . . . . . . . . . . . . . . . . . . . . 56
4.4.2 Integrated Behavior Therapy for Selective Mutism . . . . 58
4.5 Summary of Interventions for Young Anxious Children . . . . . 59
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
5 The Taming Sneaky Fears Program: Development
and Refinement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.1 Creation of the Taming Sneaky Fears Program
and Historical Context. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.1.1 Development of the Child Component. . . . . . . . . . . . 63
5.1.2 Development of the Parent Component . . . . . . . . . . . 65
5.1.3 Combining Child and Parent Components . . . . . . . . . 65
Contents ix
5.2 Research on the Taming Sneaky Fears Program . . . . . . . . . . . 66
5.2.1 First Feasibility Study. . . . . . . . . . . . . . . . . . . . . . . . 66
5.2.2 Pilot Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
5.2.3 Comparative Study . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.2.4 Selective Mutism and Social Anxiety Disorder
Feasibility Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.2.5 Current Randomized Control Trial. . . . . . . . . . . . . . . 73
5.2.6 Quality Improvement Study . . . . . . . . . . . . . . . . . . . 75
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
6 The Taming Sneaky Fears Program: Theoretical Framework,
Requirements for Implementation, and Program Overview . . . . . . 79
6.1 Theoretical Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
6.1.1 Adapting Traditional CBT for Young Children. . . . . . 80
6.2 Requirements for Implementation. . . . . . . . . . . . . . . . . . . . . . 83
6.2.1 Who Is a Good Candidate for Participation? . . . . . . . 84
6.2.2 Who Is Qualified to Implement the Taming
Sneaky Fears Program?. . . . . . . . . . . . . . . . . . . . . . . 86
6.2.3 Where Can the Taming Sneaky Fears Program
Be Implemented? . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
6.2.4 When to Implement the Taming Sneaky Fears
Program? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
6.3 Program Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
6.3.1 Duration and Frequency . . . . . . . . . . . . . . . . . . . . . . 88
6.3.2 Therapists-to-Parents and Therapists-to-Children
Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
6.3.3 Setting and Materials . . . . . . . . . . . . . . . . . . . . . . . . 89
6.3.4 Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
7 The Taming Sneaky Fears Program: Introduction Session. . . . . . . 101
7.1 Purpose of the Introduction Session . . . . . . . . . . . . . . . . . . . . 101
7.2 Step-by-Step Guidelines to Implement the Introduction
Session. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
7.2.1 Days or Weeks Prior to the Introduction Session . . . . 101
7.2.2 On the Day of the Introduction Session . . . . . . . . . . . 102
7.2.3 Introduction Session—Part A (Child Group
Therapist Led) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
7.2.4 Introduction Session—Part B (Parent Group
Therapist Led) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
x Contents
8 The Taming Sneaky Fears Program: How to Be a Feeling
Catcher and the Boss of My Body . . . . . . . . . . . . . . . . . . . . . . . . . 113
8.1 Overview and Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
8.2 Step-by-Step Guidelines to Implement Part 1 of Session 1. . . . 114
8.2.1 For All Parent and Child Group Therapists . . . . . . . . 114
8.3 Step-by-Step Guidelines to Implement P-Session 1 . . . . . . . . . 117
8.3.1 Part One of P-Session 1 . . . . . . . . . . . . . . . . . . . . . . 117
8.3.2 Part Two of P-Session 1 . . . . . . . . . . . . . . . . . . . . . . 117
8.3.3 Part Three of P-Session 1 . . . . . . . . . . . . . . . . . . . . . 117
8.3.4 Part Four of P-Session 1. . . . . . . . . . . . . . . . . . . . . . 118
8.3.5 Part Five of P-Session 1 . . . . . . . . . . . . . . . . . . . . . . 126
8.4 Step-by-Step Guidelines to Implement C-Session 1. . . . . . . . . 127
8.4.1 Part One of C-Session 1 . . . . . . . . . . . . . . . . . . . . . . 127
8.4.2 Part Two of C-Session 1. . . . . . . . . . . . . . . . . . . . . . 127
8.4.3 Part Three of C-Session 1. . . . . . . . . . . . . . . . . . . . . 128
8.4.4 Part Four of C-Session 1. . . . . . . . . . . . . . . . . . . . . . 129
8.4.5 Part Five of C-Session 1. . . . . . . . . . . . . . . . . . . . . . 133
8.4.6 Part Six of C-Session 1. . . . . . . . . . . . . . . . . . . . . . . 134
8.4.7 Part Seven of C-Session 1. . . . . . . . . . . . . . . . . . . . . 135
8.5 Step-by-Step Guidelines to Implement C-Session 2. . . . . . . . . 135
8.5.1 Part One of C-Session 2 . . . . . . . . . . . . . . . . . . . . . . 136
8.5.2 Part Two of C-Session 2. . . . . . . . . . . . . . . . . . . . . . 137
8.5.3 Part Three of C-Session 2. . . . . . . . . . . . . . . . . . . . . 137
8.5.4 Part Four of C-Session 2. . . . . . . . . . . . . . . . . . . . . . 140
8.5.5 Part Five of C-Session 2. . . . . . . . . . . . . . . . . . . . . . 141
8.5.6 Part Six of C-Session 2. . . . . . . . . . . . . . . . . . . . . . . 141
8.6 Step-by-Step Guidelines to Implement C-Session 5. . . . . . . . . 142
8.6.1 Part One of C-Session 5 . . . . . . . . . . . . . . . . . . . . . . 142
8.6.2 Part Two of C-Session 5. . . . . . . . . . . . . . . . . . . . . . 143
8.6.3 Part Three of C-Session 5. . . . . . . . . . . . . . . . . . . . . 144
8.6.4 Part Four of C-Session 5. . . . . . . . . . . . . . . . . . . . . . 145
8.6.5 Part Five of C-Session 5. . . . . . . . . . . . . . . . . . . . . . 146
8.6.6 Part Six of C-Session 5. . . . . . . . . . . . . . . . . . . . . . . 146
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
9 The TamingSneaky Fears Program: Howto Be a Trick Catcher
and the Boss of My Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
9.1 Overview and Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
9.2 Step-by-Step Guidelines to Implement P-Session 2 . . . . . . . . . 147
9.2.1 Part One of P-Session 2 . . . . . . . . . . . . . . . . . . . . . . 148
9.2.2 Part Two of P-Session 2 . . . . . . . . . . . . . . . . . . . . . . 149
9.2.3 Part Three of P-Session 2 . . . . . . . . . . . . . . . . . . . . . 149
9.2.4 Part Four of P-Session 2. . . . . . . . . . . . . . . . . . . . . . 155
Contents xi
9.3 Step-by-Step Guidelines to Implement C-Session 3. . . . . . . . . 155
9.3.1 Part One of C-Session 3 . . . . . . . . . . . . . . . . . . . . . . 156
9.3.2 Part Two of C-Session 3. . . . . . . . . . . . . . . . . . . . . . 157
9.3.3 Part Three of C-Session 3. . . . . . . . . . . . . . . . . . . . . 158
9.3.4 Part Four of C-Session 3. . . . . . . . . . . . . . . . . . . . . . 159
9.3.5 Part Five of C-Session 3. . . . . . . . . . . . . . . . . . . . . . 160
9.3.6 Part Six of C-Session 3. . . . . . . . . . . . . . . . . . . . . . . 160
9.4 Step-by-Step Guidelines to Implement C-Session 4. . . . . . . . . 161
9.4.1 Part One of C-Session 4 . . . . . . . . . . . . . . . . . . . . . . 162
9.4.2 Part Two of C-Session 4. . . . . . . . . . . . . . . . . . . . . . 162
9.4.3 Part Three of C-Session 4. . . . . . . . . . . . . . . . . . . . . 163
9.4.4 Part Four of C-Session 4. . . . . . . . . . . . . . . . . . . . . . 164
9.4.5 Part Five of C-Session 4. . . . . . . . . . . . . . . . . . . . . . 165
9.4.6 Part Six of C-Session 4. . . . . . . . . . . . . . . . . . . . . . . 165
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
10 The Taming Sneaky Fears Program: How to Climb Bravery
Ladders and How to Manage Excessive Worries . . . . . . . . . . . . . . 167
10.1 Overview and Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
10.2 Step-by-Step Guidelines to Implement P-Session 3 . . . . . . . . . 167
10.2.1 Part One of P-Session 3 . . . . . . . . . . . . . . . . . . . . . . 168
10.2.2 Part Two of P-Session 3 . . . . . . . . . . . . . . . . . . . . . . 169
10.2.3 Part Three of P-Session 3 . . . . . . . . . . . . . . . . . . . . . 170
10.2.4 Part Four of P-Session 3. . . . . . . . . . . . . . . . . . . . . . 173
10.3 Step-by-Step Guidelines to Implement C-Session 6. . . . . . . . . 174
10.3.1 Part One of C-Session 6 . . . . . . . . . . . . . . . . . . . . . . 175
10.3.2 Part Two of C-Session 6. . . . . . . . . . . . . . . . . . . . . . 175
10.3.3 Part Three of C-Session 6. . . . . . . . . . . . . . . . . . . . . 176
10.3.4 Part Four of C-Session 6. . . . . . . . . . . . . . . . . . . . . . 179
10.3.5 Part Five of C-Session 6. . . . . . . . . . . . . . . . . . . . . . 180
10.3.6 Part Six of C-Session 6. . . . . . . . . . . . . . . . . . . . . . . 180
10.4 Step-by-Step Guidelines to Implement C-Session 7. . . . . . . . . 181
10.4.1 Part One of C-Session 7 . . . . . . . . . . . . . . . . . . . . . . 181
10.4.2 Part Two of C-Session 7. . . . . . . . . . . . . . . . . . . . . . 182
10.4.3 Part Three of C-Session 7. . . . . . . . . . . . . . . . . . . . . 182
10.4.4 Part Four of C-Session 7. . . . . . . . . . . . . . . . . . . . . . 183
10.4.5 Part Five of C-Session 7. . . . . . . . . . . . . . . . . . . . . . 184
10.4.6 Part Six of C-Session 7. . . . . . . . . . . . . . . . . . . . . . . 184
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
11 The Taming Sneaky Fears Program: The Pivotal Role
of Parents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
11.1 Overview and Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
11.2 Step-by-Step Guidelines to Implement the Parent
Feedback Meeting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187