55. årgang, nr. 1 febr. 2018 Tema: Angst

Anxiety disorders in children

By Mikael Thastum, Professor and head of the Center for Psychological Treatment of Children and Adolescents (CEBU), Department of Psychology and Behavioural Sciences, Aarhus University
The article discusses how to distinguish between normal and pathological anxiety, and what we know about why children and adolescents develop anxiety, as well as the most common anxiety disorder in children . The purpose of the article is to pro- vide a brief and practical overview of knowledge about anxiety disorders in chil- dren .

Cognitive Behavioral Therapy for childhood anxiety

By Sonja Breinholst, Bianca Munkebo Christiansen & Barbara Hoff Esbjørn Cognitive Behavioral Therapy is the most widely used evidence-based treatment for children with anxiety disorders . Randomized controlled studies and meta-analyses find that approximately 60% of clinically anxious children are free of their anxiety after treatment .
Cognitive behavioral therapy targets solving current problems by changing un- helpful patterns in cognitions (e .g . thoughts, beliefs, and attitudes), behaviors, and emotional regulation . The two key mechanisms in cognitive behavioral therapy are 1) exposure, where the child gradually approaches the feared stimuli, and 2) cogni- tive restructuring, where irrational and maladaptive thoughts are identified and disputed . CBT can be delivered individually or in groups, with or without parental involvement . Furthermore, the format can be either manualized, where each sessi- on and homework is determined in advance, or based on a caseformulation, where the theme of the session and the homework might change with the understanding of the child’s problems from session to session.

Parental behaviour towards children with anxiety and ODD A pragmatic case study of Max and his parents

By Mette Maria Agner Pedersen, MSc in Psychology and Barbara Hoff Esbjørn, The paper examines parental behaviours that may maintain the comorbidity of childhood anxiety and oppositional defiant disorder (ODD) . Theoretically, and empirically parental reinforcement and modelling of the child’s anxious and defiant behaviour and parental control are shown to be substantial factors in maintaining anxiety and ODD . The paper provides a case study of the cognitive behavioural tre- atment of an anxious and defiant boy, Max, and his parents . Through use of quanti- tative and qualitative data the paper illustrates the role of parents in maintaining and ameliorating Max’s anxious and defiant behaviour . At the end of treatment, Max’s anxiety symptoms were diminished, but the parent’s behaviour appears unchanged and qualitative observations of Max’s defiant behaviour suggest that it remains a problem even at the last treatment session . It is speculated that the pre- sence of this behaviour is influenced by the lack of change in parental behaviour, possibly being a risk factor for a subsequent relapse . Furthermore, the role of the psychologist treating the family is discussed, as well as how therapeutic work with parents in the treatment of comorbid anxiety and ODD may be assisted by the fin- dings in future treatments .

OCD in children and adolescents Obsessions and compulsions

By Marie Tolstrup
The paper describes obsessive-compulsive disorders (OCD) in children, and what PPR can do when identifying such children . Based on various clinical examples, ob- sessive thoughts and compulsive behaviours are defined, and the varieties within il- lustrated . The paper also identifies ways in which OCD differs from that of other anxiety disorders, with OCD symptoms differing in terms of feelings of shame and bizarreness . Relevant questionnaires are mentioned, as well as encouraged when needing to pinpoint the specifics of OCD: Emphasis is placed on how PPR can help identify children with OCD, and how through this understanding, they can help not only the child, but also parents and school personnel to understand how this disor- der manifests and maintains its hold on the child . When psychiatric and possibly medical intervention is deemed necessary, PPR can help the child’s transition to the psychiatric system, by offering a thorough description of the presenting OCD symp- toms, and the extent thereof . Finally, recommended treatments are highlighted .

Help to Self-help – a parent based group CBT programme

By Bianca Munkebo Christiansen, Barbara Hoff Esbjørn & Sonja Breinholst
This article reports on a pilot study testing a self-help programme with minimal therapist involvement developed at Centre for Anxiety, University of Copenhagen . The self-help programme is aimed at parents of anxious children and focuses on the transfer of control from therapist to parents . The programme comprised of two therapist-led workshops, a Facebook group, and manuals for parents and children adapted from the Cool Kids programme . The sample for the pilot study consisted of 26 families, of which 21 completed the programme . Intent to treat analyses revealed that 61 .5 % of the children where free of both their primary and all anxiety dis- orders following treatment . As such, our results suggest that this parent-based self- help programme might be a new and promising low-intensive treatment of children with moderate anxiety levels in a cost-effective manner .

How can a self-help programme for children with anxiety be implemented in a Danish municipality?

By Jennifer Therese Løth
Childhood anxiety is highly prevalent and is the cause of distress for many children and families . This article is a presentation of a pilot project in a Danish municipa- lity aimed at children with moderate anxiety . The method was a self-help program- me addressed at the parents, based on the cognitive behavioural programme Cool Kids . The programme consisted of two therapist-led workshops, Cool Kids manuals and a Facebook group . 61 families completed the programme within a year and overall the feedback was positive . The use of professional resources is minimal com- pared to the large number of children receiving help, and the programme makes it possible to treat and help children, who would otherwise not receive help . Simulta- neously, the group of therapists involved have received a thorough education in cog- nitive behavioural therapy for childhood anxiety, giving them the skills to offer qualified help to children with anxiety and to their families .

Preventing anxiety through the provision of general pedagogy in Early Childhood Education and Care

By Pernille Hviid, Barbara Hoff Esbjørn and Jakob Waag Villadsen
Clinical child psychology, general developmental psychology and pedagogical prac- tices all provide different contributions to the prevention of child anxiety . However, a dialogue between these areas is lacking, prohibiting the development of new knowledge and practices that may prevent the development of child anxiety through the pedagogical practice in children’s everyday lives . This paper provides such a contribution and invites further dialogue between the different fields . The off-set for the dialogue is the recognition and acknowledgement of the different qua- lities and contributions from the fields of knowledge . In the paper, we outline and discuss some of the possible areas that may further our prevention of anxiety . We believe that the general everyday life setting, with its pedagogical practice and fo- cus on play and general positive development, provides an optimal way to increase the number of children who may benefit from the interventions without focusing on illness per se . We hope that our paper will provide a foundation from which comple- mentary preventive initiatives may be discussed and developed as part of the eve- ryday pedagogical practice .