Cognitive Behaviour Therapy With Children and Young People: A Selective Review of Key Issues

Abstract

The growing interest in the use of cognitive behaviour therapy with children and young people has been encouraged by emerging evidence suggesting that CBT is effective with a wide range of child disorders. Typically, models and techniques developed for work with adults have been extended downwards and applied to children. This review questions the appropriateness of this approach and selectively identifies a number of key issues that need to be addressed. The absence of developmentally appropriate theoretical models to understand the onset and maintenance of maladaptive cognitive processes in children is highlighted. This lack of a coherent theoretical framework has led to a proliferation of diverse interventions falling under the general umbrella of cognitive behaviour therapy with the predominant emphasis being behavioural, rather than cognitive. Developmental factors, the nature, extent and type of cognitive processes in children and the important role of the parent in the onset and treatment of childhood problems have received comparatively little attention. There is a need to understand more about the cognitive processes of children and young people and to develop robust and testable developmentally appropriate theoretical models. In turn this will begin to address the question of which specific cognitive behaviour therapy programmes are effective for which childhood problems.

An experimental manipulation of responsibility in children: A test of the inflated responsibility model of obsessive-compulsive disorder

“…This study suggests that if inflated responsibility beliefs in children can be reduced in therapy (for example by using responsibility pie charts), this may help reduce their checking behaviour (Van Oppen & Arntz, 1994). However, it is vital to use developmentally appropriate techniques with children and this is an area of considerable discussion within the child CBT literature (for example Friedberg & McClure, 2002;Quakley, Reynolds, & Coker, 2004;Ronen, 1997;Stallard, 2002).…”

An evaluation of the FRIENDS programme: a cognitive behaviour therapy intervention to promote emotional resilience

“…Although there is a clinical consensus that children aged 7 and above are able to participate in CBT, it will only be effective if it is adapted to be compatible with the child's level of development. 21 While the overall results are positive, informal feedback suggests that some children may find it difficult to engage with the cognitive component of the programme.…”

Cognitive–behavioural therapy with children, young people and families: from individual to systemic therapy

“…of CBT may be in working with younger age groups or on a systemic basis. For reviews, see Stallard (2002) and Drinkwater & Stewart (2002).…”

“…Instead of 'giving solutions', the therapist's emphasis is on guided discovery using Socratic dialogue (Padesky 1995) and systematic use of casespecific and standardised ratings to promote selfhelp and problemsolving. Failure to appreciate that therapy is explicitly based on a shared formulation, rather than being a collection of 'bolton' techniques or a manualbased approach, has resulted in a disparate range of interventions, often purely behavioural or prescriptive, being used as 'CBT for children' (Stallard 2002). There is now widespread appreciation of the need to define CBT for children, young people and families and, in particular, to ensure that interventions are formulationbased through a collaborative reflection on not only individual but also systemic and developmental factors (an opinion confirmed at the inaugural meeting of the Child and Adolescent Special Interest Branch of the British Association for Behavioural and Cognitive Psychotherapies (BABCP) in 2001).…”