Expanding horizons: Adapting manual-based treatments for anxious children with comorbid diagnoses

Therapist responsiveness to child engagement: flexibility within manual‐based CBT for anxious youth

“…The restricted range of racial diversity constrains conclusions about the role of race/ethnicity in therapist responsiveness, and the high comorbidities among anxiety disorders (60% had multiple anxiety disorders) constrains conclusions regarding primary diagnosis. The fact that comorbidities did not predict flexibility, though replicating previous work (Kendall & Chu, 2000), contrasts with suggestions that increased case complexity would require greater adaptations (Hudson et al, 2001). Future research that includes activities outside the therapy room as part of therapist flexibility may increase the relationship between therapist responsiveness and case complexity.…”

“…In the present study we assessed client characteristics (i.e., child diagnoses and comorbid disorders) that potentially prompt the therapist to use greater flexibility. It has been recommended that special attention be given to comorbid conditions in treatment implementation (Hudson, Krain, & Kendall, 2001), leading to the prediction that flexibility may vary depending on comorbidity. The present study also examined the relationship between therapist flexibility and treatment outcome.…”

Comorbid Depressive Disorders in Anxiety-disordered Youth: Demographic, Clinical, and Family Characteristics

“…Further research is necessary to confirm these initial findings and investigate whether current treatments for child anxiety should be modified for youth with comorbid depression. If modification is warranted, clinicians may wish to add additional sessions that address depressive symptoms to current CBT protocols for anxiety (see suggestions of Crawley et al [38], Hudson et al [42], and Kendall et al [43]). These modifications might include the addition of behavioral activation techniques to increase motivation and engagement in treatment and cognitive restructuring that targets depressive cognitions in addition to anxious cognitions [42].…”

“…If modification is warranted, clinicians may wish to add additional sessions that address depressive symptoms to current CBT protocols for anxiety (see suggestions of Crawley et al [38], Hudson et al [42], and Kendall et al [43]). These modifications might include the addition of behavioral activation techniques to increase motivation and engagement in treatment and cognitive restructuring that targets depressive cognitions in addition to anxious cognitions [42]. Future research should also investigate whether comorbid depression is a moderator of outcome for individual and family modalities of treatment, given the poorer family functioning reported by AD-DD youth in the current study.…”

Social Phobia and Selective Mutism

“…Manualized anxiety treatment can be adapted for use with SM, involving increased parent training, school collaboration, psychoeducation about SM, and simplifying the cognitive restructuring component for the likely younger age of the SM patient. 92,101,102 Adaptation of the Coping Cat manual is described in a case report involving an 8-year-old girl with SM; adapted strategies include developing rapport with the parent-child dyad with reduced emphasis on the child, shaping communication through praise of spontaneous speech efforts, utilizing parent-only sessions to teach behavior modification strategies such as shaping and creating daily structure, collaborating with the parent to teach coping skills, and utilizing video and audio recordings to implement a gradual hierarchy of speech exercises. 101 In another case report, a modularized CBT manual is adapted for use with an 8-year-old boy with SM; specific strategies include developing an initial rapport through shaping, consistently utilizing teacher and parent reports, offering positive coping statements, and creating an exposure hierarchy based on increasingly distressing speech tasks.…”