Jami M. Furr, Shilpee Tiwari, Cynthia Suveg, and Philip C. Kendall
Maladaptive anxiety in youth occurs when the fear associated with a situation or object is disproportionate in the level and duration of distress experienced and to what is developmentally appropriate. This chapter provides an overview of how anxiety in youth is expressed with respect to cognition, physiological arousal, and emotion dysregulation. Next, this chapter reviews the specific symptoms and diagnostic criteria for each of the anxiety disorders that often onset during childhood. It also describes the epidemiology of, and risk factors associated with, anxiety in youth, and reviews the empirical literature on the assessment and treatment of anxiety in youth. Finally, this chapter highlights areas in need of further empirical attention.
Amanda L. Richdale
Parents of children with a developmental disability more commonly report sleep problems than parents of typically developing children. These sleep problems include difficulties getting their child to bed, and that their child takes a long time to fall asleep, wakes frequently, and/or wakes for long periods during the night. These reports are generally supported by objective findings. Sleep-disordered breathing is more common in children with specific developmental disorders such as Down syndrome and Prader-Willi syndrome, where craniofacial features associated with the disorder place them at high risk. Poor sleep in children with a developmental disability is generally associated with more severe daytime behavior difficulties, lower IQ, poorer adaptive behavior, compromised parent sleep, and increased parent stress, placing parents at risk for increased symptoms of anxiety and depression. Such sleep problems are likely to be multifactorial and are best viewed within a biopsychosocial context. Further research on the etiology, impact and intervention for sleep problems in children with a developmental disability is required.
Kelly C. Allison and David B. Sarwer
Body image disturbances are common among women in the general population. Less is known about their prevalence and impact during pregnancy. This chapter examines the history of body image theory and research. Next, we examine issues related to body image during pregnancy, such as pregravid weight, gestational weight gain, and the unique ways women think about the changes to their body during pregnancy. The role of physical activity, mood, and eating disorders in relation to peripartum body image disturbance is also discussed. Finally, assessment of body image disturbance and existing treatments are presented. Future research is needed to develop peripartum-specific body image assessment tools and to assess the impact of psychosocial interventions during and after pregnancy on body image dissatisfaction.
Challenges in the Assessment and Diagnosis of Eating Disorders in Childhood and Adolescence Given Current Diagnostic and Assessment Instruments
Jennifer L. Couturier and Sherry L. Blyderveen
The diagnosis and assessment of children and adolescents with eating disorders is fraught with challenges. This chapter reviews the problems inherent within the most widely used classification systems and assessment instruments currently available. The greatest challenge is that these systems and measures have typically been designed for adult populations, and thus, are often developmentally inappropriate for youth. It is recommended that future diagnostic criteria and assessment instruments be specifically designed at inception for youth, taking their developmental stages into account. Further, norm-referenced tests for different ages and genders are needed. Other essential elements of a multimethod assessment should be included in the assessment and diagnosis of youth with eating disorders, particularly collateral information, especially from parents, and both formal and informal observations. These elements are particularly important given the denial, minimization, shame, and guilt associated with eating disorders, which are perhaps even more prominent in children and adolescents.
Michael Kölch, Jörg M. Fegert, and Ulrike M.E. Schulze
In child and adolescent mental health care, the competing goals of protecting young people as a vulnerable population and their increasing legal autonomy constitute a specific ethical problem. Improving care, assessment, and treatment interventions requires research. Research that includes this vulnerable underage population has to be minimally burdensome and harmful and requires the informed consent of both children and parents. Therefore, adherence to evidence-based interventions and weighing the risks and benefits of interventions are of utmost importance in child and adolescent psychiatry. While access to mental health care can vary widely, it is crucial for at-risk populations such as children from families of low socioeconomic status, children of the mentally ill, and, in particular, children in youth welfare systems.
John E. Lochman, Caroline Boxmeyer, Nicole Powell, and Thomas J. Dishion
This chapter describes issues related to cognitive-behavioral group-based interventions for children with aggressive behavior problems. It describes beneficial aspects of group formats and notes the longer-term effects of the Coping Power program. It discusses potential problems in group-based interventions with aggressive children, including the potential for deviant peer effects and deviancy training. It then describes a study of Coping Power that randomly assigned schools to either group or individual formats for aggressive children. Results indicated significant reduction in behavioral problems for children in both conditions. However, teacher ratings indicated significantly stronger effects apparent by a 1-year follow-up for children in the individual sessions compared to the group format. The chapter discusses why these differences may have emerged and how group therapist behavior may be important in protecting against longer term follow-up deviant peer effects.
Filip De Fruyt and Barbara De Clercq
The personality disorders of the American Psychiatric Association would have antecedents in childhood and adolescence, but this has been a relatively weak area of investigation. This absence is the more remarkable given the abundant evidence that has accumulated over the years on the stability of psychopathology, the presence of prodromal signs of adult psychopathology in childhood, and the empirical support for temperament and personality traits in childhood and adolescence. This chapter begins with a review of personality disorder antecedents through the history of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders and follows with a discussion of the most recent evidence underscoring the importance of incorporating such a perspective for a better conceptual representation, assessment, and understanding of personality pathology across the life span.
Kathleen K. M. Deidrick and Elena Harlan Drewel
Children with chronic health conditions form a heterogeneous group at increased risk for cognitive and emotional difficulties that may lead to difficulties in academic and social environments. Rehabilitation psychologists are in a unique position to provide support to children with chronic health conditions due to their expertise in neuropsychology, mental health, and psychological aspects of illness and disability. However, research in pediatric rehabilitation psychology is limited by small sample sizes, cross-sectional research designs, and a lack of empirically supported interventions that are population and domain specific. In the future, research in these areas will provide a rich literature to guide work in pediatric rehabilitation psychology.
R. Robert Auger and Stephanie J. Crowley
Delayed sleep phase disorder (DSPD), common among adolescents, is characterized by an extreme “eveningness” circadian preference. Various etiologies have been proposed for this presumably multifactorial condition. As those afflicted frequently present during a time of transition to earlier school start times, sleep restriction can be profound, which may mediate described associated emotional and mental health difficulties, poor academic performance, and increased risk of unintentional injuries or death. A thorough assessment is required for accurate diagnosis and appropriate treatment. More studies are needed to establish evidence-based clinical guidelines for this young population, particularly as implementation of adult-based therapies are met with numerous barriers.
Thomas H. Ollendick and Stephen R. Shirk
This chapter on clinical interventions with children and adolescents has four primary goals: (1) to review early efforts to identify evidence-based psychosocial treatments for youth and their families; (2) to provide an overview of current evidentiary support for the treatment of the four most prevalent psychiatric disorders in youth: anxiety disorders, mood disorders, attentional disorders, and oppositional/conduct disorders; (3) to examine relational and developmental factors that qualify and potentially moderate these efficacious treatments; and (4) to speculate on the future of psychotherapy research and practice with youth. Our review indicates that several evidence-based interventions are available, although with few exceptions they are cognitive-behavioral ones. However, we conclude that the evidence base even for these interventions is not overly robust at this time, and that we must evaluate other commonly practiced interventions such as play therapy, family systems therapy, and psychodynamic-based therapies before their routine use can be endorsed. We also identify important developmental, contextual, and relationship variables that qualify these efficacious findings and encourage the pursuit of additional process and outcome research. We conclude our discourse by suggesting that we must move beyond reliance upon manual-based treatments to the development of principle-based interventions that draw upon these specific evidence-based interventions but move beyond and unify them. Although much progress has occurred in the past 50 years, much work remains to be done. This is an exciting time in the child and adolescent psychotherapy arena.