Many kids with ADHD also have symptoms of anxiety. For some, it might be a simple phobia, like a fear of spiders, which is only a problem when there’s a spider in the room. For others, the anxiety is more pervasive, and crops up in social situations, at bedtime when a child is afraid to sleep alone, or in school situations, like a fear of going to school or a fear of poor academic performance. Traditionally, evidence-based treatments for anxiety disorders have focused on individual sessions with the child, where they receive cognitive behavior therapy (CBT). In these sessions, kids learn strategies for challenging anxious thoughts and reducing their anxiety-avoidance behaviors (you can learn more about CBT here).
While CBT can be very effective for many kids with anxiety disorders, not all children respond to this treatment, and when parents aren’t involved in the therapy, they often struggle with knowing how to best support their child at home. A recent study takes a different approach to treatment, one that may be a better fit for many kids and their parents. Researchers at the Yale Child Study Center are testing a parent-focused treatment where the child doesn’t attend any therapy sessions. Instead, their parents meet with the therapist and learn strategies for helping reduce their child’s anxiety at home. For parents of kids with ADHD, this approach may sound familiar, since this is exactly what evidence-based treatments for ADHD provide (you can learn more about these treatments, like behavioral parent training, here).
The new intervention is based on strong evidence showing that the degree to which parents accommodate a child’s anxiety and avoidance behavior is directly related to the persistence of a child’s anxiety symptoms. This means the more parents rescue their child when they are anxious, the less likely it is that the child’s anxiety symptoms will improve. An example from a recent NPR article on this treatment really highlights the challenge: if you have a child who is afraid of sleeping alone, it’s natural as a parent to want to reduce their anxiety by allowing them to sleep with you or by staying in their room each night until they fall asleep. The problem is that in doing so, you’re accommodating the anxiety, and as a result, the child never learns that there is really nothing to fear. Without this learning process, their anxiety continues to creep up night after night and never goes away.
As a parent, it’s very hard to know how much to accommodate and comfort your child and how much to pull back and allow your child to experience their anxiety symptoms. This is where parent coaching comes in. The therapist discusses very specific anxiety-provoking situations that the child experiences and develops a detailed, systematic plan for gradually exposing the child to their anxiety until they have eventually mastered their fear. The therapist checks in regularly with the parents to discuss how the child is responding to the plan and to make adjustments as needed.
So far, this treatment is looking very promising and may be something that eventually moves into standard care for child anxiety disorders. In the meantime, if you think you could benefit from therapist coaching to help your child overcome their anxiety, reach out to a CBT therapist. They’ll be able to help you develop a detailed intervention plan similar to those used in the ongoing Yale study, and will coach you through the challenges that come with helping your anxious child.
Mary Rooney, Ph.D., is a licensed clinical psychologist in the Department of Psychiatry at the University of California San Francisco. Dr Rooney is a researcher and clinician specializing in the evaluation and treatment of ADHD and co-occurring behavioral, anxiety, and mood disorders. A strong advocate for those with attention and behavior problems, Dr. Rooney is committed to developing and providing comprehensive, cutting edge treatments tailored to meet the unique needs of each child and adolescent. Dr. Rooney's clinical interventions and research avenues emphasize working closely with parents and teachers to create supportive, structured home and school environments that enable children and adolescents to reach their full potential. In addition, Dr. Rooney serves as a consultant and ADHD expert to Huntington Learning Centers.
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