Anxiety and Phobic Disorders: A Pragmatic Approach by Wendy K. Silverman

By Wendy K. Silverman

For decades, nervousness and phobie issues ofchildhoodand youth have been neglected by means of clinicians and researchers alike. They have been considered as principally benign, as difficulties that have been fairly light, age-specific, and transitory. With time, it was once inspiration, they'd easily disappear or "go away"-that the kid or adolescent may magically "outgrow" them with improvement and they wouldn't adversely have an effect on the transforming into baby or adolescent. accordingly ofsuch considering, it used to be concluded that those "internalizing" difficulties weren't important or deserving of our concerted and cautious attention-that different difficulties of youth and early life and, particularly, "externalizing" difficulties comparable to behavior disturbance, oppositional defiance, and attention-deficit difficulties deĀ­ manded our expert energies and assets. those assumptions and asserĀ­ tions were challenged vigorously in recent times. Scholarly books (King, Hamilton, & Ollendick, 1988; Morris & Kratochwill, 1983) have documented the significant misery and distress linked to those problems, whereas reports ofthe literature have established that those problems are something yet transitory; for an important variety of formative years those difficulties persist into past due formative years and maturity (Ollendick & King, 1994). in actual fact, such findings sign the necessity for therapy courses that "work"--programs which are powerful within the brief time period and efficacious over the lengthy haul, generating results which are sturdy and generalizable, as weil as results that increase the existence functioning of youngsters and young people and the households that evince such problems.

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We have also described and iIlustrated some of the range of settings you are likely to encounter in working with children with anxiety and phobic disorders and some of the range of methods likely to meet your assessment needs . We discussed the types of settings and assessment methods that can be used in such settings in some detail in order to give you a good, solid sense ofthe range ofproblems and alternatives for solving problems you are likely to encounter. Some of the comrnon goals in clinical assessment identified in this chapter are screening, diagnosis, identifying symptoms and behaviors, gauging treatment outcome, and obtaining a richer picture ofpatients' 36 Chapter 2 problem behaviors.

Self-Rating Scales for Screening (continued) Validity : Confirrnatory factor analysis revealed a good fit for the three-factor model. 65 Validity : Positive and significant correlati ons between STAIC scores and oth er anx iety/fear measures . Findings more rnixed when multitrait multimethod meth odology is used. 80 for A-Trait scale Validity : Positive and significant correlations between RCMAS total scores and other anxietyl fear measure s. Findings more mixed when rnultitrait multimethod methodology is used.

The phobie situation is avoided or endured with great anxiety or anguish . E. This avoidanee, antieipation, or distress signifieantly interferes with the ehild's daily routines , functioning , activities , andlor relationships or there is distress about having the phobia. F. Duration of at least 6 months in ehildren and adoleseents . G. The disturbanee must not be due to another DSM disorder. we needed to be flexible in applying this criterion that the fear must be age-appropriate for it to be diagnosable: Sometimes we have found that a child's fear was totally age-appropriate, but nevertheless, it was so c1early excessive and impairing that there was no way that we wanted to "wait" until the child's fear was no longer age-appropriate before we wished to diagnose and/or treat it!

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