Fig. 6.2 Overlap between traditional CBT and the Taming Sneaky Fears program
6.2.1 Who Is a Good Candidate for Participation?
Most four- to seven-year-old children who have incapacitating anxiety symptoms or a formal diagnosis of anxiety disorder are good candidates for participation in the Taming Sneaky Fears program. While most four- to seven-year-old children have fears or worries at some time or another, it is when the fears and worries become excessive and/or interfere in the day-to-day functioning of children that they become an anxiety disorder. That is, children may have an anxiety disorder when anxiety symptoms prevent them from doing age-appropriate activities such as getting to school and functioning in the school setting (e.g., speaking with a normal voice to teachers and peers, being dropped off without excessive distress), socializing with peers (e.g., going on play dates, participating in extra-curricular activities), or functioning at home (e.g., separating from parents, sleeping in their own bed).
Table1.2(Chap. 1) lists diagnostic criteria for various anxiety disorders affecting young children while Table6.1describes the symptoms and primary fear or worry expressed by young anxious children. Panic disorder is not included as a diagnosis in Table6.1because it is virtually never diagnosed in four- to seven-year-old children, as mentioned in Chap.1. However, young children may display panic attacks, which do not represent a psychiatric disorder per se. Panic attacks require the presence of four or more of symptoms such as, racing heartbeat, trouble catching breath, chest pain, nausea, stomachache, shaking, feeling hot and/or sweaty or cold, dizziness or lightheadedness, and tingling or numbing of fingers or other body parts.
A comprehensive and sensitively conducted clinical assessment completed with anxious young children and their parents by a qualified professional helps to identify the children’s primary fear and/or worry and allows for the confirmation of an anxiety disorder diagnosis. The various assessment tools described in Chaps.2and3could be used to assist with completing a comprehensive clinical assessment. Not all children participating in the Taming Sneaky Fears program must undergo a psychiatric or psychological assessment. However, such assessments are encouraged as they help clinicians and researchers implementing the Taming Sneaky Fears program tailor the program to meet the specific needs of the participating children and ensure that the children’sprimaryproblem is anxiety (as opposed to a disruptive behavior disorder, autism spectrum disorder, or other disorders that are not appropriate for the Taming Sneaky Fears program). Children who do not meet all required diagnostic criteria for a DSM-5 (American Psychiatric Association,2013) or ICD-10 (World Health Organization,2016) anxiety disorder diagnosis but experience fears and worries that cause mild interference in their functioning or children whose symptoms of anxiety are recurrent in nature (e.g., waxing and waning nature in response to stressors) could also benefit from the Taming Sneaky Fears program (again, if their primary underlying diagnosis is not disruptive behavior disorder, autism spectrum disorder, or other disorders).
Table 6.1 Anxiety disorders—symptoms and primary fear or worry Anxiety disorder Symptomsathat interfere with
functioning
Primary fear or worry Generalized anxiety disorder Worry excessively, more than
most peers, and have trouble controlling worries Seek reassurance, but not easily reassured Somatic complaints (e.g., stomachache)
Many situations: the future, the past, friends, weather, skills and abilities, every day situations (e.g., being late, making mistakes), etc.
Social anxiety disorder Excessive shyness,
self-consciousness (e.g., think that they will do something embarrassing and people will laugh at them or make fun of them), freeze when in the spotlight
Require warm-up period before can start to interact and have trouble approaching new people and new situations, raising hand in classroom to ask or answer questions, speaking on the phone, having their picture taken, using public washrooms, eating in front of people, etc.
Performance anxiety
Doing or saying something silly or embarrassing in front of others or that others will laugh at them or think bad things about them
Selective mutism Fear of being seen or heard speaking in some situations so do not speak in specific situations (e.g., school), but speak without problem in others (e.g., at home)
Voice sounds weird or funny to others
Specific phobia Incapacitating fear or anxiety about a specific object or situation
Animal (e.g., spiders, insects, dogs)
Natural environment (e.g., heights, storms, water) Blood-injection-injury (e.g., needles, invasive medical procedures)
aMany children with anxiety disorders have temperamental traits such as high intensity of reactions, low adaptability (e.g., trouble adapting to changes in routines and transitions), and perfectionism
Table6.2provides a list to assist clinicians and researchers in determining char- acteristics of parents and children that make them good candidates for participation in the Taming Sneaky Fears program or indicate that they should be excluded from participation.
6.2.2 Who Is Qualified to Implement the Taming Sneaky Fears Program?
The Taming Sneaky Fears program has successfully been implemented by a variety of mental health professionals, including psychiatrists, child and adolescent psychi- atrists, psychologists, social workers, child and youth workers, speech and language pathologists, and trainees from these various disciplines. Parent group therapists and child group therapists may also be guidance counselors or other school mental health therapists, and other health professionals with experience working with young children, including pediatricians, family physicians, nurse practitioners, nurses, and others, as well as trainees in all these aforementioned disciplines, under supervi- sion. To date, all therapists involved in the implementation of the Taming Sneaky Fears program have had at minimum the designation of child and youth worker, which is a three-year advanced college course focusing on the skills and knowledge required to work with children, adolescents, and families with a variety of emotional, social, behavioral, and/or mental health needs. At minimum, the equivalent training (i.e., college course focusing on working with children and youths with a variety of psycho-social-emotional needs) is required to implement the program.
Although not necessary, both parent and child group therapists benefit from having previous experience working in a group format and with young children and parents.
6.2.3 Where Can the Taming Sneaky Fears Program Be Implemented?
The Taming Sneaky Fears group CBT program has successfully been implemented in tertiary psychiatric settings and community mental health agencies. The program could be implemented in a variety of clinical settings such as psychiatric, psycho- logical, and other health and mental health settings. Additionally, the program may be implemented in school settings by school social workers, psychologists, or coun- selors with experience in children’s mental health.
To date, the Taming Sneaky Fears program has been implemented mostly as a group treatment program in clinical and research settings. However, as previously mentioned, clinicians have successfully used the program in individual sessions with
Table 6.2 Characteristics of parents and children who are good candidates for participation in the Taming Sneaky Fears program or who should be excluded from participation
Good candidates Exclusionary characteristicsa Parents Understand and speak fluently the
language in which the program is offered
Lack of fluency in the language in which the program is offered and/or difficulties with literacy
Are the children’s primary caregivers Custody and access dispute Willing to discuss self and child in a
group format
Unresolved child protection matter Available for program
– One parent must attend all sessions
– Live in close enough proximity to commit to regular attendance
Unable to commit to attending all sessions
Willing to engage in the treatment program and implement recommended strategies at home
Too anxious to function in a group setting
Amenable to change Acute or poorly managed mental health or addiction problem (e.g., depression, psychosis, posttraumatic stress disorder, substance abuse)
Children Between ages of four and seven years Eight years or older; younger than fourb Have a primary anxiety disorder or
symptoms of anxiety that cause at least mild interference with functioning and/or are recurrent in nature
Primary diagnosis is autism spectrum disorder, posttraumatic stress disorder, or a non-anxiety disorder
Of average intelligence (based on clinical impression, not formal testing)
Brain injury or significant developmental delay Understand and speak fluently the
language in which the program is offered
Too aggressive
Able to attend and focus sufficiently Too disruptive May have co-morbid diagnoses of
attention deficit hyperactivity disorder or oppositional defiant disorder, but the primary problem is anxiety
Do not have a primary caregiver
aParents and/or children should not receive other concurrent mental health counseling, but other types of interventions can co-occur, such as, for the children, Occupational Therapy, Physiotherapy, Speech and Language Therapy, participation in psychological assessments, psychiatric assessment or follow up, and for the parents, psychiatric assessment or follow up, addiction support programs such as Alcoholic Anonymous, Narcotic Anonymous, etc.
bTo date, the Taming Sneaky Fears program has been implemented mostly with four- to seven- year-old children. However, clinicians have successfully used aspects of the program in individual sessions with children as young as three years old, in conjunction with separate sessions with their parents. Therefore, clinicians and researchers could consider using aspects of the Taming Sneaky Fears program with some (carefully selected) children as young as three years old
young anxious children, in conjunction with separate sessions with their parents.
Therefore, clinicians and researchers could consider using the program as individual sessions with young children and having additional sessions with their parents to provide parents with the necessary information about the parent program.
6.2.4 When to Implement the Taming Sneaky Fears Program?
Given the young age of the children, consideration should be given to running the Taming Sneaky Fears program during the morning or early to mid-afternoon as young four- to seven-year-old children generally absorb information better early during the day rather than in the late afternoon or early evening.