Can very young children do cognitive-behavioral therapy ?

CBT for young childrenFive key considerations for working with young traumatized children” by Dr. Alex de Young was one of our most popular blogposts last year. We know relatively little of young children’s recovery and of how we can help them. The field is rapidly moving forward however and one of its pioneers, Prof. Michael Scheeringa, has agreed to tell you more about his new CBT approach for very young children.

Children younger than seven years of age obviously do not have the mature cognitive skills for causal reasoning, perspective taking, self-reflection, verbal expression, or autobiographical memory that would make CBT work smoothly. At Tulane University, we have developed and tested a CBT treatment specifically for preschool children (3-6 years).

The results of a randomized trial of the manual were published in 2011 (Scheeringa et al). While two previous studies had already shown the effectiveness of CBT for young victims of sexual abuse (Cohen and Mannarino, 1996; Deblinger et al., 2001), this trial showed that CBT was effective for a wide variety of traumas including accidental injuries, witnessed domestic violence, and disasters.

The study also documented for the first time the feasibility of specific CBT techniques in this age group. The overall frequency for children to complete 60 CBT tasks over the 12 sessions was 83.5%. These ratings were made by the therapists. An independent rater who scored 30.7% of the treatment sessions agreed with the therapists’ ratings 96.2% of the time. Several of the tasks seemed easier for the 5-6 year-olds compared to the 3-4 year-olds, such as the ability to identify feelings, recount autobiographical narratives, and discuss the concept of future events.

How are very young children able to engage in the cognitive therapy tasks that are required? Young children have never been asked by an adult to do this type of work before. The potential to make a change in their way of thinking may be relatively greater than at any other age. In the manual (freely available on the web), I give a number of directions:

  • In session 1, children’s symptoms are given a name and put in a story form, which involves the cognitive tasks of self-reflection, autobiographical recall, and causal reasoning.
  • In session 3, their fears are placed in a bigger context of other feelings and other situations.
  • In session 4, they are taught self-control with relaxation tools with the implicit message that these carry a change in locus of control of one’s self.
  • By being asked by therapists to engage in exposure and relaxation exercises repeatedly, there is an implicit message that control over anxiety is possible.
  • In session 11, children are asked to imagine themselves in future situations that may trigger anxiety.  This is a purely cognitive task of perspective taking and causal reasoning.
  • In sessions 10-12, children review their drawing and homework sheets.  This is involves the cognitive tasks of autobiographical recall and self-reflection.

For therapists interested in learning more about this therapy, Dr. Scheeringa is offering a two-day training in New Orleans, Louisiana on March 18-19, 2013.  The training brochure may be viewed at the Tulane Institute of Infant and Early Childhood Mental Health website, (many helpful measures and manuals available there!).

Main reference:
Scheeringa, M., Weems, C., Cohen, J., Amaya-Jackson, L., & Guthrie, D. (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial Journal of Child Psychology and Psychiatry, 52 (8), 853-860 DOI: 10.1111/j.1469-7610.2010.02354.x

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