Medicine and Health Sciences | Rehabilitation and Therapy


An estimated 28 percent of Americans will meet diagnostic criteria for an anxiety disorder within their lifetime. Over half of those cases will be diagnosed before age 12 (Kessler, Berglund, Demler, Jin, Merikangas, & Walters 2005). Having some anxiety is a normal part of childhood, as many children express fears that would be considered unreasonable for an adult, such as being in the dark, or being separated from parents. Alternately, a childhood anxiety disorder is diagnosed when the child experiences intense fear or worry, somatic complaints, or clinginess that exceed normal reactions for their level of development (Mash & Wolfe, 2010). The consequences of childhood anxiety are severe, with children diagnosed with anxiety disorders having higher rates of academic and social difficulties as compared to their neuro-typical peers. Left untreated, childhood anxiety often continues into adulthood, where its consequences continue to grow. Therefore, early intervention for children with anxiety disorders is vitally important in order to prevent later negative outcomes (Kendall, Compton, Walkup, Birmaher, Albano, Sherrill, . . .Piacentini, 2010; Podell, Mychailyszyn, Edmunds, Puleo, & Kendall, 2010, Ginsburg, Silverman, & Kurtines, 1995).

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) recognizes 12 different types of anxiety disorders. The disorders most commonly diagnosed in childhood are generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social anxiety disorder (formerly referred to as Social Phobia). Throughout this review, the term ‘childhood anxiety disorders’ will refer to the three above mentioned disorders unless otherwise specified.

Research has shown Cognitive Behavioral Therapy (CBT) to be effective in treating childhood anxiety disorders. In 2002, Muris, Meesterse, and VanMelick, found children involved in CBT to have a significant reduction in anxiety as compared to a psychological placebo and wait list control. Treatment utilizing CBT has not only shown promise in reducing anxiety in the short term, but also in maintaining those gains at three year follow up (Kendall & Southam-Gerow, 1996). Based on its superiority to wait list controls in more than two studies conducted by independent researchers, CBT has been labeled a “probably efficacious treatment” for childhood anxiety disorders (Silverman, Pina, & Viswesvaran, 2008; Davis & Whiting, 2011; Kendall, Suveg, & Kingery, 2006).

While most clinicians utilizing CBT adhere to the same basic principles, there is much diversity in how those principles are practiced. Kendall, Suveg, and Kingery (2006), emphasize the importance of flexibility in adapting protocols for individual clients while strongly adhering to the principles of cognitive behavioral therapy. Therefore, clinicians must make informed decisions regarding how to flexibly utilize CBT with their client while maintaining the underlying principles. This manuscript explores the current body of knowledge surrounding important areas of consideration for treating childhood anxiety disorders using cognitive behavioral therapy.

Additional Files

Final.Clincal guide for treating childhood anxiety with CBT.odt (11 kB)
Treating Childhood Anxiety with Cognitive-behavioral Therapy: A Guide for Clinicians