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Treating Pre-Adolescents with Anxiety Disorders

Using cognitive-behavioral and sensory-integrative approaches for self-regulation

Vol. 28 • Issue 15 • Page 17

Children and Youth

Although occupational therapy has strong roots in the mental health setting, there has been an increasing trend in pediatric clients with mood disorders entering therapy over the last few years. Pre-adolescent children with a primary diagnosis of anxiety disorders, who had otherwise given up on traditional types of "therapy," began filtering through outpatient clinic doors.

The Anxious Child

Anxiety is a rather tricky phenomenon. However, the beauty of occupational therapy is that, initially, the therapist does not have to focus on whether a child is anxious. Instead, the therapist concentrates on the symptoms of the anxiety.

Many times the child's heightened state of awareness causes difficulties with planning and organizing. This often results in a heightened emotional-sensory response. In other instances, if the child primarily has praxis and sensory-processing concerns that cause the anxiety, the occupational therapist can address these core issues and not talk or try to discuss feelings-an approach which is often challenging for children in this age range.

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Rapport between the therapist and the client must be established before the real work can begin. This is paramount; otherwise the child will not let you into his/her world. Often the therapist can use humor and his or her own childhood stories to facilitate this process. Treating the child like a child, not a client, appears to be influential in this process as well.

In many cases, occupational therapy's role is to be a safe place where the child can literally just relax. There are no consequences to imperfect performance as long as there is effort, nor are there time constraints.

In addition, the activities presented are often designed to reduce children's arousal states. Linear movement, deep pressure, proprioception and oral input, in a fun and low-pressure setting, help to set up an internally organized child. In turn, discussion is often more beneficial because the child is more apt to share, process and assimilate what has transpired in therapy.

Scales and Self-awareness

In my experience, these pre-adolescents know that they feel anxious when they are anxious. They understand the difference when they are not anxious, but do not have the ability to feel the "in between" stages. Some children know their triggers, but most do not.

Occupational therapists can help these children understand themselves better by using both cognitive-behavioral and sensory-integrative approaches. The modified Alert Program/How Does Your Engine Run? by Mary Sue Williams and Sherry Shellenberger and The Incredible 5-Point Scale by Kari Dunn Buron and Mitzi Curtis can both be helpful in identifying what soothes and triggers changes in arousal states.

They can also help increase a child's awareness of anxiety prevention by identifying what his body feels like when anxiety levels are escalating. The child can decipher at what point his arousal state is too high, and at what point he must de-escalate in order to prevent a panic attack or an embarrassing moment. For example "My hands are sweating, my mouth is dry and I am thinking about negative repetitive thoughts. This means that I am at a 3 on my Anxiety Scale and I must do something now to bring myself back to a 2 or 1, or I will have an embarrassing moment."

Using a number scale is just one approach; let the child guide the therapist. I have used fire scales (burning embers to rampant fire), different types of coffee beverages, roar scales (how loud on a scale of 1-5), and colors identifying emotions on a paint wheel.

Fun Breeds Success

Once the child better understands how his body works from a cognitive perspective, introducing sensory-motor activities may be highly beneficial. Although many of the linear swinging, bouncing, "crashing," scooter boarding, gum chewing, straw blowing, and other tasks are designed to make the nervous system feel good, they are also fun. Many children with anxiety disorders have trouble just having fun.

Teaching the child to be aware of how these organizing tasks impact their anxiety is essential for success. If the child truly has sensory-processing and motor-planning issues that have not been addressed, then these therapeutic activities are helpful in many ways. Children truly coping with anxiety typically achieve a calm and relaxed state after such activities.

Once they start seeing successes in therapy, these children are able to generalize the skills they have learned to other environments. This progress is further expanded when family members see growth and provide even more encouragement. In addition, movement inspires language, facilitating discussions that might not happen because of a lack of organization of thought processes.

Occupational therapy is just one of the pieces of the puzzle when working with children with mood disorders. Nonetheless, it is apparent that our role is prevalent with this growing population.

 Jill S. Feldman, OTR/L, C/SIPT, is a pediatric therapist at Building Bridges Therapy in Cumming, GA.


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