Anxiety disorders are among the most common forms of psychopathology reported by children and adolescents. Anxiety disorders in children have debilitating consequences, both for the child and his/her family. In addition, research indicates that, in many cases, these disorders follow a chronic and persistent course. The efficacy of child-focused cognitive-behavioural interventions in the treatment of childhood anxiety disorders has been well demonstrated by recent, well-controlled research. This treatment outcome literature is briefly reviewed. Most recently, however, interventions used in the treatment of childhood anxiety disorders have taken the form of combined interventions aimed both at the anxious child and his or her family. This paper reviews two related bodies of research in presenting a case for the involvement of families in the treatment of childhood anxiety. First, the etiological evidence implicating the families of anxious children in the development and/or maintenance of childhood anxiety is presented. Second, the treatment outcome studies that have empirically evaluated this type of combined intervention are reviewed.

A case study is presented of a 13-year-old adolescent male with a long history of anxious symptoms related to school attendance. At the time of referral to the school refusal clinic, the adolescent had significant difficulty attending school, having attended for only 1 day in the past 3 weeks. A cognitive-behavioural treatment program was conducted over 3 weeks, consisting of seven sessions with the adolescent, seven sessions with his parents, and consultation to school personnel. Treatment focused on the implementation of behaviour management techniques by caregivers as well as teaching anxiety management skills to the adolescent. Positive treatment outcomes included the adolescent's return to full-time attendance at school as well as a decrease in emotional distress. The implications of treatment are discussed in relation to the simultaneous application of behaviour management and anxiety management strategies in the treatment of school refusal.

Treatment of conduct problems in the home setting has received much attention in the literature, and there are well established, empirically derived treatment programs that have been demonstrated to be effective. However, treatment for conduct problems in the classroom has not received a comparable amount of attention, and the intervention programs are diverse, occasionally lacking empirical support, and often not consistent with strategies used in the home setting. As past research has demonstrated that conduct problems in multiple settings is related to poorer prognosis, it is logical to suggest that interventions should focus on as many of the settings as possible in which a child displays the behaviour problems. This paper reviews the literature on the effects of conduct problems in the classroom, on teacher managerial skills, and on interventions across the home and school settings. It is concluded that classroom management of conduct problems could be improved by providing a hierarchical system of intervention strategies.

This paper provides an overview of cognitive-behavioural interventions in pediatric behavioural medicine. Although the literature so far is sparse, the contribution of cognitive-behavioural therapy is reviewed in the areas of pediatric cancer, asthma, and diabetes mellitus. The future potential of cognitive-behavioural therapy for the management of other chronic conditions, including cystic fibrosis and rheumatoid arthritis, is recommended.

Traditionally, mental health professionals and school authorities have found school refusal to be a perplexing and challenging problem. Relevant to an understanding of school refusal, we initially review some important developmental-normative considerations. The clinical features, epidemiology, and etiology of school refusal are also briefly discussed. We then describe a number of behavioural strategies that have been used in the management of school refusal. Finally, we review the research support for the efficacy and acceptability of behavioural strategies in the treatment of school refusal.

Despite the very significant proportion of people with panic disorder who have accompanying agoraphobia, there is considerable controversy about the variables that influence the development of this avoidance behaviour. This study investigated whether degree of avoidance is a function of extent of fear and prevalence of negative cognitions about autonomic arousal symptoms and whether the use of, and confidence in, behavioural strategies to cope with panic sensations also influences agoraphobic avoidance. Thirty-nine people who met DSM-IV criteria for panic disorder completed questionnaires measuring fear and negative cognitions about autonomic arousal and panic sensations, and a questionnaire measuring their use of largely behavioural strategies to cope with panic attacks. Fear of autonomic arousal and negative cognitions in response to the occurrence of these arousal symptoms were jointly related to situational avoidance. There was little relationship between the use of, and confidence in, panic coping strategies and less agoraphobic avoidance, although simply allowing panic symptoms to develop and pass predicted less avoidance. The results were interpreted as providing an empirical basis for treatment that reduces fear of panic sensations and allows their experience to be tolerated while preventing escape and avoidance of situations in which panic occurs. There was little evidence that additional teaching of behavioural coping strategies would be useful in reducing agoraphobic avoidance.

The heterogeneous nature of school refusal has led to much confusion surrounding the conceptualisation of this phenomenon. A number of researchers have developed taxonomic systems in an effort to enhance our understanding of school refusal and to facilitate communication among professionals working in the field. The current paper explores the evolution of these systems and outlines the limitations of each. Non-empirical classificatory systems are reviewed first, followed by empirical systems based on factor analyses and diagnostic profiles. A functional taxonomic system for problematic school attendance is then reviewed. Future research based on sound methodological procedures should aim to examine a broad range of child and family characteristics in order to develop reliable, homogenous subtypes for this population.

Blood-injection-injury phobia involves stimulus-bound fear and faintness. The present paper outlines a program of research that has been investigating the nature of symptoms elicited by these stimuli. The structure of the symptoms and their heritability is examined, and it is speculated that the symptoms may form a triphasic response of anticipatory anxiety, stimulus-bound fear, and faintness. The treatments for blood-injury-injection phobia are examined, and data suggesting ways to improve existing treatments are outlined.

This article describes a cognitive-behavioural intervention implemented over 10 sessions with an adolescent girl experiencing school refusal and depression. Treatment focused on the learning of various coping skills to deal with stressful situations at home and school. Following a decision to change schools, a rapid school return was employed. A multimethod, multisource evaluation was used at pretreatment, posttreatment, and follow-up assessments. The data indicated positive treatment outcomes: the adolescent returned to full-time attendance at school and exhibited decreased levels of emotional distress. The treatment gains were maintained at a 3-month follow-up.

Evidence suggests that cognitive behaviour therapy is the treatment of choice for both irritable bowel syndrome (IBS) and panic disorder (PD). The present study examines the treatment issues relating to a woman diagnosed with both IBS and PD (with agoraphobia), where therapy for PD was disrupted by IBS symptoms. Group therapy was then initiated for IBS, and this was associated with a large decrease in general anxiety and depression, and an increase in confidence concerning management of the pain caused by the IBS. This finding is discussed with respect to its possible implications for the treatment of people suffering both IBS and PD.

This paper examines the clinical entity of obsessional indecision. It argues for its conceptualisation as a form of “pure” obsessional disorder and discusses assessment issues and proposed intervention techniques. Data gathered from four patients treated by the authors is used to substarniate the arguments and points made. The paper illustrates the nature of the problem, as well as highlighting its varying topography and elucidating a novel treatment package that appears to show promise.

School refusal is a complex and heterogeneously determined and experienced behaviour problem. Due to its complexity and heterogeneity, a multimethod and multisource approach to assessment is required. The approach is described as a hypothesis-testing approach which uses developmentally sensitive and empirically validated procedures. Clinical-behavioural interviews, structured diagnostic interviews, self-reports, reports of significant others, self-monitoring, and behavioural observations are recommended. Issues associated with these procedures are reviewed.

Four self-management exercises completed by advanced psychology students as part of their course of instruction are summarised. The cases illustrate the level of sophistication of clinical replications that can be attempted in a semester unit. These cases were chosen because they targeted long-standing serious problems which none of the students thought would be responsive to behavioural-cognitive techniques applied by themselves. The problems were nocturnal bruxism, excessive urinary frequency, unassertiveness, and dog phobia. All were successful in meeting the initial therapeutic objectives that had been set, but gains were not maintained in the cases of bruxism and excessive urinary frequency. The value and problems associated with self-management exercises as a teaching tool are discussed.

The aim of the study was to compare the psychophysiological pattern associated with obsessive–compulsive disorder (OCD) in clinical patients (n = 13) and checking behaviours in a nonclinical population (n = 13) to evaluate the validity of the anxiety reduction hypothesis. A second objective was to examine the psychophysiological pattern associated with prevention of ritualistic behaviour in the OCD group and of checking behaviour in the control group. A guided imagery methodology was utilised in order to examine the progression of the behaviours over time. Various psychophysiological measures were incorporated to account for the response to personalised imagery presented in four distinct stages. The stages included setting the scene, approach, incident, and consequence. Both the psychophysiological and the subjective response to the ritual/checking and response-prevention/no-checking scripts were higher than to the neutral script for both groups. A trend towards significantly higher heart rate response to the response-prevention/no-checking than to the ritual/checking script was also observed. Higher levels of depersonalisation and anxiety in the OCD group were observed following prevention of the ritual. The patterns of response indicated obsessive–compulsive behaviour may act to prevent the level of anxiety experienced by an individual from escalating, rather than to reduce it from an already elevated level.

Following Bandura's theory, a Self-efficacy Questionnaire for School Situations (SEQ-SS) was developed to assess the cognitions of school refusers. The instrument contains twelve school-related situations which are rated by children according to their belief about their ability to cope with each situation. Factor analysis yielded two reliable factors labelled Academic/Social Stress and Separation/Discipline Stress. Psychometric evaluation also revealed good internal consistency and test-retest reliability. Total self-efficacy scores for 135 school refusers ranged from very low to very high. Self-efficacy was highest with regard to doing school work and lowest with regard to answering peers' questions about absences. The clinical utility of the SEQ-SS is discussed, with implications for the selection of cognitive and behavioural treatment procedures. The application of the instrument in future research is also considered.

This paper reviews the role and indications for pharmacotherapy of children with school refusal. The psychopharmacological treatment of school refusal is based mainly on evidence of the effectiveness of certain drugs in the treatment of adult disorders. There is some evidence that tricyclic antidepressants and benzobiazepines may be specifically useful in the treatment of school refusal, but further research is warranted. Potentially serious side effects mean that drugs are best confined to cases where psychological treatments have not been effective or where drugs are used briefly as an adjunct to a broader psychological treatment plan. Drugs may also have a role in the specific treatment of comorbid conditions associated with school refusal. Any use of drugs should involve regular reviews to monitor response, compliance, and side effects.