Childhood Anxiety: Occupational Disruption

By Christie, Ann | New Zealand Journal of Occupational Therapy, September 2007 | Go to article overview
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Childhood Anxiety: Occupational Disruption


Christie, Ann, New Zealand Journal of Occupational Therapy


Childhood anxiety is often unrecognised until a major depressive episode draws the attention of families. A child's presentation of mood differs somewhat from the adolescent or adult, with the disruption varying according to developmental ages and stages. Shyness, worry and nervousness may lead to internalised personal suffering for children. The effects of this can interfere with making friends, academic progress, family cohesion and activities, general happiness and self-esteem. Thus early recognition of childhood anxiety is critical in the prevention of long-term, debilitating problems in adolescence and adulthood such as depression, social isolation and even suicide.

The challenge of applying theory to practice is ongoing for occupational therapists who work in a multidisciplinary specialist area such as child adolescent and family mental health. The client includes the family/whanau as well the as child/adolescent. Due to the complex presentation of families/ whanau it is important to develop collaborative partnerships with team members and to think eclectically when making decisions about assessment and intervention plans (Christie & Scaletti, 2000; Geldard & Geldard, 2002; Cronin Mosey, 1996). This way of working can assist the process of theory to practice, critical reflection and evaluative processes.

Literature review

New Zealand studies from other disciplines indicate that anxiety is the most common disorder in children and adolescents (Anderson, Williams, McGee, et. al. 1987; Fergusson, Horwood & Lynskey,1993; Hetrick, Proctor, & Merry, et. al., 2005; Merry, Hetrick, & McDowell, et. al., 2004; Watson, Clark, & Denny, et. al., 2003;). Theoretical foundations include literature from both occupational therapy and other disciplines.

A review of occupational therapy literature over the last 15 years reveals few models of practice designed for use within child, adolescent and family services (Cronin Mosey, 1996; Lougher, 2000; Creek, 2001). The available literature did not specifically focus on anxiety but rather on the role and a service delivery of occupational therapy. For instance, occupational therapy literature provides concepts of the psychosocial components of a family system (Humphry & Case-Smith, 1996), play theory in middle childhood (6-12yrs) (Florey & Green, 1997) and the development of play behaviours (Bundy, 1997; Cronin, 1996; Cronin Mosey, 1996; Hagedorn 1997; Law, Baum, & Dunn, 2005). Florey & Green (1997) also write about the problems of behaviour or emotions not always being noticeable until triggered by internal or external experiences.

Developmental theories which include the temperament (biological), emotional and social competency of a child within their environment (context) are of importance when developing intervention plans (Hetherington, Park & Locke, 2002) Attachment theory is also important (Fongay, 2002; James, 1994;) as attachment is seen as a prerequisite for successful socialisation. Scientifically, this theory shows how our earliest relationship with our mother influences later relationships in life.

Other useful therapeutic theories include narrative and family therapy (Freeman, Epston, & Lobovits, 1997; Goldenberg, & Goldenberg, 2004) to assist in externalizing the problem, getting to know the child, their identity and abilities. Family therapy also incorporates the family and extended family into the process. The elective model of Sequentially Planned Integrative Counselling for Children (Geldard & Geldard, 2002) allows the integration of occupational therapy applied frames of reference to focus on psychosocial dysfunction. Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders (American Academy of Child and Adolescent Psychiatry, 1997) provided evidence based guidelines for intervention.

Case study

This is the story of Maize, her family, and her road to recovery.

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