Working with anxious children and their families presents a number of challenges to the clinician and researcher. Issues related to diagnosis, assessment, and treatment abound. Many of these children present with co-occurring problems of depression, attention, and oppositionality. Furthermore, for many of these children, anxiety is embedded in familial and social contexts and varies across development. As a result, anxiety does not exist solely in the child. Rather, important developmental and contextual factors must be considered both in the assessment and treatment of these children and their families. Toward this end, a wide array of assessment strategies may prove useful, including diagnostic interviews, self-report questionnaires, parent and teacher behavior checklists, and behavioral observation of the child and his or her family in various contexts. Empirically supported treatments have been developed to address these problems, including behavioral and cognitive-behavioral procedures. Diagnosis, assessment, and treatment are
W orry, fear, and anxiety are part of normal development. Some years ago, Marks (1969) described a normal, developmental sequence of fear and anxiety that is both predictable and universal among children. Distress following sudden loud noises is common among infants but disappears, for the most part, shortly thereafter. Fears and avoidance of novel stimuli, heights, separation from attachment figures, and fear of strangers emerge around 6 months of age and diminish between the ages of 18 and 24 months. Fears of animals, imaginary creatures, and the dark are common during early childhood but usually dissipate prior to early adolescence. illustrated in a case study that illustrates several issues in working with these children and their families.