doctor with child cbt patient

Child Cognitive Behavioral Therapy (CBT) Program

The mission of the Child Cognitive Behavioral Therapy Program at Massachusetts General Hospital is to provide state-of-the-art cognitive behavioral therapy to children, adolescents and young adults with a range of emotional and behavioral problems.
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Overview

doctor doing cbt with child patient

The Child Cognitive Behavioral Therapy (CBT) program at Massachusetts General Hospital provides state-of-the-art treatment options for children, adolescents and young adults (ages 3-24) facing a range of emotional and behavioral problems. In addition to our clinical practice, we work to advance the scientific understanding of CBT approaches and to foster the dissemination of CBT techniques.

CBT aims to reduce emotional distress and psychological symptoms by changing the underlying factors, including negative thoughts or errors in interpretation, unhelpful coping strategies and behaviors that may inadvertently reinforce these feelings and symptoms. CBT works by teaching patients new coping skills and providing opportunities, both in-session and between sessions, to practice these skills.

Skills Taught in CBT

  • Gaining a thorough understanding of factors maintaining emotional distress and situational avoidance
  • Identifying and modifying negative patterns of thinking
  • Developing problem-solving skills
  • Mastering relaxation and deep breathing techniques
  • Learning to gradually face feared situations rather than avoid them
  • Developing organizational skills
  • Improving social interactions
  • Improving parent-child interactions

Research supports the use of CBT with children, adolescents and young adults. For youth with mild-to-moderate symptoms, CBT alone can result in significant improvement. For youth with more severe symptoms, CBT used together with medication can lead to a significant reduction in symptoms and improvements in day-to-day living. Recent research has shown that CBT can also be effectively administered via modalities such as the internet, increasing its potential for widespread use and administration.

Learn more about the Child CBT Program

 

Our Team

Professional Staff

  • Aude Henin, PhD

    Aude Henin is co-founder and co-director of the Child Cognitive Behavioral Therapy (CBT) program at Mass General. She is also a staff psychologist in the Department of Psychiatry at the Mass General and an assistant professor of psychology in the Department of Psychiatry at Harvard Medical School. Dr. Henin specializes in CBT for youth with severe mood and anxiety disorders, and has particular interest and expertise in working with adolescents transitioning to adulthood.

    Her research interests include the development of integrative CBT interventions for transition-age youth with severe psychiatric disorders and the evaluation of risk factors for the development of psychiatric disorders in youth. She has received funding for her work from the National Institute of Mental Health, the Department of Defense, the Brain and Behavior Research Foundation, Mass General and Harvard University. She regularly lectures on the implementation of CBT with youth, and is actively involved in mentoring students and junior faculty around CBT approaches.

    Please note that Dr. Henin does not accept insurance in the Child CBT Program, and that any visits with her are self-pay only.

  • Dina Hirshfeld-Becker, PhD

    Dina Hirshfeld-Becker, PhD is co-founder and co-director of the Mass General Child Cognitive Behavioral Therapy Program, and an associate professor of psychology in the Department of Psychiatry at the Harvard Medical School. She specializes in CBT with children, adolescents and young adults with anxiety and mood disorders. Dr. Hirshfeld-Becker has particular expertise in treating anxiety in preschool and early elementary school children.

    Dr. Hirshfeld-Becker’s research interests focus on identifying early temperamental, behavioral and familial risk factors for childhood disorders and on using this information to develop preventative interventions.

  • Christine Darsney, PhD

    Christine Darsney, PhD, is an assistant in psychology at Massachusetts General Hospital and an instructor of psychology in the Department of Psychiatry at Harvard Medical School. She completed her doctoral training at Boston College, her predoctoral internship at Boston Children’s Hospital, and postdoctoral fellowships at both Boston Children’s Hospital and Mass General. Her clinical interests include the use of trauma-focused CBT with children and adolescents in treating a range of childhood traumatic experiences including sexual abuse and traumatic loss. Dr. Darsney additionally has extensive experience working with children, adolescents and families experiencing divorce, along with other disruptive situations that have led to legal involvement. She also has experience working with children, adolescents and young adults with autism spectrum disorders and anxiety. In addition to her clinical work, Dr. Darsney is involved in teaching and supervising child psychiatry residents and postdoctoral fellows in psychology at Mass General.

  • Julie Edmunds, PhD

    Julie Edmunds, PhD, is an assistant in psychology at Mass General and an instructor of psychology in the Department of Psychiatry at Harvard Medical School. Dr. Edmunds specializes in CBT for children, adolescents and young adults with anxiety, mood and behavioral disorders. Her research interests center on the dissemination of empirically-based interventions into community practice.

  • Kaila Norman, PhD

    Kaila Norman, PhD, is an assistant in psychology at Mass General and an instructor in psychology at Harvard Medical School. She completed her doctoral training at University of California Santa Barbara, her clinical internship at the University of Arizona Medical Center and her postdoctoral training at the Yale School of Medicine Child Study Center. Dr. Norman specializes in evidence-based assessment and CBT for children, adolescents and young adults with a variety of issues. Her work often involves working together with youth and their parents.

    In addition to her clinical work, Dr. Norman is involved in teaching and the supervision of trainees at Mass General. Her research interests include the treatment of co-occurring disorders, collaborative/therapeutic assessment, early psychosis intervention and how best to include parents in the treatment of mental health problems among youth.

  • Michael Schonberg, PhD

    Michael Schonberg, PhD, is an assistant in psychology at Mass General and an instructor in psychology at Harvard Medical School. He has experience working with youth who display a wide variety of behavioral and emotional concerns (e.g.,aggression, oppositionality, anxiety, depression). He also has expertise in treating youth suffering from chronic health problems and in using CBT to help parents to manage their children’s behavioral and emotional concerns. He has a particular interest in working with adolescents in the midst of interpersonal struggles or relationship problems.

Administrative Staff

  • Dorothy Weremito, BA

    Dorothy Weremito is the patient service coordinator for the Child CBT Program. She is a current student at Lasell College in Newton perusing a masters in hospitality and event management. Dorothy received her BA in psychology and sociology from the University of Massachusetts Boston in 2014. At the CBT Program, Dorothy works at the front desk and handles other administrative duties.

  • Flavia L. Vaz De Souza, BA

    Flavia L. Vaz De Souza is a staff assistant for the Child CBT Program. She is a graduate of the Catholic University of Brasilia and received a BA in Business Administration in 2012. At the CBT program, Flavia provides administrative support to the staff by organizing priorities, completing tasks, managing phone screens and assisting with research data entry.

Our Services

The Child Cognitive Behavioral Therapy (CBT) Program at Massachusetts General Hospital offers clinical care for youth ages 3-24 years with a range of emotional and behavioral problems. Our program provides treatment through a number of different services.

Learn more about what you can expect from CBT treatment in our program and the research we conduct through the Child CBT Program.

Individual/Family Therapy

We provide well-established CBT treatments for young people with mood, anxiety and disruptive behavior disorders. Treatment is usually short term (on average 12-16 sessions), targeted around specific issues and focused on measurable improvements.

Condition-specific Services

We provide specialized, leading-edge services, including treatment of:

  • Preschool- and early elementary school-aged children with anxiety disorders
  • Children of all ages with severe anxiety disorders such as OCD
  • Children of all ages with autism spectrum disorders and comorbid anxiety and mood disorders
  • Transition-age youth with autism spectrum disorders
  • Adolescents and young adults with bipolar disorder
  • Preventative services for children of all ages at risk for mood and anxiety disorders

Learn more about the conditions we treat.

Diagnostic Consultations

We offer diagnostic and treatment consultations for children already receiving psychosocial treatment. We regularly collaborate with other treatment professionals, including psychiatrists, social workers and teachers.

Intensive CBT Program for Youth with Anxiety Disorders

For youth ages 10-24 years with more severe anxiety disorders, we periodically offer an intensive therapy program. Intensive CBT is offered for three hours per day, for two to ten days (though sometimes this may be extended) and focuses on teaching skills to tolerate and manage anxiety and prolonged practice of facing fears in a gradual, progressive manner.

The intensive therapy program is only for young people whose primary concerns are anxiety and who are otherwise medically and psychiatrically stable. Learn more about the Intensive CBT Program.

School Consultation

Our program offers telephone or in-person visits to schools as part of ongoing care. The purpose of these visits includes observing the child in the school setting, participating in team meetings to develop or revise IEP or 504 plans, or collaborating with school personnel as needed.

School consultations are not billable to insurance plans and are self-pay only. The cost of the consultation is based on the time spent at the school and travel time. If this is a service that you are interested in pursuing, please speak to your clinician.

 

 

What to Expect

What to Expect from CBT Treatment

child cbt patients

When you call the Child CBT Program at Massachusetts General Hospital, we will collect preliminary information about you, your child and your reasons for seeking treatment. If it seems that our program would be a good fit, we will schedule an initial appointment.

During this appointment, we will do a comprehensive evaluation to help identify your child's treatment needs. This evaluation is also an opportunity to meet the clinician and begin to establish a working relationship. Whenever possible, we conduct an evaluation with both the child and the parents to get different perspectives. During the first few sessions, we will ask about:

  • Your child's current symptoms
  • His or her psychiatric history
  • Current treatment goals for your child

Most treatment is provided one-on-one with your child, although in many cases, we involve parents in treatment as well (particularly with younger children, who may need more support from parents to implement CBT skills between sessions). In addition, we may have group treatment options. Sessions are usually scheduled once a week at the beginning of treatment and last 45 minutes. As treatment progresses, the frequency of sessions decreases to enable your child to practice skills more independently. The first eight sessions are typically scheduled during the day, but subsequent sessions may be scheduled during after-school hours depending on the clinician’s availability.

Because of the emphasis in CBT on measurable results, we will regularly evaluate your child’s progress to determine whether additional treatment is needed. At the initial visit and then every eight weeks thereafter, we ask patients (and their parents, when appropriate) to complete questionnaires about their symptoms and their functioning. This information is important to therapy because it allows us to assess progress, ensure that treatment is on track and make adjustments as needed.

Please note: We are not an urgent-care facility. We cannot provide treatment to youth who are at acute risk to themselves or others, exhibit high levels of aggression or self-injury or are unable to actively participate in the CBT sessions because of the severity of their symptoms.

We also do not accept patients directly from inpatient facilities, but we will provide treatment once symptoms have stabilized enough to benefit from once-per-week outpatient treatment.

Program Costs

We accept most major insurances and will obtain insurance preapproval prior to your first visit.  Patients and families are responsible for paying the co-pay at the time of the visit. We accept payments by check or credit card. If your insurance does not cover a service, you will be responsible for any costs incurred. Note that some of our clinicians offer only self-pay services.

Prior to your first appointment, we ask that you ensure that your information is properly updated in the Mass General patient registration system. To do this, please call 866-211-6588.

Wait Time for Services

Because of our number of referrals, we typically have a waiting period between the initial referral and the start of treatment, which may range from one to six months. Upon reviewing the initial phone intake, we will let you know how long you can expect to wait. Please note that these are estimates and that there may be variability in wait times. There is typically less of a wait if you can come regularly during daytime hours, as our after-school times tend to be more heavily booked. If your child cannot wait for treatment to begin, we recommend that you seek treatment elsewhere in the interim.

Eligibility

Because of the high demand for services, we are only able to care for children and youth who are already connected with Massachusetts General Hospital. We accept referrals from other psychiatry programs at Mass General and providers affiliated with Mass General or other Partners hospitals, as well as children of Partners employees.

If you do not have any affiliation with Mass General or Partners Healthcare, we unfortunately are unable to provide care at this time. However, care is available to all patients who are eligible for our clinical trials. Learn more about our current research.

To request an appointment in the Child CBT Program, please fill out our intake form:

Go to intake form

Research

The Child Cognitive Behavioral Therapy Program at Massachusetts General Hospital is actively involved in a wide variety of research to evaluate the efficacy of novel CBT treatments for youth, improve the efficacy of CBT interventions and develop treatments to help children who do not respond to traditional CBT approaches.

We are also interested in understanding predictors of treatment response, including genetics, neuroimaging, family factors, and identifying the neurobiological underpinnings of treatment response to clarify how CBT exerts its effects on the brain.

Our staff has also been involved in long-term studies of children at risk for psychiatric disorders to understand factors that might increase risk for developing anxiety and mood disorders and identify factors that may enhance resilience in these youth.

See a list of our recent publications.

Current Research Projects

RAGE-Control: Teaching emotional self-regulation through videogame play

RAGE-Control (Regulate and Gain Emotional Control) is a study that combines learning relaxation skills with a specialized videogame that encourages relaxation to treat children and adolescents (age 7-17) who frequently get angry or lose their temper.  Participation in this study includes:

  • An initial evaluation session
  • Six study visits (which include relaxation training and videogame play)
  • Two follow-up sessions at 2 weeks and 3 months after completion of the research intervention 

This study is funded by Harvard University and the American Academy of Child and Adolescent Psychiatry. For more information about this study, please contact Carrie Vaudreuil, MD (RAGEstudy@partners.org).

(PI: Carrie Vaudreuil, MD)

Children Suffering from Tics and ADHD

If you have a child who is bothered by tics and ADHD symptoms, we may be able to help. We are conducting a clinical trial with children and adolescents (ages 11 to 17 years) who are bothered by their tics and are suffering from ADHD. Those qualified will receive a diagnostic evaluation and a modified version of comprehensive behavioral intervention for tics (CBIT) at no cost.

If you are interested in participating in this research study, please contact Erica Greenberg, MD (617-643-9341, egreenberg@partners.org) or Jenny Fehring (617-643-6204, jfehring@partners.org) in the Obsessive Compulsive and Related Disorders Clinic at Mass General.

(PI: Erica Greenberg, MD)

A Randomized Controlled Trial of Intranasal Oxytocin as an Adjunct to Behavioral Therapy for Autism Spectrum Disorder

This study, funded by the Department of Defense, is examining two cognitive-behavioral interventions for young male adults (ages 18-30) with an autism spectrum disorder. It is comparing social skills training with anxiety/stress management in these young people.  It is also examining whether oxytocin, a naturally occurring hormone that has been associated with bonding and socialization, can enhance the effects of CBT. 

For more information about this study, please contact Christian Hoover (cshoover@partners.org).

(PI: Aude Henin, MD/John Gabrieli, PhD)

Connectomes Related to Anxiety and Depression in Adolescents

This study examines acute threat and reward prediction error in adolescents (ages 14-15) with anxiety and depression. Adolescents in the study participate in clinical and behavioral assessments, as well as an MRI scan. They also have a brief follow up 6 months and 12 months after initial assessment. This a collaborative effort between Mass General, MIT, McLean Hospital, Boston University and the Human Connectome Project (HCP).

(PI: Gabrieli/Whitfield/Gabrieli)

 

Contact Us

Child Cognitive-Behavioral Therapy Program

151 Merrimac Street, 3rd floor
Boston, MA 021114

Phone: 617-643-9898

You may also fill out our intake form to request an appointment.

PLEASE NOTE: Because of the high demand for services, we are only able to care for children who are already connected with Massachusetts General Hospital. We accept referrals from other psychiatry programs at Mass General and providers affiliated with Mass General or other Partners hospitals, as well as children of Partners employees.

 

Intensive CBT Program

Intensive CBT Program for Youth with Anxiety Disorders

For youth ages 10-24 years with more severe anxiety disorders, we periodically offer an intensive therapy program. This therapy is typically conducted during school vacations, although alternative times may be arranged on a case-by-case basis. Intensive CBT is offered for three hours per day, for two to ten days (though sometimes this may be extended) and focuses on teaching skills to tolerate and manage anxiety and prolonged practice of facing fears in a gradual, progressive manner. There is also the opportunity for the therapist to travel with the patient to their home or other places in the community where the anxiety is occurring.

Advantages of this approach:

  • It offers the possibility of making greater progress more quickly
  • Therapy can be scheduled during a school break or vacation
  • Skills can be practiced directly in the environment in which they are needed, which may make therapy more effective

The intensive therapy program is only for individuals whose primary concerns are anxiety and who are otherwise medically and psychiatrically stable. Because it proceeds more rapidly and intensely, it is not appropriate for individuals who are at a higher risk of harming themselves, are highly aggressive or non-compliant, or are not motivated for treatment.

The first session is an evaluation of your child in which the clinician will conduct a thorough assessment to determine whether the intensive program is appropriate. If so, he/she will discuss goals for treatment and decide together with you what an appropriate length for treatment will be, then create a contract. At the end of the program, families are provided with tailored treatment recommendations going forward. We also encourage a follow-up appointment with the clinician approximately one month after program completion to refresh skills, assess progress, and troubleshoot obstacles that may have arisen.

Program Costs

Please note that the intensive therapy program does not accept any insurance and is self-pay only. Because of the format of the program and the services provided, it is considered an elective treatment that is not reimbursed by the vast majority of insurances. You will be responsible for payment of all fees at the beginning of treatment, regardless of whether or not you/your child attend all of the contracted days. We cannot assist you in obtaining any insurance reimbursement for these services, either prior to or following completion of the intensive program.

The program costs $540 per day of treatment. Fees for the initial evaluation and travel by clinicians to and from locations outside of the hospital are charged in addition to this daily rate.

Program Enrollment

Please also know that the intensive program has limited availability. If you are interested in the intensive therapy program, please complete the Intensive CBT Referral Form.

Go to Intensive CBT referral form

Publications

Recent Publications by Our Group

  • Henin A, Berman N. The promise and peril of emerging adulthood: Introduction to the special series. Cognitive and Behavioral Practice. 2016 Aug 23(3): 263-412.
  • Storch EA, Wilhelm S, Sprich S, Henin A, Micco J, Small BJ, McGuire J, Mutch PJ, Lewin AB, Murphy TK, Geller DA. Efficacy of Augmentation of Cognitive Behavior Therapy With Weight-Adjusted d-Cycloserine vs Placebo in Pediatric Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2016 Aug 1;73(8):779-88.
  • Freed RD, Tompson MC, Otto MW, Nierenberg AA, Henin A. A latent class analysis of parental bipolar disorder: Examining associations with offspring psychopathology. Psychiatry Research. 2015 Dec 15;230(2):314-22.
  • Schwartz CE, Kunwar PS, Hirshfeld-Becker DR, Henin A, Vangel MG, Rauch SL, Biederman J, Rosenbaum JF. Behavioral inhibition in childhood predicts smaller hippocampal volume in adolescent offspring of parents with panic disorder. Translational Psychiatry. 2015 Jul 21;5:e605. doi: 10.1038/tp.2015.95.
  • Freed RD, Tompson MC, Wang CH, Otto MW, Hirshfeld-Becker DR, Nierenberg AA, Henin A. (2015). Family functioning in the context of parental bipolar disorder: Associations with offspring age, sex, and psychopathology. Journal of Family Psychology. Feb;29(1):108-18.
  • Abramovitch A, Mittelman A, Henin A & Geller D. Neuroimaging and neuropsychological findings in pediatric obsessive-compulsive disorder: A review and developmental considerations. Neuropsychiatry, 2012; 2(4): 313-329
  • Micco, J.M., Henin, A., & Hirshfeld-Becker, D.R. (2014). Efficacy of interpretation bias modification in depressed adolescents and young adults. Cognitive Therapy and Research, 38, 89-102.
  • Freed, R.D., Tompson, M.C., Otto, M.W., Nierenberg, A.A., Hirshfeld-Becker, D., Wang, C.H., & Henin, A. (2014). Early risk factors for psychopathology in offspring of parents with bipolar disorder: The role of obstetric complications and maternal comorbid anxiety. Depression and Anxiety, 31, 583-90.
  • Hirshfeld-Becker, D.R., Micco, J.A., Henin, A., Petty, C., Faraone, S.V, Mazursky, H. … Biederman J. (2012). Psychopathology in adolescent offspring of parents with panic disorder, major depression, or both: a 10-year follow-up. American Journal of Psychiatry,169, 1175-1184.
  • Wozniak, J., Gonenc, A., Biederman, J., Moore, C., Joshi, G., Georgiopoulos, A., … Henin, A. (2012).  A magnetic resonance spectroscopy study of the anterior cingulate cortex in youth with emotional dysregulation. Israeli Journal of Psychiatry and Related Sciences, 49(1), 62-69.
  • Hirshfeld-Becker, D.R., Micco, J.A., Mazursky, H., Bruett, L., & Henin, A. (2011). Applying cognitive behavioral therapy for anxiety to the younger child. Child and Adolescent Psychiatric Clinics of North America, 20(2), 349-68.
  • Hirshfeld-Becker, D.R., Masek, B., Henin, A., Blakely, L.R., Pollock-Wurman, R.A., McQuade, J., … Biederman J. (2010). Cognitive-behavioral therapy for 4- to 7-year old children with anxiety disorders: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 78, 498-510.
  • Henin, A., Micco, J., Wozniak, J., Briesch, J., Narayan, A., & Hirshfeld-Becker, D.R. (2009). Neurocognitive functioning in bipolar disorder. Clinical Psychology: Science and Practice, 16, 231–250.
  • Micco, J.A., Henin, A., Mick, E., Kim, S., Hopkins, C.A., Biederman, J., & Hirshfeld-Becker, D.R. (2009). Anxiety and depressive disorders in offspring at high risk for anxiety: a meta-analysis. Journal of Anxiety Disorders, 23, 1158-1164.
  • Henin, A., Mick, E., Biederman, J., Fried, R., Hirshfeld-Becker, D.R., Micco, J.A., … Wozniak J. (2009). Is psychopharmacologic treatment associated with neuropsychological deficits in bipolar youth? Journal of Clinical Psychiatry, 70, 1178-1185.

Training

Advocating for the Use of Cognitive Behavioral Therapy in Children

The Child Cognitive Behavioural Therapy (CBT) Program at Massachusetts General Hospital is committed to training professionals in the use of CBT. Although there is a great deal of research to support the use of CBT with children, there is evidence that these approaches are often not being used in the community. This is likely because it is difficult to obtain CBT training and supervision for this specialized form of treatment and there is apprehension about using CBT techniques because they differ from more traditional psychotherapy. At the same time, CBT is relatively easy to disseminate because it uses well-established treatment manuals and focuses on measurable, observable goals.

To bridge the gap between science and practice in the community, we offer seminars and courses for licensed medical professionals, along with intensive training via didactic seminars and ongoing supervision for those who wish to specialize in CBT. We also offer training and supervision to predoctoral psychology fellows as part of Massachusetts General Hospital's Psychology Internship and to child psychiatry fellows as part of the Child Psychiatry Residency at the Mass General/Harvard Medical School.

Continuing Education Courses

We offer online courses via the Mass General Psychiatry Academy including:

  • Fundamentals Course in Child CBT - this course provides a basic primer for clinicians about CBT interventions and their use with children and adolescents
  • CBT for Children with Obsessive Compulsive Disorder (OCD) - this course provides more in-depth training about implementing well-established CBT interventions for youth with OCD

In both courses, role-playing is used to highlight important concepts. As part of these online courses, we offer a message board and call-in times for more individualized feedback.

For more information about upcoming courses, please visit the Mass General Psychiatry Academy website.

Disorders

Research over the past 40 years has shown that cognitive behavioral therapy (CBT) can be very effective in treating a range of disorders in children and adolescents. Among young people, anxiety disorders are the most common form of psychological distress, with approximately 10% of youth suffering from an anxiety disorders. CBT can be particularly helpful in treating these anxiety disorders and stress-related problems.

Types of Anxiety and Stress-Related Disorders

Separation Anxiety

Excessive anxiety caused by being separated from parents or away from home can cause significant distress or interfere in a child’s daily functioning. Children with this condition may be reluctant or unable to go to school or elsewhere because of anxiety about separation, may complain of physical symptoms when separation is imminent, or may express and display high levels of fear, aggression or distress when separated.

Associated symptoms include:

  • “Shadowing” parents around the house
  • Difficulty sleeping alone
  • Anxiety about going to parts of the house alone

Social Phobia

Social phobia is excessive, persistent anxiety caused by being the focus of attention or doing something embarrassing or foolish in front of others. Although mild social concerns are typical of middle-school aged youth or adolescents, social phobia is diagnosed when the child’s distress is severe and interferes with his/her ability to engage in age-appropriate tasks. Some social anxiety may be very specific, for example, fears of eating in public because of embarrassment, Some children may experience significant anxiety in many or most social situations. Anxiety may be most pronounced in unfamiliar situations or with new peers, and the child may be described as very “shy” or withdrawn.

Common signs of social phobia:

  • Avoidance of social situations
  • Difficulty making friends
  • Vulnerability to social exclusion or teasing

Generalized Anxiety Disorder (GAD)

Children with this condition are often described as always worried. Although a certain amount of worry is normal in childhood, children with GAD worry excessively most days and experience any number of physical symptoms. Frequent focuses of worry include schoolwork and grades, performance in other extracurricular activities, family, health, world issues; and smaller events that may have happened in the past (“did I make a mistake or say the wrong thing?”). Many of these children may be perfectionistic and highly driven. Although this worry may interfere in daily life, many of these children may be doing well in school or other areas. However, a diagnosis of GAD is considered when the worry prevents the child from enjoying activities or causes excessive distress.

Physical symptoms of GAD:

  • Headache or stomachache
  • Difficulty sleeping
  • Feeling tense and irritable
  • Difficulty sitting still or concentrating
  • Inability to relax

Panic Disorder

This disorder involves the experience of recurrent panic attacks. During a panic attack, the child experiences numerous, intense symptoms of anxiety that come on unexpectedly and peak very rapidly. Children may also cry, lash out or cling to parents during these attacks. 

Physical symptoms of panic attacks:

  • Racing heartbeat or chest pain
  • Rapid breathing
  • Dizziness
  • Nausea
  • Cold sweats or hot flashes
  • Trembling
  • Sense of dread
  • Fear of losing control or going crazy

Agoraphobia

This condition often (but not always) accompanies panic disorder. Children with agoraphobia fear going places where they may have a panic attack or become very anxious, but in which it would be difficulty to escape or get help. They feel very anxious when they are in this type of situation and often try to avoid situations where they could feel anxious or panicky.

Commonly feared situations:

  • Crowded settings
  • Elevators
  • Public transportation
  • Being alone
  • Going to school

Specific Phobia

Fears of specific objects are extremely common in childhood (some studies have found that the average child has approximately three fears at any time). However, phobias can be distinguished from more typical fears by their intensity, persistence and interference. A child with a phobia will become highly distressed when confronted by the feared object. He/she will avoid the anxiety-provoking situation to the point where it interferes with their ability to function, participate in age-appropriate activities or limit their daily routines.

Common phobias include:

  • Animals, birds or insects
  • Deep water
  • Clowns/costumed characters
  • Blood/injections
  • Heights

 

Obsessive-compulsive Disorder (OCD)

A form of anxiety in which the child experiences repetitive, unwanted, or distressing thoughts (obsessions) or an urge to perform repeated behaviors (compulsions). These are different from typical rituals of childhood, such as bedtime rituals, because the child feels compelled to engage in these behaviors and experiences significant distress, fear or discomfort if he or she cannot. The obsessions and compulsions are time-consuming and often interfere significantly in the child’s daily functioning. Children may also engage in significant avoidance behaviors because of their concerns and may demand that other family members also engage in rituals or avoid certain things because of the OCD.

Common obsessions:

  • Distressing thoughts about harm coming to loved ones or to self
  • Concerns about germs
  • Inappropriate and unwanted sexual thoughts
  • Doubting thoughts (Did I do this or not?)
  • Distressing thoughts about religious matters

Common compulsions:

  • Washing and grooming rituals
  • Counting and having “good” and “bad” numbers
  • Praying or saying phrases repeatedly
  • Checking behaviors
  • Symmetry rituals (e.g., touching something with the left hand if touched with the right hand)
  • Repeating rituals (e.g., walking repeatedly through a doorway until it “feels right”)

Resources

Books for Parents

  • 1-2-3 Magic: Effective Discipline for Children 2-12, Thomas W. Phelan
  • Raising a Thinking Child, Myrna Shure
  • SOS! Help for Parents, Lynn Clark
  • How to Talk So Kids Will Listen and Listen So Kids Will Talk, Adele Fabel and Elaine Mazlish

On Obsessive-Compulsive Disorder

  • Freeing Your Child from Obsessive-Compulsive Disorder, Tamar Ellsas Chansky
  • Talking Back to OCD: The Program That Helps Kids and Teens Say "No Way"--and Parents Say "Way to Go", John S. March
  • What to Do When Your Child Has Obsessive-compulsive Disorder: Strategies and Solutions, Aureen Pinto Wagner

On Anxiety

  • Freeing Your Child From Anxiety, Tamar Chansky
  • Help for Worried Kids, Cynthia G. Last
  • Mastery of Anxiety and Panic for Adolescents (Riding the Wave), Donna B. Pincus, Jill T. Ehrenreich, Sara G Mattis
  • Riding the Wave Workbook,  Donna B. Pincus, Jill T. Ehrenreich, David A. Spiegel

Books for Kids

  • Up and Down the Worry Hill: A Children's Book about Obsessive-Compulsive Disorder and its Treatment, Aureen Pinto Wagner
  • Take Control of OCD: The Ultimate Guide for Kids with OCD, Bonnie Zucker
  • Blink, Blink, Clop, Clop: Why Do We Do Things We Can’t Stop? An OCD Storybook, E. Katia Moritz and Jennifer Jablonsky

Our Program in the News

General Psychiatry Resources Online

This list is provided to help you find useful resources. This page does not indicate an endorsement by Mass General of any products or services offered by these authors.

Support Our Work

Although the Child CBT Program at Mass General is thriving, we also need your help. There are many services that we provide that are not covered by insurance, and many children who are not receiving care because of our current limits in available providers. In addition some of the research opportunities that we would like to pursue are not funded, especially now that federal funding mechanisms have become increasingly limited in size and scope. At the same time, there remains a great need for research on treatments for youth with severe psychiatric conditions.

It is increasingly recognized that early psychological intervention is key, and our field has made great strides in identifying and disseminating effective treatments. However, a sizeable minority of children do not respond to available treatments, and many are not receiving care that is supported by research. Our program is committed to caring for children who may not have responded well to previous treatment. We are also committed to pursuing research to develop and refine cognitive behavioral therapy (CBT) interventions to improve their efficacy, and to disseminating accurate information about mental health conditions in youth and effective treatment strategies.

Many of these goals can only be achieved because of the generosity of families and organizations that have donated to our program, and we are grateful for the support we have received so far. We welcome and encourage the support of other families who share our vision.

To support the Child CBT Program, please contact:

Molly McCarthy, Mass General Development
617-643-8827
mmccarthy50@partners.org

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