Children’s Anxiety: A Contextual Approach

Abstract

By Peter, Appleton London : Routledge , 2008 ISBN 9780415459440 , 179 pp, £24.99 In Children’s Anxiety, the authors demonstrate the importance of understanding a child or young person’s social contexts, when treating his or her problematic anxiety. As Peter Appleton points out in the preface, the majority of research in this area examines anxiety from a medical or purely psychological perspective, rather than accounting for the effects of the contexts in which the anxiety is occurring. This text, by focusing on how life contexts can give rise to or exacerbate anxiety, is a welcome addition to the literature. The text comprises three parts: the first part (written by Appleton) outlines a developmental framework within which to situate anxiety; the second consists of nine case studies and the final part gives a summary of the important points emerging from the clinical case studies. In the early chapters, Appleton shows that viewing anxiety via a framework of children’s development allows us to see children as individuals and to map out the progression of disorders over time. Several important themes seem to be common to this approach; most notably that complex anxiety has several contributing factors, rather than just one simple explanation, such as genetics. Appleton also uses attachment theory to explain how the development of relationships in early childhood is key to a child’s sense of safety in the world and can also be a crucial factor in promoting children’s resilience. Appleton states that resilience is, rather than being a fixed character trait, the result of processes during development that can give a child the strengths to survive complicated and distressing contexts. There are a variety of anxiety disorders and Chapter 2 gives a clear and concise introduction to them describing diagnostic criteria for: panic disorder; specific phobias; Post-Traumatic Stress Disorder (PTSD); Agoraphobia; Generalised Anxiety Disorder (GAD); Social Anxiety Disorder; Separation Anxiety Disorder; selective mutism; Obsessive-Compulsive Disorder (OCD) and health anxiety. It is also pointed out that it is common for disorders to co-occur and readers are reminded that while diagnosis can be useful in pointing the way ahead to treatment, diagnosis can also deflect attention away from consideration of the role played by the child’s life contexts in his/her experience of anxiety. The nine clinical case studies are by various authors and cover a range of childhood contexts and types of disorder including: a nine-year-old male Kosovan refugee, with PTSD as a result of his experiences during war in his home country; a girl of four undergoing treatment to prevent anxiety following a serious accident; a 14-year-old girl struggling to deal with her anxiety and her learning disabilities and an 11-year-old boy experiencing a change of foster family. A variety of therapies are used and described including play therapy, family systemic therapy and cognitive-behaviour therapy. The most reflective chapter is that detailing the treatment of the 14-year-old girl with learning disabilities, who underwent psychodynamic psychotherapy. The therapist, Helen Bell, gives a fascinating account of how the emotions produced by the girl were ‘projected into’ the therapist, so that the therapist could assist the girl in containing and managing what had previously seemed unmanageable. Although the text does contain quotes from the children and young people who feature in the case studies, first-hand accounts from some of them of how they experienced the various therapies would have given an extra dimension. Early in the book, Appleton writes that there is currently not sufficient understanding of the various developmental trajectories followed by children. Incorporating their own accounts within the research literature where possible, could extend our understanding. The text succeeds in its aim of providing an introduction to the subject of severe and complex anxiety in children and teenagers and would make useful reading for any professionals with an interest in child/adolescent mental health.