Assessment

ASSESSMENT:

Prior to engaging in psychological services, children/adolescents should undergo a medical examination by a pediatrician or family doctor to rule out physical causes for emotional and/or behavioural symptoms.

 

Following this, a comprehensive psychological evaluation is completed, lasting from 2-4 sessions. At the end of the evaluation, initial impressions and a working diagnosis are formulated.  A treatment plan is then developed, tailored to your specific needs.

Treatment Modalities
  • CBT - Cognitive Behavioural Therapy
  • ERP - Exposure Response Prevention
  • FBT - Family Based Treatment
  • MBSR - Mindfulness Based Stress Reduction
  • DBT - Dialectical Behavioural Therapy
 
Cognitive Behavioural Therapy (CBT)

Many children and teens struggle with anxious thoughts and worries, depression, or anger management issues that can interfere with their enjoyment of daily life and their ability to succeed at school.  The most evidenced-based approach to treat these issues is Cognitive Behavioural Therapy (CBT).  Cognitive behavior therapy (CBT) is a short-term treatment (8-12 sessions) that can be highly effective for many disorders including childhood anxiety, depression, and explosive anger disorders.  As the name suggests, CBT focuses on the way people think ("cognitive") and act ("behavioural"). The concept behind CBT is that our thoughts about a situation affect how we feel (emotionally and physically) and how we behave in that situation.  

 

CBT aims to teach children and teens positive behavioral coping such as relaxation, deep breathing, and visualization skills to help manage negative emotions.  It also teaches them positive cognitive coping skills such as challenging negative thought patterns and developing healthier approaches to thinking about day-to-day experiences.  CBT interventions involve the use of talking therapy, worksheets and activities to provide behavioural and cognitive interventions. These include problem-solving skills, anger management, stress management, communication and assertiveness training, and social skills training. Numerous studies show that CBT is as effective or more effective than medication in the treatment of depression, anxiety, obsessions and other fears, without the negative side effects of medications.

 
Exposure Response Prevention (ERP)

One of the most important techniques used in CBT for children with anxiety is called exposure and response prevention (ERP). The basic idea is that kids are exposed to the things that trigger their anxiety in structured, incremental steps, in a safe setting. As they become accustomed to each of the triggers, the anxiety fades, and they are ready to take on increasingly more challenging ones. As parents, it is tempting to protect kids from things that make them anxious, but learning to tolerate anxiety is how we overcome fears.  In exposure therapy we try to change the behavior to get rid of the fear.  Exposure therapy is effective for many different types of anxiety, including separation anxiety, phobias, obsessive-compulsive disorder (OCD), and social anxiety.  Recently, it is being used in the treatment of an eating disorder called ARFID (avoidant restrictive food intake disorder), where children are exposed to foods they fear in hierarchical steps.

 
Family Based Treatment (FBT) for Eating Disorders

Childhood and adolescence are times of significant growth and development.  Any weight loss, preoccupation with body image, and dietary restriction may suggest an underlying issue.  Concerns about eating disorder behaviours (e.g., Anorexia Nervosa, Bulimia) need to be addressed first by a family doctor or pediatrician, experienced in treating eating disorders. Referrals can then be made to a psychologist for Family-Based Treatment (FBT).


FBT is an intensive outpatient treatment where parents play an active and positive role in order to:

1. Help restore their child’s weight to expected levels based upon their age and height.

2. Hand the control over eating back to the child/adolescent.

3. Help their child reach a healthy sense of identity by talking about how the eating disorder has affected their development and how they will be able to move forward.  

 

This is achieved in three phases across 20 treatment sessions over a 12-month period.  The main difference between FBT and traditional treatments is that parents are seen as a key resource in assisting their child to recover.  FBT believes that the child is not to blame for the eating disorder behaviours, rather these symptoms are mostly outside of the child/adolescent’s control (externalizing the illness).

 

While the physical and emotional consequences of an eating disorder can be devastating, this approach holds great promise for most children and adolescents who have been ill for a relatively short period of time (i.e. less than 3 years). Family-based treatment can prevent hospitalization and assist the child/adolescent in her/his recovery, provided that parents play an active role in treatment.  Using FBT, young people with eating disorders can regain their health, learn to eat normally again, and develop healthier attitudes about food and their bodies.

 
Mindfulness Based Stress Reduction (MBSR)

In today’s world, children and teens are under more pressure and experiencing higher levels of stress than ever before.  The stresses of school, extracurricular activities, and even daily family life can make kids feel overwhelmed and distracted.  For teens, an increasing demand in technology, academic preparation and life transitions often result in physical and emotional stressors that can affect their well-being.  Mindfulness Based Stress Reduction (MBSR) has proven to be an effective way to develop appropriate coping strategies in managing stress and restoring health and balance.  MBSR teaches the art of living in the present moment in a non-judgmental way. This is achieved through simple meditation practices including breathing exercises, progressive muscle relaxation practices, visualization and loving-kindness meditations designed to reduce the challenges of everyday stressors.

 

In the last few years, mindfulness has emerged as a way of treating children and adolescents with conditions ranging from ADHD to anxiety, autism spectrum disorders, depression and stress.  A growing body of evidence suggests that mindfulness practice can help children cultivate empathy, as well as skills for concentration and impulse control.  In short, mindfulness can help your child or teen learn the art of resilience - a skill that will last a lifetime.

 
Dialectical Behavioural Therapy (DBT)

Does your child/teen struggle with intense emotions?  Dialectical Behaviour Therapy (DBT) is a highly structured, evidenced-based treatment approach that is effective for children and teens who struggle with intense emotions, self-harm, suicidal thoughts, depression, bipolar disorder, substance abuse, eating disorders and anxiety disorders.  Through DBT, young people have the opportunity to learn a variety of skills in the following areas: mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.  DBT seeks to balance two concepts that may appear to be quite opposite; acceptance and change.  As teens learn to accept their situation and make changes that are possible, life becomes worth living.

 

DBT is designed to help with extreme emotional instability or "dysregulation"—the inability to manage intense emotions.  Dysregulation often leads to impulsive, self-destructive, or self-harming behaviors. The goal of DBT is to teach adolescents techniques to help them understand their emotions without judgment (using mindfulness) and also to give them skills and techniques to manage those emotions and change behaviors in ways that will make their lives better.  It takes hard work and commitment.

 

DBT can also involve sharing information and teaching specific skills to parents.  Parents learn to observe how intense and negative emotions affect their child and how these emotions result in problematic behaviors.  Improved understanding allows parents to intervene early and respond to their child's emotion with greater acceptance. It enables parents to be more effective in helping their child feel more in control and better about him/herself.

989 Eglinton Avenue West. Suite #1

Toronto, ON M6C 2C6

Dr. Melissa Lieberman

Child and Youth Psychology

© 2019