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The Worry Hill - Page 12

Wagner rightfully notes that some kids take longer to begin exposure work. (In my experience, the actual treatment frequently uses up additional sessions, too.) She comments that more reluctant children may benefit from medication. I'd suggest they might also be helped by other treatment approaches. For example, a straightforward (and more playful) narrative strategy with children—as well as their parents—can be effective in managing those OCD bullies.

For OCD, exposure and ritual prevention strategies employed skillfully—as in this case—are clearly beneficial. Still, many problems of childhood are messy, poorly understood, and inadequately formulated. The DSM-IV is woefully inadequate in describing complex kids. Sometimes, though, a symptom constellation like OCD presents itself with diagnostic precision, and then we can turn with confidence to this strong, evidence-based practice model. For motivated children and families contending predominately with the incapacitation of OCD, the treatment plan described by Aureen Pinto Wagner is a clear guide to effective, sensitive intervention.

Aureen Pinto Wagner, Ph.D., is clinical associate professor of neurology at the University of Rochester School of Medicine and Dentistry, and a member of the Scientific Advisory Board of the Obsessive Compulsive Foundation. She specializes in CBT for anxiety in children and adolescents. She's the author of several books and professional resources, including the children's book Up and Down the Worry Hill; Worried No More: Help and Hope for Anxious Children; and Treatment of OCD in Children and Adolescents: Professional's Kit. She provides in-depth CBT training workshops for professionals. Website:

Martha Straus, Ph.D., is a professor in the Department of Clinical Psychology at Antioch University New England in Keene, New Hampshire, and adjunct instructor in psychiatry at Dartmouth Medical School. She's the author of No-Talk Therapy for Children and Adolescents and of Adolescent Girls in Crisis: Intervention and Hope. Contact:

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