Cognitive-behavioral treatment for specific phobias with a child demonstrating severe problem behavior and developmental delays.
One three-hour CBT session ended water and height phobias in a 7-year-old with developmental delays.
01Research in Context
What this study did
A 7-year-old boy with developmental delays was terrified of water and heights. He screamed, hit, and ran away when asked to go near a pool or a balcony.
The team used one-session CBT. They stayed in one room for three hours. They played games, drew pictures, and took tiny steps toward the scary things. The child chose the steps and earned stickers for trying.
What they found
After the single session the boy put his face in the pool and stood on a high balcony without crying. One month later he was still doing both.
No one had to drag or restrain him. The fear dropped and stayed low.
How this fits with other research
Peters et al. (2013) also cured phobias in preschoolers, but they needed 10–13 short visits. Emerson et al. (2007) shows one longer visit can work when the child has delays.
Mulder et al. (2020) asked parents of kids with ID if CBT was possible. Most said yes if you slow it down and use pictures. This case proves they were right.
Rosen et al. (2016) reviewed many studies and found gradual exposure plus prizes works for anxiety in lower-functioning autism. The 2007 study is a live example of that recipe packed into one afternoon.
Why it matters
You can help kids with delays beat strong fears fast. Pick one safe place, bring favorite toys, and let the child set the pace. Reward every small try. One long, playful session can replace weeks of dragged-out exposure. Try it next time a learner avoids swings, dogs, or loud halls.
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Schedule a single 3-hour fun exposure block, let the child pick tiny steps, and hand out stickers for each try.
02At a glance
03Original abstract
Cognitive-behavioral treatments (CBTs) are widely used for anxiety disorders in typically developing children; however, there has been no previous attempt to administer CBT for specific phobia (in this case study, one-session treatment) to developmentally or intellectually disabled children. This case study integrates both cognitive-behavioral and behavior analytic assessment techniques in the CBT of water and height phobia in a 7-year-old male with developmental delays and severe behavior problems. One-session treatment [Ost, L. G. (1989). One-session treatment for specific phobias. Behaviour Research and Therapy, 27, 1-7; Ost, L. G. (1997). Rapid treatment of specific phobias. In G. C. L. Davey (Ed.), Phobias: A handbook of theory, research, and treatment (pp. 227-247). New York: Wiley] was provided for water phobia and then 2 months later for height phobia. The massed exposure therapy sessions combined graduated in vivo exposure, participant modeling, cognitive challenges, reinforcement, and other techniques. Both indirect and direct observation measures were utilized to evaluate treatment efficacy. Results suggested CBT reduced or eliminated behavioral avoidance, specific phobia symptoms, and subjective fear. Negative vocalizations were reduced during height exposure following treatment. Vocalizations following treatment for water phobia were less clear and may have been indicative of typical 7-year-old protests during bath time. Findings indicate CBT can be effective for treating clinical fears in an individual with developmental disabilities and severe behavior. Future research in this population should examine CBT as an alternative to other techniques (e.g., forced exposure) for treating fears.
Research in developmental disabilities, 2007 · doi:10.1016/j.ridd.2006.07.003