Restricted accessResearch articleFirst published online 2017-5
Insights into the Feelings,Thoughts,and Behaviors of Children with Visual Impairments: A Focus Group Study Prior to Adapting a Cognitive Behavior Therapy–Based Anxiety Intervention
Anxiety is the most common psychological problem reported among children with visual impairments. Although cognitive behavior therapy interventions have proven successful in treating childhood anxiety, it is unclear whether they are suitable and accessible for children who have visual impairments. This study aimed to determine if and how traditional cognitive behavior therapy–based interventions could be adapted for use with this specific population by interviewing children with visual impairments themselves.
Methods
A qualitative research design was used. Sixteen children with visual impairments (aged 9 to 13 years) participated in two focus group interviews. Participants attended two special schools in the Western Cape, South Africa. Interviews were audio-recorded and transcribed verbatim, and content analysis was undertaken.
Results
Three primary themes emerged from the focus group data: (1) difficulties encountered by children with visual impairments; (2) existing coping strategies; and (3) insight into the concepts of feelings, thoughts and behaviors (central to cognitive behavior therapy).
Discussion
The emergent themes and their implications for the adaptation of a cognitive behavior therapy–based anxiety intervention are discussed.
Implications for practitioners
Results provide practitioners with guidelines to consider when using or adapting therapeutic techniques such as cognitive behavior therapy for children with visual impairments.
Get full access to this article
View all access options for this article.
References
1.
AyersT. S.SandierI. N.WestS. G., & RoosaM. W. (1996). A dispositional and situational assessment of children's coping: Testing alternative models of coping. Journal of Personality, 64(4), 923–958.
2.
BandE. B., & WeiszJ. R. (1988). How to feel better when it feels bad: Children's perspectives on coping with everyday stress. Developmental Psychology, 24(2), 247–253.
3.
BarrettP. M., & SondereggerR. (2005). Anxiety in children-FRIENDS program. In FelgoiseS.NezuA. M.NezuC. M., & ReineckeM. A. (Eds.), Encyclopaedia of cognitive behavior therapy (1st ed., pp. 42–45). New York, NY: Springer.
4.
BarrettP. M. (2005). Friends for life.Brisbane, Australia: Australian Academic Press.
5.
BraunV., & ClarkeV. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
6.
Cartwright-HattonS.McNicolK., & DoubledayE. (2006). Anxiety in a neglected population: Prevalence of anxiety disorders in pre-adolescent children. Clinical Psychology Review, 26(7), 817–833.
7.
ChalfantA. M.RapeeR., & CarrollL. (2007). Treating anxiety disorders in children with high-functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37(10), 1842–1857.
8.
DaddsM. R.SpenceS. H.HollandD. E.BarrettP. M., & LaurensK. R. (1997). Prevention and early intervention for anxiety disorders: A controlled trial. Journal of Consulting and Clinical Psychology, 65(4), 627–635.
9.
DowlingJ. S. (2014). School-age children talking about humor: Data from focus groups. HUMOR, 27(1), 121–139.
10.
ElbedourS.ShulmanS., & KedemP. (1997). Children's fears: Cultural and developmental perspectives. Behaviour Research and Therapy, 35(6), 491–496.
11.
EllisA. (1979). Negative linking of RET to positive thinking.New York, NY: Academic Press.
12.
EriksonE. H. (1993). Childhood and society.New York, NY: W. W. Norton & Company.
13.
GulloneE. (1996). Normal fear in people with a physical or intellectual disability. Clinical Psychology Review, 16(8), 689–706.
14.
GulloneE., & KingN. J. (1997). Three-year follow-up of normal fear in children and adolescents aged 7 to 18 years. British Journal of Developmental Psychology, 15(1), 97–111.
15.
HornerS. D. (2000). Using focus group methods with middle school children. Research in Nursing & Health, 23(6), 510–517.
16.
JemtåL.DahlM.NordahlG., & Fugl-MeyerK. (2007). Coping strategies among Swedish children and adolescents with mobility impairment in relation to demographic data, disability characteristics and well-being. Acta Paediatrica, 96(8), 1184–1189.
17.
KendallP. C. (1990). The coping cat workbook. Unpublished manuscript.
KhadkaJ.RyanB.MargrainT. H.Wood-houseJ. M., & DaviesN. (2012). Listening to voices of children with a visual impairment: A focus group study. British Journal of Visual Impairment, 30(3), 182–196.
20.
LastC. G. (2006). Help for worried kids: How your child can conquer anxiety and fear.New York, NY: Guilford Press.
21.
LastC. G.PerrinS.HersenM., & KazdinA. E. (1996). A prospective study of childhood anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 35(11), 1502–1510.
22.
LiH., & MorrisR. J. (2006). Fears and related anxieties in children having a disability: A synthesis of research findings from 1937 to 2004. In MorrisR. J. (Ed.), Disability research and policy: Current perspectives (pp. 163–184). Mahwah, NJ: Lawrence Erlbaum Associates.
23.
LiH., & MorrisR. J. (2007). Assessing fears and related anxieties in children and adolescents with learning disabilities or mild mental retardation. Research in Developmental Disabilities, 28(5), 445–457.
24.
LiH., & PrevattF. (2007). Fears and related anxieties across three age groups of Mexican-American and White children with disabilities. The Journal of Genetic Psychology, 168(4), 381–400.
25.
LickelA.MacLeanW. E.Jr.Blakeley-SmithA., & HepburnS. (2012). Assessment of the prerequisite skills for cognitive behavioral therapy in children with and without autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(6), 992–1000.
26.
MargalitM., & RavivA. (1984). LDs’ expressions of anxiety in terms of minor somatic complaints. Journal of Learning Disabilities, 17(4), 226–228.
27.
OllendickT. H.MatsonJ. L., & HelselW. J. (1985). Fears in visually-impaired and normally-sighted youths. Behaviour Research and Therapy, 23(3), 375–378.
28.
RadnitzC. L., & OronsonJ. (2000). Visual impairments in cognitive behavioural therapy for persons with disabilities. In JacksonW. T., & TaylorR. E. (Eds.), Cognitive behaviour therapy for persons with disabilities (pp. 159–181). Northvale, NJ: Jason Aronson.
29.
RapeeR. M., & LynehamH. (2006). Cool kids—Child & adolescent anxiety program therapist manual.Sydney, Australia: Center for Emotional Health, Maquarie University.
30.
ReavenJ.Blakeley-SmithA.Culhane-ShelburneK., & HepburnS. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53(4), 410–419.
31.
ReavenJ.Blakeley-SmithA.LeutheE.MoodyE., & HepburnS. (2012). Facing your fears in adolescence: Cognitive-behavioral therapy for high-functioning autism spectrum disorders and anxiety. Autism Research and Treatment, 2012, 1–13.
32.
SilvermanW. K., & KurtinesW. M. (1996). Anxiety and phobic disorders: A pragmatic approach.New York, NY: Springer.
33.
SilvermanW. K.La GrecaA. M., & WassersteinS. B. (1995). What do children worry about? Worry and its relation to anxiety. Child Development, 66, 671–686.
34.
SilvermanW. K.PinaA. A., & ViswesvaranC. (2008). Evidence-based psycho-social treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 37(1), 105–130.
35.
StallardP. (2003). Think good-feel good: A cognitive behaviour therapy workbook for children and young people.West Sussex, England: John Wiley & Sons.
36.
SungM.OoiY. P.GohT. J.PathyP.FungD. S.AngR. P., … LamC. M. (2011). Effects of cognitive-behavioral therapy on anxiety in children with autism spectrum disorders: A randomized controlled trial. Child Psychiatry & Human Development, 42(6), 634–649.
37.
TaylorJ. A.PhillipsR.CookE.GeorgiouL.StallardP., & SayalK. (2014). A qualitative process evaluation of classroom-based cognitive behaviour therapy to reduce adolescent depression. International Journal of Environmental Research and Public Health, 11(6), 5951–5969.
38.
Van StarrenburgM. (2013). Dappere kat. kognitiewe gedragstherapie bij kinderen en jongeren met angstklachten: Een protocol van 12 sessies. theraputen handleiding voor de groepstraining. [The brave cat. Cognitive behavioural therapy for children and adolescents with anxiety: A 12 session protocol. Therapeutic Manual for the group training.] Unpublished manuscript.
39.
VisagieL., & LoxtonH. (2014). Child-friendly procedures and accommodations for the use of a self-report fear survey with children who have visual impairments: Reflections on a South African case study. British Journal of Visual Impairment, 32(3), 179–190.
40.
VisagieL.LoxtonH.OllendickT. H., & SteelH. (2013). Comparing fears in South African children with and without visual impairments. Journal of Visual Impairment & Blindness, 107(3), 193–205.
41.
VisagieL.LoxtonH., & SilvermanW. K. (2015). Research protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention program for the management of anxiety symptoms in South African children with visual impairments. African Journal of Disability, 4(1), 1–10. http://dx.doi.org/10.4102/ajod.v4i1.160
42.
WalkupJ. T.AlbanoA. M.PiacentiniJ.BirmaherB.ComptonS. N.SherrillJ. T., … WaslickB. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766.
43.
WeemsC. F.SilvermanW. K., & La GrecaA. M. (2000). What do youth referred for anxiety problems worry about? Worry and its relation to anxiety and anxiety disorders in children and adolescents. Journal of Abnormal Child Psychology, 28, 63–72.
44.
WestenbergP.DrewesM. J.GoedhartA. W.SiebelinkB. M., & TreffersP. D. (2004). A developmental analysis of self-reported fears in late childhood through mid-adolescence: Social-evaluative fears on the rise?Journal of Child Psychology and Psychiatry, 45(3), 481–495.
45.
WhiteS. W.OllendickT.ScahillL.OswaldD., & AlbanoA. M. (2009). Preliminary efficacy of a cognitive-behavioral treatment program for anxious youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(12), 1652–1662.
46.
WillnerP. (2005). The effectiveness of psychotherapeutic interventions for people with learning disabilities: A critical overview. Journal of Intellectual Disability Research, 49(1), 73–85.
47.
WoodJ. J.DrahotaA.SzeK.HarK.ChiuA., & LangerD. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.
