I treat children and adolescents between the ages of 4 and 18, generally for social skill problems, interfering or problem behaviors, symptoms related to developmental disorders such as autism, Asperger's, or mental retardation; learning disabilities or ADHD, and spectrum anxiety disorders.  

4-8 years:  In general, I gather information from families prior to the first meeting. I generally prefer to observe children this age at school rather than having them come to my office. I may develop a plan with the parents and/or school staff and create an intervention without ever actually meeting individually with the child, especially for children under 9 years of age. My rationale for this is that much of the information I gather in the session is actually via parent report. By meeting the child at school, it is less stigmatizing. Beside, much of the work I do is through parents and teachers in helping children, particularly those with social challenges.

If it does appear helpful to meet with the child in the office, I use one of two primary methods: (1) I meet with the child and parent(s) together; (2) I meet with the child alone, but include the use of computer animation, PowerPoints, or develop a web site/web form with the child which focuses on the types of behaviors that may benefit from change. I have found that using some form of technology "softens" the therapy experience for children and adolescents, maintains their interest, and provides a mechanism for them to rehearse strategies we develop outside the therapy session. I have used these approaches for nearly a decade and consistently find that it adds to the session and helps motivate children.

This also ties into my belief that it is critically important that the child have some understanding of why they have come for a visit, but not feel as though they are being forced to "talk about their problems." Believe it or not, younger children can learn to track their own behavior and, in doing so, develop a heightened sense of how unacceptable or avoidance behaviors interfere with their functioning.
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8-12 years: As children develop, their capacity for reasoning and understanding the consequences of behaviors matures as well. Providing opportunities for children to meet individually can be useful, but I also often blend such meetings with family and school consultations, depending upon the reason a child was initially referred. Children in this age group often benefit considerably from developing and rehearsing positive coping methods to manage troubling feelings or to increase their social competence.  I use many of the techniques described for the 4-8 year old range.  However,  I encourage children in the 8-12 range to make better use of their developing verbal and thinking skills to develop cognitive-behavioral tutorials which they can access online.  It is also often helpful to use computer animation and video to practice positive social strategies.
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12-18 years: Adolescents often are faced with the combined challenges of their developing individuality, hormonal changes, increases in peer pressures, and worries about whether they "fit in." Respecting their viewpoints is a critical part of the therapy process. It is all too easy to become critical of adolescents as they try out their new-found emerging sense of self. In school, the transition to middle school can be particularly problematic, especially for children with learning or social challenges or social shyness. My treatment model is generally similar, but there may be an increased helping the adolescent feel they have a say in the treatment process and, to the extent feasible, insure that they feel the therapy is not something "being done to them," Rather, it is a collaborative process designed to help them feel in control of what happens during therapy.
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