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Other Problems of Childhood and Adolescence

Evidence-based care for children and adolescents for anxiety and other problems.

Other Problems of Childhood and Adolescence

Unfortunately, most youth do not see a mental health professional until their anxiety or other behaviors have been causing difficulty for a long time. Anxiety in children and teens may appear in a variety of ways, including difficulties at school, increased distress when facing challenges, changes in mood or behavior, social withdrawal, or avoidance of previously typical social, family, or school activities. Recognizing these patterns can be an important step in understanding when anxiety may be affecting a child’s well-being.
Families across Seattle and throughout Washington (via telehealth) seek care at EBTCS for specialized support when anxiety and related difficulties in childhood and adolescence begin to interfere with functioning and daily life.
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School Refusal and School Avoidance

School refusal is rarely about school itself — it is about distress that has become unmanageable.

School refusal occurs when a child experiences overwhelming emotional distress related to attending school. This distress may be anxiety-based, panic-driven, mood-related, or connected to trauma or perfectionism.

What it often looks like
  • Difficulty leaving home or getting to school
  • Physical complaints that intensify in the morning
  • Panic or emotional shutdown around school attendance
  • Frequent early dismissals or absences
  • Increasing family stress and morning conflict
Once avoidance takes hold, it tends to escalate quickly.
Why early intervention matters
The longer a child is out of school, the harder returning becomes — academically, socially, and emotionally. Research-supported treatment focuses on both the emotional drivers and the behavioral patterns that maintain avoidance.
How effective treatment works

Successful treatment typically includes:

  • CBT to address anxiety and distress
  • Gradual, supported exposure to school routines
  • Evidence-based parent coaching
  • Coordination with schools when appropriate
Families are not expected to manage this alone. With structured, expert care, many children return to school and regain confidence far more quickly than families expect.

Selective Mutism

Selective mutism is not willful silence or extreme shyness—it is an anxiety-based condition that limits a child’s ability to speak in certain settings.
Selective mutism typically begins in early childhood and affects approximately 1 in 140 children. Children with selective mutism are able to speak comfortably in some settings (often at home), but feel unable to speak in others, such as school or social environments.
What families and schools may notice
  • Little or no speaking at school despite typical speech at home
  • Reliance on gestures, nodding, or whispering
  • Avoidance of speaking situations or visible distress when expected to talk
  • Academic or social difficulties related to limited verbal participation
Because children with selective mutism are often described as “quiet” or “well-behaved,” the condition can go unrecognized for long periods.
Why early, specialized treatment matters
Without targeted intervention, selective mutism often becomes more entrenched and can interfere with academic progress, peer relationships, and independence.
Evidence-based behavioral and exposure-based treatments—delivered gradually and collaboratively—can help children build comfort speaking across settings. With the right care, many children make meaningful gains and begin communicating more freely.

Screen Use and Technology-Related Difficulties

Problematic screen use is rarely the core issue—it is often a coping strategy for underlying distress.
While screens are a normal part of modern life, excessive or inflexible screen use can interfere with sleep, school engagement, emotional regulation, and family relationships. Research consistently links extended daily screen time with higher rates of anxiety, depression, and attention difficulties.
When screen use becomes a concern
  • Increasing conflict around limits
  • Difficulty disengaging from devices
  • Reliance on screens to manage anxiety or distress
  • Withdrawal from in-person activities or relationships
  • Sleep disruption
Our approach
At EBTCS, we do not focus on screen reduction alone. We evaluate why screens have become central and address the emotional, behavioral, and developmental needs underneath—helping families restore balance in ways that are realistic and sustainable.

Treatments We Provide at The Child Anxiety Center

Decades of research have identified effective treatments for child anxiety disorders. Broadly speaking, the two most effective approaches are therapy and medication.
Click on each tab to expand more information about the treatments we provide.
School Refusal Intervention (Kearney Model)

School refusal treatment at EBTCS is informed by Christopher Kearney’s functional model, which focuses on understanding why a child is avoiding school and tailoring intervention accordingly.
Rather than using a one-size-fits-all approach, treatment targets the specific reasons behind avoidance—such as anxiety, distress, difficulty with transitions, or patterns that have developed over time.
Intervention typically includes gradual return-to-school plans, exposure-based strategies, and structured parent guidance. Collaboration with schools helps create consistency and support across environments.
This approach brings clarity to what often feels overwhelming and helps families move forward with a clear, coordinated plan.

Why this treatment is used:
To help children return to school in a structured, supported way when anxiety or distress has made attendance difficult.

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PCIT-SM is a specialized behavioral treatment for young children with selective mutism. It is an adaptation of Parent-Child Interaction Therapy (PCIT) that focuses on helping children gradually increase verbal communication across settings.
Treatment involves coaching parents in real time to support their child’s communication through structured, step-by-step interactions. Children are guided to speak in increasingly challenging situations, beginning in low-pressure environments and expanding to settings such as school or social situations.
This approach is designed to feel supportive and achievable for both children and parents, with progress building in small, meaningful steps.

Why this treatment is used:
To help children who feel “stuck” not speaking in certain settings gradually build confidence and begin communicating more comfortably.

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Cognitive-behavioral approaches can be used when technology use begins to interfere with sleep, school, relationships, or emotional well-being.
Treatment focuses on understanding how technology is being used—especially when it becomes a way to cope with anxiety, boredom, or stress. From there, children and families learn practical strategies to reduce reliance on screens, increase flexibility, and re-engage in offline activities.
The goal is not to eliminate screens, but to help children use them in a more balanced and intentional way.

Why this treatment is used:
To help children and families regain balance when screen use starts to crowd out sleep, responsibilities, or real-world activities.

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Standard Outpatient Therapy
Our team of expert clinicians is here to help children, teens, and families by providing gold-standard treatment for anxiety and related problems.
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Anxiety and OCD Intensive Treatment Program

We provide intensive treatment services for children, teens, and adults with severe OCD and other anxiety disorders. The goal of intensive treatment is to provide focused, highly structured and individualized therapy multiple days per week.

Intensive treatment is appropriate when someone cannot function optimally in their daily life (i.e, cannot attend school, go to work, or participate in social or family activities). Intensive services may also be appropriate when standard outpatient treatment is not working and a higher level of care is needed.
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Consultation

Our expert clinicians offer consultation services for families considering care at the Child Anxiety Center, as well as for medical and mental health professionals seeking guidance regarding the treatment of children and adolescents with anxiety, obsessive-compulsive, and related disorders.

Contact Us

Standard Outpatient Therapy

Our team of expert clinicians is here to help children, teens, and families by providing gold-standard treatment for anxiety and related problems.
Learn More

Anxiety and OCD Intensive Treatment Program

We provide intensive treatment services for children, teens, and adults with severe OCD and other anxiety disorders. The goal of intensive treatment is to provide focused, highly structured and individualized therapy multiple days per week.
Intensive treatment is appropriate when someone cannot function optimally in their daily life (i.e, cannot attend school, go to work, or participate in social or family activities). Intensive services may also be appropriate when standard outpatient treatment is not working and a higher level of care is needed.
Learn More

Consultation

Our expert clinicians offer consultation services for families considering care at the Child Anxiety Center, as well as for medical and mental health professionals seeking guidance regarding the treatment of children and adolescents with anxiety, obsessive-compulsive, and related disorders.
Contact Us

Get in Touch With Us

Please provide your information below and a member of our team will respond as soon as possible.

Address

1200 5th Avenue,
Suite 800 Seattle, WA 98101

Email

info@ebtseattle.com