Expanding horizons: Adapting manual-based treatments for anxious children with comorbid diagnoses

Children presenting for treatment at specialized anxiety clinics rarely present with a single diagnosis. Rather, anxious children present with complex diagnostic profiles typically consisting of comorbid anxiety, mood, and behavior disorders. These complex profiles can challenge the therapist's ability to creatively and flexibly apply a manual-based treatment. This article presents several cases of children with anxiety and comorbid conditions seen at the Child and Adolescent Anxiety Disorders Clinic (CAADC) at Temple University, Philadelphia. In presenting these cases, we provide examples of and suggestions about the flexible adaptation of the Coping Cat program (manual; Kendall, 1992) in the case of comorbid ADHD, depression, selective mutism, and physical and developmental disabilities.