Fluid reasoning is involved in inductive and deductive thinking. When IQ results demonstrate that children’s inductive and deductive reasoning abilities are limited, cognitive interventions emphasizing complex rational analysis are not indicated (Donoghue, Stallard, & Kucia, 2010). Indeed, the Kaufman scales readily reveal strength and weaknesses in sequential reasoning. For example, continua, decatastrophizing, logical Socratic methods, and complex tests of evidence need to be judiciously applied. Traditional rational analysis techniques make heavy demands on cognitive processing. As noted:

These cognitive behavioural techniques require that the individual has the ability to not only experience complex negative cognitions but also reflect on them and to engage them in highly complex reasoning processes in which hypotheses are evaluated and alternative solutions to problems are generated. (p. 310)

Relying on self-instruction augmented by rehearsal rather than rational analysis is a productive alternative (Dagnan & Jahoda, 2006; Willner, 2006).

If therapists elect to apply rational analysis, these methods need to be simplified and reduced to their core elements. Cognitive restructuring is more likely to be effective if delivered via modeling approaches than through complex Socratic dialogues (Shirk & Russell, 1996). Stories and other narrative forms may aid the compromised reasoning processes of children (Grave & Blissett, 2004).

Using child-friendly language is a must for most children but is especially crucial for a patient with language deficits (Moree & Davis, 2010; Stallard 2002a, 2002b). Shelby and Berk (2009) offered several scaffolding recommendations in these cases. For instance, index cards containing photographs or drawings instead of words could be used for less verbal children. Providing lists of emotions and coping thoughts for children with less developed verbal/language skills are good strategies (Moree & Davis, 2010). Writing material on a white board is a valuable practice (Sauter, Heyne, & Westenberg, 2009). Videotapes and pictures are methods that may resonate with children who tend to be more visually oriented (Holmbeck, Devine, & Bruno, 2010). Kendall et al. (2008) recommended the use of photographs as visual reminders of children’s brave approach behaviors.

Children who have well-developed visual spatial abilities may be more suited to approaches using imaginal stimuli (e.g., systematic desensitization, imagery; Ollendick & Vasey, 1999). For children whose visual-spatial abilities are not so well developed, Ollendick (1979) recommended using counter conditioning agents such as play, food, and music in lieu of deep muscle relaxation and presenting the anxiety producing scenes in vivo during systematic desensitization.

When concerned about anxious children’s receptive language, several scaffolding procedures are indicated. Donoghue et al. (2010) recommended the liberal use of verbal summaries by children to communicate their understanding and written log books to record key points in ­session. Suveg, Roblek et al. (2006) described the very creative the use of dance (“nervous dance”) in CBT with a cognitively delayed anxious child.

Zhu and Weiss (2005) noted that processing speed is correlated with working memory, fluid reasoning, and learning. More specifically, they concluded that efficient and rapid processing speed decreases demand on working memory and therefore enhances reasoning capacities. Anxiety in children may result in “cognitive dulling” (Davis, Ollendick, & Nebel-Schwalm, 2008, p. 50). Davis et al. (2008) noted that intrusive worries may result in constant and pervasive stress which zaps children’s available mental resources. Therefore, tailoring treatment plans to these abilities is recommended.

For children whose working memory and processing speed is impaired, coping skills need to be highly accessible, simple, and memorable. Highly distractible and easily frustrated children may require shorter sessions (Donoghue et al., 2010). Liberal use of handouts and mnemonic devices are indicated to prompt children’s acquisition of skills (Sauter et al., 2009). For example, one young patient (age 14) with impaired working memory found the mnemonic cue, “Think in 3 C’s. I am confusing convenience with catastrophe” a helpful self-instruction. Writing mnemonic coping thoughts (e.g., “Difficulty is not the same as disaster”) on ­colorful adhesive labels and sticking them to notebooks or inside lockers may resonate with children. Multiple rehearsals of coping thoughts and problem-solving strategies are also helpful. The use of technology for prompts (e.g., text messages from parents with coping thoughts or encouragement for exposures, tape recordings) can also augment treatment. Finally, photographs and videotapes are other commonly used strategies (Kendall et al., 1992). Table 6.2 summarizes the clinical issues and recommendation discussed above in this section.