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Abstract  
This paper reviews the literature of how three aspects of metacognition, relevant to working with children in clinical settings, develop across childhood. In cognitive therapy children use their metacognition to monitor the recall of thoughts from memory and to control thoughts as they are actively worked on and restructured. This paper will show that over childhood children usemetacognitive monitoring and control abilities in increasingly complex ways and it will provide the ages at which children may be consistently using the cognitive abilities necessary to fully benefit from cognitive therapies.
Keywords  Cognitive development – Children – Metacognitive processes
Introduction
Cognitive behavioral treatments have been widely used to alleviate a range of adult problems(Dobson et al. 2008; Gosselin et al. 2006; Mendes et al. 2008). Because of its popularity with adult populations, there has been much interest in adapting CBT for children and adolescents (Southam-Gerow and Kendall 2000). Despite the increasing interest there has not yet been a detailed examination of the cognitive capacities that are required for children to successfully engage in CBT. Without acareful review of what children are capable of certain CBT treatment components may not fit the developmental capability of young children. At the same time, we have begun to see more and more attention being focused on uncovering the underlying mechanisms responsible for effective treatments (Prins and Ollendick 2003; Sauter et al. 2009; Tryon 2009). Adapting CBT for younger children requires acareful examination of children’s cognitive development and the skills that are rapidly changing during this time including how children’s emerging metacognitive abilities influence their capacity to fully engage in CBT (Sauter et al. 2009; Southam-Gerow and Kendall 2000).
Cognitive-Behavioral Therapy Applied to Children
The cornerstone of CBT is that maladaptive ways of thinking about the worldare a cause of distress and correcting inaccurate thoughts is the hallmark of this approach. Under the umbrella of CBT several techniques can be used to change one’s thinking including cognitive restructuring (Southam-Gerow and Kendall 2000).
The participants in meta-analyses and individual CBT effectiveness studies that have shown the benefits in symptom reduction include young children. Althoughmeta-analyses are powerful tools to synthesize information, they do have certain limitations. Some of the limitations include problems in the design of the original studies that can be carried forward to the meta-analysis and influence the results (Thompson and Pocock 1991). These problems might include flawed treatment randomization procedures and poor compliance to treatment protocol in one ofthe conditions (Flather et al. 1997). In addition, it is more likely that study trials with favorable results, as opposed to trials with uncertain results, were published in the literature that the meta-analysis pools from, thus leading to an overestimation of treatment effects. Despite the above limitations the results of the following meta-analyses help to establish some guidelines regarding theages at which CBT is successful for children and can prompt future researchers to purposefully design new studies to examine the issue of the development of cognitive abilities in CBT outcomes.
A meta-analysis by Harrington and colleagues included 8-year-old children (Harrington et al. 1998) and the participants in another meta-analysis conducted by Reinecke et al. (1998) were 11-years-old andolder. Other meta-analyses, however, include children as young as 5- (Durlak et al. 1991; In-Albon and Schneider 2007) and 6-years-old (James et al. 2005; Shortt et al. 2001), but only one study has examined the effect of age on therapeutic outcome. Let’s take a look at the details of this meta-analysis a bit closer. In 1991, Durlak et al. conducted a meta-analysis of studies published between...