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When to Worry About Your Child’s Worries

Presented by Jerry Bubrick, Ph.D. ##

Join Dr. Jerry Bubrick, Senior Psychologist, from the Child Mind Institute for a presentation and focused Q and A on ‘When to Worry About Your Child’s Worries’. He will speak about children’s mental health, signs to look out for, what anxiety looks like in school, what parents can do, and when to get help.

Jerry Bubrick, PhD, is a senior clinical psychologist in the Anxiety Disorders Center and director of the Obsessive-Compulsive Disorder Service at the Child Mind Institute. He is a cognitive and behavioral psychologist who specializes in the treatment of obsessive-compulsive disorder (OCD). Widely recognized for developing one of the world’s most intensive pediatric programs for OCD, he is a pioneer in using cognitive-behavioral therapy (CBT) to treat children and teens with OCD and related anxiety disorders. He has led workshops on OCD and anxiety disorders, and in his role as a public lecturer he has presented at primary and secondary schools, academic medical centers, community health organizations and professional conferences.

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The New Jersey Center for Tourette Syndrome and Associated Disorders, its directors, and employees, assume no responsibility for the accuracy, completeness, objectivity, or usefulness of the information presented. We do not endorse any recommendation or opinion made, by any member or physician. Nor do we advocate for a treatment. You are responsible for your own medical decisions.
1:35
Now, I’m going to turn over the introductions of our speakers to Barbara …, the Program Manager of NJCTS
1:42
Barbara: Thanks, Kelley, and good evening, everyone, and thank you for joining us this evening.
1:50
Doctor Jerry Bubrick is a Senior Clinical Psychologist, in the Anxiety Disorder Center and Director of the Obsessive Compulsive Disorder Service at the Child’s Mind Institute.
1:59
He is a cognitive and behavioral psychologist who specializes in the treatment of obsessive compulsive disorder widely recognized for developing one of the world’s most intensive pediatric programs for OCD. He is a pioneer in using cognitive behavioral therapy to treat children teens with OCD related anxiety disorders.
2:19
Dr. Bubrick has provided direct patient care, supervised psychiatric residents, and train child and adolescent psychiatrists and psychologists and the CBT treatment for anxiety disorders.
2:31
He is, he also, co-authored Overcoming Compulsive Affording, the first book ever written on the topic.
2:37
A dedicated advocate for children and their families. Doctor Bubrick is a significant public voice educating parents and teachers about the fear at the roots of anxiety and how it’s effectively treated.
2:49
It is my pleasure now to welcome Doctor Bubrick and turn it over to him.
2:55
OK, hello, everyone, I’m doctor Jerry Bubrick. I’m a child psychologist at the Child Mind Institute, and, like Barbara said, I specialize in anxiety disorders. So, happy to have you with me tonight. We’re going to run through a presentation and have some time for questions and answers at the end.
3:13
So, let’s get started.
3:16
A little bit about Childs Mind Institute, if you’re not familiar with us.
3:20
We are a national, independent, non-profit dedicated to kids’ mental health.
3:25
We have kind of a research arm, a clinical arm, and a public education arm.
3:34
On the clinical side, we provide world-class clinical care to kids struggling with mental health issues, and learning disabilities, or disorders. We’ve helped thousands of kids in the in the tri-state area, and we have several intensive outpatient programs including my OCD program and we have one for selective mutism, which we’ll talk about later those conditions, but we see kids from all over the world who come to us for specialized care.
4:00
We also have the research division, We’re, we’re at the forefront of a lot of pioneering research.
4:07
One of our largest studies right now is called the Healthy Brain Network, where we are gathering 10,000 kids to participate in the study. It’s free. We actually pay them to participate.
4:21
We’re looking at wresting Set, MRI EEG, Psychiatric Assessments and Neurological Assessment, Sleep Assessment, really getting a good overall clinical view of them so that we could eventually one day be able to find biomarkers in the brain. So, we would be able to identify the brain of a child with ADHD versus an OCD versus a learning difference.
4:46
As, you know, all those conditions right now are, or, are, diagnosed by symptom report only, and we have a Public Education Campaign, where we really reach millions of people through our social media outlets, and our public education.
5:05
Campaigns. We work with educators, we work with policymakers, to really try to raise awareness of mental health conditions, decrease bias, and stigma, and make it so that no child really has to suffer with anything, that we’re able to bring treatments to scale.
5:23
Educate the public about what conditions are, and how to get help.
5:29
So it’s really an amazing place to work. I’ve been here for 10 years, and don’t see myself leaving anytime soon. I love it here, so it’s, it’s a, it’s a good place. I really believe strongly, in the mission.
5:41
OK, so getting into anxiety, Just some basic facts.
5:51
OK, so basic facts about anxiety For the past 10 years or so there’s been definitely an increase in anxiety in young people. We noticed that certainly before Covid, I would imagine. Now, there’s an even higher increase of larger increase in an anxiety and kids. At some point.
6:12
Roughly a third of children and adolescents will meet criteria for an anxiety disorder by the time they’re age 18. Yet over 80% of them will never get help and will bring those conditions into adulthood.
6:23
This is not an American condition. This isn’t a worldwide condition. Over 115 million people worldwide have suffered from an anxiety disorder at some point, and the age of onset media age of onset for most anxiety disorders as around the age of six. So, we’re seeing it at the slightly younger. And we’re, but we’re becoming better at detecting that we’re becoming better at diagnosing it. And we’re certainly better at treating it than we were when I started my career 20 years ago or so.
6:53
So, when we look at the graph, we can see there’s an overlap with anxiety disorders and ADHD and depression, and other mood disorders, and, certainly, eating disorders, and, there, you can see that at times, that the overlap and the severity can be quite high.
7:17
So when we’re looking at anxiety, it’s important to talk about what is anxiety. Anxiety is a normal adaptive bodily system that tells us where if we’re in danger.
7:27
It’s, it’s healthy. It’s, it’s our way arts are our minds. We have connecting to our body to let us know that there’s trouble, and we should prepare.
7:35
So, common symptoms that you would see an anxiety are. Any number of these starting with, you know, your, your skin. You might feel sweaty or shaky or heart beats really fast. I think that’s a pretty common feature for anxiety. for a lot of us. Changes in your breathing, your pupils, dilate, you may have an upset stomach or you feel like, you may have to urinate a lot, or maybe desiccate quite a bit.
8:01
You may have a dry mouth or you might have more saliva. So there’s a lot of different ways that we all feel it will talk about a panic attack, which is basically, like, all of these at the same time. But certainly, when you’re in any kind of situation where your brain is, detecting there might be some danger.
8:15
It’s normal to feel some of these symptoms, which are referred to as they fight or flight response.
8:22
So what makes some kids more anxious than others? Here, I usually talk about, you know, I have identical twin daughters, who are 16. They have the same exact DNA, although, DNA changes over time. But yet, they are wildly different people.
8:37
I joke with people that they are same height, weight, hair, color, hair length, but they have very different tastes in music and food and fashion, but they have to pee at the same time.
8:49
So it’s funny, that’s funny, in five until it with, but so we kind of look at this bio psychosocial model that kind of helps us to explain why some kids are anxious, and maybe why others aren’t.
9:00
We’re looking at this combination of the biological Predisposition, their temperament, their genetics, their physiology, combining that with their psychological characteristics, their own thoughts, and feelings, and behaviors, and how those things kind of coexist within their social environments.
9:17
So even though my daughters have the same DNA, they have different experiences, they have different friends, they have different thoughts.
9:25
And they have a different reaction and relationship with environments.
9:30
So one daughter may be very anxious when the other might be very common, one situation, and it might be reversed and certainly if you have twins, you know that they’re never the same all the time, but we look at this, it’s not just genes or just thoughts and behaviors or just the interaction with the world, it’s kinda how they all overlap and intertwine together.
9:51
So before we can talk about anxiety disorders and what they are and how they play out, it’s, it’s important to kinda think about what are what are called normative developmental fears.
10:01
What are normal fears for kids at certain ages?
10:04
We see in the ages of infancy, sudden loud noises, loss of support, being in high places, being around strangers’ separation from caregivers can cause very, you know, intense fear, but that’s kind of normal. And as they age, because they get older and they mature, those things stop being scary and they don’t have that fear anymore.
10:25
Coming into the preschool years, we start seeing kids being afraid of animals in the dark and imaginary creatures, zombies, monsters.
10:34
And they start having what we call anticipatory anxiety, where they’re starting to worry ahead about something.
10:39
Um, well, we’re going to talk a lot more about that, as we go further into the talk, as we get into the school age kids, are looking at specific realistic fears, how they fit in socially, how they’re doing with their school, you know, how they’re gonna be able to transfer it to a new high school, or eventually go to college, and starting to have those kinds of concerns and fears.
11:00
And then, we’ll get into the adolescent years. We start having thoughts, or fears about fears kind of the ability to abstract, think, abstractly about fears.
11:10
Very common for teenagers, to have this existential angst of, you know, what is why am I here, what’s the meaning of life. We’re all going to die anyway. So I don’t have to do my homework. So those are kind of normal developmental fears for, for adolescence to have.
11:27
So when it’s anxiety problem, there are these this is a very, if I have to think about the most commonly asked question, I get about anxiety, having been an anxiety specialist for the last 20 years.
11:40
I would say this is probably one at the top.
11:42
When it’s anxiety a problem, we look at these kind of three red flags, if you will, about how anxiety affects us, the frequency, the duration, and the impairment.
11:55
So, frequency means how often the symptoms come.
11:59
You know, if your child is anxious once in a while and it’s not that, you know, doesn’t really affect them so much, then that’s really nothing to worry about.
12:06
But if it’s every day or every hour or every morning or every Wednesday, you know, that’s that’s something a little bit different to look at.
12:13
The duration, how long do the two the symptoms last for when they come?
12:17
Are they fleeting? And they don’t really seem to bother anybody that much? That’s normal, great. But if they’re kind of lasting for hours on end, that’s a different story.
12:27
And the impairment certainly is a big feature, too, because, if you have some anxiety that’s there, and it’s, it’s, you know, it’s lasting awhile, but it doesn’t really bother you.
12:35
It may not be an issue, but if it really takes away from the quality of your life, affects you, prevents you from going to work, or to school, or going to play dates, are going to parties, a lot of resistance And doing things. And that’s a big problem.
12:52
So, you know, kind of taking that into consideration if I had social anxiety, which we’ll talk about later in the presentation, which is essentially the fear of being perceived in a negative way, or being judged or doing something embarrassing.
13:07
And I had this boat, you know, I have this condition, something like this, doing a presentation for all of you, would be very scary for me.
13:16
I may not, um, the fears might be unrealistic, might think, I’m going to make a fool of myself, no one’s going to take me seriously after this. They’re not going to laugh at my jokes, and I might, The anxiety might be out of proportion.
13:33
I might be thinking about it.
13:36
It’s going to be this catastrophic mess and it’s going to become a complete trainwreck.
13:40
I might be overly self conscious that, you know, this is just, there’s something on my face, the early looking at me. I can’t see you guys so you can see me. That’s my shirt, look, OK. Do I have a stain on my shirt like I’m going to be really into my, like thinking about myself and focus myself.
13:57
These thoughts, I don’t want these thoughts. They’re coming in there, but they’re bothering me. They’re not going away. And it might lead me to, to avoid. So, I might have called Barbara and Kelly and said, listen, I’m not feeling so well tonight. You can. The audience is going to be fine without this talk. I’ll do it next month.
14:15
So, these are the the ways that the frequency duration and impairment kind of play out.
14:20
The fears are unrealistic out of proportion leads. to avoidance. They don’t go away, You can’t have, you don’t really have any control, and you just can’t get out of your own way.
14:30
So, if any of those sounds familiar to you, and one of those, and if you have two, or three, or four, or five of them, the more you have, the more you should be concerned and maybe be reaching out for help.
14:42
OK, so these are the different types of anxiety disorders.
14:45
I’m going to go through each one, give you an idea of how the conditions play out, what they look like at home, and at school, then talk a little bit later about what parents and educators can do, Um, in response to these conditions, to help our kids overcome them.
15:04
Generalized anxiety disorder, you know, there’s there’s some interesting literature to be in the literature about where generalized anxiety disorder should live.
15:12
Categorically.
15:13
Right now, it’s listed as an anxiety disorder, But there are some people who believe that it should be listed with the mood disorders because a high percentage of kids who have untreated generalized anxiety disorder will go on and develop a depression or some sort of depressive disorder. So some people think it’s like a precursor to depression. But what generalized anxiety disorder is, are, these are, what if kids, these are kids who just worry about everything. Chronic and exaggerated, excessive worries about everyday life without real reasons to have those worries.
15:48
They may stop, they may not, they may worry a lot about. Families, health, money, family school, or my parents will lose their job. What if we lose our house would have a storm comes through and blows us close, Close the house away.
16:03
They tend to go to worst-case scenario very quickly and expect disasters.
16:08
They are, um, very hard on themselves. Those who did, they tend to have very perfectionist qualities. Girls are more likely to have this condition than boys, and it’s roughly in 1% of the population. So, what does this look like?
16:24
We see a lot of worries. How am I doing in school, even as young as like, you know, I seek G a D, and kids worrying about grades as young as third and fourth and fifth grades.
16:34
If I get a, If I don’t get an A on my third grade, If I don’t get an AMI test, I’m not going to make it to go to college.
16:42
So, we, as parents know, that’s ridiculous. But these kids feel so strongly about it, that it’s, it’s very real for them.
16:49
They are very hard on themselves. They tend to be perfectionist.
16:53
So, you know, again, like if I got a 95 on a test, I basically failed, because it wasn’t 100.
17:00
They always seem to expect the worst. They are irritable and restless.
17:04
They have disturbances with sleep. They have a very hard time falling asleep because they really can’t turn off their brains.
17:13
And when they laid on embed, it just acquired time to worry about lots of things.
17:16
They have a hard time falling asleep, they end up falling asleep, but then sleep through the night, but then they don’t get enough sleep, and they’re tired.
17:24
The next day, which doesn’t help anything for anxiety and cope with an anxiety, if you’re overtired, we’re gonna see somatic symptoms and a lot of these conditions, that means having headaches, stomach aches, aches and pains, that are directly related, from the impact of the anxiety, or the stress, without necessarily having an awareness that my stomach is hurting. because I’m so anxious.
17:45
Kids with GHG will sometimes think, in the mornings they’re so anxious about going to school that day for a test that, they have a stomach ache and they’re pleading with the parents. I have a stomach ache. Please don’t make me go. I promise, I’ll go tomorrow. When my stomach doesn’t hurt, but, so they’re not really seeing the connection between their anxiety and how the somatic aches and pains play out.
18:09
Social, anxiety disorder, I kind of talked a little bit about that before in the example of how anxiety is problematic, social anxiety disorder is not the fear of being in a social situation.
18:21
It’s it’s It comes out in those situations.
18:23
But what it really what it really is about is about the fear of doing something embarrassing while in that social situation or being perceived or judged negatively because of something they did in that social situation.
18:39
So it’s more about the fear of being perceived negatively than it is really about the social situation that just comes out in that situation more.
18:46
Again, the fear is disproportionate to the context of the situation, there is a performance only subtype here where the fear is really restricted to public speaking, like what I’m doing with you now, or some sort of performance.
19:00
Um, it’s very common in kids. The prevalence rates can be up to upwards of seven to 10%, and it’s slightly more common in invoice.
19:08
So what it looks like is?
19:10
Excessive shyness, it’s just easier.
19:14
two, I’m only gonna raise my hand in class if I know for sure I have the right answer, Because if it’s possible, I don’t have the right answer and I and I give that answer.
19:24
It’s possible someone might think I’m stupid, or they might not think I’m smart or they might make fun of me or they might tease me.
19:31
So, you see a lot of kids not really engaging in a lot of conversations, sometimes when they’re socially anxious. And not really participating unless they are confident they have the answer. They don’t. They’re not risk takers when it comes to asking questions.
19:46
They tend to engage in primarily solitary activities.
19:49
Again, so if I’m not, you know, I prefer to be doing something like us like swimming for myself than being on a team sport. Because it’s I don’t have to worry about my teammates making fun of me or, you know, being involved in that environment. I get to have my exercise, but I’m just kind of, I might do my own thing.
20:07
They tend to isolate in social activities.
20:11
Unless there are with really close friends or family, then they’re very confident that their themselves. But when, a lot of times, when a new person comes in or they go to their best friend’s house, and they didn’t know that, the best friend invited their cousin over and now, it’s a new person. And, what does the person thinking and what do they like me? But not like me, and they’re just kind of in their head worrying so much about how they’re being perceived.
20:33
Um, you might, they might talk about having feeling like, they’re blushing or, they feel, like, they’re, worrying about their trembling over there, with their words. Or, they may actually be trembling a little bit because they’re just so worried. And it’s very difficult for these kids to make eye contact, because that is really, you really are making herself very vulnerable when you make eye contact with someone.
20:54
And, a lot of kids just don’t wanna go there, so they will kind of look away, or they’re looking down, and it may seem like they’re not interested, So they get, kind of a bad rap, sometimes it’s not being interested socially, whether it’s exactly the opposite, they are very interested, but terrified, they’re going to make themselves look foolish.
21:14
Separation anxiety is having intense anxiety. When separated from a caregiver or a parents, it involves some persistent worry that something bad will happen to the caregiver, or the parents in the separation.
21:30
Um, so a kid might think, if you take me to school and drop me off at school, I’m going to be really worried, because what if something happens to you when we’re apart? What if you get in a car accident?
21:39
Or what if, know, someone kidnaps you or something so that the kid is really worrying more about the parents. Sometimes we see separation anxiety, the other way around, with anxious parents. Drop kids off at school and don’t want a separate, that’s not really separation anxiety, that’s more anxiety of the parent, but it’s, it’s, it’s funny how it can play both ways.
22:00
Most prevalent anxiety disorder in kids younger than the age of 12.
22:04
Age of onset is usually before the age of 10, usually more prominent in girls than boys and as can be outgrown.
22:11
So what it looks like is the refusal to go to sleepovers camp, slipway camps, sometimes school, or even sometimes sleeping alone.
22:22
Because, what if, when we’re sleeping at home, what if someone breaks into the house and hurts my family, So, I’d rather be with them, so we can be together? Right? We see a lot of reassurance seeking which we’ll talk more about later in the talk asking a lot of questions for comfort.
22:42
We see a lot of tantrums crying so, social withdrawal. And, again, those psychosomatic issues of headaches and stomach aches again without the awareness that it’s tied into the anxiety.
22:54
OCD.
22:55
Obsessive compulsive disorder.
22:58
I could talk about OCD and for another full hour.
23:02
It’s really fascinating condition I love treating it, I love helping kids with it.
23:08
Broken up into two parts, obsessions and Compulsions obsessions are defined as unwanted intrusive thoughts, images or impulses that cause a great deal of anxiety, and then compulsion or the things that people do to reduce things out from those thoughts.
23:22
If you think about, I grew up in Minnesota.
23:27
I joke sometimes like the mosquito is like the state bird, but if you get bit by mosquito itches, and to make it feel better, you will scratch, and while you’re scratching, it feels OK, but when you stop scratching the edge and gets worse.
23:40
So the very thing you’re doing in the moment to make it better is actually making it worse. And that’s exactly how OCD works. Kids will have worries, or excessive worries about contamination.
23:52
Even beyond the, the Contamination worries, we have now with the pandemic.
24:00
About germs or toxins. They may worry about catastrophes or bad things happening to a loved one.
24:06
Excuse me. There’s something called magical thinking or superstitious, thinking and OCD that somehow.
24:13
my thoughts will affect the fate of myself for someone else, scrupulosity or worrying about offending god or doing something blasphemous. Now, sometimes nicknamed the disease of doubt.
24:24
And sometimes there isn’t any of these kind of specific worry is associated with thought. Sometimes it’s just, I won’t feel right unless I do my ritual.
24:33
And then the rituals are this is the type of scratching. The ritual is the thing that’s doing, making it better the moment, but actually making it worse over time.
24:43
And those rituals are we refer to as compulsion, …
24:47
Are things like checking, again, seeking reassurance, counting, arranging. You know, if I have a if I have to scratch myself here, I might scratch here to make that even are symmetrical.
24:58
Things with tapping and touching washing.
25:02
But washing to the point sometimes where hands get no red and cracked and bleeding in the winter, it’s very sad to see sometimes.
25:11
About a quarter of the cases will have onset before the age of 18 cases, and in childhood are more common in boys and girls.
25:20
So, what this looks like is a lot of reassurance seeking.
25:24
Sometimes kids may ask 10, 20, 30, 50, 100 times a day for reassurance, or you shy touch this.
25:32
Had a kid today that has a worry, that if someone touches their head, they’re going to have brain damage.
25:39
So, what, you might get a kid coming home from school and saying, we’re playing dodge ball and the ball may have hit my head. Do you think that’s OK? Do you think I’m gonna get sick? Am I going to have brain damage or is do you know, is this gonna make me throw up or, you know, there’s all kinds of questions that kids my kids might ask.
25:56
It’s easy for kids to stay stuck on tasks.
26:00
You might see a lot of retracing or repeating of actions. Retracing means that you’re really kind of going back.
26:06
So, if I have a worry that maybe I left something important behind when I left the classroom, I might go back to the classroom to check or if I went up the staircase to my classroom on the far end of the building.
26:20
If I have an obsession that if I don’t go back the same way I’ll have about, I’ll fail the next test. So, even though my other classroom isn’t my next classrooms on the other side of the building, I’ll go back down the same staircase I went before because that’s going to make the bad thing that happened.
26:34
You know, interestingly, a lot of kids most kids with OCD will say, I know. this sounds ridiculous. I just feel so anxious, I feel compelled to my rituals.
26:43
So we see as excessive checking of blocks and doors and windows the stove. There’s a lot of distractions and attention. It gets misdiagnose for ADHD all the time. If I’m sitting in class and I’m thinking, did I check to make sure the stove wasn’t on, was off when I left the house, I think I checked it, but I’m not sure. And then the teacher calls somebody, Jerry, what’s the answer? The question on the board.
27:05
I don’t know. I’m paying attention to that. So the teacher, it might look like I have an attention problem. So it’s really, we talk a lot about, We’re not so focused on the, on the behavior. We’re trying to figure out what’s driving that behavior, because that’s more of concern to us.
27:17
Um, you may see a lot of avoidance of triggering situations. We talked about the tapping and touching.
27:23
And certainly, kids who have OCD, they’re thinking more than the rest of us.
27:28
And so it’s common for them to talk about feeling tired, and fatigued a lot.
27:36
Selective mutism, it’s kind of like social anxiety on steroids for little kids.
27:42
It’s the fear of speaking in certain social situations or environments. Severe distress is experienced when the expectation is for them to speak.
27:52
It’s they’re not being wilful They’re not being oppositional there.
27:58
It’s kind of, like I said before, it’s just easier to not speak than it is to speak in people to people when there’s an expectation to when you’re this anxious.
28:08
It happens around the age of five, or typically before the age of five.
28:12
A lot of times these kids are talkative, chatterboxes at home, where they’re comfortable, and as soon as they go out into new situations or in high pressure situations, they don’t talk at all.
28:24
And it’s not because they have a cognitive delay or they have a language delay.
28:29
It’s there’s nothing there. They’re neuro typical. They are just highly anxious in these situations.
28:36
So what it looks like? Because, again, these kids are really talkative at home are places where they feel comfortable, highly restricted speech in situations where talking as expected like the classroom, They may want to avoid situations altogether. They don’t communicate needs, which is heartbreaking. Because we’ll have a lot of kids, soil, themselves in classrooms, because it’s too big to anxiety provoking to raise their hand and say, I have to go the bathroom.
29:03
You can imagine this results in a lot of being teased, and bullying and offspring ostracized.
29:08
And that may also lead to school refusal behaviors and like, in separation anxiety, you can imagine how nightmarish it probably has to go into this environment and be separate from your parents. So we see a lot of separation and difficulty separating for parents, especially in these, to these situations.
29:28
Specific phobia kind of place.
29:32
It gives me kinda plays out like OCD, very similar, live in the same similar part of the brain, similar symptoms, similar treatment response. But these are more specific and not just general, as you might see with OCD.
29:47
So, these are unrealistic and expressed excessive fears of certain situations or objects. Darkness, strangers, animals, dogs, especially to take a hit here. Snakes. Seeing blood.
30:04
Having needles and vomit. Vomit is often that the Fear of vomit, as we see, this more closely tied to our city is sometimes referred to as a metaphor via.
30:14
You can imagine if, So, again, going back to my daughters with the identical twins, one of my daughters, freakishly, likes having her blood be drawn. Like, It’s like she, She looks forward to it kinda weird, but I think it’s kinda funny. The other daughter needs like 14 nurses to hold her down because she’s terrified of needles. But, you can imagine, like, for a child who might have diabetes or, and there has to have blood checked a lot, to not want to have to have, you know, 19. So, it’s fitting that people hold them down isn’t a pleasant experience. And that’s not something they’re jumping up. Saying, oh, let’s go to the doctor today. I really want to be tortured.
30:49
So, we’ve seen a lot of avoidance in those situations.
30:53
Prevalence is about 5% of kids and hired in the teens, 15, 16%, and in adolescence. Twice as common and girls and boys.
31:02
So again, what it looks like is, again, this these chronic patterns of crying and aggressive behavior, clingy, tantrums behaviors related specifically to the being exposed to these phobias.
31:14
So in general, they’re happy go lucky kids. But as soon as you start start talking about dogs, you start talking about need or the needles are getting blood drawn or getting a shot.
31:23
These kids kind of melt down and have they don’t have coping skills to deal with the high levels of anxiety and stress, they feel.
31:31
Um, they may be restricted in their food.
31:35
They may be super picky eaters because they don’t want to have this food, touch that food, because maybe if they do touch there, they’re not supposed to be touching maybe in the stomach. They’ll have, they’ll get sick.
31:45
I mean, the logic sometimes doesn’t make sense, but it does to them if it means that they code, reduce or eliminate the possibility that it could happen.
31:56
And a lot of times, these kids don’t recognize that the fear is irrational.
31:59
They might say dogs are to be fear of dogs by people, and they can show you videos of where that happens on YouTube or something, and they see this as real. So they don’t necessarily recognize that their fear is irrational.
32:13
Panic disorder we talked about at the beginning of the talk, if you have all of those symptoms that we talked about with the fight or flight response.
32:21
The symptoms on the right-hand side here palpitations increased heartbeat sweating, shaking, feeling dizzy or faint Chest pain or tightness feel like you’re joking or you’re: You feel nauseated. You have all of those symptoms at the same time.
32:36
That That coming back to the what is inside the second point, what’s interesting that people with panic disorder, panic attacks is that they misinterpret those symptoms as the signs of a heart attack or a stroke and they end up in the emergency room thinking that they’re dying.
32:53
Then they have, after that, they have a panic attack.
32:56
They can have continued worries about having another one, um, so a lot of times.
33:04
So, for example, if, if I have a panic attack while crossing the bridge, I might think, you know what, that was highly unpleasant.
33:12
I’ll just avoid bridges. So I don’t need to leave the city anymore, I’ll just stay here. There’s everything I need is here, Fine, don’t worry about it. Right? So, or if I, but, you could maybe justify that in some weird way, but it’s harder for repairs to justify a kid saying, I had a panic attack in math class. Therefore, I’m not going back to math class, because I don’t want to have another panic attack.
33:36
So people make that association, about where it happened, and think that if they go back there, it’s going to happen. Again.
33:43
Very common, very uncommon, excuse me, to see this in kids younger than the age of 14.
33:50
And more common in girls than boys.
33:53
So, again, we see avoidance of these situations, where they think it could happen. They often fear having another attack, or that they’re going crazy, these kids, like kids with generalized anxiety disorder or the nurse’s office quite a bit. Are they seeking, they’re seeking out doctor’s appointments.
34:09
And it’s, it’s, again, it’s highly unpleasant to experience that, and then the worry about it happening as is almost as scary for these people, OK? So, those are the anxiety disorders.
34:21
So, now, I’m coming into what’s, how we treat them. So, overall CBT cognitive behavioral therapy is the most effective treatment for the anxiety disorders.
34:34
Really state-of-the-art treatments where we’re looking at, kind of changing the, the, it looking at this, what we call this, this triad of our thoughts, feelings, and actions think, feel do about our thoughts.
34:48
Create feelings, our feelings create, or our behaviors, and we decided to do things because of those feelings, and then how we do those things. Re-enforces, you know, how we feel about them.
35:01
So, like, if, like, you know, if I’m have social anxiety, and I think, you know, if, if I go to a party and I make a fool of myself, so I don’t, I’m not gonna really talk to anybody. And then I choose to kinda stay in the corner, and then, no one talks to me. I could say, well, see, no one really, really interested with me, anyways, because no one talked to me.
35:21
But they’re not really aware, like, well, maybe they’re not talking to you, because you were sitting in a corner looking down the whole time, and not looking super approachable.
35:29
But though that kind of process between our thoughts, feelings, and actions to how they intertwine is really what we’re doing in CBT is we’re looking to change that cycle.
35:40
That if we can identify thinking errors that no one is a perfect thinker.
35:44
If we could identify where your thinking is, distorted or flawed in some way.
35:51
That we can then change how you feel and then what you do.
35:56
So, and we’re helping kids face their fears rather than avoid them. I use this quote from Robert Frost all the time, the only way around us through that we’re not going to be able to overcome your fears by avoiding them. The only way we’re going to overcome them is to face them.
36:16
So, part of what we’re doing is, is, it’s modeling the right mindset.
36:22
I love this slide.
36:24
I have, if you were here with my with me and my office, you would see it posted all over my, my, my board behind my computer, I’m usually giving lists like this on paper to, to everyone I work with.
36:36
I love this slide of thinking about the right mindset, that we’re, if we’re in a growth mindset.
36:43
We’re being very open minded about who we are, that life is about learning and learning from mistakes, that mistakes are good.
36:51
They help us grow, and we’re able to be vulnerable and see vulnerability as a strength. It’s really the work of Rene Brown.
36:58
It’s this amazing sociological researcher who looks at, she’s done a lot of work in guilt and shame and recently in vulnerability.
37:07
And interestingly, she has found, and it certainly makes sense, that people who see vulnerability as a strength tend to have more loving connected relationships than people who see vulnerability as a weakness.
37:19
If you’re in the growth mindset, you see vulnerability as a strength.
37:23
So you would say to your thing, see yourself things like, failure is an opportunity to grow. I can learn to do anything. I want to do.
37:29
Challenges helped me grow.
37:32
Feedback is constructive. I like to try new things. There’s this kind of, You know, it’s not this kaki, like, I’m the best in the world kind of mentality. But, it’s like, confidence, I can do this, and if I fail, it’s OK, I’ll grow from that.
37:45
Whereas, if you’re in the fixed mindset, it’s more about your, it’s it’s more categorical failure. is the is that the evidence of the limit of my abilities? I’m either good at something, or I’m not.
37:58
I don’t like to be challenged, I can’t do something.
38:01
When I’m frustrated. I quit.
38:04
I stick to what I know, right?
38:06
So, we’re really trying to take someone with a fit, an anxious fixed mindset, looking at those thoughts, feelings, and actions, and helping them kind of become and grow into a growth mindset.
38:22
OK, so it’s super important to understand this, what we call negative reinforcement cycle of anxiety.
38:28
You know, in psychology, we come up with fancy words for easy topics, because it makes us feel important, but that this is a really easy.
38:36
Crafter, circled cycle to understand, really, as a parent, and certainly as a teacher, how this works?
38:44
So, let’s say that I’m Jerry and I’m a student and a school, and I’m gonna give a presentation in front of the class, and it’s, it’s the morning before school, and I’m thinking to myself, There’s no way I’m going. I’m going to make a fool of myself, my classmates, are going to laugh at me. This isn’t gonna go well, and I started to get really anxious. I start were opened my parents and mom, dad, you gotta help me. I can’t do this.
39:09
I don’t feel, Well, I promise, I’ll go tomorrow. Don’t make me go today. Or they may seek a lot of I might seek a lot of reassurance my parents. Are you sure it’s gonna be OK? But if I make a joke of myself, What if someone laughs at me and then the parent might say, Oh my gosh, all right, you know what?
39:24
Let’s just not go today.
39:25
You’re too anxious. Let’s just chill out for today.
39:29
Which makes me the Jerry, the kids, feel great because now I don’t have to worry about this stuff today. And my parents now get to chill out because I’m not bothering them with all my anxiety.
39:40
So both child’s anxiety and parents’ anxiety is lowered until the next situation comes.
39:48
So me as a child all I’ve learned in that situation is anxiety is insurmountable and if I Um, if I complain about it enough, not in a, in a, in a manipulative way. But if I express it enough and I talk about it enough with, with someone, they’re gonna take me off the hook.
40:05
And so, taking me off the hook becomes my really bad coping skill.
40:10
So, parents often become kind of like Aiders and Abettors, if you will, of the anxiety process, by doing what would they think is coming from a loving place of not wanting your child to suffer?
40:21
But what it actually does, just make the child more anxious over time, because now, you’re scratching for them.
40:30
OK, so, These are the kind of the ways that parents will inadvertently play a role in the child’s anxiety symptoms.
40:40
Participate in the child’s act, Anxiety behaviors, helping the child avoid anxiety provoking situations like the example which talked about, changing family routines.
40:51
So, Jerry, if you’re afraid of of, of bridges and you don’t want to have a panic attack on the next bridge, it’s OK for our next family trip will just figure out a way to take tunnel’s instead of bridges, right?
41:01
You’d be surprised how much families will cater to kids anxieties for the kind of the keeping the peace, if you will.
41:12
Families often provide reassurance, which, we’ll talk about a little bit more at the end, about why that’s bad. It’s really just another form of scratching.
41:22
Taking on extra responsibilities, um, making changes in your own lives, or your, in your family’s lives.
41:31
So, we’re help, we’re enabling by helping the children of avoid doing what they fear.
41:39
But, in the end, what we really wanted to work with, with parents and teachers, is not helping them avoid their fear.
41:45
We want to help them face their fear, and manage and tolerate their anxiety in the process, so that they can learn to be anxious and still, function, instead of, if, I’m anxious. I can’t function.
41:57
Which is kind of how it usually plays out, So, our job is to not necessarily give them the answer or fix the problem for them.
42:05
Artists are, our job is to help them face a situation and tolerate the uncertainty, or tolerate the discomfort.
42:13
And that’s really what builds confidence, and grit and perseverance and resilience, right, that I like.
42:22
I was really worried about the talk. I went, I did it!
42:25
It was hard at times, but I managed to get myself through it, And you know what? I can do that again?
42:32
That’s the process that we want kids to experience, but they’re never going to experience that if we’re allowing them to avoid the situation at all.
42:41
OK, So, now we’ve talked about what not to do. That we’re gonna talk about what to do, So Helping Anxious Kids starts with education about anxiety and mental health. You guys can check that box off for joining the talk tonight. Certainly, read as much as you certainly as you can about the anxiety and mental health.
43:01
I always talk about with families, If you know your child has an anxiety disorder, you should educate yourself about what that condition is. As if your child had diabetes, if your child was diagnosed with diabetes, you’d be reading like crazy about what that condition is, how it works with the treatments, are, what to do, what not to do. But somehow, we sometimes think as parents, like, well, someone will figure it out, someone will help the kid with anxiety. But really helpful to learn as much as you can. Establish an open communication with your child. Being open to interventions with school.
43:33
Connecting with the school, listening, without jumping to problem solving problems.
43:40
I talk a lot about in these talks about how our job as parents changes over time.
43:49
And our job as parents, and when my kids are young is to be fixtures and protectors, we put little things in drawers. They can’t push fingers. We block staircases that can fill up or down.
44:00
If something’s going on at the school, we call the teacher, they want to play date, we call the parent, falls off his bike, we patch them up and send them on his way.
44:07
But, at some point, the job changes. We become more like consultants.
44:12
And certainly, teachers fall into this role as well.
44:15
Where our job isn’t to provide the answer to their anxiety. Our job is to help them figure out solutions for themselves.
44:22
Um, so.
44:26
So, you know, if your child is saying, I’m so anxious about the test and you say, Oh, don’t worry about it. You always worry about these things, but you always to create your kind of and fix it mode.
44:35
Whereas if you said, you know what? I hear you, you’re really worried. What are some things you could do to feel better here?
44:41
Now we’re having a conversation about thinking about coping skills and ways to get through it, and you’re being more that consultants instance instead of the fixer Modeling. Not anxious. Coping strategies is super important. Your kids are sponges, they absorb everything you’re doing. They listen to everything you’re doing and they learn from you.
45:01
So let’s say you are walking with your child and you are afraid of dogs, and you’re holding your child’s hand, and you see a dog and you grasp your child’s hand. titre, you pull them closer to you and you walk away from the dog.
45:16
What your child is learning is?
45:19
Dogs are to be feared. Moms are afraid of dogs. I should be afraid of dogs because they’re scary, they’re dangerous.
45:25
So instead, what it has helped?
45:28
It’s more helpful to be able to say to them, Know what?
45:31
I don’t love dogs, they’re, you know, they’re they are they are what they are. I don’t, I don’t love them so much. I’m a little bit of afraid of them. But you know what?
45:41
I’m going to take a deep breath.
45:42
I’m going to walk past it and be brief, and then get past it and be like, well, that was scary for me, but I did it. I’m so proud of myself that I did that. Now, your child is learning a very different way to react or to, to a scary situation.
45:56
Excuse me.
45:59
I brought that word, critz up before about, you know, getting a sense of confidence with our kids about how to foster that grit, that ability to work through problems, sees challenges as something to overcome.
46:13
I think about the slogan from member from the marines are improvise, adapt, overcome.
46:20
Right. You never hear the marines say, well, it seems too scary, we’re going to pass today.
46:25
So this idea that we want to help our kids face or face their fears and overcome them, and manage them, because that’s what’s going to develop grit.
46:37
So we want to promote that perseverance, but not in a controlling way, We want to help coach them through like that example I gave about. I hear you. You’re anxious.
46:46
What are some things you can do here to be better?
46:48
How can you face this and be strong and brave?
46:53
We want to recognize and celebrate efforts.
46:56
If there’s one thing you take away from this talk, that is the one I would highlight for you. We want to recognize and celebrate effort, not outcome.
47:05
That if, again, using my daughters, they are taking the same tests in science. one of my daughters studies are hard out, goes to extra help. Us forms a study group is really up studying late at night.
47:18
It gets a B on the test. The other daughter could care. Less, doesn’t, study, barely, raised, no extra help, and gets any other test. As a parents, I’m going to be more proud of the first daughter, because of the effort that went into it.
47:32
So, instead of saying, great job on your test. I love that you got to that grade.
47:37
It would be way better if you could say, you know what, I know you were really worried about that science test. I’m so proud of how much effort you put into studying to it.
47:44
For it last night, that’s much more motivating and much more real for the kids. And we want to recognize and celebrate failure. It’s not a typo. It’s, it’s supposed to say that.
47:56
Going back to the growth mindset.
47:58
You know, what she got? You got a couple wrong on this test, are you that?
48:01
you take this test OK, let’s learn from it and let’s try again the next time Because or you know, it makes me a little crazy when the kids will take a test and they’ll say I got an 85 of the test What did you get wrong? I don’t know.
48:19
Well, the whole point of the test is to learn. Right? So I talked to teachers a lot about when you, when you give a test back, don’t just give the grade.
48:26
Have the kids go back and review what they got right, and be happy about that, and what they got wrong so they could learn from that and feel like if they had to do that again, they would do better, because they know what they did wrong.
48:38
And certainly, we’re never going to get grits by quitting.
48:41
So, again, there’s something, something we can model for them. But we never quit on a bad day, and I don’t even like the idea of a bad day.
48:48
You could have a bad moments, you could have a bad experience. But the day is, is a collection of experiences, so you had 1 bad 1. But how many good ones that you have?
48:57
I don’t, I don’t like the idea of marking days, good or bad.
49:03
We talked about modeling appropriate reactions for your kids stress. Don’t be afraid to talk about your child’s feelings, Don’t be afraid to talk about your own feelings, It’s perfectly fine for you to say it unhealthy for you, to say to your child, you know what, I had a rough day at work today. My boss wasn’t so nice.
49:18
She, or he said these things to me, I kinda deserved it, But I thought about it, I took a deep breath, I thought, You know what? She’s got a point. I do these things.
49:28
And I I, I kind of, I realized, for myself, I have to make these changes, so it wasn’t great, but I learned from it.
49:36
Imagine that conversation with your child and what your child takes away from that conversation rather than How was Workday mom fine? Was your day fine?
49:43
Right, OK, reassurance seeking.
49:48
In general, it’s it’s a very confusing topic, but it’s super important when we’re talking about anxiety about what to do, and what not to do. A reassurance question is a form of accommodation we see in kids with anxiety. Where they’re seeking comfort from some outcome that they’re fearing. They repeatedly asked questions.
50:06
They already know the answers to an assurance is something a child doesn’t know the answer to.
50:12
Who’s picking me up from school today? Your father is OK now. The child already heard the answer. If they’re seeking a reassurance, They’re saying, Are you sure it’s going to be him?
50:22
I didn’t know it’s going to be him.
50:24
What? you said five o’clock because it really going to be five o’clock, what time-stamp it came up again. So they know the answer but they’re they’re trying to quell their kind of eliminate this doubt or this uncertainty.
50:36
Uncertainty and doubt is the hallmark.
50:38
It’s the core of all anxiety disorders difficulty tolerating uncertainty.
50:43
Our job is not to give them the answer. Our job is to help them tolerate, not knowing.
50:49
So that reassurance provides that short-term relief. Like that scratching ends up making … worse and in the long run. So, some examples of this, am I going to get sick from eating this? Are you sure you lock the door? Did you wash your hands?
51:01
So, what you can do instead is encourage them to practice being uncertain, right? Use lots of praise. When you talk about being brave, I just answered that question. I want you to be brave and go with what I said, because I don’t want to say it again.
51:19
Right, I know that it’s really hard for you.
51:22
I’m not going to answer that again. Hold onto what you know and do the best. You can be brave, that’s our really amazing way to respond, instead of continuing to give them the answer.
51:34
Prompt them to use their coping skills. Give them confidence, I know you could handle, I know this isn’t easy for you, but I believe in you, you can get through this.
51:42
And, again, praising for being brave.
51:48
Again, more things that we can do. We just talked about praising efforts towards approaching difficult situations.
51:55
We can certainly create reward systems for kids.
51:58
We know that facing anxiety is hard, so if we can incentivize them a little bit to have rewards for facing them, then the rewards help.
52:08
And over time, as the kid learns that they can, um, face those situations and they get a sense of confidence. They don’t need the reward anymore because the reward becomes the confidence to be able to do it again.
52:20
The reward is just really like training wheels to get them off the ground.
52:24
We want to be a cheerleader for encouraging kids to face fears and like we’ve talked about, model approach model behaviors when, when, when appropriate, kids who have anxiety disorders and mood disorders and learning issues thrive in structure.
52:41
Try to establish family routines, try to establish routines in the classroom.
52:46
I just worked with a family this morning who, since the beginning of …, had, like, six moves, and one of the children just, was like, I’m not having it every time there’s a move, there’s a breakdown, there’s a meltdown. It’s something new to get used to, and as soon as she gets used to it, there’s another transition.
53:02
So that’s really tough.
53:03
Obviously, you can’t always control for that, but I think giving advance notice, hey, this is coming.
53:10
Know, if you ask kids, What time does third period started school, they have, it will say like 127. They know that down Pat, because they know what to expect. But then the weekends, things fall apart, there’s no structure. So, you may want to give a little bit of a of a of an itinerary for the weekend, not minutes, a minute or hour to hour. But like, hey, these are the things that we’re doing in the morning. These are things we’re doing the afternoon and give a sense of what to expect.
53:37
And then working with school.
53:40
Sometimes it’s helpful for case of X and a tablet that timelines for tests or papers, ability to use a private room for assignments or for tests, so that they don’t have to necessarily worry about who’s watching them and who’s done first. And, Oh, my gosh, They’re done first and knowledge. And are they smarter than me? And what’s in the super caught up in that? So having ability to do things privately could be really helpful.
54:04
And then, using your own coping skills.
54:09
We talk a lot about you are only as happy as your least happy child. But at the same time, if you’re not taking care of your own mental health, you’re not going to be a very effective parent for them. And they think about the, the thing on the rule, on airplanes, they go through the whole safety speech, and they say, In the, in the case of emergency, the Austrian max will will come down.
54:30
Place yours on first before helping your child.
54:33
Right.
54:33
There’s a reason for that because they want you to be in charge of yourself, because if you’re not in charge of yourself, you can’t help anyone else.
54:40
So please, as parents, think about taking a break.
54:44
Doing some meditation and mindfulness.
54:47
It’s OK. To delegate tasks to your spouse or your partner, and just say, I need I need a break schedule in an hour or two every day for yourself, and you can tag teams with that. Really important that you take care of yourselves in order to effectively apparent kids. Especially kids with anxiety disorders. Just kind of wrapping up a little bit. It’s also important to think about being aware of triggering events.
55:11
What might lead your kids to be more anxious?
55:15
Poor nutrition, not getting enough calories or nutrition and during the day, medication side effects, illnesses, transitions, unexpected, things, noisy, crowded hallways, then it just in general being more it’ll irritable, or sad. If they had an issue with a friend, it’s gonna make it harder for them to fight through and face their anxiety. they might be more likely to, to avoid.
55:38
So just be aware of what’s going on at your child’s children’s lives, and then kind of ending the general do’s and don’ts kind of a summary of today.
55:49
We want to express positive and realistic expectations. We want to listen to and respect our kids feelings.
55:55
We want to help our kids tolerate the anxiety and not avoid it.
55:59
We want to help them think through and be that good consultants that we’ve talked about.
56:03
And we want to model healthy ways of dealing with anxiety for ourselves.
56:08
We want to stay away from avoiding things that we know might make them anxious. We don’t want to ask you the questions: How was your anxiety today? Not a good question. We don’t want to reinforce fears or avoidance.
56:22
And we don’t want to give a lot of reassurance, and again, the goal of this for parents, and certainly for educators, is not to eliminate anxiety. Our job is to help them manage it.
56:33
That’s it.
56:36
So, thank you for listening.
56:39
I hope you enjoyed the talk, and I’m happy to answer any questions you may have.
56:46
Thank you very much, doctor …, for that really informative presentation. Lots of great information and great suggestions in terms of helping folks to manage manage anxiety, so we have just a couple of questions that will that will toss out to you. So someone is asking if an older child or teenager had panic attacks for several years ahead therapy, and I guess then they improved, is it possible to have them, again, when the person is an adult?
57:18
No idea. Until you can go.
57:21
So Yeah.
57:24
I mean, it’s, it’s possible, You know, It also depends on when you say the child’s had therapy, OK. So there’s different types of therapy.
57:33
As you all know, if someone kind of was able to go to a therapist and kind of talk about stuff and make some sense of things. And kind of realized like, they didn’t, you know, need to be so worried about certain situations and that made them feel more relaxed.
57:50
And the panic went away, that’s wonderful, but if they didn’t learn skills to manage the panic or know what to do when the panic attacks come, then if situation triggers the anxiety, yeah, it might come back, it might develop again.
58:04
So, it really I think it depends on what kind of therapy was done, what was done in the therapy. And even with good treatment, even with good solid CBT, whether you’re learning the skills, you could get rusty on those skills. If you haven’t used those skills in a couple of years.
58:20
And you have, you know, a flare up of anxiety, and you forget to use your skills, you could have a panic attack, which would then make you more worried about having another one. So.
58:30
So the good news here is that if you were successful and treatment before, you’ll be successful in treatment again.
58:36
You just have to get kind of a booster or what we call booster of those skills.
58:42
Might just be a few sessions OK, great. Thank you.
58:46
Someone is asking it about positional disorder. Let’s see where I can find the question again.
59:00
Is oppositional disorder linked to anxiety and a second question, could anxiety be driving self harm thoughts and lead to acting on it?
59:14
Yup, OK, good question.
59:15
So so there’s there’s there’s a difference between being oppositional and having oppositional defiant disorder, OK, it’s very common for kids to have anxiety disorders and be oppositional and response, or exhibit oppositional behaviors, because of the impact of the anxiety. A really good example of this, is, I worked with a young boy, he was probably 12 or 13 at the time.
59:45
When I met him, he had just been, through this really kind of intense situation.
59:51
At school, where a kid, I told him that this girl in class wanted to, he wanted to show her show, he wanted, the kid wanted him to see a picture of this girl in the bikini and she said, Well, now, she wants to see a picture of you, in a bathing suit and he got completely freaked out.
1:00:09
Highly anxious did not want to do that, didn’t know what to do and ran out of the classroom, running down the hallways of the school.
1:00:16
And, um, got to the principal’s office and did not was, the principal was kind of like blocking the door.
1:00:24
So he kind of pushed off all the papers on the desk, and he kind of trash the principal’s office. They called 911.
1:00:31
And he was taken to a hospital where he was diagnosed with his oppositional defiant disorder.
1:00:37
But when I met him, I kind of walked them through. And I was like, well, what really happened?
1:00:41
And he was just mortified that someone he didn’t want to see this picture in the first place, and he was terrified of having to show a picture of himself. He didn’t really want to do that. And he was afraid, if he did that, what the reaction would be.
1:00:53
So, he just kind of lost his cool.
1:00:56
But he was the mild mannered sweet kid, But in that situation, when highly anxious and having no coping skills for the anxiety, it’s easy for kids to be disruptive. So I think we have to, again, not focus on the behavior but focus on what’s driving the behavior instead.
1:01:14
And there are kids who have a true, existing kind of co-occurring oppositional defiant disorder with anxiety. But I did. But I think that’s, that would be, that the opposition Audi is completely separate from the anxiety, the kid could be completely calm and not anxious, and breaking a lot of rules and being argumentative. and there’s nothing as his or her fault. So I think that those two things could coexist.
1:01:39
Um.
1:01:43
I lost the second part of the question. What was the second part? Me one second. We’ll come back to it. I had at the beginning.
1:01:52
Hmm.
1:01:55
Could anxiety be? Driving self harm thoughts on it? Yep, so again, there is a self harming kind of condition, and there’s self harming that could be in response to anxiety. So, again, we’re not so focused on the behavior, even though self harm is scary, looking more at what’s driving the behavior. So, I have a young man who I’m working with now who has OCD.
1:02:24
And anytime there’s a conflict in the, in the situation, there’s, um, yelling or there’s some sort of conflict at school, there’s a debate, and he’s getting very anxious because he’s worrying, Did I say something that made them kind of react to the thing he’s thinking and it says fault, and he starts to then hit his head really hard so that everyone stops doing what they’re doing and focuses at him. And then the hitting himself stops the tension from happening.
1:02:52
So that’s an example of where the anxiety could lead to it, but it’s not because there’s an intention to hurt themselves. The intention is to stop the anxiety from happening.
1:03:02
Whereas someone who has self injury behaviors because they’re depressed, is a, is a different entity.
1:03:11
So when, you know, when we’re talking about cutting, or scratching, or some sort of self injury, that’s unrelated to a specific anxiety. It’s more about mood.
1:03:22
Kids are self injuring for 1 of 2 reasons.
1:03:26
They’re either self injuring, because they’re so overwhelmed with emotion that they can’t think straight. So that cutting themselves or something gives them something to focus. The pain gives them something to focus on, instead of all the madness in their minds.
1:03:39
Or they are they are feeling so numb.
1:03:42
They don’t feel anything.
1:03:44
So cutting or injuring themselves gives them pain gives them something to feel.
1:03:49
So again, I think it’s not just the behavior that we’re looking at. We’re really trying to figure out what’s driving that behavior and treating what’s driving it.
1:03:56
It is more important than looking at just the behavior itself.
1:04:01
OK, great, thank you.
1:04:03
Yeah, just a couple of other questions, so one is, somebody’s asking about someone who is 13 year old?
1:04:14
Girl diagnosed with generalized anxiety disorder, but also has other symptoms of some of the other anxieties you describe such as fear of vomit needles, panic attacks, separation anxiety. And the question is, is it normal to have overlapping anxiety symptoms?
1:04:32
Yes.
1:04:33
It’s normal to have, you know, it’s rare that someone just fits perfectly into one box and doesn’t have any symptoms of anything else, and just because you have symptoms of other things, doesn’t mean you have those conditions, right?
1:04:46
So, in order to meet the criteria, I didn’t go through like specific diagnostic criteria with you in each of these conditions, but in order to meet criteria for each of these conditions, you have to meet several different steps. I usually talk about like a cough is a good example. A cough could be a symptom of an allergy. It could be a symptom of the flu. It could be the symptom of.
1:05:11
You know, diabetes. It could be the symptoms of cancer. Just because you have that symptom doesn’t mean you have all those conditions. It just means you have a symptom.
1:05:21
So, so, I think it while it’s normal to have other anxiety with GED doesn’t mean she has all these other conditions.
1:05:30
But, the good news is it doesn’t really matter because the treatment is so effective, and it’s a lot of the same skills and strategies that we teach for the think Feel do.
1:05:41
Um, that a good solid CBT clinician would be able to treat all those different symptoms.
1:05:48
OK, I have another question.
1:05:52
Any advice, do you have any advice for those who are obsessed with their grades, when they have a four GPA?
1:06:00
Yup.
1:06:03
Again, I would, I would ask them, you know, what are they worrying about?
1:06:07
Are they worrying that if they get us?
1:06:09
If they have a 3.98 that they’re not going to get into the same, they won’t have the same options as if they had a four, and, you know, for someone who’s who has a four, and worrying about it, is probably spending an excessive amount of time studying and doing the work to get there.
1:06:29
And I would say, well, if you’re stuck, if you’re spending three hours a night for hours to anyone in your homework, and then they’re probably laughing at me and say, that’s, that’s nothing they’re probably spending 6 or 7 hours a night and their homework. But if you’re spending that much time and you’re getting the aes, is it possible that some of that time is overkill?
1:06:45
And you could actually still get deejays by spending four hours instead of six?
1:06:48
So why don’t we take a chance, spend less time, and see what happens?
1:06:53
Because wouldn’t it be nice to have an extra two hours of the day, do something else?
1:06:57
So, I think I would try to find ways to challenge them. not by saying that they’re wrong, or that this is the better way to do it.
1:07:04
I would challenge them to take risks, that maybe there’s another way to do this that could still be productive for them.
1:07:13
OK, and here’s another one. How can you help a young child figure out what is worrying them if they are feeling anxious but don’t know why?
1:07:23
Yeah. It’s a really good question. A lot of times, parents will say, Kids will say, I’m anxious, include parents, will say, What are you worrying about the kids that I don’t know, and it’s, it’s kind of cyclical conversation of why you worrying, I don’t know, whether, you know, it’s worry, and that’s not helpful. So, and even, certainly, lives, we talked about an OCD.
1:07:44
Specifically, kids might have these worries or have these, these anxieties?
1:07:51
not, definitely, because there’s a reason, but just because they won’t feel right unless they do the rituals.
1:07:57
So, and certainly I would expect this with younger kids to not necessarily have the emotional maturity or articulate the the actual feelings that they’re having or be able to talk about those feelings. It might be bigger than they’re able to, to, to, to, to talk about.
1:08:15
So, I wouldn’t still be so focused on what they’re worrying about.
1:08:22
I would be more focused on how to help them learn to be, um, to learn, to overcome their feelings, and how to function while anxious instead of, often thinking, I can’t do anything if I’m anxious.
1:08:36
So, I would be more focused on coping skills to power through it, that would be to try to figure out what it is exactly.
1:08:45
OK, and we do have, actually, a number of additional questions, but in the interest of time, I’m going to pose one more.
1:08:53
And then, those questions that have not been answered will be answered in the, in the blog post that Rick will do, following the webinar. So the last question that I’ll post for tonight is, someone is asking about sleep worries. So, any suggestions on how to manage when kids are concerned about sleep? And they started talking about it, you know, before the When the bedtime routine get started. And they start asking, if, you know, the parent will stay with them, or or sit with them for an hour. Those kinds of things. Yeah, yeah, Very, very common questions.
1:09:36
Again, what I would say in general is that we want to help, um, do this and steps, so we don’t want to just go cold, turkey and say, I’m out of your room to figure it out on your own and then have the kids, you know? we’re not, we’re not … here this way. But we are interested in scaling back slowly.
1:09:57
So we would talk about, know, is there something specifically the kid it’s worrying about. I had, once a kid who’s who’s terrified to sleep in his own bed and slept with the parents light because his older brother told him that sometimes sharks will come out of the toilet and find his way into the room and eat them. So so, we just made a sign on the door. No Sharks allowed.
1:10:22
And that solved it. right? So sometimes, the answer is super simple. You just have to know what you’re doing, what you’re facing.
1:10:29
So But if the child is afraid of you know, a lot of times, a child might be afraid of burglars coming in or robbers coming in, or someone’s going to kidnap them. So we want to give them a lot of skills during the daytime and talk about those things are the daytime.
1:10:45
So that way they can use those skills at night.
1:10:48
But if it just kind of like a general, I just don’t feel comfortable on my own. I want to sleep with my parents.
1:10:53
Then we we set up structures and systems to the parents so that parents can, you know, stay with the child at night, at bedtime, sitting at that at either the foot of the bed, or maybe at the mid side of the bed. No touching no affection, no nothing that was all done before. Now, it’s lights out.
1:11:10
I’ll be here for a certain amount of time, a half an hour, 20 minutes, whatever it is, and then I’m going.
1:11:17
And you can, if you stay in your bedroom, the whole night, you earns two stars in the morning.
1:11:22
If you got up wants to come get me, then when I walk you back, there’s no affection, there’s no talking. There’s no, there’s no nothing. Put the kid back to bed.
1:11:31
You sit at the foot of bed again for 10 minutes, but leave.
1:11:34
And if they can stay through the bed on their own bed, the whole night, they get one star, and they can trade and stars for prizes.
1:11:41
So we’re, again, we’re using those rewards, and every, every kid has a slightly different system with rewards, but we’re using those rewards as incentive for them to be brave and stay through the night.
1:11:53
Because we know that as they continue to do that, I did that once I could do it again, and they do it again, and again and again, then, being able to sleep on their own feels really good. We don’t need the rewards as much.
1:12:03
But we really have to make sure that parents are on board with being consistent, because if you do this well for a couple of nights and then you cave and you fall asleep with your kid, you know, on the fifth night, you just offset everything that you have to start over from zero. So it’s not just where it’s not just the kids. It’s having a connection and having a partnership with the parents and the kids. That this will be the consistent plan.
1:12:27
OK, great, thank you very much for that answer and all of the great information that you provided tonight as I said, in the interest of time, I think we will end the questioning here, but those questions that have not been answered will be answered in the blog post. I’d also like to call your attention to the the handouts.
1:12:46
on your dashboard, I believe it is the PDF of the slides so that you can have them if you want to access them later. And, again, thank you very much, everyone, for attending. Thank you very, very much to doctor Bubrick and I’m going to turn it over to Kelley who will wrap things up for the evening.
1:13:09
Thank you for joining our webinar or when to worry about your child’s worries. There is an exit survey, which we need everyone attending to fill out.
1:13:18
The webinar blog is open now and available for the next seven days on the NJCTS website for any additional questions that were not covered in tonight’s presentation, That website is www.njcts.org. Also, an archived recording of tonight’s webinar will be posted to our site.
1:13:44
Our next presentation, the importance of play, will be presented by doctor Colleen Daly Martinez, and is scheduled for April 21st, 2021. This ends tonight.
1:13:57
Session. Thank you, doctor Bubrick, for your candid answers and thank you everyone for attending. Goodnight.



 

Comments(13)

  1. Katie says

    The instruction and tips about reassurance seeking were SO helpful for me with my daughter’s anxiety. Thank you! Along with her generalized anxiety, she feels the need to “confess” things to me all the time. These are not big, bad things but super minor things (like accidentally getting some spit on the counter when she was brushing her teeth or things like that). I think this is OCD-related, but I realized during your webinar that it fits into “reassurance seeking” just like her anxiety. How do I respond to her confessions appropriately so I can be supportive and helpful but also not enable her?

  2. DinaA says

    When you discussed accomodations in the classroom, could that lead to enabling the child by helping them avoiding developing coping skills to perform in the classroom.

  3. LD says

    With a high functioning adol with Autism, he reacts with great anxiety with timelines with turning in work despite being provided with extended time. How can he be scheduled with extended time. Do we offer him 1 week, 2 weeks.

  4. PD says

    Is there a link to further reading and additional resources in parenting a child with anxiety? Specifically, resources related to tourettes and ocd.

  5. FD says

    My son , 16 , has a horrible procrastination – avoidance cycle. He failing 3 classes from avoiding work, any advice?

  6. AH says

    Where is the info available re: current research studies you mentioned to refer youth/family?

  7. BM says

    how about kids who do not care at all about grades, skips zooms, etc…12 us old boy

  8. CM says

    I work with a third grade boy that twirls the hair on the top of his end and then pulls it out. He actually has a bald spot there. He has been diagnosed with GAD. When he is in school and/or remote learning, should we address it or let it go? I don’t want him to become more anxious but he has shared that he is self-conscious about his bald spot. He also has been diagnosed with Tourette’s so this may be a tic. I would never say anything aloud….maybe just a private signal or something to keep his hands busy.

    • EH says

      Hi! I have an 11 yr old son who done this. When I notice the behavior I tend to give him a “fidget” or something to do with his hands to help him stop. Other times I give a private signal like tugging my ear to help him recognize the behavior. It definitely has helped.

  9. ER says

    I’m seeing my almost-9 year-old son blame others or make excuses when he is corrected. Could this behavior be a response to anxiety? It sounds like it could be reactive to social anxiety.

  10. BR says

    Do you find that once a child turns high school age that they deny that they have anxiety or refuse help for it and that they don’t want to be labeled anymore as when they were younger

  11. JW says

    Should there be a combination of medication and cognitive behavioral therapy? what are some effective medications for anxiety for teenagers?

  12. JWill says

    Is cognitive behavioral therapy the best intervention when a child has anxiety due to trauma? Which do you address first – the trauma or the anxiety or both at the same time?

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