Neurodevelopmental Conditions and Anxiety: Common Causes and Effective Solutions

Presented by Christopher Lynch, Ph.D##

High rates of anxiety have been reported across a range of neurodevelopmental conditions including ADHD, Autism, Tourette Syndrome, and Learning Disability. In this webinar, Dr. Lynch explores the reasons why these conditions are so often accompanied by anxiety. Practical and effective strategies for addressing anxiety in children with these conditions will also be covered.

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Thank You, Kelley and good evening, everyone. Thank you for joining us on our webinar this evening. Tonight’s presenter is doctor Christopher Lynch. Doctor Lynch is the program co-ordinator for the Pediatric Behavioral Medicine, Department of Goryeb, Children’s Hospital and Atlantic Health System, Children’s Health. Through this department, doctor Lynch overseas programs designed to build resiliency, enhance, health outcomes, and improve the quality of life for children with chronic illness and chronic pain conditions. Doctor Lynch also has an interest in anxiety management for children on the autism spectrum. He has written two books on this topic, including The award winning Totally Chill: My Complete Guide to Stay Cool and Anxiety Management for Kids on the Autism Spectrum. Here, guide to Preventing meltdowns and Unlocking potential.


Doctor Lynch promote behavioral health in the community by providing talks and seminars to a wide range of audiences and also Panza blog for Psychology Today. We’re lucky lucky to have him with us tonight. And without further ado, doctor Lynch, take it away. Thank you very much. You can see my screen.


OK, great. OK, so I thank you for the kind introduction. So, as you heard, I’m a child psychologist and I work out of Gauri at Children’s Hospital, which is in Morristown, New Jersey.


And I have a special interest in working with kids with neurodevelopmental concerns. And in particular, anxiety management because I find that kids with neurodevelopmental concerns, anxiety is prevalent and often contributes to behavioral challenges.


Speaking of anxiety I certainly want to acknowledge the stress and anxiety that we’re all experiencing as a result of the pandemic and certainly I want to touch on this. But first I want to step back and talk specifically about kids with neurodevelopmental conditions so that we have an idea of how to approach this particular group of people so that we can support them both through the pandemic and beyond as well.




So, first, before we go on to anxiety, I’d like to talk just a little bit about the whole concept of diagnostic overshadowing. Because it wasn’t that long ago that mental health concerns and developmental issues were not thought of as being able to occur together. And this was partly due to diagnostic overshadowing diagnostic Overshadowing means that if somebody had a neurodevelopmental issue, that’s all that we saw and we didn’t look beyond that to consider that they may have co-occurring conditions.


So, for example, if someone with an intellectual disability had psychotic symptoms, we would dismiss that as being part of their develop, a part of their intellectual disability.


Someone with autism, who also had an anxiety disorder, we would say, oh, that’s that’s part of their autism.


In someone with Tourette syndrome that had OCD, we’d say, well, the OCD is really part of a part of the Tourette’s. We didn’t look beyond and neurodevelopmental condition to see that, that, that there could also be co-occurring mental health concerns, and this was a real disservice because, over time, with research, with clinical experience, what was found was that not only do people with developmental conditions have mental health concerns. They have them at rates that are actually higher than that, than the population at large. So it’s real important issue to address.


And as I said earlier, anxiety seems to be particularly prevalent amongst this group.


So let’s just wanted to talk just a little bit about what anxiety is. Because anxiety is something we all experience, Anxiety is, is, and yet the anxiety is something that’s hard to, to describe in words. So we talk about the symptoms of anxiety, and some of the symptoms we can observe. So, for example, we can see someone being tense.


We can see somebody breathing rapidly or sweating, Some of these we can ask about, or people can tell us about. So, for example, if somebody is worried about something or they have a particular fear that they can tell us about.


But a lot of these we need to infer, particularly with children. Because if a child can’t express him or herself, with, with, with words adequately, we have to infer what what’s causing their, their distress.


And so some of the behavioral symptoms of anxiety that we have to that we have to infer from include avoidance. An exacerbation of ticks, or compulsive types, of behaviors, and behavioral challenges in general.


So I have some research. I’m not going to go too much into detail regarding the research, but I just want to give you a flavor for how prevalent anxiety is across a wide range of developmental concerns. So, for example, we see anxiety and intellectual disability.


This study here took a look at children with intellectual disability, and they found that close to 40% met the criteria for at least one mental health disorder, the highest being disruptive behavior disorders, and anxiety disorders.


We know that anxiety is quite prevalent in autism.


This started here was a, did a meta analysis where they, they looked at a number of different studies, and they review that research, and they found that close to 40% of children and adolescents on the autism spectrum met the criteria for at least one anxiety disorder.


Then, we have anxiety and ADHD, as well. So this was a literature review, literature review that looked at anxiety and ADHD across the lifespan.


And they found a 25% co morbidity rate. And they, they noted how anxiety impacted and exacerbated symptoms of ADHD.


So it made working memory deficits even worse, and it impacted sleep even worse when somebody had the combination of anxiety and ADHD.


And then finally, we certainly seeing xiety in Tourette syndrome and this study looked at 126 children with Tourette syndrome. And they found that 21% comorbidity with generalized anxiety disorder. And the recommendation that came out of this study was that any child that’s diagnosed with Tourette syndrome should also be screened for both anxiety and depression because of mental health concerns that we see.


And in Tourette syndrome OK. So what’s my story? Do you recognize the country?


That’s right, Some of you are sure. I’ve got it, right? It’s Ireland. So for a period of time, I had worked in Ireland, I worked there for a period of five years, and my commute was to the left of those mountains there, to camera mountains. And while I was in Ireland, one of my students was doing a group for teens on the autism spectrum. So what do you do? when you have a group of kids on the spectrum, you do social skills? So, I, It was It was billed as a social skills group, but it was going OK. But the interactions were a bit still. Did. it just felt a bit bit tense.


So what I decided to do was I decided to start off each meeting with a relaxation strategy as much for me as for them. So for example, one session I may do, a deep breathing exercise, another session I may teach a meditation exercise, and so on.


And I discovered a couple of things.


First, I discovered that the group members were well able to learn the techniques. And they really saw the value in it.


They really, they really liked the techniques, and they found them very useful.


But secondly, what I discovered was that once they were relaxed, their social skills improved. Imagine that the idea that that that the more relaxed we are at the better we are able to socialize. And though that sounds kind of silly now. But again, that goes back to that.


That whole idea of diagnostic overshadowing, that that people with neurodevelopmental concerns things like anxiety affect them the same way that it affects us. And so we need to address that for kids with neurodevelopmental concerns just like we do for anybody else.


So it was at that point when I really started to shift the focus of my work from being skills based, primarily teaching social skills, to being therapy, based primarily teaching, coping skills. And in particular, anxiety management. Because you can teach a kid all the skills in the world, But if they have anxiety, they’re not going to pull that off. And you can have all the behavior plans in the world. But if anxiety is driving that behavior until you’re addressing anxiety, you’re not going to change that behavior.


So why do we find anxiety? Across so many neurodevelopmental conditions.


Well, there’s a couple of physiological explanations, or I should say, contributing factors. So we have neuro anatomical brain differences. So there is a structure in the brain called the amygdala. And this is highly implicated in processing of emotions, and in particular, has very strong associations with fear and anxiety.


And this tends to grow differently across a range of neurodevelopmental conditions, including autism, ADHD, and Tourette syndrome.


There are also neurochemical differences, Neurotransmitters such as serotonin and dopamine, are highly implicated in processing of emotion. And then, again, we find those differences in the regulation of these neurotransmitters across neurodevelopmental conditions.


So there’s very interesting research that’s being done in terms of the physiological aspects of what’s going on here, but that’s not my focus.


For one thing, I’m not going to as a psychologist, I’m not going to be able to intervene at a, at a physiological level.


Secondly, we have the whole chicken egg problem, is the neuro develop, are they biological differences, causing anxiety, or is anxiety causing the biological differences?


So what I’m more interested in is I’m more interested in focusing on what I can change through either therapy or through recommending changes in the environment. So I’m gonna look at tonight, I’m gonna go over common neuro, psychological and neuropsychological characteristics That may be contributing to anxiety. In addition, I think it’s very important to address stigma, stress, and strain, because our kids, regardless of what condition they have, very often they do encounter prejudice and stigma, and that creates a lot of stress and strain, which again will contribute to anxiety.


OK, so the first thing I’m going to cover are cognitive factors.


Whether you have an intellectual disability, autism, ADHD, or Tourette syndrome, there are some differences in the way that information is processed. 


And one of these differences is that kids that I work with across a wide range of neurodevelopmental concerns tend to process information in The detail oriented matter. They, they tend to the manner, they they tend to be focused on details, and they tend to have difficulty with understanding contexts.


So, for example, take the example of my office. So my office here, I have, I don’t know if you can see any bit of it, but there’s a painting behind me of the beach scene. There’s a couple of chairs to the right of me and I have a little bird statuette.


Now if a kid doesn’t have a neurodevelopmental condition and this little statuette is missing, they may notice said they may not, but it’s not going to be big deal. They may say, oh, what happened to the little bird?


But if I have a kid coming in, let’s say, for example, with, with autism, and they notice that this is missing, well, first of all, they’re going to notice this immediately.


And then, secondly, they’re going to be a little bit distressed by it, because when you process the world by details, if a detail changes, your entire world has changed, and it can really throw our kids off.


So for that reason, a lot of our kids get very anxious when things change, particularly if it’s ONIX, unexpected change, OK.


The transitions are related to this, so that a transition is when you move from one task or situation to another.


And again, if you process the world by details, when you’re moving from one task or situation to another, you have to adjust to a whole new set of details, and it can take some time to do that.


So when we Russia, kids from one task or situation to another, or even if we’re taking our time to our kids, it may seem like we’re rushing them.


They get distress because you’re confused. And that distress, feeling and confusion can quickly lead to to anxiety. So, for example, getting ready in the morning, moving from task to task within within, within a school day, I find that even here, when I’m doing therapy with kids, I find that they get kind of dysregulation it as they start this session. And then when they end this session, because, again, that’s a transition, and they have to get used to that.


Inflexibility is another characteristic that can contribute to anxiety, the brain likes order. And we kids have a neurodevelopmental condition no matter what it is.


They try to make up for it, not for that disorder by imposing a lot of rules on on themselves and on the world. So, they may develop, very, they may be very keen to point out when, when kids break rules, they may point that out to, to the teacher or to each, or two other kids. They may correct teachers, as they get older, they may get them into trouble because they may correct law enforcement, people, or they may correct their bosses.


Kids I work with, are, you know, they’re, they’re, they’re very intelligent. And so if I say anything that’s even mildly inaccurate, they’re gonna pointed out to me, you know, because they have that, that certain rigidity about things. So if they’re talking about a Marvel, Superhero, and I mentioned a superhero, that’s from DC. Comics. Man, I’m going to hear about it and now it’s like, oh doctor Lynch, you got it all wrong, that is not a Marvel character. So, so that, that creates that strain and anxiety that unfortunately it doesn’t do them a favor socially.


There’s related to that are fixed routines for a lot of the kids I work with, they like things to happen in a certain order or … or in a certain way and if you deviate from from that, they can create anxiety. I think one of the clearest examples are the routes that you take places. So if you ever route that, you take to school or to to the shopping center.


If there’s a tree down and you have to go a different route, that can really cause a lot of stress for for kids with neurodevelopmental issues. Again, it comes way back to the way that the processing information, and it’s not that they want to be anxious, or they want to be difficult. But, when things don’t go the way that the brain expects it, it really throws our kids off.


OK, so what can we do about this? Well, first of all, you want to, whenever possible, minimize abrupt or multiple changes. You don’t want to run your home or your class like like a bootcamp, But you want to make sure that if you do have changes going on, That you make sure that there’s 1 or 2 at a time.


And that you prepare your student or your child as much as possible for that.


You want to ease people into transitions. So providing reminders and providing visual supports can really help Someone to understand what’s going to happen next and that can really ease anxiety one caveat here you want to be careful with the notion of time. Time is an abstract Concept that a lot of our kids struggle with and one of the clearest example as video games.


So, if you tell your kid, you know, 10 minutes, you have to get off that video game, It could be nine minutes and NaN, and they can just about be ready to reach a new level, or achieve some kind of new achievement in the game. And forget it, you’re not going to get them off at that time. Or if you do it, there’s going to be a significant amount of distress, and it may be even behavioral challenge.


So what I recommend is, if you try to avoid using time, if you can, you can always but, talk about the sequence of events. And when it comes to video games, if you talk with your child, about how long does this game take, or how long will it take to you to get to the next safe point? They may say, 10 minutes, you say.


OK, so I’ll tell you what soon as his games over then, turn it off, And then we’re going to get ready to go, OK? Now, you may still need to be kind of hovering around, and you may still need to remind your child. But that’s going to help to ease them into that transition so much better than if you just use an arbitrary time.


You want to prevent routines from from forming in the first place. So, for example, I had consulted at one time with a with a preschool, and they had tricycles out in the yard where they had their free time. And they were different colors.


If a preschooler went out and they chose, let’s say the red tricycle on one day, the next day, we would steer them towards, let’s say the green tricycle.


Because what would happen is if they chose the red cycle on day one, tricycle on Day one, then on Day two, then a Day three?


That’s it. That could be enough to form a very rigid pattern. So that if another child one at that red tricycle on day four, it can really cause problems.


She, you want structure, but you want to mix it up, within that overall structure, and certainly you want to provide a praise for when change or transition are handled well and point out to your child or student how that really helped, helped him or her OK, sensory sensitivities.


Sensory sensitivities occur. Across a range of neurodevelopmental concerns. I think it’s most blatantly obvious in autism, but you see it in other conditions as well.


And sensory regulation difficulties can be hypo sensitive, where you don’t get enough input from the environment. Or in the case of anxiety, was more likely it’s hypersensitivity where things were a sensory input doesn’t get properly filtered so it comes crashing through and it’s experienced as being very harsh and even painful.


OK this sensory sensitivities can happen with the five traditional senses and it could be general or specific. So regarding noise for example. You a child may be sensitive to noise in general or it may be very particular noises that really cause distress.


With touch things like being in crowds can be challenging. Or it can be the feel of things on your body. So a lot of my kids, for example, they don’t like the feeling of tags on their shirts or the feeling of seams on their socks. In this can cause distress. With site, for example, a lot of my kids are sensitive to light and they particularly don’t like fluorescent lighting.


With smell again, it could be general or specific. And with taste, you can you can have taste aversions that can contribute to restricted eating patterns.


That’s important to note that there are other census B five besides the five traditional and autistic persons who are able to articulate about their condition of really pointed this out. So you have vestibular senses the sense of balance. You also have things like pain and temperature and even barometric pressure that people with sensory sensitivities notes having and they note that it causes distress.


And in general, people with developmental challenges have an overall narrow sensory comfort zone. We all have this comfort zone that we operate in, but with kids who have developmental concerns, it’s very narrow. So the very easily overstimulated are very easily understood emulated. If they’re under stimulated, then they get their brain starts to look for a little bit of action. And that’s where they might get kind of a little bit wiggly. And they might kind of get a little bit. Poky might start to kind of cause problems, not because they want to, but because their brains looking for stimulation.


And if they’re overstimulated, then they’re going to get anxious. and they may withdraw or again, have behavioral challenges.


OK, so what are some strategies for sensory sensitivities? Well, first of all, if it’s, if it’s something you could easily avoid or minimize without it affecting the kids child’s life, then do so. So, for example, if it will say if a kid is sitting in class and they’re distracted by kids in the hallway while you can move, move their seat are allowed. Or if there have challenges with the crowds in the hallway will say post pandemic they can leave the class early or they can wear tinted glasses for lights or headphones or earbuds to deal. With, sounds OK. There’s also broader environmental strategies, such as, using sound absorbing tiles, or the use of natural lighting, All these things can just help increase comfort level for our kids.


And you want to come up with a coping plan for dealing with sensory challenges. So for example, we’ll say post pandemic, if you’re going on vacation, you can think about what restaurants you may go to or where you may go, where it may be crowded and have a plan So that if your child gets over stimulated, you know what you can do.


When I’m working with kids, again, post pandemic or pre pandemic, if they’re going to an event like a wedding.


Many reception halls have full, floor plans, on the Internet, will look those up. And we’ll see, OK, there’s a balcony over there, there’s a little nook over there. And so if you get overstimulated, here’s some places you can go to. And, of course, I would do that in consultation with the parents so that everyone is everybody’s on board with the plan, and we know that it’s safe.


And in general, you want to be aware of an aim to keep a child in his or her comfort zone. And if you see them being under stimulated, when they start to get kind of Poky, try to get them engaged in something. And if they seem overstimulated, try to give them some respite from from that.


OK, there are also social challenges, and again, kids with a wide range of developmental concerns can struggle socially, and there’s a number of reasons for this.


For one, there’s language demands and social situations call for a lot of language and a lot of it’s kind of metaphorical. And so, a lot of our kids struggle with that kind of language. For example, I was working with a teen, and he was invited to hang out with five of his peers, and I was absolutely delighted for him. But then, he looks at me says, doctor Lynch, I can’t do that.


How can I how can I meet with five kids? How can I have five conversations at once? I don’t have five mouths.


So, wasn’t that he was shy.


It was that the language demands, which is overwhelming for him, just the idea of it was overwhelming for him.


Again, as I mentioned earlier, there are sensory factors that happened in in social situations.


When you think about social situations pre and post pandemic, they tend to happen in loud crowd at places where there may be a lot of smells and other things going on, but there’s also social skills development. A lot of our kids lag in their social skills, OK? And again, I find this across developmental issues, and so when they’re younger, they may struggle with things like eye contact and turn taking, starting conversations, and in conversations. And so this can create some anxiety in social situations.


As they get a bit older, they may master some of the mechanics of social situations. But then social situations start to become more complex and nuanced, and they can’t keep up.


And it’s stressful to be in a situation where, you know, you’re not quite getting it, but you’re not sure why.


And so, again, that contributes to social anxiety, then there’s the whole idea of stigma. And so, if a kid does have behaviors such as ticks or, or self stimulatory behaviors, this might create some self consciousness and again, contribute to to anxiety in social situations.


OK, so what can we do about the social challenges? Well, first of all, you want to set up such social situations that are more likely to foster success and not failure.


In general, the kids that I work with tend to do better in situations that are small, structured, and strength based. So 1 or 2 other kids to start with.


Maybe, maybe three, have a task that they’re, that they’re doing, such as playing a particular game, or going to like a movie or something like that, and base it around their strength. So that is something that they feel good in.


Sometimes what I find parents do is they throw their kids into activities because they think it’d be good for them socially. But, for example, they may throw them into a team sport ticket. It’s going to help them, but it doesn’t, because it’s a situation that’s very large, it’s very unstructured, there’s a lot of language going on. And so unfortunately, they fail at that, and it doesn’t do them any felt favors, socially, and then the next time, they’re even less likely to have a good experience. Not, again, this doesn’t apply to all kids. And again, this is something that you start with, and then you can build from there.


And you can work on social skills. And if you do, though, you really want to focus on generalization. So, there have been times when I taught, I may have talked to a kid about starting a conversation, and I asked him about it a week later.


It’s like, Oh, you wanted me to do that at school. Oh, I didn’t realize that.


So, you have to be very specific and close to the time when you want to see a social skill. And then you need to prompt it, QA and reinforce it, OK? So, for example, have somebody right before lunchtime, again, will say, post pandemic. Say, hey, I know you like Star Wars, you know what Charlie like. Star Wars two.


Why don’t you ask him about the new movie that just came out, then check on it right afterwards. They did, you, Did, you ask about it? Oh, yeah, great. So now you know that, that Charlie also like Star Wars. You guys can talk about that again. So, the more concrete, the more specific the near you are in time, the more likely you are to get a skill across to your child or student. And, in general, we want to foster a toddler and atmosphere. Our kids have so much to offer other kids. And so much of the behavior is is is non intentional. And we need to help the other kids to understand that our kids are not dangerous or not weird. They may have some quirks, but that’s also could be a real source of strength for them. And we need to build up that tolerance, because nobody’s comfortable in a situation where you feel like you don’t belong to the more we can bring on that atmosphere, the better off our kids will pay.


OK, language demands, so, lot of our kids struggle and aspects of language, Expressive language is the ability to convey information through language. Receptive is the ability to take in and under and understand, OK?


So, having difficulty with expressing yourself can really create a lot of anxiety and if you do get anxious or frustrated, it makes it difficult for you to express that to others. And then to get help, so that can only ramp up your anxiety.


And if you don’t understand somebody, you don’t understand the direction at somebody’s giving you, again, that’s going to create anxiety.


But even kids who can communicate their basic wants and needs, they struggle with more abstract aspects of language, such as pragmatic language, which is the ability to apply language in a social context.


And also, with non literal forms of language, such such as metaphors, similes, and sarcasm, and trying to keep up with that socially nuanced language can really lead to anxiety and confusion for our kids.


OK, so what can we do about this? I’m a really big believer in visual supports. And yes, I know you could have kids that read, read words. But a little bit of support goes a long way.


When you think about, when we go to places like airports and it’s color coded, that helps so much, because we then don’t have to read each airline and on, on a, on a particular sign, or a parking lot that is color coded. So, little little bit of visual support goes goes a long way. So, using a visual schedule to help kids to understand what to come next. Using pictures to remind somebody of expectations and what you expect of them behaviorally, if they’re moving to a new school, using photographs or video of the new school to get them ready for it. All of these things can really help to ease anxiety.


You want to use clear communication using what’s called reduce language when necessary. So you want to focus on a few key concepts and not be long winded. When we’re trying to convey something to to our kids. The example I often give is that if you’re trying to get ready and you’re trying to get a kid ready. What you don’t want to do is you don’t want to do this. Come on, get ready now, get your socks and shoes on because they’re going to anti Mary’s house. And don’t forget what happened Last time. We were late, we, mister Kagan, Everybody was really, really upset.


know, all that may be true, but that’s just too much language for the kid, it’s going too fast process.


So you want to break it down and say, OK, we’re going to anti marys, get that idea through then we need to get ready.


You need to get your socks and shoes on, OK.


But don’t get me wrong, I don’t want you talking like a robot to your kids all the time. But certainly during those times when you’re getting needed to get me to get a message across, you need to use that kind of language. OK, and you want to give a means for expressing frustration or our anxiety, particularly kids that may be minimally verbal, and it could be a single word, or short phrase. It could be a picture that they show you. If they use an augmentative device, make sure that they have a way to tell you when they’re anxious or need help.


OK, Task Frustration. So a lot of our kids struggle and have, our, first of all, our kids have wonderful strengths, and they have excellent memories are very creative And there’s some things that they absolutely thrive at.


But very often, there are pockets of challenges for our kids, one area, or our motor skills, particularly fine motor skills.


I find that a letter a lot of our kids struggle with, with fine motor skills, OK? There’s also executive function skills. Executive function is kinda like the manager. part of the brain. An example that I give is that, you can have a restaurant and a great location with a great waitstaff and a great chef. But if the manager’s lousy, it’s not going to pull it all together. And that’s what happens to a lot of our kids. They have wonderful strengths. Wonderful skills, where it’s pulling it all together that the struggle in. Its organizing information and it’s planning it.


That’s where they, they, they, they struggle, abstract thinking skills, too, especially abstract, social emotional concepts. A lot of our kids struggle with. So, for example, when they, when, when language arts starts to get to poetry, or when writing gets to opinion pieces. A lot of our kids get very anxious around that. And there are a couple of key academic areas that, that a lot of my kids tend to struggle with, reading comprehension is one of them where they can read fluently, but may have difficulty with understanding what they’re reading. But one area that a lot of our kids struggle with, is, isn’t writing, because writing really relies on. all of those aspects that I just went over, Some motor component.


There is a planning and organization component, and it’s an abstract concept, because you’re trying to get, you have to convey to the reader what you’re, what’s in your mind, and that’s, it. sets an abstract task.


Alright, so, what can we do about test frustration?


First of all, you want to make sure that your, your child, the student, has a way to express when they, when they are frustrated.


So, again, could be a word or phrase, A picture, what have you, and then the phrase I like to use is remediate, accommodate, or celebrate. Remediate means to build up relative weaknesses through targeted intervention.


Accommodate means that you use supports to work around that particular challenge or workaround a weakness. And then celebrate is that you use design task in a way that’s really going to drive the child’s strengths. So, take writing, for example. So using occupational therapy techniques to improve writing, to prove the phone. My fine motor aspect is an example of remediation. Given a child. A laptop or speech to text capability is a way that you’re accommodating for that. And having a child writes a story about, let’s say, Star Wars or Minecraft. or whatever. The thing is, among us, is a way that you can, again, get them motivated and interested in, really have them use your strength, even if it’s an area that they’re not strong in typically.


You also want to consider the timing of tasks, so you want to give challenging tasks when the kid is most alert. Some kids, This is the beginning of the day, some kids, maybe it’s after a particular rest period.


And for some kids, you want to alternate task between challenging and easy task.


Just want to get that sweet spot. We all need that sweet spot where we’re challenged, but we’re not overwhelmed, and we have to consider that. And that’s where, why you wanna present task, challenging tasks on a, graduated, I, graduated basis, make sure you’re kind of hitting that sweet spot.


The problem with our kids are, the challenge of our kids, is that, that can vary from day to day. So, there may be one day, where they’re able to take on quite a lot of challenge than another day, when they’re not able to, Maybe they didn’t sleep as well. Maybe they’re going through medication adjustment, what have you. So, we need to be sensitive to where our child is at any particular day.


All right.


Now want to mention here, briefly Tourette syndrome, and in Anxiety and OCD, because more than a third of persons with Tourette syndrome also have OCD and all this anxiety is and it’s reached reduction of anxiety is, is a common component of OCD. So I thought I’d mention it here.


All right. So I’m going to shift gears now and we’re going to talk now. Because everything I just talked about are things that we can do to manage the environment, to set up things for, for, for our kids. But what I want to talk about now is giving our kids coping skills so that they can manage your own anxiety. Why is this important? Well, first of all, we can’t eliminate anxiety. Anxiety is part of life, and no matter what we do, our kids are going to experience it.


Secondly, there won’t always be a supportive person nearby. You may be fantastic at spotting your your child’s distress, but not everybody’s going to do that, and you may, you may not always be there, or teacher or an aide may not always be there to spot that.


And then, most importantly, it helps to develop confidence and problem solving skills and independence. It’s important for us to have a sense of control over our environment and to know that, when we get distressed, there are things that we can do about it.


We don’t have to just rely on others.


So I teach a range of relaxation skills, and the important thing is that every kid I work with, whether or not they have a developmental condition, can learn these, Yes. I need to modify in certain ways, but there are ways that we can teach this. So there are deep breathing strategies. In particular, I’d like to teach at Diaphragmatic breadth, where were you? When you breathe in a way that you expand here here here, your lungs by lowering the diaphragm, Muslim, There’s something called progressive muscle relaxation, where you tense different muscle groups, and then you relax them, and you learn to relax them automatically over time.


The use of imagery is picture in something that makes you feel relaxed. So I may go overseen with the kids that I work with, such as a waterfall, or a beach. And then I might have to make up their own scene just to get some buy in.


And then meditation, whether we’re talking about classic meditation, by repeating a mantra, or a word, or a phrase. Or mindfulness meditation, which is generally just kind of accepting, whatever. Kind of comes into your awareness and going with that.


So there are there are activities that combine both these body techniques and these mining techniques such as yoga and Tai Chi and they can be fantastic. And there are plenty of classes out there, specifically for children, and there’s also classes specifically for, for kids with developmental needs. So I encourage you to at least explore that possibility.


I don’t want to leave our kids with higher support needs. So kids that might have more intellectual challenge, or that might be minimally verbal, So you want to make sure that they have a means to express your anxiety. Again, I mentioned this earlier, whether they have a touch talk or a pointing to something.


You want to find things that are comforting could be music. It could be peaceful place and try to have them engaged in that so that if they can turn on the music or tell you what they like or indicates what kind of music they want to hear, that’s going to give them that little bit of sense of control. Comfort objects can be great for getting through challenging situations, particularly things like medical visits, That could be a stuffed animal, or favorite toy, and you want to have active strategy, so giving somebody something that they can do, such as a stress ball. I have a rubber snake that I have here, a lot of the kids like it, and I call them Oscar. And I have one of the kids I work with is minimum, minimally verbal, And sometimes I’ll hit his head.


And I’ll just look at them and I’ll say, Oscar, and Whole **** not his head, and I give them that, that, that rubber snake to play with, and it really, really helps him.


And it’s also important to have care for the givers to care for the caregivers.


When you Karen, for a kid with developmental needs that they can really be taxing. It can really take a lot out of you, and it can be draining and it can be difficult to kind of step outside the situation and manage your child’s stress when your resources or tap. So I’m a real big advocate of organizations such as this that can provide you with with support. I’m a real big advocate of giving parents respite and give them the resources so that they can cope, because once they can cope, then they can, they can better help their child, OK?


All right.


And certainly, if anxiety gets to the point where it’s causing significant challenge and distress, you want to recommend therapy such as cognitive behavior. Therapy has a really good track record. They do relaxation exposures, getting used to things that you get anxious about. Cognitive reframing is looking at situations from a from a different standpoint.


If your school based anxiety you want to co-ordinate with the school and certainly you want to make sure that you’re co-ordinating with all the medical professionals, kids with developmental needs often have a number of different professionals. And sometimes different professionals are prescribing different things.


Please make sure they’re communicating because some of these things can contribute to anxiety OK, just want to talk a little bit about as promised about the challenges of covert 19 pandemic, So So just looking at the time here, OK, great.


So we have a number of challenges, We have anxiety and fear over the virus and this has changed over over time. So at first it was what is this virus, what does it do? Kids were very nervous about that. Now we have a better understanding of it, but now we’re asking our kids to engage in what we call relative risk.


This is the idea that this such a situation, we’re telling our kids, that situations that were dangerous are now safe.


And this is happening on a week to week basis and even a day to day basis. And that’s difficult for a kid, because kids like to know. They’d like to think in absolute terms, either a situation is completely dangerous or completely safe.


Not that school was was safe on, on, on, On Tuesday, but it’s not safe today, but it’ll be safe again next week so that causes a lot of bang, is causing a lot of anxiety for kids and for us.


Adjusting to new and changing routines, kids need stability and they need routines to thrive. We certainly know this with kids with developmental issues, and we’ve, we’ve been asked to constantly adjust, and this is creating stress.


Maintaining our academic progress and motivation.


Kids are doing well in terms of this.


But even the most highly motivated Vedic kid is really starting to tire of virtual learning and their client. It’s kinda as if they’re going through the motions and they’re not fully engaged with the learning.


And our kids with developmental issues, they really are suffering from a lack of individualized support. If there’s anything this pandemic is teaching us, it’s how important that 1 to 1 support is. It’s not so much for the content of learning. It’s that mental anchor that, that 1 to 1 support provides.


There are practical challenges associated with virtual. Excuse me, I skipped one. There’s the challenges of coping with the confines of quarantine. I don’t care how big your house is, it probably seems pretty small right now. I know during the height of pandemic when I was at home no matter where I want it to be, I had a family member that I think there was a family member there. And if there wasn’t a human family member, my My dog was where I wanted to be. And I know that sounds kind of trivial, But that little stress builds up over time.


And there’s also very practical challenges of virtual learning. So some of our kids are struggling with the technology aspect. They may have weak Internet connections. And this can certainly create a lot of stress.


I saw a clip of a teenage girl, was talking about a situation where her mom had gotten out of the shower and they have to keep the camera on during their, their virtual schooling. And the mom walked in front of camera with just a towel on. And it was mortifying for this for this teenage girl, as as you can imagine. So kids, some kids don’t want to show their rooms. So there’s a lot of these practical challenges and there’s less socializing and extracurricular activity and and socializing extracurricular activity are really buffers distress. And we’re really missing that. Yes, we’re doing it but it’s still not quite the same.


So, how do we cope? Well, first of all, you want to answer your children’s questions about the pandemic.


There’s nothing scarier than what a kid can imagine in his or her own own mine so make sure if they have questions make sure that you answer those questions honestly but provide the information at a level that the child can process and make sure to define any terms that might be confusing for them.


You want to maintain structure with regular sleep wake cycles. Routines, and environmental cues, try to have the virtual days and in person days be as normal as possible. I’m encouraging my kids to wake up the same time no matter what and to get dressed. No matter what as if it’s a school day, you can make sure that in your house you have zones If you can do this.


Designated for school work and other ones designated for relaxation.


Also, of course, you want to balance that with variety.


You want to watch for signs of stress and remember with kids, they may not tell you when they’re stressed, but you may see it through other signs, such as irritability, changes in sleep, and appetite, and behavioral changes. And you certainly want to get, again, emphasize, get that individualized support. However you can get it fight for an advocate for it’s so important. And use virtual mental health care. Mental health professionals were very quick to adopt to virtual platforms. So please take advantage of that.


OK, So these are my resources. I have a couple of books, one is totally chil My Complete Guide to Staying Cool. That’s a workbook for kids with a wide range of neurodevelopmental concerns. So I talk about how to manage stress, but in light of their concerns, I talk about sensory sensitivities and feeling left out, those sorts of things.


Anxiety management for kids on the Autism spectrum is geared for parents, teachers, and therapists. That’s autism specific, but, but again, it can can apply broadly as well.


I also have a website, more than behavior dot com. I do a blog for Psychology Today and on social media you can find me on Facebook at more than behavior.


OK, so with that, the key takeaways mental health needs are common across neurodevelopmental conditions. There are things we can do to the environment to help, but they can. Your kids can also learn coping strategies.


With that, I’d like to thank you for your time and then open it up for for questions and answers.


Great. Thank you, doctor Lynch. Thank you very much for that very clear and informative presentation with lots of great tips and takeaways. We have just a few questions. So, I’m going to start with this one.


Is there any evidence that magnesium and vitamin B six helps reduce motor tics?


Yeah. That’s lower anxiety in children.


That’s OK. Now I find that that goes kind of back oh, I’m not kind of, that goes beyond my training as a clinical psychologist. And certainly, you know, you if you want to work with a nutritionist would be great. In consultation with your pediatrician. There’s a lot of research that that that shows there’s multiple connections between the mind and the body. And the GI tract has a lot of those connections. In fact, the GI tract is referred to as the second brain, partly partly for that reason. So so in terms of what I recommend, I’m a big believer in, in good nutrition. In general, because if we have good nutrition in general, we’re healthy, and a healthier, we are in general, the better we are. We are to buffer stress. I can’t speak to specific supplements. That’s beyond my training, but I certainly would encourage you to talk both with a nutritionist as well, in consultation with, either a pediatrician or a general practitioner for, for an older person.


OK, great, thank you. Someone notes that their child suffers from the cycle of anxiety, procrastination, avoidance, anxiety. Do you have any tips or strategies on how to help them break this cycle?


Yeah. Yay, anxiety is one of the, the major if not the major, major cause of procrastination.


There are kids, they have a double whammy, because number one, they have anxiety that that contributes to the procrastination. But number two, they have challenges with that executive function that I mentioned earlier. So they, they, they have challenges with understanding how long an assignment takes. They have challenges with planning, how to do assignments, and how to break, how to break those assignments down. So, certainly, you want to want to help with anxiety as through all those things that I mentioned. But you also want to help your child to help them with the organization. And the planning, and have it, again, visual supports having a calendar out and having intermediary deadlines can really help to, to alleviate that anxiety around procrastination. But, it’s, it’s an excellent question, because it’s a very common pattern. So, please, make sure you work in both an anxiety piece, but also the organization side of things. 


OK, thank you, and Do you have any suggestions as to how parents can work with teachers in terms of trying to incorporate some of the suggestions and strategies that you, mentioned?


Yeah, it’s, it’s, the more you share with teachers, the better, and, again, when I say teachers, I’m talking too broad. I mean, educational staff, and in general. Because there may be an aid, there, may be a resource teacher.


Sometimes if your child has medical need, sometimes anxiety shows up in the nurse’s office, so you want to make sure that the school understood the school in general, understands what your child’s needs are, and you want to make sure that they understand how anxiety may be impacting on him or her.


So you can do that through conversations, certainly during parent teacher conferences. But if you’re getting feedback on your child’s behavior, and I will say, make sure that your teacher understands that that certainly you’re going to address it. But make sure they understand that. The behavior is not intentional, but that anxiety is a component. And let them know what works for you. You know. If you, if you’d let them know that.


you, too struggle, and some of the same things, whether that’s paying attention, or, or getting up a lot, but you find something that works, make sure they understand that.


You can also encourage, if you’re, if you have a child seeing a behavioral health professional, encourage them to communicate with, with the teacher, and so that they, they can also help to reinforce some of those concepts.


OK, thank you. Someone writes, I work with autistic students in public school who have a very difficult time staying online for any length of time to participate in online school. What are some strategies that you can recommend?


I’ve been telling kids you got it. You have to take, you have to take breaks and it breaks can mean different things. So if somebody is has to be online for 30 minutes, you know, they may not be able to, to turn off, or to walk away from, from the camera. They may, if you can build that in, if you have a class where where people have similar needs, you can certainly do that. So what I’m teaching, now, as I’m teaching kids some, some physical strategies, so that might be standing up, posting their body. There’s the kids get a kick out of. Posing. Like, a superhero. Take some deep breaths, closing their eyes, and counting counting to, maybe three or to five, very slowly, in their mind. So it’s not disruptive. Or stigmatizing given them. Some ways to kind of clear the mind. I always talk to kids about the difference between head filling activities, and had clearing activities.


And that when they do take breaks from a screen, make sure they’re not Taking a break with another screen. And make sure that you’re doing something to clear their mind. And to take advantage of whatever breaks that they had. And, of course, working with the teachers around around ways of doing that. I have I’ve had some students tell me that they’re one of the their teachers has everybody applaud at the beginning of class and at the end of class, and I think it’s a wonderful strategy. I know it sounds so simplistic. But it gets that energy level up and it clears the mind so that they’re ready to look at the screen for another 30 or 40 minutes. But it’s A challenge is definitely a challenge. And so again, like everyone else, we’re really looking forward to when this is over. But in the meantime, we have to employ whatever strategies. Who can’t?


OK, next, we have somebody that is asking about a teenager, how you can help a teenager with irrational fears at bedtime, such as being scared of kidnappers, robbers, et cetera, OK? So if that could be a, OK, I’m not going to make a diagnosis for a specific child, but very often that, that kind of fear is indicative of separation anxiety, in general, So so sometimes kids that have those fears, MA in, general, kind of worry about their parents, or caregivers, they may have difficulty separating at school.


And so you want to give them ways to, certainly, you can comfort them, but when, when you comfort somebody for anxiety, It’s important to have a I call it a warm, but matter of fact, approach.


So you don’t want to be dismissive of their anxiety and say, Can I just just just go to bed? Just just get over it?


There’s nobody here but she also don’t want to be overly indulgent and it’s natural to do that. Don’t get me wrong but cheap, but you want to say, OK.


What can you do about this? Let’s think about this. How are we safe? The doors locked, we live in a safe neighborhood. Whatever, you can, give that child, just go over it, briefly, kind of matter of Factly. And if you do have a strategy that that he or she can use, whether that’s listening to music, or a night light or a comfort object, say, OK, Now we know it’s safe.


Here’s your comfort object, have a great sleep, and here’s what you, here’s what you can do. And if they need to go in to you, than what you do, is you go back to the room, you comfort them there, so that they get used to comfort themselves in their own bed.


OK, and going back to a question about working with autistic students. There was the previous question was about staying focused on line. And we have some other kind of picks up on that and asking about, what if autistic children have sensory issues related to the use of screens, and they need to learn online? Are there any strategies that can relate to addressing their sensory issues?


Yeah, there may be talk with your pediatrician now or with an optometrist or ophthalmologist, but there are certainly things that you can do with screen glare.


I don’t know about the validity of these things. But I’ve seen there’s been seeing glasses for kids that are tinted that that can help can help with the glare aspect of it as as well. So that, that, that, that might be useful.


Encouraging them to look away from the screen during breaks, if they can, or during breaks in the teaching material, can certainly help, and. And again, it’s just kind of doing what we can to get through this, but I would definitely look at, because typically.


It’s the, it’s we all suffer from, from from the glare. But, but with kids on the spectrum, it reaches another level, particularly if it’s bright. So, there may be things that they can do with their settings to, perhaps, dammit. Some of those things may help as well.


OK, thank you. We have just 1 or 2 more questions. I think we can get them in.


For someone who’s asking about if you have any thoughts on the use of anti-depressants for social anxiety, Yeah.


So, medication is sometimes needed for anxiety.


I have some kids that I’ve worked with and they want to learn the therapeutic techniques, but they’re so anxious. They can’t even practice the techniques, not even in my office. So, in that case, I would often seek a consultation from, from a psychiatrist preferably.


And there’s some pediatricians that are comfortable as well, width, width, prescribing. SSRI, are they, in terms of anxiety disorders, SSRI’s are the first line treatment. There are benzodiazepines, which are short Acting Anxiety meds, but, but the problem with those is that they’re, they’re short acting in their addictive. So, they should not be prescribed long term. And, again, I’m not, I’m not a physician, says, just bear that in mind. So certainly, if somebody needs medication for anxiety, in general, including socially related anxiety, that is certainly something that, that that can’t be considered. But again, obviously, these things would be done in consultation.


And if you do have, if you see a psychiatrist, but you also have a neurologist in the mix and maybe another professional, please Make sure they’re communicating, OK.


OK, and let’s try one last question. I think So. We have someone that asks if all of the things that you are speaking about, which many, of which are sort of talking about younger children, if these things would also pertain to a 23 year old, that has a history FTS and ADD and Bad Anxiety. So, are the things that you mentioned for younger kids also, things that could be helpful for someone who is 23 with those diagnoses? Yeah. No, that’s that’s a great question.


And I should have pointed that out earlier, Usually at the beginning of the talk, I mentioned that my work throughout my career has kind of bounce between adults and kids, and, but my last states over the last 10 years, it’s printed with kids. So a lot of my examples are kid based. But a lot of what I said, I have all of what I said, what could also apply to two, it would also apply to adults as well.


Just, the content of my examples was was geared for our child, the audience, But yeah, so, you know, if you’re talking about adults, So you’re not talking so much about school, but you’re talking about what the work setting here, so you want to make sure that people in the work setting understand some of these things, and it’s setting up that work environment. So that it’s optimal.


Or if somebody’s in a supportive, living situation, you want to make sure that the residential staff are also aware of what somebody’s anxiety triggers, or I said they did that, they can help to manage it, OK, great. We are at 8 30, so I think we’ll stop there. There’s perhaps 1 or 2 questions that we didn’t get to, and if there are any, then we can, we can address those on the blog. So I want to thank you, again, doctor Lynch, for a great presentation with some really practical takeaways and strategies. And I’d like to turn it over to Kelly now to conclude the evening.


You’re welcome. My pleasure.


Thank you all for joining us on our webinar, our Neurodevelopmental Conditions and Anxiety: Common Causes of Causes: An Effective Solutions. There is an exit survey, which we need everyone attending to fill out. Our blog is open now and available for the next seven days on 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 the site.


Our next presentation, Using Positive Psychology to Find More Happiness Every Day, will be presented by doctor Anton’s Shcherbakov and is scheduled for January 13th, 2021. Wow. That seems like so far away. This ends tonight’s session, Thank you, doctor Lynch, for your candid answers, and thank you everyone for attending.



  1. Morgan Miller; says:

    Hello, I had to leave the webinar early so I will finish watching when the replay is posted. My question is: what are techniques to use for child who has school refusal.

    • Dr Lynch says:

      A key aspect of school refusal is to make sure that you have a consistent plan between home and school. Provide your child with calming techniques (e.g. breathing, counting, positive imagery) to use in the morning and for the school to provide during the school day. Be warm but matter of fact in telling your child that it is time to go to school and if he/she is upset refer back to the calming techniques.

  2. CBerrry says:

    What can be done when a parent insists on gen. ed. setting when the accomodations are not appropriate for that setting?

    • Christopher Lynch, Ph.D. says:

      Strive for a partnership with parents so that all can share what works and what doesn’t work under particular situations. Highlight what the needs are and why you think they cannot be adequately accommodated for and then listen to see if the parents have ideas on what may work. There are a range of alternatives that exist between general education and special educational settings (e.g. part time placement). You may be able to find a way to “test” what works and what doesn’t so that both the school and parents can assess what level of accommodation is most appropriate at any period of time. Remind all that placement is never set in stone and should evolve to meet changing circumstances.

  3. Michelle D says:

    Are there any good resources for making friendships?

    • Christopher Lynch, Ph.D. says:

      Natural resources are best because they tend to last the longest and tend to foster the most genuine types of friendships. Find what your child likes to do and see if there are activities that center around that. Social skills groups can provide some valuable instruction but, like all of us, we thrive best when around people that share our common interests.

  4. Katherine DT says:

    Based on your experience, is there any difference for autistic girls and anxiety versus boys?

    • Christopher Lynch, Ph.D. says:

      Autism is under diagnosed in girls. The struggle with understanding social situations is present in both but may be more subtle in girls and, thus, go undetected. Due to societal expectations, girls may also have less overt behavioral challenges and this too can result in them not being diagnosis or getting fewer resources than they really need.

  5. Fran D says:

    My 16 son who has Tourette’s syndrome , very mild tics, but with stronger anxiety. Pre pandemic he was an honors student, currently he is failing 3 classes and when we speak he explains he has no motivation due to constant virtual school learning . Suggestions to help this situation.

    • Christopher Lynch, Ph.D. says:

      Find some way to get some direct, one to one instruction from teaching staff. Your son is as intelligent as he ever was but many of the kids I work with are REALLY missing the direct instruction from teaching staff. Having live, one to one access to a teacher really serves as a “mental anchor” for a lot of kids.

  6. DeniseM says:

    Any resources for a 23 yo on handling anxiety.

    • Christopher Lynch, Ph.D. says:

      There are a wide range of books, blogs, articles etc. on the topic of anxiety management. If the 23 year old does not have developmental delay then I would suggest doing a web search and seeing what is appealing. If the anxiety is causing distress and impacting functioning then I would definitely recommend seeking therapy. You can always begin the discussion with a primary care physician. There are also a wide variety of apps that center around relaxation including breathing and meditation.