Parenting the Anxious Child

Presented by Marla Deibler, Psy.D.

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Anxiety Disorders are among the most common childhood mental health struggles. Learning to effectively cope with distressing thoughts and anxious emotions can be challenging. When feelings of anxiety are excessive and become overwhelming, children instinctively rely on their parents to help them cope and rid them of these unwanted feelings. And, many well-meaning, caring parents do just that; however, this can become unintentionally problematic, impairing the ability of the child to function independently and preventing them from developing the ability to cope on their own. Understanding the context of anxiety in the family system provides a unique opportunity for parents to effectively help their children through their own behavioral changes.

Marla W. Deibler, PsyD is a Licensed Clinical Psychologist and the Founder and Executive Director of The Center for Emotional Health of Greater Philadelphia. Dr. Deibler holds a doctorate in clinical psychology (Psy.D.) with a concentration in health/neuropsychology and a post-doctoral master of science in clinical psychopharmacology (MSCP). Dr. Deibler gained her formative clinical and research experiences at the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH), Children’s National Medical Center, and the Kennedy Krieger Institute at Johns Hopkins University Medical Center. She gained specialized behavior therapy experience in the treatment of obsessive compulsive and related disorders at the Behavior Therapy Center of Greater Washington. Dr. Deibler served as a clinician at the National Center for Phobias, Anxiety, and Depression as well as on the clinical faculty at Temple University Children’s Medical Center and Temple University Schools of Medicine, Dentistry, and Allied Health.


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Hello. My name is Kelly Teabo, and I’m with the New Jersey Center for Tourette Syndrome and Associated Disorders. I will be your organizer for this evening, and we’d like to welcome you to our webinar on Parenting The Anxious Child. Thank you all for joining us. Before I have my colleague introduce the speaker for tonight, I’m going to cover some housekeeping items with you, all. participants are muted. if you have a question, please type it in the bottom of your question box and click send. We’ll get to as many queries as time allows. And in addition, tonight’s presenter is available to take your questions on the Wednesday webinar blog, which is accessed from our homepage. Under the heading programs. This blog will be monitored for the next seven days. Feel free to look and post questions as often as you like, questions will be archived for future reference, If you missed part of the presentation, or would like to watch it again.


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New Jersey Center for Tourette’s Syndrome and Associated Disorders and its directors, an employee, assume no responsibility for the accuracy, completeness, objectivity, or usefulness of the information presented on presented. We do not endorse any recommendation, or opinion made, by any member or physician. Nor do we advocate for any treatment. You are responsible for your own medical decisions.


Now, I’m going to turn over the introductions of our speaker to Martha Butterfield, the Webinar co-ordinator of NJCTS, Marty.


Kelley. Thanks and good evening, everyone. Before I get started with tonight’s announcement and introduction of our speaker, I want to pass along a special thank you to all of you from the staff at … for joining us tonight.


These are unusual times. we’re experiencing. We want you to know that. We appreciate your continued support and interest, not just in our webinars, but our other programming as well.


We sincerely hope all of you and your families stay well.


I do have one announcement tonight about an upcoming online event.


Thursday, April 30 sets tomorrow, at 7:00 PM, you can join our online support group facilitated by doctor Graham Hartkey, the director of the TS Clinic at Rutgers University.


You can register via the Coming Events tab on our website.


Now, to the introduction of tonight’s presenter, doctor Marla Deibler, she is a licensed clinical psychologist, and the Founder and Executive Director of the Center for Emotional Health of Greater Philadelphia.


She holds a doctorate in clinical psychology, with a concentration in health and neuro psychology, and a postdoctoral Master of Science and Clinical Psychopharmacology.


She currently serves on the board of directors of the foundation for body focused, repetitive behaviors, and, on the faculty of the Professional Training Institute, She also serves as Vice President of the Board of Directors of OCD, New Jersey, the New Jersey affiliate of the International OCD Foundation.


Doctor Deibler is dedicated to educating other professionals in the greater community about mental health and wellness.


Doctor Deibler, we are pleased to have you join us tonight and now, without further introduction, I’ll turn tonight’s presentation over to you.


Great, Thanks so much and excited to be here.


And let’s get started. I’m going to be talking today about parenting, the anxious child, and specifically about the family system. So we’re going to talk a little bit about what anxiety is specifically about the function of anxiety and the function that it serves for us. Because anxiety is a natural response. We’re going to talk about what anxiety is and what it isn’t. What’s normal and what’s not normal when it becomes excessive.


And we’re going to talk about the importance of systems in childhood anxiety, both the family systems and other systems in a child’s life, the accommodation of anxiety as something that unintentionally maintains anxiety within a child’s life.


How you can support your child rather than your child’s anxiety.


And how you can help your child overcome anxiety. Whether that’s in the context of an individual treatment or outside of individual treatment, whether your child wants to be part of that change or whether they don’t want to be that change.


So let’s start a little bit at the beginning, talk a little bit about what anxiety is. So anxiety is a natural response. It’s a healthy biological protective mechanism that we all have that serves as a means of alerting us to danger. So that we can do what we need to do, to respond to it, to protect ourselves. You may have heard of it referred to as the fight or flight response and it’s a good thing.


So essentially, when we’re faced with some sort of stressor or some situation, immediately our mind assesses that situation it basically asks is this safe?


And in response, we generate thoughts and feelings and physiological responses, sensations.


And as a result, we come to an assessment of whether or not we need to respond or the way in which we need to respond behaviorally in order to either fight that potential threat or flee from it.


And that is the stress response.


And in terms of anxiety in kids, everyone experiences, anxiety, kids experience, anxiety, adults, experience, anxiety, anxiety is adaptive, it can be very helpful to us. And anxiety is particularly helpful in kids. Especially as they grow and develop as they explore the world, and they learn, and they grow. They learn new things. We want them to experience some anxiety. We want them to approach unfamiliar things with some caution. Right, we don’t want them to.


We don’t want them to approach new things with, without some caution, right? We want them to approach new things with a little bit of apprehension. We want them to have that alert system Say, hold on a second. Let’s check this out and make sure that it see first. We want them to look at the stove and think first. Is this safe? Can I touch it? We want them to look at the pool and, you know, approach it with some caution and not just jump right in. This is a good thing. Anxiety alerts us to potential harm and, and that’s good.


However, anxiety can be excessive, And this is where we’re going to talk a little bit about what that looks like and what we need to be able to do about it. So, anxiety is excessive when it’s intense, high in intensity, And when it’s persistent, right, when it doesn’t relent and pass quickly.


Anxiety can be really maladaptive and interfere with a child’s daily functioning. And what I mean by that is, you might see changes in a kids’ ability to sleep and bedtime behavior. You might see it interfere with a child’s inability to eat or with their mealtime behavior. You might see changes in mood, You might see them become irritable. It might interfere with a young child’s toileting behavior. You might notice changes in separation behavior. You might see an impact, other areas of their daily functioning in their activities and their ability to concentrate to complete daily tasks like hallmark, or extracurricular activities, or other activities that they would normally engage. And so you want to look for changes in daily function.


Excessive anxiety can also interfere with a child’s accomplishment of some basic developmental tasks.


And what I mean by that is, because a child is focused on avoidance and anxiety, another word, when, when a child becomes very anxious about a particular thing, Naturally, they try to find ways to avoid feeling anxious, right? No one likes feeling anxious, and, it’s natural to want to avoid feeling anxious. And so, they become very focused on trying to do things to avoid the thing that makes them feel anxious, right? That seems very natural, but it can be really maladaptive, right.


Putting all of your energy into avoiding the thing that makes you feel anxious could potentially be really problematic. And so, when one does that, particularly as a child, that can interfere with all sorts of things that a typical child should be doing, developmentally speaking.


So, for example, you might have a child who is unwilling to, for example, learned to brush their teeth because they were afraid of the sensation or they may be reluctant to learn to toilet train or use a shower or learn to ride a bike or learn to swim, Because the idea of learning to try new things, because they are afraid of unfamiliar things or things that cause anxiety.


Because that anxiety has become generalized spread to other things essentially. Things that are unfamiliar, things that seem new, things that seem scary, things that lead them to be afraid of what could happen, causes them trouble.


And so they wind up having difficulty engaging in things that would normally the things that kids their age should be doing, and so it becomes very problematic or potentially problematic for them.


And so kids can have anxiety disorders, and there are a host of anxiety disorders that kids can have. And we’re not going to spend a lot of time on this, but I do at least want you to be familiar with what they at least look like.


There’s generalized anxiety disorder, which is the anxiety related to a lot of different kinds of things in someone’s life is obsessive compulsive disorder, which involves both intrusive thoughts or images and compulsions behaviors or mental acts carried out to reduce the anxiety associated with the obsessions. There’s social anxiety disorder, selective mutism, specific kinds of phobias panic disorder, not as common with children but you sometimes see it.


Post-traumatic stress disorder, avoidant restrictive food intake disorder, then other kinds of anxiety not so much anxiety disorders but they’re also often modulated by anxiety. In other words, they are often associated with anxiety. They tend to be exacerbated by anxiety, such as trichotillomania, which is a hair pulling disorder, Excoriation disorder, which Skin Picking Disorder there belong to a group of disorders referred to, often as body focus repetitive behaviors, tic, disorders, Tourette’s disorder, and other disorders such as this.


And anxiety disorders in children are not uncommon, one in eight children suffers from an anxiety disorder.


The good news is that anxiety disorders are actually very treatable, the American Academy of Child and Adolescent Psychiatry.


And the American Academy of Pediatrics recommends cognitive behavioral therapy for anxiety disorders. And CBT cognitive behavioral therapy is considered to be the most evidence based psychotherapy, And specifically, for anxiety disorders. Of course, severe anxiety disorders, CBT along with medication is recommended for anxiety disorders and so CBT. We’re gonna talk a little bit about CBT. Specifically, just so you have an understanding of what the treatment is like, but, we’re going to talk more about what parents can do. The same thing, but I do want you to be at least familiar with what CBT for anxiety disorders, what that looks like.


Before we do that, I want you to know a little bit about what maintains anxiety, like, how did we get here, right. Well, what exactly leads to anxiety becoming?


so, maladaptive, what leads to such poor functioning in someone’s life?


So what happens is, let’s, let’s use an example of, let’s say, a metaphor via a metaphor, B, is the fear of vomiting.


So let’s say a child is afraid of vomiting on the school bus, this is something that is not uncommon in our practice. So a child wakes up on Monday morning and is afraid to get on the bus to go to school. And so, they wake up in the morning and they think, oh, my gosh, I don’t want to get on the school bus. The ride to school is going to make me feel nauseous, I might throw up on the bus. I might get really embarrassed, and kids are going to make fun of me. It’s going to be awful. I can’t handle that. This is going to be terrible.


I can’t go, and they feel really distressed, really, really distressed.


And so they get really worked up, and they wind up saying to mom or Dad, I can’t go to school today. I can’t get on the bus, I feel sick. I don’t wanna go, I, I can’t go, I feel like I’m gonna throw up.


And so, It’s not really that they feel sick, it’s that they feel really anxious and they may or may not know this, they might really feel like they have an upset stomach. That’s also not uncommon for anxiety and kids.


Or they might be really anxious and this is their way of sort of avoiding anxiety.


And so mom or dad say, OK, I’ll try it. I’ll drive you to school.


Let’s say they know it’s anxiety, they say, OK, I will drive you to school, let’s get in the car. Will go to school. And so, they get in the car, and they go to school.


And so, what happens as a result is they get to experience temporary relief, In other words, their anxiety comes down, so short-term relief. OK, oh, I didn’t have to.


Face feeling anxious and nauseous and sick on the bus, and I didn’t have to vomit on the bus from feeling sick and having to do that. And I didn’t have to experience that, I feel so much better And they get to go through their school day, and they’re OK.


However, what they also experienced is they didn’t get to experience a corrective experience.


In other words, they didn’t get to learn that they get on the bus and they don’t throw up. And they made it to school and they’re fine or no Worst-case scenario, they get on the bus.


No worst outcomes happens, Which is that they throw up unlikely. But certainly within the realm of possibilities, and they survive it. It doesn’t end there worlds, you know.


They get through it and you know, they live to see another day.


The absence of a corrected experience.


And so what happens is that likelihood they wake up again the next morning are another morning soon, and they’re nervous about the possibility of throwing up again.


And they get really nervous again and they want to avoid it again.


And the whole system reinforces itself.


The avoidance begets more avoidance and increases the anxiety which increases the wind’s, which increases anxiety.


And so that’s how anxiety is reinforced.


And that’s how others help to unintentionally reinforce the anxiety. And that’s really what we’re here to talk about today, it’s about how systems, families, but other people too unintentionally, reinforce anxiety. And that’s really important to talk about.


We’ll use another example.


While we’re looking at this little diagram here. Let’s talk about fear of the dark, because this one is really simple, and it’s something that we’ve all done with our kids, myself, included. Here are the dark.


Um, you have a toddler. Your toddlers afraid the dark.


Toddler doesn’t like to go to sleep in a dark room.


Toddler scared, very upset, wants you to have a nightlights, very simple thing.


Kids afraid, once you have a nightlight, want you to leave a little light on a nightlight.


You put a nightlight, are in the room, OK.


You give the kid a nightlight, they get to avoid feeling scared.


They feel a little bit calmer, OK? Great.


Problem solved.


They get to feel relief. OK, less anxious, wonderful. Nothing bad happened. No monster came out and grabbed me. Nothing bad happened. OK, I feel safe, everything is good. Wonderful, OK.




Problem is they didn’t get to experience the fact that nothing bad happened in the dark.


You’re OK in the door.


You can tolerate feeling scared in the dark.


Absence of a correct and experience.


now, then E The nightlight We’ve all done it.


Right? above May actually, as a nine year olds room, he has a nightlight.


We all do it.


But this is important.


And that’s what we’re here to talk about today.


OK, CBT. Let’s talk about the evidence based treatment for anxiety. OK? So CBT for anxiety, typically involves. one psycho education.


Psycho education is just a fancy word for teaching people about what anxiety is, and how it works, and what CBT is.


Basically, we teach people about the relationship between thoughts, feelings and behaviors, and how that works in really unhelpful patterns and how to change those patterns to more helpful patterns.


And, um, what we do is we help to correct erroneous cognitions. In other words, those unhelpful patterns we help too.


Correct them, we help them to think differently and change them to more adaptive patterns. And then what we do is exposure therapy, and what exposure therapy is. We help people to confront their anxiety in a hierarchical sort of systematic fashion.


Confront their fears, basically, in a slow, collaborative manner. So that they become less fearful, and we help them to eliminate their compulsion, or their avoidance behaviors. So that they become more confident, and more able to do the things that they were fearful of.


And that’s CBT for anxiety and then in a nutshell.


The goals for effective behavior change and building resilience for anxiety disorders is essentially that exposure therapy facilitate new learning. We want people to learn that these things are not so scary that anticipatory anxiety, that fear that we experienced before something happens is often greater than the distress of actually being faced with that scary thing. We want people to learn that. They can tolerate their own distress and learn that that distress is temporary, even though sometimes it seems like it’s not going to be. We want them to learn that feared outcomes Like that throwing up on the bus. It rarely happens, if ever. And we want people to learn.


Especially kids, that they can do it, that this is doable, that they can face their fears and that they have mastery over these things that they feel like they can’t do, and that’s really important.


And those are the goals.


OK, but we’re talking about systems, right? We’re not here to talk about exposure therapy. We’re here to talk about systems. But I wanted you to be aware of that, because I think it’s really important, and it does play a role in, in working with systems and talking about systems.


So let’s talk about system systems, play an important role in childhood anxiety.


Why? Because, kids don’t function, on their own, kids, functions, in a context, right?


Kids, distress is a family’s distress and other systems to a child who struggles with feelings of anxiety. And his overwhelmed, for example, a kid who’s overwhelmed with feelings, of anxiety, about schoolwork, is likely to have some difficulty with emotion regulation, for example, in general. In other words, if a kid who struggles with schoolwork. In general, probably has pretty big feelings, big emotions and it’s a child who’s probably going to have some meltdowns at home when it comes to homework.


And that kid, who likely has some meltdowns when it comes time for homework, is probably going to be a kid, who has some similar experiences in the classroom.


So, also in school, right, and perhaps in other settings as well.


So a child’s distress is often a family’s distress when a family comes in, who brings a child into our office because a child is struggling with anxiety. They don’t often say, help my kid with anxiety. They say they’re anxious. They come in and say, my kid is struggling with anxiety, and it’s really affecting all of us.


A child’s distress as a family’s distress, and oftentimes, you know, we wind up having to talk to school too because it’s impacting them in school and in other places as well. And so systems, that’s what I mean by systems, are really important.


Kids express their anxiety in lots of different ways and loudly, expressions of distress serve two functions.


one, strategies for emotion regulation, like when a caret, when a kid cries and screams like a baby, for example, when they cry and screamed, there’s two goals, potentially. one is that they’re trying to regulate themselves, Right?


I’m just trying to make myself feel better or two, they’re trying to manipulate the environment to gain external accomodation. In other words, I’m crying because I’m upset, and I need you to come and feed me, for example, if a baby’s crying or I need you to come and change me, right. So, they’re either trying to help themselves, or they’re trying to get help from someone else.


So, for example, what? I remember having an IEP meeting at one point with a teacher, and this teacher was really frustrated with this kid. And I could see it, It was a Kindergartener, and I said to her.


I said to her, You know, this kid, is it giving you a hard time, this kid is having a hard time. And I really meant it.


As a nice kid, actually, really nice kid, but really had a really hard time controlling his emotions.


And it really struck her, like, no, sure, you know, I think you’re right, this kid is really having a hard time. And I think that’s important to keep in mind. They’re not doing this on purpose. They are having a hard time, and they might be doing it because they need you to help them. And that’s a different thing.


Systemic factors are really important.


Because systems can unintentionally, and unknowingly maintained anxiety. like I said with the Nightlight, for example. Yeah, now my kid needs the Nightlight. I’m not blaming families, like I said my own kid has Nightlight upstairs.


Systems have the potential, however, to help the childs path to wellness. And that’s also what we’re here to talk about. Sometimes individual therapy isn’t an option, or it’s not sufficient without addressing this.


So we’re going to talk about ways that families, that parents, that systems can help.


So let’s rewind a little bit, because I want to reframe anxiety, a little bit, and the definition of anxiety. Because I think it helps a little bit, to understand it in this context.


Anxiety is a biological social response.


If you in college took Psychology 101, you might remember studying Harry Harlow.


Harry Harlow was a researcher who studied monkeys and in a phase in a famous study of infant monkeys of surrogacy. He took infant monkeys from their biological mothers and gave them to inanimate surrogate mothers.


one was made of wire and wood construction, and the other was made of similar construction but it was covered in foam and soft terry cloth.


And in the first condition, the wire mother had milk, and in the second, the soft mother had none.


In the second condition, the cloth mother had the food, and the wire mother had none.


In both conditions, the monkey’s spent more time with the cloth mother.


The first condition, the babies went to the wire mother to quickly get food, and then immediately went to the wire mother, to the cloth mother. I’m sorry to, to remain for comfort.


So no matter what these baby monkeys went to the cloth mother. Even when they needed food, they went to the month. They went to the wire mother to quickly get the food, and then they Westbrook back to the cloth mother for comfort. Now when the monkeys were put in novel situations or situations that were a little bit scary, or a little bit unfamiliar, the baby’s always went back to the cloth mother for comfort clung to the cloth mother, just like in the little picture there.


So this is fascinating and was really very important, groundbreaking.


Landmark study. Mammals are hard wired for us. We are two.


This is innate, it’s very important.


We’re made to, to comfort our, our babies and our babies are made to look to us for comfort. And that’s important.


So, unfortunately, it also means that these patterns can be enforced reinforced in really unhelpful ways, too.


Chronic over response of internal activation is also consistent with chronic over responsive, interpersonal systems. So what does that mean?


In other words, when an anxious response has consistently been exaggerated and reinforced. So I’ll explain that the response has as well.


So, for example, you have a child who becomes really anxious at the sight of blood and she’s playing in the backyard, and she’s screams out loud, and you rush over there to check on her. Make sure she’s OK and you look at her knee. And there’s a scrape, but there’s no blood. It’s just a little bit skinned.


And, she’s screaming uncontrollably and sobbing and the neighbors who are also playing outside, look over and they’re checking or she, OK, what’s going on. And it’s causing a lot of everybody’s paying attention let’s say and you cannot consult her. And she cannot stop crying and you’re asking her what happened? What’s going on? Are you OK? Let’s? and she will not stop crying and screaming.


And then all of a sudden, you notice that you’re starting to get amped up as well. And all of a sudden your gun shoots, OK? And you’re starting to get louder.


And you’re shushing loudly, and you’re just trying to get her to quiet down and settle down.


So your her, over activation is now your over activation.


As parents, we’re hard wired to notice our child’s cues and respond to that, to provide protection and regulation for our children.


But when our children are reactive, know, we’re also wired to exert control over our kids’ reactivity when they’re not self regulating.


So when our kids lack self regulation skills, it’s tough for us to kind of sit back and let them learn to self regulate, particularly if we have a kid who doesn’t self regulate so well.


And that’s challenging when we have an anxious kid.


So let’s talk about accommodation.


SIL accommodation is any behavior that is carried out to help a child avoid anxiety related distress.


It’s common. It’s natural, everybody does it. Sir responds to childhood anxiety.


Parents, like I said, are attentive to their child’s fear cues and they don’t want to see their child suffer. No one wants to see their child hurt!


No one wants to see their child upset and they do things to help them feel better. We all do it.


The behaviors are often carried out in the service of trying also to maintain the function of the system, and may do so In the short term. It’s not necessarily just to try to get by, sometimes it helps us get by.


For example, think of all the things that we’ve done as parents, and I have three kids by the way. So I I get it.


Think of all the things that we’ve done as parents to appease our kids or just to get out of the house on time, or to get to the that appointment on time or to avoid a meltdown in the middle of a store or to just get to bed or to get our kids to bed.


Um, it served to function at the time, right? Even now, sometimes we know that it’s not the thing to do in the long term.


We’ve all done it, right?


Like letting your kids crawl into bed with you at two AM, you know, that they’re going to want to crawl in bed to you with you again tomorrow night at 2 0 AM, but you’re exhausted. And it’s 2 0 AM.


And you don’t want to get up and return them to their button at two AM.


So you let them in your bed because you know you have to wake up in three hours.


Or let’s say you’re having a dinner party and you’re grilling shish kebab, let’s say, and, you know, you think grilled chicken. Your kids should be able to eat grilled chicken because they eat chicken nuggets, and that’s essentially the same thing. But your guests arrive, and everybody’s happy. And it’s good to see everyone in your mingling and everyone’s happy and running around. Kids are running around, everyone seems fine. And then your child’s very upset because they don’t see chicken nuggets.


And they ask you for chicken nuggets and you say, oh, we have grilled chicken. You like that. It’s just like chicken nuggets, and they start to get upset because it’s anxiety provoking for them. It’s not what they’re used to, And, they don’t like, try new food that makes them anxious.


So they start to get upset.


And they ask that you make them chicken nuggets, and maybe you do it because you want to avoid a meltdown in a scene, right? You do what anxiety says sometimes, because, in the short term, it serves a function.


We all do it, so OK.


But accommodations, that’s what I mean by accomodation carried out to avoid anxiety related to stress, accommodations do serve to reinforce the need for accommodations, right?


We just, unfortunately, we taught our kids that when they need that or if they do that, will help them to avoid that distress and it does negatively impact that pattern and the course potentially of anxiety disorders and of treatment outcomes if they’re in treatment. So we need to be mindful of that.


OK, so Family accommodation.


This is a slide actually from Ellie Liebowitz and his colleagues at the Yale Child Study Center that was part of the Space Program, which I’m going to talk about. It’s really great intervention. It’s just a really nice little summary of some of the literature on family accommodation.


Family commendation is something that most people do is present in about 95% of parents and anxious kids, especially mothers. It’s associated with more severe anxiety, symptoms, and more severe impairment for children and families, It does predict poorer treatment outcomes, and it leads to additional problems, including sleep related problems, and so, we need to be mindful of that when dealing with our kids.


It’s a balance. We all do it, but we need to be mindful of it.


So, let’s talk about some specific accommodations. The first thing I’m going to talk about is reassurance seeking behavior.


So, reassurance seeking behavior is when anxious children ask us, essentially, to provide them with reassurance like that everything is going to be OK in order to relieve distress.


And re-insurance seeking behavior can come in all sorts of different forms. It could be straightforward, like, essentially, asking if everything is OK.


Or, it could come in other forms as well, like seeking advice or guidance, asking questions repeatedly. It could be asking an opinion about a topic.


For example, if a child has a CD and is focused on the possibility of amorality, potentially offending somebody. Like, he or she may ask you questions about whether you’re OK or whether you’re upset or whether they heard you say something upsetting to them.


They may ask you to do something or provide them with reassurance like physically checking something where they may ask that you not do something, if they may ask you to leave your bedroom door open at night, like, for example, I’ve seen lots of kids who worry about the safety of their parents, And so they may ask you to leave your bedroom door open at night so that they can check on you to make sure you’re safe.


Or they may ask you to say particular phrases like at bedtime, like, say, goodnight, and I love you, particularly like that. And if you don’t say it like that, they insist that you say it like that. Again, to reduce their anxiety.


It’s more of like an obsessive compulsive disorder type of symptom. It could be that a child insists on going to the nurse at school to call home frequently to check in with a parent.


It could be, maybe an older child who texts apparent throughout the day and expects a child a parent, text, back and return. Otherwise, they’re going to feel particularly anxious and be upset about that, and reassurance seeking to come in all sorts of different forms. Providing children with reassurance serves the function of rescuing them from distress.


In other words, it doesn’t give them the opportunity to learn to cope with their distress. Remember, anxiety is unpleasant, but it’s not dangerous. And it’s important that people learn to experience anxiety, because it is OK. It is temporary.


And it does pass, it’s unpleasant, but we need to learn to be able to cope with all sorts of emotions, including anxiety, providing children with reinforcement, with reassurance. Also, remember, reinforces the need to gain reassurance, so you provide it and they’re probably gonna need to seek and, again, not just from you, but probably from others as well.


In addition to reassurance.


There’s also parental avoidance and request fulfillment.


In other words, demands, parents of anxious kids often fall prey to avoidance behaviors too.


Parents will engage in avoidance such as distraction or pivoting away from anxiety. In other words, maybe if I can take their mind off of this by, you know, distracting them from this thing that’s really upsetting them then that’s a really good thing. But, but, but, not a good thing.


Or, they’ll do the thing that anxiety demands of them so that they can avoid potential meltdowns or upsetting them in some way, or that they can avoid help their child avoid the unwanted consequences which are unlikely to come true, but helps their child feel like they are safe, or help them feel re-assured.


or help them to avoid, potentially behaviors that they’re worried about, like acting out behaviors, for example.


An example might be sleeping on a child’s floor until a child falls asleep, Lots of parents have fallen into that trap.


It could be something seemingly really innocuous, like, using a nightlight, like I mentioned before, a sound machine, or music in a child’s room, where parents are essentially going to do what a child’s anxiety demands in order to avoid upsetting them.


Or, you know, we could, we could use a much more intense example.


Like, maybe a parent is fearful of a child’s reaction.


Because the reaction itself is scary.


Perhaps a child, perhaps a parent feels like they’re walking on eggshells because their older child is so anxious and doesn’t self regulate well. And their anxiety, if heightened enough, comes out as anger and violence.


Perhaps they act out, perhaps they.


And perhaps they have suicidal ideation or, you know, suicidal threats or perhaps they engage in self harm.


when people are overwhelmed and they lack the skills to regulate their own emotions.


The behavior that they carry out to get others to respond can be pretty wide ranging.


Remember what I said earlier, the function of the expression of anxiety, right?


That, that screaming by the, because of scraping the knee, the little girl who fell outside, right, it’s an attempt to either self regulate, or an attempt to get others to regulate for them. Right? The the parent who ran over to this fake knee and such, right. The reason that they did that was because they needed them to us, to stop, they needed to Suzanne, they needed to regulate them.


However, it’s just a bigger version of that.


Kids need to learn to self regulate parents, it can’t continue to regulate for them, bigger, kids, bigger problems, right?


Bigger, bigger kids, bigger problems. And avoidance of potential anxiety provoking stressors serves to assist the child in escaping from distress. Rather than providing them with the opportunity to build their own coping skills, you want them to learn to cope.


Anxiety is OK.


Avoidance also reinforces the kids’ belief that the stressor must be avoided, and that they can’t do it on their own, and you don’t want to teach them that. You want to teach them that it’s OK, This is scary, but it’s OK, And you can do it, and you can get through it.


So, to give you a sense of what the accommodation cycle looks like, to just kind of give you a good visual, what this looks like, and how to put a stop to it.


As an example, distress related to the disorder. I fear that someone may break into the house while we’re asleep, for example.


The family might accomodate by checking the front door, as the child may insist, to make sure that it’s luck, and that reassures the child the child feels better and relieved and they’re able to go to sleep.


They, will, they experience a short-term reduction in distress, then unfortunately, the child also continues to depend on the parents for that regulation.


They think, OK, the only way I can feel safe at night is to make sure they lock the door. So, I’m going to continue asking, and, so the parents continue to accommodate. They continue to check the front door and to re-assure the child with the front doors locked to, the child continues to avoid feeling anxiety about that.


And so, the cycle continues.


An example of school, because I noticed that there were some school folks that were interested in attending this example of how this happens in that setting.


Distress related to the disorder a child might think, or an older child might think, I can’t tolerate having anxious thoughts about peers, judging me in class.


A teacher, And some teachers are a particularly uncomfortable with asking a student what they might need to go to guidance for. And, so, they, they might just send the child down to guidance. If the kid asks, if they could be excuse, they send them out of the room. Go down that guidance, child feels relieved.


They don’t have to sit in the classroom, surrounded by their peers, worried about what their peers might be thinking of them. They feel relieved, they don’t have to sit in class, they get to escape the scrutiny that they are worried about.


They experienced a short-term risk reduction in that distress, and they get to escape that. So they continue to depend on the staff for the teacher and the smatter for regulation.


Thinking, the only way that I can cope with these thoughts is to be excused from class, and so the school continues to accommodate by sending the kid down the guidance.


And the child continues to avoid experiencing the distress associated with their thoughts of being in the classroom surrounded by their peers by asking to be excused.


So, systems can serve a really important role in improving childs and anxiety.


It’s important that therapists adress family accommodations as school accommodations in the process of childhood exposure therapy and any kid involved and exposure therapy. This should come up. A therapist should talk about accommodations and how to address accommodations.


But what if a child is unwilling to participate in treatment? And this does happen, and we can’t force akin to engage in exposure therapy if they’re not willing.


And it does happen occasionally or what if an individual exposure based treatment isn’t accessible. And that does happen from time to time.


There are things that families can do.


Parents can help their children better manage anxiety, indirectly, by changing their own behavior.


I mean, the parents changing the parents on behavior.


So I’m going to spend a couple of minutes talking about space. I mentioned it earlier and you probably thought, What exactly did she mean by that? So space or Supportive parenting for anxious childhood behavior and Notions is a parent based treatment for anxiety. Created by a group at the Yale Child Study Center.


Before this pandemic happened, it’s one of the last trips that I took was to this wonderful training at Yale for this great intervention that works with parents, not kids. It’s an evidence based treatment for parents to help their kids overcome problematic anxiety, and it’s not anything that parents do with their kids. It is parents changing their own behavior to affect kids, anxiety. It doesn’t require a child’s participation in therapy.


And it involves unilateral, parental action, meaning that this is an intervention that parents carry out together with each other, um, on the same page as each other. Out of concern for their child to change their own behavior, Whether or not the child is co-operative or receptive or wanting to participate, Sometimes it involves other people in the family, like grandparents, if they are significant daily folks in the child’s life.


And it’s a, it’s a really cool way of getting at change in a child’s life.


The main goals in space are to, one, increase the quality of support in a child’s life, and the second is to decrease accommodation accommodation that we’ve been talking about in the family system.


So, what exactly do I mean by increased quality of support? You know, we love our kids, and we’re really supportive of our kids. What I mean is the kind of statements we make to our kids, Oftentimes, we mistakenly assume that support means that we tell our kids that, we love them, and that everything is, OK. But telling our kids that everything is OK, is often really unhelpful and actually serves to increase their anxiety. in many ways. What, I mean, by providing high quality support is to, essentially, except. Provide them with acceptance of their feelings, to provide them with validation their feelings. It’s OK, that they’re experiencing this. These emotions are not only acceptable but valid.


And that you have confidence that they can handle their feelings.


That is good, high quality support. That is what you want to convey to your kid.


Essentially, I see that this is hard for you, but I know that you can handle this These are real feelings and valid feelings, but I know that you can handle these feelings.


That’s the kind of stuff that you want to practice. That’s the kind of support that you want to be given to your kid.


So what you want to be doing is providing that kind of high quality support.


Supporting them, not the anxiety telling your child that they’re going to be OK, is supporting the anxiety.


It’s OK, anxiety, You’ll be all right, you don’t want to tell them that. You want to tell the kid.


You are capable of managing your feelings. And that will strengthen their ability to manage their anxiety. That’s really the goal.


And then eliminating accommodations is, is key eliminating accommodations on the parent, right? Basically saying, I know that it isn’t good for you that, that, we’re doing that, that we do these things. And so we’re not going to do these things.


Not exactly like that, but doing that will slowly, basically provide them with the opportunity to have to figure out ways to cope on their own, which provides them with the opportunity to engage and exposure a little bit.


The goal for a healthy System is to slowly work on eliminating accommodations, whether through space, or in individual therapy, or on one’s own as a family. Spaces is, provides the opportunity for a family in a structured, systematic, collaborative way to reduce accommodations, as implemented with a therapist, by parents, over the course of weeks, and months.


And although it is beyond the time constraints of this webinar, you can do that if you choose.


At the end of this talk, I do have a resource for finding space treatment providers. I’m not the only person in New Jersey that’s been trained to do this, but But you can, you can do that if you choose. And I’m going to talk to you about some other ways, beyond space, as well. The intention is for parents to change their own behavior, thereby influencing the child’s behavior, essentially.


So, outside of therapy, outside of individual therapy, outside of space, some tips for eliminating accommodations, you want to choose one specific accommodation at a time to reduce or eliminate or eliminate. You’re not going to basically say, I’m done, I’m not going to do any of this stuff anymore. You’re gonna just do this on your own. You’re not going to do that. You’re gonna, you’re gonna slowly do this over time, little by little.


And sometimes it’s reducing, if not eliminating, because this is hard stuff and they need to learn to do this over time. You’re gonna make this decision clearly and concisely and a consistent manner.


Consistency is really important to, you wanna make sure that all systems in the child’s daily life, that they’re all aware of these significant changes, and that they’re all on board. So if you know, grandma watches the kid after school every day, you want to make sure grandma was aware of this and that grandma was onboard and is going to be sticking to the same plan as well, You don’t want to respond to anxieties response to this change. So if, you know, the kid is gonna scream and carry on about that, that’s OK. Ignore anxieties response.


If if anxiety wants to attention seeker, be upset about it, or reassurance C corps, Or seek some sort of reaction to the greatest extent possible, you want to ignore it. Or you might want to just briefly acknowledge it. You know, I can see you’re upset about this.


I know this is difficult, but I also know that you can handle this.


again, high quality support. Ignore at that point and move on. Ignoring or discontinuing previously reinforce behavior will decrease the behavior that’s called extinction. So ignore, acknowledge, ignore, it will go away. So hang in there, like teaching kids asleep on their own.


So elimination in the accommodation cycle. Going back to those earlier examples, just so you can see how this works, going back to that first example, I fear someone may break into the house while asleep.


If, instead, you say, we understand this, feel scary to you, but we know you can manage this feeling, for example. And the child is left to feel anxious, understandably so. They’re going to have to figure out what to do about that.


And so, you might have a rough night, or they might have a rough night.


However, they’re unable to avoid or escape that distress, and the child will learn what to do about that. They’ll either learn that they were able to manage the distress on their own, They’ll figure out what to do, and they’ll fall asleep.


Which is a good thing, And you wake up in the morning, and, yay, you didn’t have to check the door, and they’ll learn, Hey, mom or dad didn’t have to check the door, and they didn’t have to tell me that they checked the door. Awesome, I did it.


Great, fantastic.


And, it didn’t get reinforced, awesome.


Um, there are ways to help the kid cope as well, like, if the kid is also.


Willing to work on this to create a list of ways that they can, you know, coping skills that they can Udall utilize to sort of help them to.


To tolerate those feelings, that’s great, you can help them even come up with a list of things that they can do with those feelings. That’s great.


But letting them learn to cope with the feelings without you doing the checking is important.


And that school example, for example, I can’t tolerate heading anxious thoughts about Peers judging me in class. Instead of the teachers sending, the kid to guidance, teacher remains flexible for the student to employees skills to remain in class.


Kid’s gonna feel uncomfortable, experience distress. But the kid will learn that they were able to manage the distress and not have to leave the room, and eventually it will be able to stay in class. Now. I know that’s hard. There will probably have to be some plan put in place. They might have to work with guidance. They might have to work with a therapist even to put a plan in place. They might have to create some sort of menu of coping tools, tools for use in the classroom when they’re feeling uncomfortable that they might have to pull from. They might have to create some sort of RP stands for a response prevention plan. For example, you can’t, you know, there’s gonna be no texting of Mom. while you’re in class, to provide reassurance.


You might have to say that There’s no checking in with the teacher to ask, even to go down to guidance. You might have to agree that the teacher is going to, when they see the kid uncomfortable, engage the kid in some classroom discussion, to keep the kid involved, so the kid doesn’t sort of mentally check out. There might have to be some plan put in place, but the kid will learn that they’re able to sit and manage their own distress and that is the goal. That’s the key. To not reinforcing the anxiety and to achieve the mastery Experience.


Facilitating new learning.


All right, couple of minutes of wrap up here, building your own coping skills.


So, kids don’t always come by anxiety on their own. Sometimes, they They also have anxious parents. Anxiety is often hereditary and sometimes parents are anxious. Or, you know, sometimes parents are anxious about their kids being anxious. Parents must learn to tolerate their own kids distress, and it’s hard, it’s it is hard to see your kids anxious and upset. So, parents need to be able to model acceptance of all emotions, including their own kids, anxiety, anxiety is normal, it’s OK. And it’s temporary. And it does pass.


Remember that building resiliency, we’re building coping skills and effective tools to manage anxiety and distress far outweighs the temporary relief of providing accommodation and avoidance for your child.


And also, if parents themselves struggle with anxiety, it’s important to seek help. It’s not just about your kids. You know, taking time for yourself. Even for this kind of stuff is really important. You know, it’s like, it’s like the, you know, when you get on an airplane and you take a flight, you know, the idea of putting on the oxygen mask for yourself before putting it on your child, you know, if you need help, seek help for yourself. It’s important that you take care of yourself so that you can provide good help for your child.


And, you know, be kind to yourself. Stay calm and cool and collected and model openness and and emotion regulation and problem solving skills and inflexibility or your child. Make sure that you’re able to do that for yourself.


Remember the most important thing about overcoming anxiety is the exposure piece and learning to manage anxiety and distress. But behavior change is a process of shaping.


You’ll want to be able to encourage reinforcement of desirable behavior and refraining from reinforcing the previously reinforced undesirable behavior, right? That extinction stuff that I mentioned, right? You know, we want to ignore the stuff that we previously reinforced that, we want to discourage and it will go away. Understanding.


How these systems work so that we can change them for the better for the adaptive is really essential to helping kids overcome anxiety.


I do have some resources and some readings that I’ve listed for folks. There are so many. It was really hard to pare them down to, to the things that I really like most. But, there are some websites here that for organizations that I find really helpful and really, really useful. I recommend highly, if you’re looking for some good resources, there’s also some really great books that I find to be really helpful for, people looking for, anxiety, guidance for kids in general. Both young kids and slightly older kids.


All right, I’m happy to take any questions.


OK, and we definitely have some, Great, we’re going a little over, so I’m going to launch right into these, OK.


Um, have a question having to do with the current state of events, have a question about the fear of returning to school before the end of the school year when the child is worried about the virus. So could you talk about that and the possibility I’m not even sure if it’s a possibility that kids are going to return to school this year. I think it depends on where you are.


But let’s assume they do.




So could you address that?


Yeah, it’s really hard to say. Right.


I mean, in my opinion aside, my opinion being that, I think it’s very unlikely, with 43 states already saying that they are not going to return to school this year, and with us being the second most infected state in the country. I think it’s highly unlikely that.


Being said as a psychologist who specializes in anxiety, we don’t know, right, we don’t know, and it’s an uncertainty is an OK thing to sit with.


Um, we don’t know for sure, and that’s OK.


And it’s important for us too, Adress, how kids are feeling about that.


So, what I would say is, when talking to kids about their concerns, it’s important for us to one, help them to identify how they’re feeling about that, so I would say, you know?


Tell me how you’re feeling about that. Are you nervous about that?


Know, what’s, what, what makes you nervous about that? I want to know how they’re feeling, and then I would want to validate those feelings, you know? I can understand how that would make you nervous.


I think a lot of people are probably feeling pretty nervous about that.


I think that’s normal and valid, and it’s OK to be feeling nervous about that. That being said, it’s also important to point out what they can control, right? What are the things that you can do to stay safe? What are the things that are recommended for you to stay safe, right? Well, the CDC is telling us that when we go out in public, we’re supposed to maintain social distancing, right? We’re supposed to wear masks when we’re out in certain places, right?


We are, if we do return to school, those kinds of rules, definitely, those kinds of guidance will be put in place, right? And we’re going to be told, specifically, what kinds of things to do by our government, by our state government, and by our health officials to stay safe, because that’s their job.


And that is going to be within our control to carry out.


And that’s what we’ll do.


So, it’s important for us to validate their feelings and to tell them what they can do to stay safe. What we’ll do to help them stay safe. And what others will do. Who have the authority and the scientific knowledge to help them stay safe and stay safe as well.


OK, that’s a great answer And I just I also think that there’s a place for parents not to become overwhelmed themself with the worrying over this. If there’s an old grandparent, you know, there’s this extended families that they’re concerned about and in demonstrating that drama to a kid who has anxiety issues, I’m not sure is a good thing or a my office.


Absolutely, absolutely, it’s, You know, we’re all in this together. This is a really hard time for everyone. It’s a really hard situation for all of us to navigate. I think we’ve all probably had those moments of saying, OK, I need to kind of real it in here myself.


Um, and those probably include times of Reflecting on how do I control myself.


And if we have kids, we need to consider what we are exposing our kids to.


So that we know if we’re watching the news or listening to you, know, Governor Murphy is Daily Briefing Briefings or Governor Cuomo’s daily briefings, and they’re wonderful, but, you know, is that going to contribute to our children’s anxiety. We probably need to limit that, is that going to contribute to our own?


We probably need to limit that conversations that we do have with our elders. Or with other people. Or we talk about concerns for our elders. You know, we need to be mindful of, are we having those conversations around our children? Are we talking about those conversations around our children?


We just need to be mindful of, you know, when we’re having those conversations, whether or not having those conversations around our kids and limiting the intake for ourselves because it’s a lot, right? We’ve all been sort of inundated by information at various times and you know, it unpacks, it impacts us as well. You know, we’ve all probably had a little information overload from time to time, and limiting some of that is good for our own mental health in our being able to sort of put a little bit of a limit on that. And engage and engage in some stuff that gives us a little bit of a break from that is healthy.


OK, I’m going to move on to the next question.


This is a question from a school psychologist pertaining to a high school freshmen and the question about this is, this is a school psychologist and the case manager this, this freshmen has severe anxiety there then whenever academic demands placed on them, there’s been medication, this, that accommodations, there’s been reduced workload.


So all of the things that the school can can do too to work with this child. Apparently, they are doing but, the anxiety apparently is paralyzing And so the question is how what can the school to help break that cycle?


Mmm hmm.


I would probably want to know a little bit more detail about what’s happening exactly.


What exactly is paralyzing? What does that look like in the classroom?


Um, what’s happened over time?


Um, yeah, I’d probably want to know more about what that looks like.


Whether or not there’s been observation in terms of like, has there been an observation from the behavior analyst?


Like what does that look like? What exactly is causing the anxiety? Is the kids perfectionist?


Or are they getting frozen because there getting caught up in perfectionism?


Is the kid perhaps does the kid have OCD or they’re getting caught up in which realization is the kid does the kid have GED or they caught up in?


And that depends, I think exactly what’s going on in terms of.


Got it. A lot. Yeah, there’s a lot of unanswered.


I’d say, yeah, I would say refer them to a clinical psychologist and have them, if you can, and have them evaluated to see exactly what’s going on and see if, see if co-ordination with treatment might help them to function a little bit more. So just say that the parent also suffers from anxiety. So I think it’s tough.


Quite a mix there. That’s probably complicating the situation as well.




Yeah, these, these situations are often difficult, and ninth grade is tough, right? The transition to high school this year has been particularly complicated, right? Oh, sure, yeah. All right, I’m gonna go right to the next one. What can you tell us about the genetic basis for anxiety? We may be dealing with anxious children, of parents, with anxiety. How do we tease apart the genetics and the environment?


We can’t, we can’t really tease it apart, Is really not, then it’s, I’m sorry, just to clarify. You’re saying, you cannot tease it, apart, Really?


Yeah, we can’t really tease it apart.


I mean, the answer really is that there is a very significant genetic predisposition for anxiety.


And at the same time, anxiety is also influenced by someone’s environment.


So most of the time, when someone has an anxiety disorder, we expect that there is a genetic predisposition, But there are probably also maintaining factors. And the environment is really multi-faceted so most of the time, there are multiple factors involved in how someone winds up struggling with significant anxiety.


OK, all right, thank you.


I don’t remember where, in your presentation, this question, this question was posted, but, it was in the area. We were talking about, accommodations for, your, your kid with anxiety, and in this, in this man says that I did seek accommodations for my son at school. Was that a negative behavior as a parent? So, we all know, those of us that have kids with issues, certainly sick, you know, 504 is IEPs, do the things at school. So, is, so, how do you distinguish there between the parent?


It’s good question, so the word accommodation in this use is different than the word accommodation that’s used in a school setting.


That, like, a child study team would use, in terms of helping a kid plan for, like, a reasonable educational plan, like 4 or 504, and IEP. Different use different words, essentially. Different words. It is reasonable to ask for accommodations.


In school, if a child lacks the ability to learn in a way that allows them to keep up with other kids in the classroom, essentially.


So, there’s nothing wrong with making accommodations for that children, for that child, to be able to perform up to their potential, or perform up to there, their ability. There’s nothing wrong with that. Accommodating anxiety is, it is a different thing altogether.


So, can you make an accommodation, however, that is problematic in the school setting? Yes.


I’ll give you an example of that. An example of that might be, and we often get called into schools.


As consultants, to help schools explain to families how these things sometimes get muddy. And although it seems like you might want these as accommodations, they actually wind up being unhelpful.


And sometimes requires us to plan to help a kid become more independent instead of setting these accommodations up.


So here’s a couple examples.


one might be, we had a kid who was thought to have a problem with writing.


And so he had OCD.


But he was thought to have a problem with writing. He didn’t wanna write. He couldn’t write. He was a kid who had some trouble with ADHD and he, he didn’t. Want to use a pencil didn’t want to write. And so they made the accommodation of giving him a keyboard. Now, this is not an unusual accommodation in a school. This is not unusual, and there’s nothing wrong with that accommodation, in and of itself.


The problem was this kid had OCD and the function of that.


The function of it was his avoidance of writing was not that there was anything wrong mechanically with his hand. The problem was that he had OCD, in which he felt like he had to write his letters in a particular way and had to perfect his letters. He had to write and rewrite and connect his letters in such a way that he had to write, and rewrite and cross out and erase and make them just so. It took up a lot of time and, and school was very, very frustrated with this. And so they didn’t want to give him the time, and he didn’t want to take the time and he didn’t want to engage in the exposures, and they just said forget, it will give them a keyboard.


And that’s not good.


Because in the end, it accommodates his anxiety.


He’ll never right, basically.


And that’s a problem.


So, that’s not a good accomodation what we, what we want to do instead is we want to exposure and response prevention for him and get him to use a pencil and write and learn to write in his life.


Otherwise, he’ll never do that.


They’ll never be able to write properly, always avoid it and his OCD will probably grab onto other things.


So, that’s not that’s not a reasonable accommodation that’s not because of a disability. Really, that’s because of avoidance and anxiety related to its OCD and it’s one that is easily eliminated with a little bit of treatment.


OK, all right, we have really gone well over as I go to. This will be the last question, OK. So this is, and I think this is kind of, again, apropos to the situation. So we have a child, I don’t know how old that is, has a lot of attachment issues, and she’s the parent believes that the child is really relieved to be out of school and home with the bomb.


So, do you have any advice on re-entry to school, whether it’s in just, you know, September or or now, you know, whatever?


So, advice on re-entry, and when the time comes, how can the parents prepare this child for going back to school?


How old, she doesn’t mention and age, I don’t know, and I don’t know if the mom is still online, actually, so we may not get an answer.


I think actually, this is going to be a really common issue.


And we often see without a kindergarten, and she just popped up on the screen, so, Sheets, the child’s in kindergarten one. So, we often see, we often see kids like this of of varying ages, but the young ones are a little bit simpler in many ways. So, what we would typically recommend is we would work with the school.


You can work with the school to do what we would call sort of a graded exposure, in other words, very gradual sort of way to have her sort of ranter to prepare her for the idea of going back to school.


So, at first, we might have her, look at pictures, maybe of school. Maybe talk about the idea of playing with friends at school, or talking about friends at school, or maybe having a phone call with her teacher from school, or writing a letter to her teacher. At school. Maybe getting a letter from her teacher? At school, Maybe. We would drive to the school and sit in the parking lot. And look at the school, maybe get a tour of the school.


Maybe we would then go to maybe sitting in the library, the school maybe spending an hour at the library, maybe maybe with mom at the school, not by herself, but maybe spending an hour in the library at the school before going back to school.


Then, sort of gradually going from spending a little bit of time there to maybe spending a little bit of time alone there to a little bit more time and more time until she’s able to spend the day there.


All right.


So, that that then means that there is school has already started then, and with this has the potential of becoming us.


School refusals situation, then, if it’s not handled well, technically, potentially, But, usually, usually schools will take a little bit of time in advance, if they know a kid needs. A little bit of help, sort of, over the summer, or a couple of days beforehand, and giving them a little bit of a tour beforehand, or you can usually, management to spend a couple of days with helping a kid get used to the setting before the school year starts. So, it doesn’t have to be.


OK, All right, thank you very much. I’m going to end it here and turn this back over to Kelly.


Thank you for joining our webinar on Parenting, You’re Anxious Child. There is an exit survey which we need everyone attending to fill out.


The webinar blog is open and available for the next seven days on the N J CTS Website for any additional questions that were not covered in tonight’s presentation, that website is WWW dot N J C T S dot org. Also, an archived recording of tonight’s Webinar will be posted. Our next presentation is going to be an entire hour of Q and A You will have the opportunity to ask Stacy Greenwald, Esquire, who is a child advocate to any questions you have regarding 500 and fours, IEPs, and legal stuff with schools. This is scheduled for May 13th, 2020.


This ends tonight’s Webinar. Thank you, doctor Dipolar, for your presentation. And, thank you, everyone, for attending. Goodnight.

The Center for Emotional Health of Greater Philadelphia


  1. SandyD says:

    Left untreated, what are the risks associated with childhood anxiety into adulthood?

    • Dr. Marla Deibler says:

      Left untreated, anxiety tends to restrict a child’s ability to function and may lead to continued or worsening of impairment, including the development of anxiety disorders or related disorders that commonly co-occur.

  2. Kristen S says:

    What have you found to be most challenging about changing anxiety within a family system?

    • Dr. Marla Deibler says:

      There are times when anxiety is maintained, in part, because of a shared belief within a family system. For example, a child with OCD who has scrupulosity obsessions and rituals involving prayer may have practices that appear to be reasonable religious practices shared by family members, when in actuality, they case the child a great deal of distress and impairment. Or, a child with contamination OCD who insists on washing his hands prior to dinner, may also have parents who view this practice as being necessary hygiene. In both scenarios, despite the child’s OCD, the family system shares the belief that the behavior is reasonable, even though it is being carried out to decrease anxiety related to the obsession in the short-term and increases the distress and maintains the symptoms in the long-term. These parents are not accommodating the symptoms in the same way as some of the others in our lecture, but they aren’t providing corrective information and are nonetheless reinforcing the problem. When this happens, we have to spend time talking to the family to educate them about this and sometimes consulting with others as well, such as religious leaders to discuss the importance of being flexible in the interest in the child’s health.

  3. SGreen says:

    How do I respond to my child when they ask about fears that I don’t feel like I have a satisfactory response to? For example, right now, my child asks me what’s going to happen with the pandemic. Is it safe? Is he going to go back to school? Is this going to end? Are we going to get sick? How do I respond?

    • Marla Deibler says:

      Help a child to identify how they are feeling about the situation. Let them know that their feelings are ok and that many kids feel the same way. Acknowledge the uncertainty of what is going to happen and focus on what is within their control. Talk about what can they do to stay safe. (wash hands, wear masks in public spaces, practice social distancing, etc.) Talk about what others are doing to keep them safe. (This includes others in the family, doctors, researchers, CDC, local government, etc). Lastly, talk about what they can do to manage their feelings (get a hug from mom or dad, play with a sibling, call a friend, play a game, listen to music, etc.) Remember to give high quality support.

  4. FNottingham says:

    My grandson is in 1st grade and prior to this pandemic situation he was already struggling with school refusal due to anxiety around the active shooter drills. Now it’s this virus. I can’t imagine how he’s going to manage getting back to school when it reopens. I would appreciate your comments.

    • Marla Deibler says:

      There will be many children who will struggle with transitioning back to the classroom; he is not alone. Acknowledging his strong feelings is important. This is hard. And, it’s scary. We don’t know when or how kids will return to school yet. When worry creeps in, it’s important to pull kids back to the present. What do we know right now? Right now, we know that kids are not yet returning to school. That’s it. Ok. So, the hard part is the not knowing. Yeah, that can be hard. When we know more, we can talk about what we do know, how we feel about that, and what we might do to help make that easier for you. Until then, it sounds like, it’s just that we don’t know. Let’s see if we can practice getting good at not knowing and being ok with that.

  5. bcrosby says:

    Is there a rule of thumb for how long a child should show anxiety before it becomes not normal?

    • Marla Deibler says:

      There is no rule of thumb in terms of length of time. We are more concerned with developmental appropriateness and how impairing it is to an individual’s ability to function.

  6. cwojihowitz says:

    Isn’t it difficult for a parent who has trouble self-regulating to care for a child who has the same behavior? Don’t they sort of feed off each other?

    • Marla Deibler says:

      Yes, this can absolutely be a challenge. Sometimes, it can be helpful for dysregulated parent(s) to also have their own therapist(s) to learn better self-regulation as well. Family therapy can sometimes be helpful in addressing issues around systemic communication.

  7. HFarmer says:

    Would it correct to say that it’s not wrong for the child to ask for chicken nuggets, but rather their behavior when they don’t get what they want?

    • Marla Deibler says:

      (Assuming this is referring to the dinner party example from the presentation) I wouldn’t say that it’s wrong for a child to ask for chicken nuggets; the child is just being a kid, trying to figure out how to bring down the distress they feel they see there’s only grilled chicken available, so they do what they have learned works.

  8. FHolmes says:

    Regarding the child who’s checking in with parents during the day about their welfare: could that not be a red flag that there is some other issue in the home? Is there a fine line between looking deeper into a particular home situation?

    • Marla Deibler says:

      Yes, of course. I would not make an assumption about what is going on. If, for example, this texting behavior was going on at school, the school would certainly want to contact home to assess the situation. We were using examples of anxiety-driven behavior. We should not make the assumption that a behavior is anxiety driven and should always assess for safety.

  9. ArnoldP says:

    What do you suggest for kids that are flooded with stress all day with many triggers (LD, TS, social issues, gifted)? Is a smaller setting accommodating the anxiety, or could it be part of the treatment?

    • Marla Deibler says:

      Well-crafted accommodations in school for LD, TS, and ADHD, for example, are likely to help a child minimize distraction, maximize their ability to stay on task, and minimize their academic distress as it relates to their diagnoses. Sometimes, kids require smaller class sizes, for example, in order to cultivate a learning environment that is more conducive to learning for that individual because of their disabilities. That isn’t “accommodating” in the sense that we are using the word. That is the intended function of the 504 and IEP. And, that’s a good thing. However, as I mentioned, in the presentation, “the devil is in the details”. The function of each recommendation is important to consider, as the goal, of course, is to maximize the child’s ability to function independently and to their own potential. So, the goals may change to scaffold the child toward higher functioning.

  10. AmyZ says:

    My child has had a lot of questions around death. When she will die? How she will die? When will I die? What will happen to her if I die? Are there resources or stories I can use to better explain to her?

    • Marla Deibler says:

      This is a common fear for kids and there are some good resources out there, depending on the age of your child. Normalize her feelings. They are understandable. Everyone has these thoughts and feelings. There are so many different beliefs about what happens after someone dies. You can talk about some of those stories and beliefs, religious or otherwise. Convey the facts about how our bodies stop working when we die and that we will all die some day and that all living things die. There are also some storybooks (depends on her age) you can find on Amazon that are good reads.

  11. MMThurston says:

    I would appreciate your comments on co-sleeping. My grandson is 3 and until very recently was co-sleeping with his parents. Now he starts out in his own bed, but inevitably wakes up and mom gets in with him. Otherwise he’s behaves appropriately for his age, he’s toilet trained, speaking in sentences etc. Do you think this is an anxiety issue or just a bad habit that needs some tough love?

    • Marla Deibler says:

      Parents often have strong beliefs and feelings about co-sleeping. While some parents enjoy sharing a “family bed,” it is an important developmental task for a child to learn to fall asleep and fall back asleep on one’s own. Sometimes failure to do so is related to anxiety, or sometimes it is simply related to reinforcement of the behavior of being joined by a parent or joining the parent(s) – it’s warm and snuggly – or sometimes both. Also, it’s important for families to have boundaries for kids and parents and sharing sleep space (although a really nice experience, at times, for everyone) can blur those boundaries. For a healthy family system, and a good night sleep for all, it’s best to teach kids to sleep in their own beds.

  12. Tracy says:

    How do I go back to listen to this webinar? I fell asleep before the end and missed the answer to my question.

    • Marla Deibler says:

      It did go late, didn’t it?! You can watch it again or skip around. Just click “View the Webinar” at the top of the page.