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[Music]
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as a child I had many fears I was afraid
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of lightning insects loud noises and
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costume characters I also had to very
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severe phobias of doctors and injections
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during my struggles to escape from our
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family doctor I would become so
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physically combative that he actually
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slapped me in the face to stun me I was
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six I was all fight-or-flight back then
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and holding me down for a simple vaccine
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took three or four adults including my
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parents later our family moved from New
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York to Florida just as I was starting
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high school and being the new kid at the
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parochial school not knowing anyone and
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being worried about fitting in on the
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very first day of school a teacher takes
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role and calls out Ann Marie albano to
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which I respond here she laughs and says
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Oh precious stand up Sadie oh gee and I
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respond dog the class broke out and
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laughter along with the teacher and so
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it went because she had many more words
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to humiliate me with I went home sobbing
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distraught and begging to be sent back
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to New York or to some nunnery I did not
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want to go back to that school again no
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way my parents listened and told me that
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they would investigate with the
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Monsignor back in New York but that I
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had to keep going in each day so I'd
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have the attendance record to transfer
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to ninth grade on Staten Island all of
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this was before email and cell phones so
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over the next several weeks supposedly
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there were letters being sent between
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the Archdiocese of Manhattan and Miami
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and with the Vatican and each day I'd go
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into school crying and come home crying
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to which my mother would give me an
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update from some Cardinal or Bishop to
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keep her going to school while
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find her a spot was i naive or what well
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after a couple of weeks one day while
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waiting for the school bus I met a girl
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named Debbie and she introduced me to
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her friends and they became my friends
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and well the Pope was off the hook I
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began to calm down and settle in my past
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three decades of studying anxiety in
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children stems partly from my own search
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for self understanding and I've learned
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much for young people anxiety is the
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most common childhood psychiatric
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condition these disorders start early by
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age four and by adolescents one in
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twelve youths are severely impaired
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in their ability to function at home in
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school and with peers these kids are so
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frightened worried literally physically
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uncomfortable due to their anxiety it's
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difficult for them to pay attention in
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school relax and have fun make friends
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and do all the things the kids should be
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doing anxiety can create misery for the
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child and the parents are front and
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center in witnessing their child's
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distress as I met more and more children
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with anxiety through my work I had to go
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back to mom and dad and ask them a
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couple of questions why did you hold me
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down
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when I was so frightened of getting
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injections and forced them on me
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and why tell me these tall tales to make
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me go to school when I was so worried
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about being embarrassed again they said
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our hearts broke for you each time but
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we knew that these were things that you
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had to do we had to risk you becoming
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upset while we waited for you to get
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used to the situation with time and with
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more experience you had to get
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vaccinated you had to go to school
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little did my parent
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no but they were doing more than
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inoculating me from the measles
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they were also inoculating me from a
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lifetime of anxiety disorders excessive
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anxiety in a young child is like a super
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bug and infectious even multiplying such
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that many of the youth that I see come
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in with more than one anxiety condition
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occurring at the same time for example
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they'll have specific phobia plus
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separation anxiety plus social anxiety
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altogether left untreated anxiety in
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early childhood can lead to depression
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by adolescence it can also contribute to
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substance abuse and to suicidality my
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parents were not therapists they didn't
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know any psychologists all they knew is
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that these situations may have been
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uncomfortable for me but they were not
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harmful my excessive anxiety would harm
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me more over the long term if they let
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me avoid and escape these situations and
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not learn how to tolerate occasional
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distress
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so in essence mom and dad were doing
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their own homegrown version of exposure
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therapy which is the central and key
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component of cognitive behavioral
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treatment for anxiety my colleagues and
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I conducted the largest randomized
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controlled study of the treatments of
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anxiety in children ages 7 to 17 we
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found that child focused cognitive
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behavioral exposure therapy or
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medication with a selective serotonin
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reuptake inhibitor are effective for 60%
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of treated youth and their combination
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gets 80% of kids well within three
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months this is all good news and if they
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stay on the medication or do monthly
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exposure treatments as we did in the
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length of the study they could stay well
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for upwards of a year however after this
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treatment study ended we went back and
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did
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follow-up study of the participants and
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we found that many of these kids
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relapsed over time and despite the best
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of evidence-based treatments we also
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found that for about 40% of the kids
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with anxiety they remained ill
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throughout the course of the time we've
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thought a lot about these results what
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were we missing we've had pathi sized
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that because we were focusing on just
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child focused intervention perhaps
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there's something important about
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addressing the parents and involving
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them in treatment two studies from my
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own lab and from colleagues around the
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world have shown a consistent trend
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well-meaning parents are often
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inadvertently drawn into the cycle of
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anxiety they give in and they make too
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many accommodations for their child and
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they let their children escape
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challenging situations I want you to
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think about it like this your child
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comes into the house to you crying in
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tears they're five or six years of age
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nobody at school likes me these kids are
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mean no one would play with me how do
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you feel seeing your child so upset what
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do you do the natural parenting instinct
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is to comfort that child soothe them
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protect them and fix the situation
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calling the teacher to intervene or the
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other parents to arrange playdates that
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may be fine at age five but what do you
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do if your child keeps coming home day
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after day in tears
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do you still fix things for them at age
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eight 1014 for children as they are
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developing they invariably are going to
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be encountering challenging situations
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sleepovers oral reports a challenging
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test that pops up trying out for a
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sports team or a spot in the school play
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conflicts with peers all these
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situations and
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of risk risk of not doing well not
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getting what they want
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risk of maybe making mistakes or being
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embarrassed for kids with anxiety who
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don't take risks and engage they then
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don't learn how to manage these types of
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situations
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right because skills develop with
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exposure over time repeated exposure to
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everyday situations that kids encounter
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self soothing skills or the ability to
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calm oneself down when upset
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problem-solving skills including the
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ability to resolve conflicts with others
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delay of gratification or the ability to
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keep your efforts going despite the fact
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that you have to wait over time to see
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what happens these and many other skills
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are developing and children who take
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risks and engage and self-efficacy takes
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shape which simply put is the belief in
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oneself that you can overcome
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challenging situations for kids with
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anxiety who escape and avoid these
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situations and get other people to do
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them for them they become more and more
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anxious with time while less confident
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in themselves contrary to their peers
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who don't suffer with anxiety they come
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to believe that they are incapable of
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managing these situations they think
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that they need someone someone like
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their parents to do things for them now
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while the natural parenting instinct is
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to comfort and protect and reassure kids
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in 1930 the psychiatrist Alfred Adler
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had already cautioned parents that we
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can love a child as much as we wish but
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we must not make that child dependent he
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advise parents to begin training kids
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from the very beginning to stand on
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their own two feet
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he also cautioned that if children gets
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the impression that their parents have
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thing better to do than be at their beck
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and call they would gain a false idea of
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love for children with anxiety in this
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day and age they are always calling
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their parents or texting distress calls
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at all hours of the day and night so if
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children with anxiety don't learn the
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proper coping mechanisms when young what
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happens to them when they grow up
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I run groups for parents of young adults
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with anxiety disorders these youth are
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between a the ages of 18 and 28
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they are mostly living at home dependent
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on their parents many of them may have
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attended school in college some have
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graduated almost all are not working
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just staying at home and not doing much
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of anything
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they don't have meaningful relationships
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with others and they are very very
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dependent on their parents to do all
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sorts of things for them their parents
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still make their doctor's appointments
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for them they call the kids old friends
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and beg them to come visit they do the
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kids laundry and cook for them and they
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are in great conflict with their young
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adult because the anxiety has flourished
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but the youth has not these parents feel
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enormous guilt but then resentment and
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then more guilt okay how about some good
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news if parents and key figures in a
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child's life can help the child assist
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them to confront their fears and learn
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how to problem-solve then it is more
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likely that the children are going to
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develop their own internal coping
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mechanisms for managing their anxiety we
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teach parents now to be mindful in the
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moment and think about their reaction to
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their child's anxiety we ask them look
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at the situation and ask what is this
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situation at hand how threatening is it
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to my child and what do i altom utley
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want them to learn
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from it now of course we want parents to
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listen very carefully because if a child
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is being bullied seriously or put in
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harm's way we want parents to intervene
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absolutely but in typical everyday
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anxiety-producing situations parents can
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be most helpful to their child if they
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remain calm and matter-of-fact and warm
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if they validate the child's feelings
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but then help the child assist them in
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planning how the child is going to
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manage the situation and then this is
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key to actually have the child deal with
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the situation themselves of course it is
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heartbreaking to watch a child suffer as
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my parents told me years later when you
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see your child suffering but you think
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you could swoop in and save them from
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the pain of it that's everything right
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that's what we want to do but whether we
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are young or old excessive anxiety leads
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us to overestimate risk and distress
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while under estimating our ability to
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cope we know that we repeated exposure
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to what we fear weakens anxiety while
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building resources and resilience my
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parents were on to something
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today's hyper anxious youth are not
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being helped by overly protective
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parenting calmness and confidence are
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not just emotions they are coping skills
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that parents and children can learn
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thank you
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[Applause]
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[Music]
