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