- Hello, and welcome to an Ohio Learns 360 Family Webinar.

I'm Amy Juravich from WOSU Public Media.

We're here today to discuss childhood anxiety and depression.

This event will help parents understand if their child's fears and worries are normal or something to be concerned about.

And we will learn about talking to our children about their big emotions and when do we need to seek professional help.

Joining us for this discussion is Rachel Busman, a licensed clinical psychologist and the Senior Director of the Child and Adolescent Anxiety and Related Disorders Program at Cognitive and Behavioral Consultants.

Welcome to Dr. Busman.

- Thank you so much for having me.

- And Dr. Busman, you have a lot of experience in treating children who are struggling with anxiety.

How does a parent know if their child's worries are just something normal, children worry sometimes, or if it's something bigger than that?

- This is a really good question and one that probably I get asked all the time.

This is what often prompts parents to potentially seek professional help.

The first thing to say is that all people have worries.

As you said, a lot of people do worry and it's really normal for kids to worry and it's helpful for parents to know that kids worries tend to follow sort of a developmental trajectory or meaning, it's not uncommon to see specific worries at specific ages, right.

So babies and toddlers might be nervous about new things, new people, like stranger anxiety or separation anxiety.

And then as kids get a little bit older, four and five, they might be worried about monsters under the bed or things they don't fully understand like ghosts or vampires.

And that's really normal 'cause kids' imaginations are growing.

Kids might worry about going to school and I could certainly talk more about all the different kinds of worries.

But to say, at first, worries are pretty normal.

The ways we think about if worries are more typical or more of a cause for concern, have to do with how long they persist or linger and how much they interfere with daily life.

So a child who maybe saw something on TV and got a little bit scared and has some worries over a couple of evenings about something in the closet or under the bed, but it doesn't interfere in their life in terms of going to school or playing with friends, not much of a cause for concern.

But when these fears linger and persist and when they're accompanied by other things like physical manifestations of anxiety or behavioral manifestations, then we start to think it might be more of a cause for concern.

- So it's more of the length of time of the worry.

You know, you can be worried for a couple of days about something you saw on TV, but if a parent helps explain it and then you can move on, that kind of thing.

Okay, so the length of time.

- Right.

So length of time.

I do think sometimes what happens is, a kid could be worried about something and maybe it just lasts for a day or so, or two, three days, but then it pops back a week later and lasts for multiple days, right.

So I think the length of time, yes.

But then if the frequency of how often this worry is sort of interfering and intruding, I think then we start to, we might be collecting more information over a period of several months.

But I think the persistence and also this interference factor, right?

'Cause even adults have things we worry about, but it doesn't necessarily mean that it interferes in our life, right?

So for me, I don't love flying on a plane and I get a little nervous before I get on one and maybe get a little trepidatious when there is a bump or turbulence.

But it doesn't stop me from taking planes, it doesn't interfere in my life of let's say travel or any of those kinds of things.

So it also has to do with how much it interferes with the rest of my life.

- And so when that comes to a kid, if they say maybe they don't wanna go to school repeatedly, I mean every kid has a day when they don't wanna go to school, but if it's a repeated thing- - Absolutely.

- And is that how it can interfere with their life where it's impacting their education too?

- Absolutely.

So we think about a kid's job and then you might think, Rachel, what are you talking about?

Kids don't have jobs, but they do, their job is to go to school or daycare or whatever their educational plan is.

They also have a social job to be a friend and make friends and have friends, be a part of a family, be part of extracurricular activities and be part of academics.

And when kids struggle in those aspects of their job, so to speak, so maybe not being able to go to school because they're too nervous or withdrawing from activities they usually liked because they're nervous about how it's gonna go or opting out of play dates.

Often, those are things that, again, should be red flags for parents as like, hmm, something's going on here.

- So if a parent does have a suspicion of a red flag, like you just said, where do they start?

Is it with their child's doctor or do they need to immediately find a therapist, the school counselor?

I'm sure there's plenty of places to start.

- Yeah, there's lots of pathways and I think it's a really reasonable question, right?

So sometimes a parent will have a very clear piece of information that lets them know exactly what their child is worried about.

So maybe, for example, the child has been coming home saying, I have this first grade performance coming up, and you can see in their face they're worried about it and they're talking about it a lot.

And then they seem to have some stomach aches that are accompanying going to school.

That doesn't take a lot to put together.

Oh, I think they might be nervous about this upcoming performance, that might lead to the parent having a conversation with the child.

Really important, having a conversation with the teacher to offer some pieces of information from home.

Sometimes, the child could be nervous at home but isn't showing that nervousness at school or vice versa, the child might be really nervous at school but not showing it at home.

So that might be a great opportunity to talk to a teacher, maybe give the child some sort of strategies, a pep talk, some information like, hey, you're probably not the only one who's nervous.

It's really normal to get worried and let's talk about how to be brave and get through it.

So that's like one example, right, where the piece of the worry isn't a big puzzle.

The parent really has a good sense of what the child's worried about.

It might not be that obvious, right?

So maybe a teacher calls or a church or temple or a girl scout or sport coach calls and says, hey, John's been seeing me a little more quiet.

Or we just started this new activity in gym class and they're really acting a little bit worried or they're asking a lot of questions about, is this okay?

Do you think this is all right?

Am I doing all right?

Now, this is new information for the parent.

So this would be a great opportunity for the parent to chat with the child.

And it might seem pretty obvious.

Of course, I talk to my child all the time, I know how to do this.

But sometimes parents can inadvertently make anxiety worse.

For example, I heard you really scared about something.

Tell me what you're feeling really scared about, might send them a signal like, I should be scared about something.

Versus, I heard you're doing a new lesson in gym class or I heard you're moving onto something different in art and your teacher said maybe you're struggling a little bit.

Tell me how that's going for you, what do you like?

What don't you like or what worries you?

So being a little more open-ended and inviting the child to tell you more rather than sort of inserting your own assumptions can help.

And then we could certainly talk about when do we go even further?

But I think the beginning is, it really just starts with a conversation and making some observations.

- Yeah, before we talk about going further, are you seeing a lot more children with anxiety than you have in the past?

I'm sure there's always been children with anxiety, but is it being diagnosed more or noticed more?

Are we more aware of it that it can happen in children?

- Yeah, I think you're asking a lot of really good questions 'cause there's two parts here.

One is I think we are getting a lot better at recognizing signs and symptoms of a lot of mental health concerns, including anxiety, because anxiety disorders broadly are the most common type of mental health concern recognized, right?

So I think we're doing a better job of recognizing it with that could be, wait, are all these kids more anxious or were they always anxious?

And we didn't really know and I wish I had a 100%, I'm sure of that answer, and I'm not.

I will say that the pandemic, not surprisingly, has increased stress, anxiety, depression across the board for a lot of people.

I'll say a lot of people have been really resilient during this time.

I see some more anxious kids as sort of a result of this multiple year event if we could call it an event more of like a whole life experience.

But I do think your point of us recognizing it more, which is so important, right?

The more we can recognize signs and symptoms of anxiety or depression, as we'll talk about, sooner is better, because then we can course correct and really potentially change a child's trajectory.

- And do you feel that if a parent has an issue with anxiety or maybe even a grandparent, is that something, do they tend to notice it more in their children?

Or is there a genetic component where you might have an anxiety disorder if there is someone else in your family with one?

- So you know, things like to hang out together, right?

So anxiety disorders like to hang out with each other and it's not uncommon for a child who has anxiety symptoms to have somewhere in their family tree, maybe some anxiety hanging out.

That's not to say that this is blame, that if you have a child with anxiety, it is definitely because you as an adult, as a parent, had anxiety.

Plenty of kids have anxiety or depression and there isn't anything in their family history.

But commonly there is, and it could be the parent themselves, it could be a grandparent or an aunt or an uncle.

You also asked a really good question, which is, if I'm a bit anxious as a parent, might that prime me to notice it in my child?

And wouldn't that be great if we could notice it?

And the answer I think is sometimes.

So sometimes a parent might say, and I've worked with families where the parent will say really honestly and bravely, I struggle with my own anxiety and I notice my child is anxious and I really wanna get on top of that.

I wanna learn strategies for myself but also my child.

Sometimes, as is common for a lot of people, when something impacts us, sometimes we can be a little more blind to it.

Like we don't notice it, which isn't something bad, it just is.

So we do need to be aware that sometimes if someone says, hey, did you know that Jackson has some anxiety?

And it's a little bit similar to what I think you might struggle with, it wouldn't be uncommon for a parent to say, oh my goodness, I didn't even recognize that.

And it's not because they're in denial, it might just be they didn't really see it or make the connection.

- And how much life disruption do you feel has to happen with the child for you to need to go further, go beyond the teacher, the school counselor, and maybe actually seeking out a therapist or even after that, I guess medication.

- Right.

So on one hand, I wouldn't want people to just jump to the child comes home and says, I'm nervous about giving a performance, and the parent calls a therapist.

But let's be honest, that probably doesn't happen, right?

Unfortunately, sometimes I end up seeing families, especially 'cause this is an area that I and my colleagues specialize in, we see families who are way, way just mired in the distress.

So I'd say I wish that families would try some informal strategies, which I know we're gonna talk about, but also be aware of this persistence and anxiety, they've chatted with school and it doesn't seem to be getting better.

Maybe they notice sleep is being disrupted or appetite or just overall mood.

And then I actually think we wanna act pretty quickly because, again, what we know is, if we seek evidence-based treatment, and I wanna talk about what that is, meaning providers who are doing therapy that we know is supported by research to be really effective, that can have great outcomes.

And so we much rather solve a smaller, a medium problem than a huge problem.

- So let's talk a little bit about that.

- [Rachel] Sure.

- What can parents do before seeking a therapist, what is an activity or something they can do with their child at home that can help their child express their emotions more and understand what's going on inside their head?

- Yeah, I think from the beginning, and this is actually taking it even several steps before getting to the anxiety is just parents can talk about their own emotional experience.

So it might sound silly, but even coming home and saying to your partner, like, man, today was a little bit of a mixed day.

I was really happy to see X coworker or Y coworker, I was excited about this project, but then I got super frustrated about this one thing, right?

And kind of talking through how that parent experienced different emotions and worked through it just sets a tone in the family.

We talk about emotions and that isn't, I don't think very jargony.

I don't think it's too touchy feely.

It just shows, hey, I'm a person, an adult who has emotions.

Sometimes I get scared, sometimes I have big emotions, sometimes I feel really excited or happy or frustrated.

So I think that's one.

Another is if your child shares with you that they have a worry, right?

So let's say a child says something like, I don't have anybody to play with on the playground.

A common thing for a parent to say, first they might think, oh my goodness, that's not true.

My child is so sweet, my child is so friendly.

I see them play all the time at the park with people.

So their first instinct might be to try to make that expression sort of go away like, but you have lots of friends or people must have been busy today.

I'm sure you have lots of people to play with.

Which sounds really nice and sounds really like trying to make your child feel better, but it actually misses the mark of doing something called validation.

So if your child says, nobody wants to play with me at recess, our inclination to say, of course, they do.

You're so awesome.

Well, we actually first wanna say something like, we don't feel like anyone wants to play with you at recess.

That stinks.

That must feel really bad.

I'm sorry that's happening.

Something like that.

And actually invite the child to talk with you more about it.

Now sometimes parents might worry, well, if I open this up then they're just going to go down a gloom and doom road.

And I don't think that's true.

I think that if you invite your child to tell you more, and you express, even if in your mind, you don't think it's true, but you say, I get it.

That's how you talk to me about it, then you're gonna, first, get a ton more information and before you jump to problem solving, you can collect some important information.

Right, so I wanna do that first before I jump to the, let me give you some tips and strategies for how you can make more friends on the playground.

- And the idea of talking about emotions for some people that just doesn't come naturally, right?

I don't know, did we all grow up learning how to talk about our emotions?

- Right, I think, I mean look, you and I are talking from multiple states away, right?

So I'm in New York and my geographic experience, probably my cultural experience is different than, you're in a different part of the country and other people are in different families, families are really different.

And then what we call families of origin.

So how my family talked about emotion and then how my parents' parents talked about emotion and it can be influenced by lots of things, our own comfort, religion, culture, ethnicity, all lots of different things, gender.

So it's not easy for people to do that.

Sometimes, going to the library and saying to the librarian, do you have some books about emotions?

What's coming up in my mind right now is there's a book series called "A Spot of Anger," a spot of, and a bunch of different feelings.

And so if you're someone who doesn't really know how to talk about emotions but you want to, there are some amazing just children's books, especially for this age group we're talking about.

Also a lot of schools across the country have incorporated what we call social emotional learning into their curriculum.

And that means that you could probably reach out to a teacher or a counselor and say, how do you guys talk about emotions at school?

And then there's nothing better than carrying over at home what happens at school.

So it's okay.

I think the validation that we give to kids, I wanna give to adults.

It's okay if it's hard for you to talk about emotions that is okay if it's hard and there are probably ways you could start to do it and start to model for your kids, which I think will be greatly beneficial to them.

- Yes.

So reading children's books is a great way to start the conversation about emotions because the character in the book is having an emotion.

You can say, have you ever felt like that.

Yeah.

And I would be remiss if I didn't mention that WOSU Public Media has a resource related to social and emotional learning.

It's called "Drawing with Mr. J," and it's an activity, it's a digital video series online where you draw along with the host Mr. J, and you learn how to discuss an emotion through your drawing.

So can you talk a little bit about maybe using that as a strategy using art... - So great.

So, kids express themselves through play, right?

And so being able to, sometimes actually this is a little bit of a tangent, but I think relevant, sometimes parents will say, I was watching my child play dolls or trucks or superheroes and I heard them talking about some stuff and it really concerned me.

They were talking about (indistinct) or something that happened at school, or they were playing in an aggressive way.

And I'd say, Paul, that doesn't necessarily mean something's bad.

We work through our emotions as kids through play, through draw, through art.

So I think having a conversation, let's say with a second grader, about talk to me about your feelings is different than saying like, hey let's color, let's draw, or let's watch a movie or let's read a book and then talk about, that picture looks like how does that character look?

Or what happened in the story?

Do you think they were happy or they were happy and then they got sad and then what happened?

Huh, that's confusing when we feel multiple things.

But actually that's really normal 'cause our brains are pretty cool and they can do really cool things and they can feel lots of things at once.

So I think it normalizes it and then it puts it at a level where kids feel comfortable like through a game or through play or through art.

- Yeah.

So I have to say wosu.org/mrj if you wanna check out the- - I think that sounds awesome.

- Drawing along.

And so asking a librarian for book suggestion, doing a drawing activity and playing with your child, that's a great way to find out what your child is feeling, to get down on the floor and play with them or even play a game and- - That's right.

- Yeah.

Make make sure they can get through the game without being too worried about losing, right?

- That's right.

And then I think this leads us to sort of the next place, which is like, it's great when we get information, but then another informal thing a parent can do is let's say they know their child is fearful of something, and this is a really important thing and, again, doesn't always come naturally because it makes sense that if your child's in distress, they're anxious, they're worried, they want to avoid the thing that's causing distress, it makes perfect sense that a parent would help that child feel more comfortable.

So I don't want to play in that soccer game, I just wanna sit with you.

Okay, sweetie, I understand that it feels scary out there, that's not mean, that's a parent trying to be a really good parent who's attentive and attuned to their child's needs.

However, if you practice things, you get pretty good at them.

If you practice avoiding things or practice opting out of things, you also get good at that.

And so the thing a parent can do is actually practice with their child ways to be brave and approach things that are hard rather than avoid them.

So for example, if we go to play dates, let's say a child always wants to have play dates at their house 'cause they feel more comfortable, they feel like they want their own parent to be there.

They don't like drop off play dates, they're scared.

Okay, easy, we have a play date at our house, no problem.

And that child's really not gonna get much practice meeting other people who the parent has said, I think Mr. Smith or Ms. Jones is safe and a friendly person, right?

So one thing a parent could do is say, so we're gonna still have play dates at our house, but we're also gonna start practicing having play dates in another person's house.

Should we start with Johnny across the street or Brian down the road, and then maybe the first time they go, sounds a little strange, but maybe the parent goes and actually says, I'm gonna sit in the driveway, right?

Which might sound like, what?

You're gonna have the parent sit in the driveway.

Well, sure, because if that's the first way you're gonna get your child to play at someone else's house and be successful would be for you to take a baby step out.

Like, I'm gonna stay for five minutes and then sit in the driveway and you're gonna stay for an hour and then we're gonna high five 'cause you are awesome, you did it, great practicing, doing something new.

And maybe the next time the parent's gonna sit in the driveway, then drive to stop and shop and come back.

So we call those things exposures.

They're ways to practice hard things in a repetitive planful way.

- And this actually goes toward one of our questions.

Families were able to submit questions in advance to our webinar guests.

So Trenelle Gravely wants to know if you have advice on ways to help parents not get frustrated with their child when they're trying to help them deal with their anxiety.

- Yeah, it can be sometimes.

I am really appreciative of that question.

I think, we can get frustrated for a couple reasons.

One, we can get frustrated because the thing that we're asking our child to do might seem easy to us, right?

Like I don't know why it's so hard to go in your room when it's nighttime, you go in your room when it's daytime all the time.

And we've already talked about monsters under the bed, right?

So that's ridiculous, come on already.

But imagine if you really truly believed that there was something scary in your basement or you really believed there was danger lurking in some way, of course, you would be scared to do it, right?

So we can remind ourselves that kids are not manipulating us.

They really sometimes feel their real fears.

Another thing that we could remind ourselves is that it takes time to get over fears, right?

So a really good example would be if you happen to have a child sleeping in your bed intermittently, maybe they're coming in in the middle of the night and they've been doing that off and on for a couple years, even months, but a couple of years, it's not gonna be one or two nights that they go into their own bed and sleep through the night and it's gonna be done.

So practice is needed, right?

And then I think the last thing is that we want to model for our kids being non-anxious, if that makes sense.

We want to be more neutral and less showing frustration because the child is gonna interpret it as, you're angry with me, you're frustrated with me.

Even if the parent's frustrated at the situation.

So staying calm, which is harder then it sounds, sometimes we need to remind ourselves like I'm going to stay calm.

I know I'm feeling like my temperature's at a 99 out of 100, but I'm gonna mentally bring it down to a 60 and pretend like I'm a lot more calm than I am will really help show your child I'm with you, I can help you.

We got this.

- And I don't want to run outta time before we talk about the other side with anxiety, is also the idea of depression.

And I have to imagine that maybe, I mean I don't have any numbers to back this up, but that anxiety is more prevalent than depression in children.

But I'm sure that there is issues with depression.

So how do you know if your child is just too sad, I guess is the way to say it?

- Yeah, I definitely think, I'm so glad we're talking about this because I do think, well, first of all, anxiety in younger children, let's say like fifth grade and younger, anxiety is more common than depression.

But depression and anxiety can hang out together.

And what started as anxiety can become depression, there's some shared features.

And what we also wanna remember is that while adults often classically show what we classically think of as depression, like looking sad, crying a lot, appearing what looks like from a media perspective to be sad and both depressed, children and teens can often show that through irritability.

So extreme irritability rather than sadness.

So that's really important to keep in mind.

I think the other thing is, while young kids like second and third graders, it's not common for them to become depressed.

It is real, right?

So, oftentimes, they'll hear what do children need to be depressed about?

All they need to do is play and go to school.

And that the truth is that kids can get depressed.

And so some of the signs might be sadness, but it might be extreme irritability and then persisting difficulties with sleep or appetite.

So, sometimes, we see kids really not sleeping well for not just a day or two, but a period of multiple days across two weeks, no appetite or could be ravenous appetite, but often lack of appetite, low energy.

And I think a really important one is withdrawn behavior, right?

So here's an example of what's not withdrawn behavior.

You have a child who just happens to be an introvert and they're kind of happy doing their own thing.

So they spend time in their room coloring, playing, doing puzzles.

I wouldn't call that withdrawn because that's their baseline.

But I think if you have a kid who often does puzzles with you or sees friends and play dates and now they're like, no, I just feel like I just wanna lay down just, feel too tired.

Nobody likes me.

I don't like anything.

That's a very different thing than staying at your baseline.

- And dealing with something like that.

I would think a parent could maybe handle dealing with worries, but whenever, if a child is just wanting to lay down all the time, I, as a parent, I would jump immediately to there's something wrong.

Let's go to the doctor.

I don't, right?

- I think you're right because I think there's something and, certainly, we didn't talk about really significant red flags, but if your child ever said something like, I wish I was just dead, it would be better if I wasn't alive.

I know people don't like to talk about that, because it's scary to them.

But if your kids say that that's serious.

Right?

- Right.

- Because kids do commit suicide.

So I do think going to a pediatrician is a helpful first step and I work with pediatricians a lot and really like them.

And sometimes you get a pediatrician for a 15 minute appointment and you let them know about your child's mood or their excessive worries, and they're like, ah, kids will be kids.

Just let them grow out of it.

They'll be fine.

I think you have to go to your mama bear, papa bear instinct, and if something tells you this isn't sitting right, that's when you really wanna seek a mental health professional.

Like a psychologist, a social worker, a psychiatrist is someone who prescribes medication.

And then certainly we want to go to where the evidence is, and the evidence for the overwhelming evidence for therapy for kids is something called cognitive behavioral therapy.

And, also, in children that are younger, often a parent component to the treatment is really important.

And that is not to say that we as clinicians are saying parents are the problem, 'cause they're not.

But they're very much part of the solution when we are talking about young children.

They often are the ones that are helping us put together a sleep plan or carry out a plan to help the child do these brave exposures or we need the parent to collaborate with us at school.

A first grader isn't gonna go in and say, teacher, I really need a meeting and I'd like you to talk to my outside therapist.

So we need parents as collaborators.

- Yeah.

And also meant something you mentioned earlier, making sure that the behavior you're seeing at home is the same happening at school, is the child acting happy at school but then comes home and is sad on the couch at home?

We have to make sure that, because it could be different in different places.

- It can be different.

And I think sometimes that's really misleading, right?

So sometimes school will say, Amy's great, she's happy, she's not complaining about homework but the parent is saying, we're getting meltdowns all night about homework.

And what I wanna say is it doesn't mean that either of those things aren't true.

Sometimes anxious kids or depressed kids will hold it together at school just like we as adults might kind of hold it together and keep it under wraps at work.

'Cause we know, hey, this is an environment I need to kind of keep things contained and then at home we kind of let it all come out.

So I think it's still it relevant if things aren't the same at school and home.

- Let's get another question that came in from our audience.

- Great.

- Jessica Boyner, she wants to know what stress looks like in children with autism.

Does it present differently for an anxious child with autism?

- So that is a really good question and I wish I had like this is exactly how it presents and there isn't one answer.

I think, again, what we think about with children on the autism spectrum is, and it is a spectrum, right?

So sometimes there are children on the autism spectrum who don't have verbal language and so it's gonna be hard, the child might not say, I feel stressed, I feel anxious, or the child might have language, but they might have difficulty talking about their emotions.

So I think this is true for all kids, but especially for kids on the spectrum, looking for shifts in behaviors, right?

So you might see more difficulties with, you might see more repetitive behaviors if that's something that the child has sort of in their repertoire or you might see difficulty again sleeping or just changes in their typical presentation and you might not be able to get that information verbally from the child.

Also, other things that come up might be changes in appetite, like accidents when the child had been toileting fine.

So I think you have to look beyond what the child is just saying to you because for some kids who are on the spectrum, they might not be able to access their language as typically, and it's gonna be a little harder for the parent to figure that out and they have to kind of have a little bit of an eye to the non-verbal.

- Okay, and let's do one more question that we have that was submitted in advance.

Caitlyn Mullner or Moller rather, she wants to know if access to electronics plays a role in childhood stress and anxiety.

And she gives an example, she says, my almost 10 year old wants a phone and we said no, and all of his friends have one.

So now he's feeling left out and embarrassed.

But where should we draw the line in helping our child not feel stress and anxiety over these kind of situations?

So there's two questions in there.

- It's two questions.

- Yeah.

- So I think, there's lots of stuff out there about the internet, video games, and screens and there's some huge benefits to them, right?

And there are some huge downsides and I think having a balanced approach is really important.

So on one hand a child needs to be able to tolerate when a parent sets a limit, right?

So that's a piece of it, right?

And then the other piece is like if it's actually true that, let's just say for this particular example, all the other friends have a phone, right?

So for my child I might say first, hold on, you're saying everybody else has one.

And sometimes that's actually not true.

It's that the child notices all the kids with the phones but they don't notice the ones without.

But then I also think, as a parent, we wanna think about what are my concerns about my child having a phone.

If my child is feeling excluded and missing social opportunities because it is true that everybody has a phone, where are my flex points?

Am I willing to let them have a phone to connect with their friends but have really clear limits around social media, right?

Or how am I going to help facilitate my child's social interactions or help them gel in their social environment while also staying true to my values, which are, these are the things I feel strongly about?

So sometimes I ask parents to say, what is the thing you're the most concerned about?

And then sometimes there are real ways to both help your child partially have the thing they want and desire and also set limits around the things that are just non-negotiables for the parent.

- Yeah.

We often hear lots of studies about an increase in anxiety and depression because of social media in teenagers.

I mean that is something that is being talked about a lot more and more, but you don't really think about that as much for the younger kids, 'cause you're like, well, my seven year old isn't gonna have an Instagram account, I'm not gonna let them have one.

So, but you have to pay attention to what they're watching on YouTube if you're letting them watch YouTube Kids.

- Yeah.

- Yeah.

- Absolutely do.

And I also think to your point, you know, sometimes, we have our kids, they're very savvy, these young ones on the internet, right?

Sometimes, I have a question and my son's been able to answer questions for me for ages and then we have to watch out for, you know, oftentimes I hear it's not my kid, I don't trust, it's everyone else, right?

So maybe they're looking up YouTube videos on people opening Christmas presents, but like pretty easily they can click on something that has content that's really concerning and it wasn't the child looking for it, it just found them right?

So we do wanna keep our eyes and ears open but also again convey a balanced approach because if we send the message to our child, internet and phones are bad, they're going to take that message and they're going to be like, this is something that sounds pretty interesting.

I really would love to check out what my parents are.

So again, so we want to have a balanced approach 'cause I think all of us would probably say, screens and the internet and phones and video games aren't inherently bad.

It's having a balanced, appropriate use of digital platforms and being able to interact in real life and have a limit to how much screen time we have and making sure that we're safe.

- And another question that was submitted, which is kind of the opposite of this social media or this internet question.

Maria Urbano wants to know if playing outdoors leads to stronger mental health in children.

- What a good question!

I think we definitely know that getting fresh air, being physically active has a bunch of benefits, right?

Do I think that it's going to necessarily decrease a child's stress, it might.

I think that it's certainly really important for our kids to get some physical activity, whether that means going outside, sometimes kids live in places where going outside might not be feasible because of the neighborhood or the weather or geographic barriers.

But getting physical activity and moving one's body is good.

It's good for brain chemistry, it's good for the muscles, it's good for the body.

Even better is playing with your kids outside if that's also feasible.

But I think it's a good question.

I do think it can contribute to a lot of positive mental health aspects.

I don't think going and riding your bike is gonna alleviate worries.

I think if kids have persistent worries and informal strategies don't help, we really want them to get some evidence-based treatment.

And I think any therapist, I certainly encourage my patients to have a well-rounded approach to their life and that's going to include moving their bodies as well.

- And before we were talking, I read you've done a lot of research and work with selective mutism, right?

- [Rachel] I have, yes.

- Can you talk to us about what that is?

Because that was a term I had never heard before.

- Yeah, and you're not the only one.

So selective mutism is a specifically an anxiety disorder, and more specifically it is an anxiety disorder where children who speak pretty comfortably at home, struggle to speak in social situations like school, play dates with extended family.

And as you could probably imagine, this is a really impairing condition and can have a lot of negative outcomes, right?

So let's say a child really wants to say to someone (indistinct) your backpack, but they just can't get words out.

Or the teacher asks them a question and they just cannot respond or they point rather than answer.

So it's a type of anxiety disorder that specifically is related to the child being able to speak in different environments where we expect speech.

- Okay.

- And if you're interested more, I would go to the Selective Mutism Association website or selectivemutism.org, 'cause it's a great resource to get more information about this particular topic.

- And that particular topic, is that something that's treated with therapy?

We haven't really discussed medication in children very much.

- Sure.

- So, yeah.

- But in terms of therapy for selective mutism, yes, again, I've talked a little bit about cognitive behavioral therapy and one of the evidence-based treatments for selective mutism is this type of that therapy, which is in essence a therapy where we teach parents specific skills to help them help their children talk more.

And then we teach those skills to teachers as well.

And we essentially provide brave opportunities for the child to face talking in a variety of settings.

First, in the comfort of just their own a parent-child interaction.

But yes, we wanna involve parents who want to involve school and obviously the child as a collaborator.

But therapy is often very helpful.

And, unfortunately, because like you said, not a lot of people always know about selective mutism or SM.

Sometimes, when by the time I see families, it's been years and the child hasn't been speaking at school.

- Okay.

And I wanted to talk a little bit about the idea of medication in children.

- [Rachel] Sure.

- Especially, since the pandemic, there's been a lot more adults talking about having anxiety and depression, a lot more adults seeking out help, a lot of discussion and normalizing the idea of you can take medication and it will help.

But where does that fall with children?

'Cause I, you know... - I think it's a big question.

I think the first thing I would say is that, we want to try therapy first usually.

There's certainly situations that are really dire and we need to consider medication in the beginning.

But I would say the first thing I look for is, is the child in what we call an evidence-based treatment.

So if a child is going to a counselor or a play therapist and they're playing every week for a bit, but there isn't a focus on a particular problem per se, like the fears are worries or sleep or mood, I'm less likely to say, oh, well therapy just isn't working.

So meaning I want to know that a family is engaged in consistent treatment with a provider that treats this particular thing and that it's in the evidence base.

And then what I would say is, I am not in the business of kids suffering and kids need to thrive and do well.

And while a lot of families will say medication is going to change my child's brain and it's going to harm them, stress and anxiety, chronic stress and anxiety and chronic symptoms of depression do actually change the brain and change the brain in not a good way.

So I keep that in mind when I talk to families that when we are in therapy and the family is doing the things, they need to be doing and the child is working hard and they're still suffering, really what the evidence tells us is that combined treatment of medication and behavioral therapy or cognitive behavioral therapy is actually where the evidence tells us the best outcomes are.

- And can you give any advice to families out there where maybe both parents are not on the same page about this?

- Yeah.

- I can imagine being in a household where one parent is handling a situation of excessive worry very differently than another parent would, where the other parent maybe just says, get over it.

How do you handle that whenever the family is not on the same page?

- I often will have the family, well, first I think it's really important as the provider to validate both sides, right?

So as a provider, you might feel like medication is warranted or you actually might feel like it's not yet warranted, and you have one parent saying one thing and one the other.

And it's important to say like, I see your point because you just told me XYZ, those are really good reasons for medication, or you told me ABC, and those are really valid concerns.

So I think you need to hear both sides.

I then will often send families to a reputable source like the Association for Behavioral and Cognitive Therapies or the Anxiety and Depression Association of America.

These are reputable resources where you can see videos, you can read articles about this topic, or I might send people to the Academy of Child and Adolescent Psychiatry.

So I often will not just give my opinion.

I mean, I can give my opinion and I can say I've seen hundreds of kids with this particular problem.

And sometimes sending someone to like a video resource or a written resource can be really helpful.

And then I often will ask a question that I don't know if it's a magic question, but I might say like for let's say I really do think that medication is needed, the child's really suffering.

I might say, how much worse would you need it to be for you to change your mind?

Like, here's what's happening now.

Your child is really struggling to get to school.

They've lost friendships, they're crying a lot, they're not sleeping.

What else would you need see for it to change your opinion?

Because this is really not good right now.

And again, it's not meant to make someone feel bad, it's really meant to just highlight like your child is really suffering and we don't like kids to suffer.

We want them to thrive.

- And we only have about a minute left, but I wanted to give one more minute to have you maybe, do you have any favorite resources?

You've mentioned some books, you've mentioned some videos.

Do you want to name any particular videos or a TV show?

- Oh my goodness, wow.

- Yeah, I know.

- Maybe I can get you this in writing so you can put this in.

I definitely think, as I said, adaa.org, that's an anxiety and depression website.

So adaa.org, also abct.org, which is the Association for Behavioral and Cognitive Therapies.

Another one I really like is Parent-Child Interaction Therapy, so pcit.org.

- [Amy] Okay.

- And, certainly, you could visit our website at Cognitive and Behavioral Therapies or cbs-psychology.com.

- Okay.

Yeah, I mean those are great resources and we'll try to maybe provide a link below the video with a list of some of these.

Yes.

- I actually have one more book that I really like that I could just tell.

A book that I like that parents might look at with their kids who are in sort of the six, seven, eight range is a series, one of them is "What to Do When You Worry Too Much."

This is easily, widely available on Amazon.

They also have one "What to Do When Your Temper Flares."

It's a whole series.

It's like a combination of a book and workbook.

I don't recommend a parent just buy it and hand it to their kid.

That's not super helpful.

I do recommend them reading it with their child because it's a cognitive behavioral therapy workbook that uses the one in what to do when you worry too much, uses the theme of vegetables growing in a garden.

And that metaphor is sort of put through the whole book, but teaches tips and strategies.

And so I think it's a great resource, not expensive, and one that falls in the let's try this informal strategy before seeking therapy.

- And, of course, you also mentioned earlier also reaching out to the child's teacher.

A lot of schools are teaching social emotional learning, so I'm sure they have a book list of things that they may even have talked about in school.

- I'm sure they do.

And you said you guys do as well.

So I think that would be really helpful.

- Yes, yes.

Well, thank you so much for this discussion and we... - Thank you.

- I've learned a lot.

I'm sure we've all learned a lot.

And this has been an "Ohio Learns 360 Webinar."

Thank you for joining us, and thank you to Dr. Rachel Busman.

Thank you for joining us today for this event.

- Thank you for having me.

- Please provide your feedback on this topic and help inform future topics by completing a brief survey.

The QR code and link is on your screen right now.

And if you're not able to take a photo right now, a link to the survey will be available in the description online and also on YouTube.

And if you do take that 5 minute survey, you'll be entered into a drawing for a chance to win a $100 gift card.

Now, please join us for our next topic, "Developing Healthy Relationships with Peers."

Thank you to Ohio Learns 360 and the Ohio Department of Education for this event.

And thank you to Amy Palermo from WOSU Classroom and the television production team at WOSU for making this event possible.

You can watch other webinars in this series and find information about upcoming virtual events by visiting our website, ohiolearns360.org.

I'm Amy Juravich, thank you for joining us and we'll see you next time.