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>> Good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne I'm your host Mark Evans, a very, very important topic and of course I think I say that every time I do a show but we always try to do important topics.

We're going to talk about the kids tonight and we're going to talk about when to worry about childhood anxiety and we have a very special guest and she's been on the show before.

She's a pediatric psychologist.

It's Dr. Rachel Lilly.

>> Nice to have you.

Thank you.

Nice to be here.

Thank you so much for being here.

We were in the green room before the show and we were talking about what we're going to talk about on the show and I'm thinking this is going to be excellent and we really need some audience participation and that's what the show's all about.

We want to help you help yourself and others.

So if you stick around for at least a few minutes you might learn something or you might want to get on the phone right now and say hey so-and-so, they're doing a show about kids anxiety.

It's rather common these days the number on the screen is what you need to call 866- (969) to seven to zero.

It is public television.

We don't stop down for commercials so we have a whole half hour to take your calls.

So start calling those in now and we're going to go ahead and get started with Dr. Lily.

>> So the things you like to talk about tonight is normalizing worry and natural responses, coping and basic cognitive strategies and also signs that further help may be needed.

>> And I think with this outline of this program we're going to tackle those things.

>> So I'd like to know right off the bat how many children in the US if there is an estimate are affected by severe anxieties affected is one one thing, right?

Like I think throughout childhood we all feel anxiety to some degree or another diagnosable, clinically significant some 10 15 percent somewhere in that range are usually diagnosed or can be diagnosed anxiety at some point.

>> And it was an interesting thing that we talked about before the show is like anxiety is not all a bad thing.

>> It's all part of life.

In fact, some anxiety is actually healthy.

>> Can you go on about that indefinitely?

At its core anxiety is adaptive.

It is a helpful emotion, a helpful feeling that we all get to feel at some point it's not necessarily something we enjoy feeling right.

It's not doesn't feel good to feel anxious but it's a helpful emotion just as all of our emotions in some capacity or another are helpful and adaptive.

So yeah, if we think about anxiety kind of on an arch right.

So feeling no anxiety that can be problematic in and of itself.

If you think the world of kids if we're talking about just test anxiety, something that a lot of people experience if I feel no test anxiety yeah.

Who cares, right?

I'm not going to study medicine.

That's not good.

No.

That has its own issues.

Then there's kind of that healthy level of anxiety.

It's helpful.

It motivates me to study it motivates me to try my best and try my hardest and then we can tip into the level of anxiety where can we enter that fight or flight or freeze mode.

Right.

And we become so overwhelmed that then we cannot perform to our best ability.

So there's kind of this like I said, this range and a little bit of anxiety is not a bad thing but what is there a difference between the things that kids worry about versus adults and to some degree, yes.

>> So there are certainly elements that we see or diagnoses or just concerns that we see more often in kids separation anxiety being one of those I just mentioned test anxiety.

I'm not taking a whole lot of tests anymore at my age so it's not something that comes up a lot and then we can also see the social anxiety piece of things.

Certainly adults can experience social anxiety.

We do often see it a little bit heightened in our teenagers.

It's part of their developmental stage that they're going through.

They care a lot about what peers think, what their social circle thinks so we can see it at different rates.

>> But yes, there are some differences.

How has social media affected our children today in so many ways kind of going back to that social anxiety piece?

Right.

If you think about I don't know when I was in high school we didn't really have social media .

I got to go home and I was home.

I wasn't on my phone.

I wasn't I had to log in through dial up to get in any contact with friends versus now we pull out our phone and if you think about anxiety being adaptive right.

Our ancestors used to compare themselves to smaller groups of people.

Right.

Am I doing what I need to do to fit in with this group?

Am I going to get excluded if I do something wrong that's adaptive, right?

It helps us maintain our social circle now our kids and us we're expanding to the world, right?

I have the world in my hand and so I'm not just comparing myself to the people who live nearby and comparing myself to someone on the other side of the world.

What do they have?

What do they look like?

What how are they dressing?

And so that can really ramp up anxiety.

>> So you would agree then maybe in the last what ten, twenty years anxiety among children has increased?

>> I don't have the data the numbers off the top of my head but yes I is social anxiety and we know that the impact that social media is playing especially on our teenagers in that anxiety so yes.

>> Well and may I ask this little sidebar you're a parent and you're usually you've got two and one and one on the way.

>> Yes.

And you mentioned that you have a boy, a girl and the one that you're going to have is a girl.

>> Do I'm trying to figure out how the best way to ask this do they all share are the two that you have now are you seeing similarities as far as anxieties or are they just two different people and they have their own set of anxieties?

>> They are two different people with their own set for the same parents.

The same home.

Now they have different life circumstances, different situations.

But yes, they definitely and they experience anxiety differently but they're also very different ages.

They're only a couple of years apart.

But right now our son is a five year old getting ready to head into kindergarten.

He's thinking and reasoning and what if this what if that first is our daughter is two and so there's a little bit more of that separation anxiety, things like that.

>> So just developmentally differently but also their personalities are quite different.

I see I it depends on personalities.

>> It definitely plays a role.

OK and what is the difference between the normal anxiety and the severe anxiety that is going to need treatment?

>> So what is the breaking point?

What's the brink?

So it kind of depends as with all things and mental and behavioral health but usually my threshold is when does this turn into a diagnosable something that's needing treatment is when it really impacts our day to day lives and our day to day functioning.

And so usually you look at what we call our ADLs or our activities of daily living right is anxiety getting in the way of my sleep?

Is it impacting my appetite?

Is it impacting my engagement with friends and social and my social circle?

Am I refusing to go to school?

Is it or my grades decreasing?

So it's when we're seeing this impact on our ability to function in our daily world.

>> My mother used to call it stages or phases adolescence you know and those are certainly going you know, as you get older and you're a teenager I'm sure the adolescence anxiety a little bit different than much younger children and my correct.

>> Yes.

And do they seem to get worse because it seems like the life gets more complicated the older you become it does and when we're three that anxiety feels really big to us at that stage.

Yeah.

When I'm five my anxiety feels really big because that's my world.

That's my cognitive ability that my cognitive capacity but yeah so we can see it ebb and flow and like you said everything is a stage of life and we're also impacted not just by our internal states but by everything that's happening in the world around us in our family and our life situations.

>> Yeah, we can have more of a predisposition towards an anxious temperament.

>> Yeah.

Well how do you tell though it's not just necessarily a stage or a phase but there is definitely some issues there that we need some extra help on when when do you identify that?

>> So a lot of times when it becomes a pattern right.

It's not just I had I know a lot of students are going through state testing right now.

That's an anxiety provoking situation.

I might lose some sleep over taking a test.

I might have a decreased appetite.

I might feel a little bit sick to my tummy the start of school also a time that can increase anxiety levels in kids.

>> And so if we get through this little phase this stage in OK, we made it through and we've kind of adapted we're doing OK and I'm not sure we necessarily need any further treatment or help.

It's when that concern persists and it becomes a pattern when I'm discharging patients who I work with and I'm saying let's wait, I'm not sure we need to meet anymore.

We're doing OK. That's usually one of the caveats that I give is when is it time to come back?

When do you need to seek help again is when it becomes a pattern.

It's not oh I had a really anxious day or I felt a lot of anxiety today.

That's part of being a human.

It's when that becomes a pattern and it starts to interfere.

>> Yeah, there are some common anxiety disorders children and adults deal with.

>> Can you tell us about those ?

Definitely they are yeah.

So I mean kind of our first big one is generalized anxiety disorder.

Sometimes it's seen and that's is that a wide spectrum there it is exactly what it sounds like.

It's generalized.

It's not just about one thing or another.

It's generalized.

There's a lot of worry and again having that impact social anxiety disorder another one again pretty much what it sounds like there's that fear or that fear of being judged that social peace there can be some performance anxiety as well.

That's where test anxiety can sometimes fall into if there's a fear of being judged on a performance.

You can look at panic disorder which are more of those panic attacks and we can see those and then it's also a fear of having a panic attack.

Let's see and then there's a lot of specific phobias which are those fears of specific situations, specific triggers.

>> So I mean agoraphobia is a fear of leaving the home or being out in a public place.

So those are the kind of the big across the life span.

We can also see separation anxiety disorder in younger children.

>> We can see it in anybody but we see it more often in younger children, which is an anxiety about separating from that a caregiver, a agoraphobic.

>> Yes.

Didn't that not to get off subject too much but it seems like that popped up a lot more during and after covid again, I don't have data.

It feels like it.

I mean we were all isolated and staying by ourselves if I don't have to to leave the home to go get Grote or at the time or if I can't leave the home right.

But if I'm not leaving the home to go get groceries and then OK, I don't have to I'm worried about being judged as much there isn't that fear of that social situation that can be reinforcing and so then it's easier and easier the right way but we fall more into that pattern of staying for more significant other of mine went through that she was very outgoing before covid hit and then as things changed she just didn't want to go out anymore, just wanted to stay home and I have a sister bless her heart is the same way and she's actually seeking help is as I speak.

>> But I just found that very, very interesting just seem to have been brought on so many other things other than what we just discussed.

You touched on this but the next question is when should parents really worry about a child's anxiety and what are the signs the clear signs that they need help?

>> Mm hmm.

So in young kids sometimes they don't even have the words to be able to say I'm feeling anxious.

Yeah, this is a worry, right?

We oftentimes we see it come out in physical symptoms.

Bellyaches are a big one.

Headaches feeling shaky and it's not and I like to emphasize to parents who I work with it's not that they're not feeling bellyaches right.

It's not that they're making it up or that they're not experiencing that their their stomach is truly hurting.

It is not feeling good but that's how it's manifesting.

So if we're seeing a lot of physical symptoms you've gone to the doctor, the pediatrician and they've said we're really not seeing any physical reason for it might not be a bad idea to consider anxiety.

>> OK, if you're joining us now we're talking about a very serious situation and issue going on right now in our human lives I guess or in society we're talking about childhood anxiety and much of it can be very severe.

And so if you have questions about that, please give us a call 866- (969) 27 two zero and Dr. Lily will answer those.

>> So we talked about when they should worry about the child's anxiety in the signs that they need the help, what happens and what are the effects or risks of an anxiety problem that isn't diagnosed and treated.

>> So I mean first and foremost it's not a comfortable feeling, right?

Feeling anxiety.

Like I said, it's a normal human emotion.

It is a normal adaptive thing that we all get to feel.

But it's also really uncomfortable and if this is pervasive and we're having this across different contexts, it's impacting our daily lives that's going to be a big impact.

I may not want to go out for my T ball team or I may have a really hard time going to school.

Grades may start to dip if I'm constantly worrying what if that person is thinking I'm right if I'm thinking and worrying constantly so we can see an impact on our lives and we can also see an impact on our health as well?

>> What about mental health long term?

I mean can some of these things actually affect you mentally even worse down the road if they're not treated well like what we just spoke about with the agoraphobia?

Yes, it can yeah.

We can definitely see an impact .

I'm not saying that everybody who experiences anxiety will have a phobia and it's yeah, we can see that it's helpful.

It's why I like to really intervene in the pediatric world.

That's where that's where I specialize just because when we treat young we give kids or adolescents coping strategies ways to think about things then I can use those as they get older and hopefully prevent some of the more pervasive more debilitating anxiety.

>> Well we certainly hope so.

But you know, they've got to get the help the parents need to identify that and not just fluff it off as oh, it's just a phase.

>> I mean it could be but again, as you said, if those symptoms tend to get worse and they're really obsessing on it, well then we've got to we got to do something about this kid shouldn't have to deal with that.

>> Many adults even especially poor kids, you know, so I'd like to get into the treatment.

>> I know there's very several as ways to treat this and of course you're a psychologist and you can't prescribed medications and so medications can help.

>> But when as a psychologist, how would you treat a child with severe anxiety?

>> Definitely and it's definitely multifaceted and depends on those diagnoses that we talked about before.

It also depends on a child's cognitive level, their developmental level.

A key piece a lot of the time is teaching coping strategies, teaching ways again when we're in that fight flight or freeze mode, how can I bring my my hyper arousal down a little bit deep breathing progressive muscle relaxation, squeezing and relaxing muscles using what we call grounding techniques a really simple one is find five things you can see for things you can hear three different textures that you can touch do things you can smell and one thing that you can taste and that brings a child kind of and a human being not just a child back to the here and now back to the present moment.

So really working, teaching practicing those coping strategies is a big starting point.

We can move into cognitive strategies so cognitive restructuring taking a look at how we think about the things that come up and my having a lot of these what ifs thoughts how do I challenge those?

How do I talk back to some of those and then ultimately with a lot of our anxiety as we move into what we call exposure and so this is really putting ourselves the person experiencing anxiety into some of those feared situations sometimes I use a metaphor with families of diving into a really cool swimming pool so we're getting into summer mode.

Pools are probably a little bit cold right now but if I go up to a really cold swimming pool and I stick my toe in and I think oh that's too cold, I'm not getting in that and I go sit back on the sideline a few minutes later I go up and they stick my toe in oh no I'm not doing that.

That's no that's not going to be comfortable.

I'm never going to get in the pool.

But if I go up to the pool and I think OK, it's going to be uncomfortable for a little bit and I jump in at first it's shocking at first it's uncomfortable at first I don't like feeling.

But what happens if we stay in the pool for a while?

Right.

We start enjoying things.

We play around with our friends.

We get used to it every once in a while we might stop and think yeah it's a little bit cold but we're in the pool and we're enjoying it and anxiety is the same kind of way a lot of the times we're going to dove in, we're going to try that thing that scares us, try that thing that makes us feel anxious and eventually our body we can't stay and fight flight or freeze for forever.

Eventually we start to get used to it and it's OK. >> This isn't as bad as those what ifs those feared thoughts that I was having.

Well, I'm tell you a little story.

It's a true story.

I did a show for another show but it's actually a story from Canada, the CNN Tower at one time it was the largest structure in the world and it's so tall I can't tell you how tall it is but I do have a fear of heights and I'm typically grounded.

OK, I'm usually on the ground if I get on a tall ladder it's like I've always been that way.

>> I've even been hypnotized before to go on a roller coaster.

It didn't work but I tried but I was so fearful and because they have a glass floor you can actually walk across this glass floor and see a thousand feet down and I was so petrified I was actually crawling.

>> I was on my hands and knees.

This is live TV by way.

I was working for another TV station in town at that time.

I was very embarrassed about that but I got up here I just totally just lost it because I hadn't had a chance to acclimate to that and I don't know what would have helped maybe just in town going to make the Lincoln Tower maybe going there at the top and just getting used to that.

>> And I've been up there before and it was it was scary enough for me but I wish I would have had maybe some of that help before I would have done that story because it was it I go well for me but that's exactly what that's a gradual exposure.

>> Right.

Maybe we might imagine ourselves on this big tower first and then we might watch a video of it and then we might go up to the top of I don't know I'm trying to think of a smaller building and I'm blinking but we gradually step our way.

We're not going automatically to that top and so we get used to thinking and I did that I can do this next thing.

>> Yeah, it was it was too much I mean it was a great visual excuse me visualization the camera shooting down you can just see it's like but my thoughts were what if this glass breaks?

>> You know there's your what if right there.

>> Yeah so there are various ways and it's kind of a personal thing right on how we handle those movies.

>> Yeah I think it's a very personal thing.

Let me ask you this when you are dealing with these children, do you deal with them by themselves or with the parents or are a little bit of both?

>> A little bit of both usually and then it kind of depends it depends on a child's insight into their triggers and their ability to cope .

Usually when we're doing some sort of exposure therapy like that, I do like to bring a parent in or a trusted other person just to help them stay accountable to be able to do that.

But the coping the cognitive strategies, a cognitive restructuring that kind of depends on an age of the child developmental level and where they're at on that journey.

>> No, you can't speak a whole lot about this but these children or people in general they do the CBT, the cognitive behavioral therapy and the exposure therapy as you explain sometimes medications are needed to help and of course you would have to refer someone to maybe a psychiatrist.

So it would depend yes, psychiatry would be one who would be able to address anxiety concerns with medication management.

A lot of the times primary care providers, pediatricians, family med providers can also help with that.

So usually I say start with your family med provider or your your child's pediatrician and see where they're at usually in conjunction with therapy is most helpful.

But yes.

So psychiatry or family medicine or pediatrician I mean it would be great if they didn't have it didn't have to have medications.

>> We just kind to talk it out, do the exposure thing and so forth.

>> So you touched on it slightly but seriously, if you have a child I'm speaking you know if I were a parent and have a child who is dealing with these things and you're very concerned about them and you see you have a pattern going as you mentioned earlier in the program, what is your first step?

What do you need to do to get this child help?

>> First of all, I would acknowledge what the child is feeling right now.

>> You're fine.

Your stomach is fine.

Don't worry about it just right.

It's OK to to acknowledge it and say whoa, I think you might be feeling a little anxious or if that's a big word sounds like you're pretty worried about whatever is going on going to writing the school bus to school so first acknowledging it helping get give your child the language to be able to say oh that's what this is feeling.

Right.

Just that simple acknowledgment that what I'm feeling is not just in my head.

It's a real true feeling to normalize it.

Oh I feel that way sometimes too.

We all feel anxiety sometimes again we're not dismissing how we all feel that way sometimes but now I feel that way sometimes too and it's really hard feeling.

What would you think about talking to someone about it and then kind of give it up?

It again depends on the child's developmental level.

A three year old is probably not going to say like OK, let's go get some therapy.

But a teenager makes you know what I do think I need to talk to somebody, OK?

And then from there it's seeking help and you can call your insurance card, see what licensed therapists are available locally.

There's some websites that you can you can search and honestly like I said, usually I say talk to your pediatrician and talk to your family med provider.

>> Usually they have a list of starting points or resources.

But Doctor, we have about thirty seconds left and I would like to pre you just have the floor for a moment and for our viewers just give them some comfort if they have a child who's going through this what should they know it's normal right?

It is it is a normal stage of development is a normal human emotion that again we all get to feel and so just that normalizing sometimes we can start to feel anxious about our anxiety or anxiety about our child's anxiety and just to pause and say OK, this is this is a normal thing and there's a lot of things that we can do to help.

There are a lot of resources and there is there's hope.

There are things that we can do and if you have to take him to the family physician, go from there.

Exactly.

Maybe they get to see somebody like you.

It's all right.

Thank you so much for being thank you and talking about this very important topic.

>> We thank you for watching and we will see you next Tuesday with another topic.

>> Until then, good night.

Good