Anxiety can be a significant problem for some children. What are some of the signs and how do you help them cope?  Chief of Child Adolescent Psychiatry at UPMC, Abigail Schlesinger, MD shares important information for parents.

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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– Anxiety can be a significant problem for some children, so how do you recognize it, and what can you do to help? Hi, I’m Tonia Caruso. Welcome to this “UPMC HealthBeat Podcast.” And joining us right now is Dr. Abigail Schlesinger. She’s the chief of Child and Adolescent Psychiatry at UPMC. Thank you so much for joining us.

– Thanks for having me.

– So when we talk about mental health, how important is mental health? Is it just as important as physical health?

– Oh, for sure. Like I often say to my patients, the brain runs the show for your body, right? So you can’t have one without the other.

– And so when it comes to young people, talk about the types of anxiety, or how early can a child begin to experience anxiety

– Well, first of all, anxiety’s normal. So it’s your body’s response to an uncomfortable situation. It would be abnormal to have no anxiety, right? So that means very young children can have anxiety. Crying could be their early signs of anxiety. And I think the other important thing to remember is that just because you have anxiety doesn’t mean, well, again, there’s something wrong with you. But the treatment and the help for anxiety is exposure, meaning doing the things that you’re fearful of.

– Give me some examples from that, then.

– I like to start with sort of normal situations first. Like, not a diagnosis, not something that might result in you needing a medicine or a therapy, just regular life, right? We all know that kids get stressed out sometimes when they need to leave the home and stay at a child care setting for the first time. That’s a normal part of life for many kids, not every kid. And the answer isn’t to never have them leave the home, it’s to support them so they can feel comfortable and go through that experience and recognize that they’ll be okay. So the treatment, the help you give for people with anxiety is to help support them through whatever’s making them anxious.

– Can you define what an anxiety disorder is as opposed to just-

– Yep, so anxiety disorder is simply having enough anxiety that it’s getting in the way of doing the things you need to do every day, not just for one day, but on a consistent basis.

– So if we all have anxiety, when do you know that this is something, just like the example that you just talked about that we should just expose our child and support them, to when is it something more serious that really would need medical attention or some sort of intervention?

– Right, so I’d say that the point where we go from normative anxiety to needing treatment is when it gets in the way, right? So brief moments of anxiety, a little bit of crying in a new scenario, it’s probably okay for some people. If a big stressor happened, being stressed out is normal. But if the anxiety and worry and the reaction to the anxiety is getting in the way of doing the things they need to do every day, that’s when we need to think about therapy or other formal supports.

– So you mentioned crying. What are some other signs of anxiety?

– Right. So, again, the anxiety is the body’s response to a new or unknown situation. And you can have two different types of reaction: a physical reaction — stomachaches, headaches, feeling tingly, feeling like the back of your neck is uncomfortable. Many adults can relate to those feelings. And then there’s the thoughts that go with anxiety, which might be worry thoughts, emotion thoughts, thoughts like you’re going to die. That would be something we see in a panic attack. So there are both the physical feelings and then the emotions and thoughts you can have.

– And so when does a parent know, like when should I make a phone call and say, “I think my child needs to see somebody,” that point of, “We need to take this more seriously”?

– Yeah, and I get this question a lot. And, again, most parents, I would say, wait. And that’s OK. That’s because they’re trying to support their kid through it. I find the parents that struggle the most are the ones that also have a little bit of their own anxiety. Now, we all have anxiety, right?

– Right.

– Again, it’s normal, but they’re trying to figure out sort of where’s the line. “Am I pushing them hard enough or not?” And, again, I often recommend that they first start with talking to the other adults in their world. Like, “Do you think this is getting in the way?” So, if as a parent you’re not sure, like, “Does my child need to get support or not?” talk to your pediatrician. They’ll have an idea of what normal expectations are, what their regular development might be, and could give you some hints about what to try before you get treatment or to go see a provider.

– And so, then, what does treatment look like? I know it would depend upon each individual in front of you, but just in general, what are sort of the elements of treatment?

– Right. So we actually work hard in western Pennsylvania at UPMC to have our pediatricians be able to do treatment from the very start with kids. And it’s helping parents and kids not avoid things that make them anxious, but sort of slowly do them. So treatment involves exposure. If something makes you fearful, figuring out what it is and slowly exposing you to that situation. It may not be, if you’re fearful of a pool, jumping in the deep end when it’s the coldest out. It might be putting your toe in first. And that’s where a therapist can really come in and help figure out how to do that gradual exposure. Like, what is the equivalent of putting your toe in, and what’s the equivalent of the deep end?

– We did another podcast recently about bullying. So what happens if your child is being bullied and has anxiety over being bullied? What steps do you take?

– Right, so I said the treatment for anxiety is exposure, but there are times when kids can’t do exposure, right? And that might be because there’s something else that’s resulting in that anxiety. And that’s where really being keyed in to your kid and asking some questions about what’s going on; in that situation, being keyed in with the school. You know, we have many kids that become fearful of going to school. That’s not unusual because that’s one of their big jobs, right? So that’s where it comes out. And if you have a kid that’s fearful of going to school, it’s really important to talk to the school. What have they seen? What have they noticed? Are there things they’re avoiding there? Ask the kid specifically. You don’t need to ask, “Are you being bullied?” To start, you could say, you know, “What are you worried about? What do you not want to do?” And you’d be surprised how quick kids will tell you.

– When does medication become involved in this?

– Yeah, so we know the most effective treatment for an anxiety disorder, so not just worry and anxiety but an anxiety disorder, is a combination of medication and therapy. So if a child is having that experience, an adolescent is having that experience, we know the most effective treatment is a combination of therapy and medication. Many people start with therapy, which makes a lot of sense, because if you could get better without having to add another thing to their routine, put another thing in their body, why not? The medicines that are effective for anxiety are called selective serotonin re-uptake inhibitors, or SSRIs. Prozac is the one people have heard of the most frequently.

– And what do they typically do in the brain?

– They literally change your brain in a positive way. And, in fact, when people have done brain scans of adolescents and adults that have had effective therapy or effective medication, the brain scans look the same.

– Wow.

– Yeah.

– And so what changes in the brain? What area of the brain? What’s going on up there?

– So it’s actually a whole bunch of thought stuff. And I think, like, if anyone ever tries to tell you that it’s simple, they’re wrong. I hear a lot of people say, “You have a chemical imbalance.” It’s not like a chemical imbalance. I instead like to think about, especially in children and adolescents, their job, in addition to going to school, is to learn how to interact with the world. And as they grow, their brain changes to help them become who they’re going to be. And if you don’t do things because you’re fearful of them, those tracks in your brain just won’t grow the same way

– Really?

– Yeah. So even though medicine does change the brain to make you more likely to do some things you were fearful of, probably at the end of the day, the thing that’s most effective for kids with anxiety is getting those experiences so that they can experience the whole world and live up to their full potential, if that makes sense.

– Can you grow out of an anxiety disorder or of anxiety?

– So, as people grow and change, we can grow out of just about anything, although we do know that kids that present young with anxiety are more likely to have more anxiety as they grow up. And I think the key thing is getting help early so that kids can learn how to use that anxiety to their advantage and when to get skills to quiet the anxiety.

– So is it hereditary, or is it environmental, or a combination of both?

– Both. It’s always both. We come with, you know, we come from the womb with who we are, and then our environment shapes us, which is why exposing ourselves to the things we’re fearful of is really important.

– Right. So you work both at Western and at UPMC Children’s. Did COVID change, and did COVID create more patients? Were you seeing more anxiety among children?

– It’s been a difficult time. I think the first thing that was clear is we saw more anxiety among adults. In fact, some of the kids looked better the first few months of COVID. They got to spend more time with their family. Now, as all of the stressors have happened, and we could spend days talking about that, I think that has resulted in more depression, more struggling with school, certainly more struggling with sleep. Yes.

– And I think we’re just working on sort of helping people get through that.

– So how did you choose this as your field? What about this made you interested and want to go into this?

– Yeah. Well, my brother had attention-deficit disorder, and my mother had trouble getting help for him. So I experienced that from a young age. And then I went to the University of Pittsburgh, which has like a phenomenal neuroscience program with Western Psych. And I got exposed pretty early in my training at undergrad to just the amazing world of neuroscience and how we can help people. And here I am.

– And so what do you love most about your job?

– Really, that moment where you see people get it and see how they stop asking the question, “What did I do wrong?” and they start seeing how they can really help kids and families do better.

– When a patient leaves you, I guess that’s a great thing.

– Mm-hmm, yeah. And patients get better. So that’s the cool thing about child and adolescent psychiatry, too. There’s a lot of plasticity. There’s a lot of change in a kid’s brain and in a kid’s life. So even though, certainly, there are a number of children we see that will struggle for a lifetime, there are a number of kids we see, and we work in primary care where we see kids very early, that if we do the right thing earlier, we can really sort of adjust that development just enough so that they really live up to an expectation that maybe wasn’t even possible in the past.

– So the sooner they get treatment, the better. But if someone does wait, is there still hope?

– Oh, yeah. There’s definitely hope. I guess the other thing I’d like to say, I say it to all the teens I see, is like, “You can always come back,” right? Because life is stressful, and that’s OK. And part of owning our own mental health is recognizing when things are starting to happen that we get help with, so that the next time, we don’t wait as long.

– Right. And what do you say to parents about, when they take their child to the pediatrician, should all the focus just be on physical? Or, what conversations, what questions, should we be asking pediatricians?

– So I would say parents have a gut instinct that they know this, right? What’s the first person you go to about behavior questions? It’s the pediatrician, right? “My kid can’t sleep, my kid can’t eat,” that’s about behaviors. That’s about how a mother and a child work together. And those are the sort of questions that pediatricians and primary care doctors have a great insight as the families grow to help them understand how to move forward. So I definitely don’t think just talking about physical health is the way to go with your primary care doctor, because they can develop a relationship with you. And many times, the primary care doctors, you know, I call them when the patient comes because they’ve seen them for years.

– And so, finally, before we wrap, what do you want to say about not being afraid to seek out therapy or help? You know, sometimes people are like, “Oh, therapy.” What do you want to say about that?

– Well, I guess what I want to say is our teens and our kids have got it right. They are not scared of getting therapy. It’s us. It’s the adults. I think that this generation has got it right. They want to get help. They’re usually not ignoring it. I think there’s still a great unknown in terms of substance use, which also affects the brain, and thinking that that’s not a problem. That’s the big stigma out there. But in terms of behavioral health, I think that, the earlier you get help, the more you seek support — and it may not just be from a therapist, it could be from your local church, from your support network.

– Right, but it’s important that the parents should take that first step with their child.

– Yep.

– Well, thank you so much, Dr. Abigail Schlesinger. We appreciate your time today. Some really good information.

– Thank you.

– I’m Tonia Caruso. Thank you for joining us. This is “UPMC HealthBeat.”

About UPMC Western Behavioral Health

UPMC Western Psychiatric Hospital is the hub of UPMC Behavioral Health, a network of community-based programs providing specialized mental health and addiction care for children, adolescents, adults, and seniors. Our mission is to provide comprehensive, compassionate care to people of all ages with mental health conditions. UPMC Western Psychiatric Hospital is a nationally recognized leader in mental health clinical care, research, and education. It is one of the nation’s foremost university-based psychiatric care facilities through its integration with the Department of Psychiatry of the University of Pittsburgh School of Medicine. We are here to help at every stage of your care and recovery.