104: How to help a child to overcome anxiety

Listeners have been asking me for an episode on supporting anxious children for a loooooong time, but I was really struggling to find anyone who didn't take a behaviorist-based approach (where behaviors are reinforced using the parent's attention (or stickers) or the withdrawal of the parent's attention or other 'privileges.'). Long-time listeners will see that these approaches don't really fit with how we usually view behavior on the show, which is an expression of a need - if you just focus on extinguishing 'undesirable' behavior, you haven't really done anything about the child's need and - even worse - you've sent a message to the child that they can't express their true feelings and needs to you. Listener Jamie sent me a link a book called Beyond Behaviors written by today's guest, Dr. Mona Delahooke, and I immediately knew that Dr. Delahooke was the right person to guide us through this. Listener Jamie comes onto the show for the first time as well to co-interview Dr. Delahooke so we can really deeply understand our children's feelings and support them in meeting their true needs - and overcome their anxiety as well.     Dr. Mona Delahooke's Books Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children's Behavioral Challenges Beyond Behaviors Flip Chart: A Psychoeducational Tool to Help Therapists & Teachers Understand and Support Children with Behavioral Changes (Affiliate links).   [accordion] [accordion-item title="Click here to read the full transcript"] Jen: 01:28 Hello and welcome to the Your Parenting Mojo podcast. Today, we're talking about a topic that parents have been asking me about for ages and that is how to support children who are experiencing anxiety. Now, it's not super hard to find research on anxiety and on treatments for anxiety, but the hard part is finding someone who doesn't just see anxiety as an unwanted behavior that we need to extinguish using reinforcements and who actually sees anxiety as a potential cause for behaviors like having a bad attitude or lacking impulse control that we might typically think of as bad behavior rather than being caused by anxiety. So, we have a special guest today who's going to help us move beyond this view of anxiety and that's Dr. Mona Delahooke. Dr. Delahooke is a licensed clinical psychologist with more than 30 years of experience caring for children in their families. She's a member of the American Psychological Association and holds the highest level of endorsement in the field of infant and toddler mental health in California, as a Reflective Practice Mentor. She has dedicated her career to promoting compassionate relationship-based neurodevelopmental interventions for children with developmental, behavioral, emotional and learning difficulties and has written a book called Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children's Behavioral Challenges. Welcome Dr. Delahooke.   Dr. Delahooke: 02:43 Thank you so much. I'm so happy to be here.   Jen: 02:45 Thank you. And we have another special guest here today as well. We've heard about her, we've heard her words and now we're going to hear her very own voice. Today, we have with us listener, Jamie. She's not listener Jamie to us. She's Jamie Ramirez in real life and she and her wife are the proud parents of now 11-month-old daughter Elliot. Jamie struggled with anxiety for a good deal of her life and has also read on this topic a lot. And she was the one who suggested that I read Dr. Delahooke’s book and so when Dr. Delahooke agreed to an interview, it was only natural to ask Jamie to join me as a co-interviewer and she enthusiastically agreed. Welcome Jamie.   Jamie: 03:22 Hi.   Jen: 03:23 Yey, you’re here. All right, so let's start kind of at the beginning I guess by talking about how Dr. Delahooke’s thinking about anxiety is different from the way that most researchers and psychologists think about it and treat anxiety and children. So Jamie, I wonder if you could start by reading one of your favorite passages from Dr. Delahooke’s book and then perhaps we can contrast this with the more common view on anxiety. So do you want to go ahead and do that?   Jamie: 03:48 Yeah.   Jen: 03:49 Okay.   Jamie: 03:50 “The truth is that we scrutinized children's behavior from the time that they're born. “She's such a good baby”, we might say of a newborn who is easy to care for, doesn't cry too much, sleeps through the night and whose moods are predictable and easy to read. Without realizing it, we are betraying our cultures understandable bias toward valuing behaviors that we can easily understand and that make our own lives easier as caregivers, teachers, or other providers. As children reach school age, we lavished praise in good grades on those who are good listeners, follow directions and can sit still and perform well on tests. We often reward these good behaviors with positive recognition, not realizing the messages we are sending to children whose natural tendencies fall outside of the easy child profile, particularly in the educational arena e.g. those who can sit still are better than those who cannot. Quiet is better than loud. While these messages may well serve the purposes of group education, they ignore the importance of understanding and appreciating and not judging the range of children's individual differences demonstrated through their behaviors.”   Jen: 04:57 That's such a powerful passage. I can see where it resonated with you. Yeah. And so Dr. Delahooke, I wonder if you can contrast that as sort of the way that you view anxiety with the way most psychologists think about anxiety. What do most psychologists think anxiety is?   Dr. Delahooke: 05:13 Well, the way I was trained and really I think the predominant thought still amongst most psychologists is that anxiety is understood as a disorder. And maybe we can understand that through understanding that the DSM, are you familiar with the DSM?   Jen: 05:35 Yeah. The Diagnostic and Statistical Manual. Just for listeners.   Dr. Delahooke: 05:38 Yes. For listeners, it's kind of the dictionary, so to speak, for labeling and diagnosing individuals along a set of criteria. So one shift that's happened in the last kind of less than a decade starting in 2013 was that the DSM that Tom Insel, who was the head of the National Institutes of Mental Health announced that the national institutes were going to be diverting funding away from straight DSM criteria and more towards looking at underlying causality. So the short answer to your question, the way many of my colleagues, I believe view anxiety is as a DSM disorder and the American Psychological Association defines anxiety as an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. So anxiety is defined kind of loosely in a way as something that if you have a certain amount of characteristics or symptoms, then you have anxiety.   Dr. Delahooke: 06:51 And that's kind of how it's viewed now as a thing, as an actual like, oh, your child has anxiety. Well, there is no blood test for anxiety. Right? So it's not exactly like your child has diabetes, you know, your child's blood sugar level is above 105 or whatever. Anxiety, the way I was trained, I was really in my education in the 80s was that it seemed like anxiety was this thing that you treat with a certain protocol such as cognitive behavioral therapy and medication if needed. And that was what would help it go away. But what I wasn't taught was what's underlying all sorts of anxiety. Well, there's all these different subtypes and so it's really exciting to me that the shift is now not just looking at a symptom checklist, but looking at the brain circuitry and the domains, the dimensions of functions rather than these categories. And it's a really exciting shift.   Jen: 08:04 Yeah. And I just want to delve a little deeper into a couple of things you mentioned, you mentioned medication and cognitive behavioral therapy, and from the research that I've done, it seems as though each of those are effective in about half of the children that are treated. Is that right?   Dr. Delahooke: 08:19 Well this, yeah, generally speaking with the research you might find different percentages, but some percentages are about a third. Some go up to a half.   Jen: 08:29 Okay.   Dr. Delahooke: 08:31 But you think about half, that still leaves another half.   Jen: 08:35 Yes, it does. Yeah. And so what are some of the challenges of treating this anxiety in children?   Dr. Delahooke: 08:42 Well, now that I have a different protocol, I'm finding much way fewer challenges that I think that early in my career when I was using the standard...