Pediatric Anxiety Epidemic: A New Approach to Treatment | Kathryn Boger | TEDxWalthamED



imagine that you're at a theme park with your four-year-old child the two of you just stepped off the tilt-a-whirl and you're feeling dizzy and giddy and you reach into your pocket to get some more tickets as you do your child's hand slips from your own and then in an instant your child is gone you scan the park you shout your child's name you see colourful lights greasy food carts tantruming children but no child he's vanished so your breathing starts to speed up and your heart starts to pound and your stomach drops your brain runs through the horrible things that could have happened to your child you've lost control of the situation and then suddenly you look across the park and there's your child your mind and your body immediately begin to settle you regain control of the situation many of us have been through at least one highly anxious experience in our lives but then the situation resolves or we figure out how to manage that situation and our anxiety abates the mind and body recalibrate we adjust but what if there were no relief what if you walked around every day with a feeling that your heart was pounding in your chest and that you couldn't breathe what if your brain was constantly telling you that the scariest most horrible things were going to happen and that the world felt like an out-of-control and unsafe place now imagine that you're 7 or 10 or 15 and that this is your daily reality this is what we need to understand about anxiety and what it's like to experience it the word anxiety has become so overused everyone has it right that the word No anger seems to capture how debilitating it can be when it reaches a level of clinical diagnosis and I should be clear worries and fears are a normal part of childhood development and many children go through phases where they fear the dark monsters thunderstorms even automatic flushing toilets that used to get me as a child and stress is everywhere in a recent survey of about 750 youth nearly 8 and 10 reported experiencing stress on a daily basis but what I'm talking about is something very different anxiety becomes diagnoseable when it's extreme and it gets in the way of living a normal life if a child is up night after night ruminating if that child experiences chronic stomach aches and headaches and avoids people or places or things that child could receive an anxiety diagnosis and needs treatment as you can see from the red line in the graph anxiety is the most common psychiatric disorder across development as compared to behavioral mood and substance use disorders and if you look across the bottom of the graph you can see that rates of anxiety increase across development epidemiologic data tell us that 13 to 20 percent of children and adolescents meet criteria for an anxiety disorder in the US according to the National Institute of Mental Health 80 percent of these children are not receiving treatment so let me see that again that's nearly one in five children who are struggling to learn to interact and to enjoy life because of an anxiety disorder and 80% of them are not receiving treatment sadly even fewer children are receiving treatments that have been supported by research without appropriate treatment anxiety tends to persist into adulthood and this of course matters because anxiety is destructive to children social emotion and academic functioning it can be the gateway to other disorders including depression substance abuse and behavioral problems this place is a massive toll on our children our families our educational system and on our society the story I'm going to tell today is about the debilitating nature of pediatric anxiety and our attempt to address this problem it's also a story about building on best practices to develop outside-the-box solutions Kim is a teenager who struggles from severe anxiety and she gave me permission to tell her story Kim had had an anxious temperament from the very beginning she was the child in preschool who would grip her mother's leg at goodbyes and she was painfully shy in the second grade Kim was at a restaurant and she witnessed a man caught up phlegm into his meal two weeks after that she developed a stomach virus and began to vomit uncontrollably these two events triggered an overwhelming fear of vomiting you may be surprised at this example because nobody likes vomiting right but for Kim this fear was all-consuming and we've actually seen many children in our clinic whose anxiety began with this specific fear for Kim she started to have panic attacks when she went into public places where she thought she could get sick and then she started to restrict her eating to avoid the possibility of vomiting as the anxiety began to cascade Kim pulled back she stopped going to stores then restaurants and then she stopped going to school when I met her she was 14 and had been out of school for nearly two years she was spending her days at home alone essentially confined to her bedroom because of anxiety while her mother was out working to support the family she had become depressed and she was sold of practice of interacting with other teenagers that she had developed social anxiety kim was hospitalized twice because of these symptoms and she was actually put on a feeding tube and she had been seeing her outpatient therapist on a weekly basis for years without much change Kim's mother watched helplessly as her daughter became debilitated by fear and by sadness the question is how can we help a child like Kim reclaim her life from anxiety cognitive behavioral therapy or CBT is currently the gold standard therapy for anxiety many of you probably heard of CBT it's a structured form of therapy that teaches people to manage their feelings by modifying their thoughts and their behaviors the cornerstone of CBT is exposure and that's the behavior part exposure essentially means facing one's fears and a gradual and structured manner to learn that that worst-case scenario fear likely doesn't happen or that if it does that it's manageable CBT takes place in the office once a week for 50-minute sessions this has been our standard of care for 50 years and it works for many kids but for children like Kim with more severe and entrenched anxiety it can be extremely difficult to gain traction in weekly 50-minute sessions in the office in fact research indicates that nearly half of children and adolescents who participate in weekly CBT for anxiety do not get better over the years my colleagues and I have seen many children like Kim who've been in weekly CBT for months and even years and they're still stuck the longer these children are stuck the farther they fall off the developmental curve and the harder it is for them to get back on track these children are not failing treatment our best treatments are failing them so my colleagues and I broke from tradition three years ago with a support of McLean Hospital we developed an intensive group based program for children and adolescents with anxiety called the mclean anxiety mastery program or MAMP in designing the program we increase the length of CBT sessions we increase the frequency of these sessions and we increase the number of CBT sessions that were taking place outside the office in the community so that children could engage with their real-life beers at man children participate in treatment for afternoons a week for two and a half hours at a time largely out in the community they also participate in weekly family work and medication consultation sessions and in the course of a month of treatment at man children receive nearly a year's worth of weekly outpatient therapy so what does this look like and practice well I'll tell you what it looked like for Kim after being housebound for two years Kim was literally unable to enter the clinic so we met her in the car and with daily support in the families Toyota Kim gradually learned how to tolerate your panic symptoms and she built the confidence in the trust to start engaging in treatment in a meaningful way and I can remember the day the Kim decided she was ready to leave the car she came inside the building and she joined group a seemingly small step but for Kim this was a huge exposure her whole face was red her body was trembling and she was hyperventilating but she did it once Kim was engaged in our daily CBT skills group she gained the skills and the strategies to start managing her extreme anxiety for example she learned how to use relaxation strategies to calm her body at night and she learned to use mindfulness to stay more present during the day Kim also gained the practice interacting with other children and group which was a powerful experience for someone who had been so socially isolated Kim's family was also involved in treatment her mother had daily contact with the treatment team and over time she learned to step back as her daughter was struggling with anxiety rather than to reach in and protect and Kim met weekly with a program psychiatrist for medication consultation sessions the foundation of Kim's treatment was exposure we exposed her to Harvard Square the noise the traffic the people can you imagine what this would be like after being housebound for two years we wrote on buses and subways we went to stores and restaurants and Kim ventured farther and farther out of her comfort zone each day and finally Kim was ready to face her big fear we exposed her to vomit and yes I spared you that slide we made a fake vomit mixture that Kim looked at and smelled and ran her hands through and then one day Kim was exiting the subway after an exposure she started to feel a little queasy and then she threw up all over her feet for Kim this was a pivotal moment in treatment she faced that worst-case scenario fear and she saw that she could handle it with this type of daily intensive support Kim was finally able to get unstuck the team and I credit the intensity and the flexibility of the treatment model in helping Kim reclaim her life in about 6 weeks time had we tried to treat her once a week for 50-minute sessions in the office I honestly don't know where she'd be today so where is Kim now two years later Kim is back in school and she's attending on a daily basis she's taking honors classes and she has a job as a cashier at a local store her mom even emailed me last week to tell me that she had won a regional science fair Kim is now going to museums to hockey games to stores and restaurants she still has bouts of anxiety but she doesn't let them hold her back from living a full life and I think what strikes me the most is that Kim is now allowing herself to appreciate the smaller more subtle things that truly make a meaningful life recently she was in the car with her mom and they were listening to the car radio and she said I'm not sure if the songs are better now than they used to me or if I'm just able to appreciate them more so do we have this figured out not yet our own research at map shows that kids do experience significant improvement over the course of treatment but we don't yet know the optimal dose of treatment or whether it varies by anxiety disorder we have a lot more to learn and more work to do but at least we have some renewed hope for children like Kim and now as an audience you're probably waiting to hear your takeaway I of course want you to better understand the challenges that children with anxiety face and this new model of treatment but I also want to ask you to consider breaking from tradition when facing a serious problem or a challenge in your workplace wherever that may be get together with colleagues and build on best practices by developing a new model and testing it even if it's messy and I mean fake vomit messy or means risk and failure if it affects the life of just one student like Kim it could make all the difference thank [Applause]

10 comments

  1. This sounds promising but is it affordable and available to the majority of children? If it’s not now, will it be? That’s the problem I’ve found – any treatment that has any real value is almost never financially feasible or geographically accessible.

  2. Not certain about the points made but ,if anyone else wants to learn about how to cure a panic attack at home try Loctavan Amazing Simple Stress Strategy (do a search on google ) ? Ive heard some extraordinary things about it and my mate got excellent success with it.

  3. I get results MUCH faster by focusing first on the initial psychotrauma whenever possible. The consequences often get resolved on their own. And I use principles behind EFT, Sedona Method, some NLP techniques, etc. I want to underscore the word "principles", not bogus explanations (as are provided, for example, by EFT and EMDR practioners). The cornerstone is also exposure, but I first use exposure in one's mind, and then in real world once that is done, if needed.

  4. My son suffers from chronic anxiety – it's nice to know he isn't alone but it's even better to start learning what I can do for him.

  5. Hi hi! Nice video you have there! On a separate note; have you thought about " Vidadsmedia Child Anxiety Treatment " (try googling it)? My sisters boss had some dealings with them and was impressed by their great treatment when the Anxiety issue was completely treated !

  6. Hi! Nice video you have there! On a separate note; have you started communicating with " Vidadsmedia Child Anxiety Treatment " (google the exact phrase)? My step brother had some transactions with them and was impressed by their awesome treatment when the Anxiety issue was completely remedied !

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