Maggie McKay (Host): When your child is suffering from anxiety, all you want to do is help them. But sometimes it's hard to know how. So today, Dr. Meghan Kanya, Child Clinical Psychologist within Children's Mercy's new Depression and Anxiety in Youth Clinic, or DAY Clinic, will give us an overview of what anxiety is and how to help your child.

 Welcome to the Parentish Podcast, where experts at Children's Mercy Kansas City talk about the little everyday things parents experience with their babies, teens, and in betweens. I'm your host, Maggie McKay.

Thank you so much for being here today, Dr. Kanya.

Meghan Kanya, PhD: Thank you so much for having me.

Host: Let's just start with what exactly is anxiety and when does it become a problem or a disorder?

Meghan Kanya, PhD: Yeah, which is such a big question to start with, if we're being honest. So anxiety at its core is a normal human emotion. This is an emotion that we have had for as long as there have been human beings. Anxiety is what keeps us safe. It keeps us out of danger. It keeps us knowing where there is dangerous stuff.

 In psychology, we like to say that, you know, back when we were cave people, anxiety was what kept us from running out of caves late at night and getting eaten by animals in the darkness. So anxiety at its core is something that is meant to be helpful. It's meant to help us understand where danger lies and how to approach it, but also it helps orient us to what is important in our life and what we really care about.

 Typically if something in life is something that you don't care about, you're not really anxious about it because there isn't enough of a will to care enough to be anxious. And so when we're experiencing anxiety, usually that's a good sign that there's something that we care about that we feel like might be under threat or in danger.

 Whether it's social status, like, are my friends going to like me? Like if I mess up and say this stupid thing or the silly thing and they laugh at me, am I going to be excluded all of sudden and lose all of my friendships? Or it might be something related a parent or guardian. And if I'm not with mom and dad and all of a sudden something bad happens to them, am I going to lose mom and dad. So again, at its core, it's really this preparation for danger and threat and how we want to deal with it. Obviously, anxiety can grow to be really big, and it can become really problematic.

And clinically, what we're looking for when it becomes a problem is how much distress it's causing in the individual or in the family. So sometimes people with a lot of anxiety, they learn how to cope with it in a pretty good way, where it doesn't really bother them anymore. But it might bother everyone around them.

 Your small child might be really okay with not going to a family get together, but you, as the parents, might be really upset that you guys, as a family, can no longer go to this family gathering because your small child is throwing a fit because they're so anxious. So we look for distress either within the family unit because of the child or teenager's anxiety, or we look for distress in the individual themselves.

 So especially once we have more language, so in our kind of middle childhood to teenagers to young adults. We're looking for more of that verbalization or the saying out loud of, I'm worried, I'm nervous, I'm anxious, and that that's happening a lot of the time. What we're also looking for is any impairment in typical activities or avoidance of typical activities.

 So I used the example before of like a family gathering, but I think a really common one is school especially for today's youth and so if you have a child who is actively refusing to go to school almost every day of the week, that is not typical anxiety. That anxiety is much too big and it's actually stopping them from getting the education that they probably need or maybe even want.

The last thing that we look for is length of time. So how often is that anxiety occurring and how long has the anxiety been at the levels that it's been at? And typically we look for anxiety to be around for more than just a couple months. Knowing that, again, some anxiety is typical, especially in the midst of big changes or transitions like going back to school or moving or changing friendship groups and things like that.

Host: Is anxiety the same thing as depression? And if not, why are they often seen together?

Meghan Kanya, PhD: Anxiety and depression are not the same thing, but oftentimes with anxiety and depression, they happen together or they occur together. Using the medical term, we sometimes call this being comorbid. And so you might hear your doctors talk about anxiety and depression being comorbid, which basically just means that they are co occurring or happening at the same time.

Sometimes I think about anxiety and depression kind of being like a chicken and the egg situation. We know that they often occur together and Initial depression, so initial feelings of just feeling really bad about yourself, feeling really low, feeling like we don't really have that same zest for life or that same interest in things, feeling like we're maybe really alone, could lead to feelings of anxiety about our status in life or kind of how we're fitting in with different people.

Similarly, if we have a lot of anxiety about performance on exams or performance on school, and then we end up doing bad on things, that can also lead to depression. Sometimes, one can cause the other, and sometimes they kind of just also pop up together at the same time.

Host: Dr. Kanya, is there always a specific cause for a child's anxiety?

Meghan Kanya, PhD: Not always, which is maybe one of the really frustrating parts about anxiety, and one of the hard parts about it too, is that we can truly be anxious about anything. And that is a whole lot of stuff to be anxious about and to screen for. What we do have, so within our diagnostic manual, we have a whole lot of different names for different anxiety disorders.

And all of those different names talk about different types of fears. So for example, we have one disorder that is labeled separation anxiety disorder. This is typically given in kind of our younger kids. So our toddlers, our preschoolers, even like our early elementary school kids. And it's anxiety about separating from loved ones or caregivers.

It's those kids that cry every time we drop them off at school, no matter how many times we've dropped them off and picked them back up safely. We also have something called social anxiety disorder, which we can find in kids of all ages. And as the name suggests, this is all about anxiety related to social situations or how others are perceiving us.

 We do have a kind of catch all diagnosis, which is Generalized Anxiety Disorder. And the definition of Generalized Anxiety Disorder is truly free floating anxiety. So we have a little bit of anxiety about a lot of different things.

Host: And what are some signs my child might be struggling with anxiety?

Meghan Kanya, PhD: The big signs that we look for in terms of thoughts are going to be having a lot of thoughts or a lot of feelings of nervousness, anxiety, worries. Your child might describe feeling really tense or even feeling really restless and fidgety a lot. You might also notice a lot of irritability, especially in younger kids.

 That irritability is typically coming from a place of exhaustion because for anyone who's ever felt anxiety, which all of us have, it is a very exhausting emotion to feel. Some of the things that you might hear your child or teenager saying might be, well, what if something bad happens? Or, I think something bad might happen. I feel like something bad might happen. A lot of times anxiety starts with that phrase of what if. So, what if I fail? What if I don't get the grade I want? What if my friends laugh at me? What if I mess up? So those are nice telltale signs of anxiety. We also see anxiety kind of being at the root of some of our perfectionism.

 So if you have a kid who is very perfectionistic or who is constantly seeking out reassurance from you. So is constantly asking, did I do that okay? Are you okay? Are you mad at me? That might be a sign too, that they're experiencing more anxiety, even if they don't label it themselves as anxiety. In addition to some of those kind of more thoughts or feelings, we're also looking for physical symptoms, knowing that anxiety often triggers our body's fight or flight response. And so some of the physical changes that we might notice in our child or youth's body would be stomach aches, headaches, changes in breathing, which might even be hyperventilating.

 We can see increased heart rate. We can also see a lot of sleep difficulties and even some changes in eating behaviors where we might eat a lot less because of upset stomachs. We also can see concentration difficulties because our mind is racing with anxiety or with anxious thoughts or our brain is focused on other things in the classroom.

And then we just see a lot of avoidance as well. So there's a lot avoiding things that scare us, a lot of avoiding things that come with some kind of what if attached to it. So we're seeing more and more hesitance in our youth or in individuals at engaging in different things.

Host: And when should I seek help for myself or my child?

Meghan Kanya, PhD: I think in general, I typically tell parents and caregivers that they can trust their gut, right? You guys know your kids the best. You are experts on your kids, on your youth. But in general, what we kind of look for clinically, or kind of when, when my spidey senses start tingling when I'm hearing someone talk, again, that high level avoidance. So if we are avoiding more and more things and that avoidance is interfering more and more with our life sometimes the way I describe this too is um, when our youth's lives get really small. So if they used to play soccer and go out with friends all the time and be engaged with family, and all of a sudden, they're just kind of spending time in their room all the time, and they've quit all the sports that they enjoyed.

They are really struggling with keeping up with schoolwork, right? Their life is just really small. It's really contained. It's really controlled. That might also be a sign that we need additional help or support. Again, if there is a high level of irritability, which is then impacting social relationships, including friendships. If your youth is either speaking themselves about just a lot of suffering, a lot of pain, a lot of struggle, or you see them suffering a lot, you see them struggling a lot, those can all be signs that we might want to seek out help for either your youth or as their parent, get some supports in place to kind of help you help them.

 And what I like to suggest for a lot of families is that the first step for seeking out that help can be either going through your child's school, so reaching out to the school counselor or social worker to get some support and resources, or going through your child's PCP, so primary care physician, or their pediatrician.

All of our medical providers are trained to help screen for anxiety in youth, so you can always go to their medical provider, and ask them to screen for anxiety.

Host: Dr. Kanya, kids of all ages have been through so much the last few years. I can't even imagine being a kid, just normally it's kind of stressful socially and now they have the whole online thing. Can anxiety lead to thoughts of self harm or suicide? And if so, what can I do to help my child stay safe?

Meghan Kanya, PhD: What I like to kind of ground the families that I work with sometimes in is those thoughts about self-harm or those thoughts about death, suicide, killing oneself, those are thoughts that most humans will experience at one time or another in their lives. Those are thoughts that are in some ways pre-scripted into our brain. I can with almost a 99 percent accuracy label what those thoughts are for people. And it's not because I'm good at my job, even though I am. It's because they're scripted, right? Like our brains are all really similar in terms of how they function.

What I like to kind of redirect, especially parents and caregivers, to hear, when their child or when a youth that they're kind of working with or caring for is talking about killing themselves, talking about maybe wanting to be better off dead or feeling like they're better off dead, is that really what they're saying and what their brain is saying is that I'm overwhelmed and I don't know what to do about it. I feel really helpless to help myself get out of this problem that I'm facing, to get out of the struggle that I'm facing. And we use, right, really extreme language like, I might be better off dead, which can kind of set off some really big reactions from parents and caregivers, um, who want nothing bad to ever happen to their, their child or youth.

 So I like to, like I said, sometimes ground people in this idea that just because we're talking about being better off dead doesn't necessarily mean that we want to be dead. Really, that is our brain's way of screaming out for help and screaming out for support. So one of the first things that you can do when your child is having thoughts like that, is to talk to them about it.

To validate what they're experiencing, right? To validate how it seems like you're feeling really overwhelmed right now. It seems like you can't solve this problem for yourself or that you're having trouble solving your, this problem for yourself. Why don't we just sit together for a little bit, I'll just stay with you.

 So really being able to open the door for some communication about what is going on for them and what is feeling so helpless or so hopeless in that moment. Depending on the level to which they are talking about hurting themselves, talking about wanting to kill themselves, the level to which that you might even have a plan about it; we also want to seek out additional resources, including medical support. So what this might look like is calling the 988 hotline number. So the 988 is kind of our 911 for mental health struggles. So just like you would call 911 if there was a fire or if there was a medical emergency,or a law enforcement emergency, we want everyone to feel really comfortable using 988, to call when there's a mental health emergency, which can be anything from self-harm and suicide to I had a really bad day at work and I just need someone to vent to because I'm feeling really overwhelmed and stuck.

And so 988 can be a great hotline for parents and youth to use to help navigate those situations. Additionally, families can always go to their nearest emergency department or emergency room and have their youth assessed by a medical provider or a mental health provider to see what level of support the youth is needing at that time.

So if you yourself feel uncomfortable with assessing that, if this is the first time this has ever come up for you or your youth, then you can go to our emergency department. And you could have a medical provider talk to your youth and really figure out what the next steps are and what they're needing in that moment to keep them safe and to keep them alive.

Host: Right. And how can I help my child manage their anxiety? I mean, I know the first step, like you said, you just talk it out, see what's really bugging them, but then how do you help them manage it?

Meghan Kanya, PhD: So validation is again, a really important step of this. Anxiety has a way of making people feel crazy because our rational brain can rationally say, this is no big deal. Right. A test is not going to kill me, right? It's just a test. But every cell in our body might be telling us that we're going to die.

That even though rationally we can say this isn't going to kill me, our body is trying to convince us that this is going to kill us. And so the first step is to validate. Validate how, like, you're feeling really nervous about this right now. How your body is really activated right now. And then the next step of that is to try to connect them to a coping tool.

So, your body is feeling really overwhelmed right now. Why don't we take a few deep breaths together? Or, wow, I'm noticing that your body is really fidgeting a lot. It seems like we might need to get up and move around. Let's go for a quick walk. So that way, number one, we're helping build community, and build support for the youth, but we're also introducing them to emotion language to be able to label their feelings and we're introducing them to coping tools that they can use both with other people and just with themselves.

We really want to try as much as possible to not shame them when they bring up worries and concerns even if again, in our adult minds, we think that what they're saying is completely irrational, completely illogical, completely silly. We don't want to tell them that. We don't want to shame them. We want to validate.

We want to say, yeah, that feels like a really big part of your life right now, right? I can hear how important it is to you to get this grade on this test. And so let's figure it out together, right? Like this is a really big issue in your world. And so let's figure it out. The last thing that I like to often tell families is, working through anxiety is often a matter of trying to approach situations instead of avoid them.

Sometimes this can be done really easily by just inviting your child to do whatever it is that they're scared of. Sometimes their fears are really big. And so sometimes we have to start small. And a lot of times I equate this to almost like building like physical muscles where you go to the gym and you work out, right.

And we build up muscles. But in anxiety work, we're building up our brave muscles or our courageous muscles. And so just like in the gym, how you're not going to go into the gym on a random Tuesday and try to bench press 300 pounds because you're going to get hurt or you're going to get frustrated and never want to go back again.

We're not going to probably start with the scariest thing for the youth. Because they're going to get frustrated, they're going to get overwhelmed, they're going to feel like it didn't go well. Instead, just like with working out and building muscles, we're going to start small. We're going to start with our 15-20 pound weights, and build our way up to bench pressing 300 pounds.

Similarly, with anxiety, we might start small. And we might start with what feels most manageable for your youth, and then slowly build up those brave muscles. Slowly build their confidence and their ability to manage that anxiety in a safe way.

Host: Thank you so much for sharing your expertise. This has been so helpful and very useful information. We really appreciate your time and you doing this.

Meghan Kanya, PhD: Absolutely, thank you so much for having me.

Host: To find out more, please visit childrensmercy.org/dbhealth. Again, that's Dr. Meghan Kanya. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. That concludes this episode of the Parentish Podcast.

For more parenting tips and tricks, visit us at parentish.org, where we help you celebrate the craziness and challenges of parenthood.