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Dr Jamie Kondis: I'm Dr. Jamie Kondis, a pediatric emergency medicine physician at Washington University St. Louis Children's Hospital., And I'm a mom doc.

Melanie Cole (Host): If you're a parent like I am, you know that right now there seems to be an increase in anxiety among our kids and even ourselves. Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. Dr. Kondis, I'm so glad to have you join us again today. This is really such an important topic right now. What have you seen as far as increases in anxiety and anxiety-related disorders, even eating disorders, over the course of the last few years?

Dr Jamie Kondis: Yes, it is a really important topic. Thank you. I think a lot of people don't realize how common anxiety disorders are becoming, especially in teenagers. We now believe that nearly one in three of all adolescents ages 13 to 18 will experience an anxiety disorder. And that includes all types of anxiety disorders, things like generalized anxiety disorder, obsessive compulsive disorder, separation anxiety, phobias. And as you said, things like eating disorders and other behavioral health disorders are on the rise as well.

Melanie Cole (Host): So let's hypothesize about what some of these causes are, because boy, there's a lot going on right now. There seems to be this whole worldwide feeling of tingling, electricity, anxiety among all of us and social media and the news, school shootings. You know, all of these things are contributing to it for all of us, really. Can you share the impact as you see it of some of this stuff on our kids right now, the news media, social media, everything that's going?

Dr Jamie Kondis: Yes. What you mentioned is exactly what we believe is causing the increase in anxiety disorders, as well as some other things. One is that our teens feel a really high pressure to succeed. You know, there's things like standardized testing and it's getting a lot harder to get into college, and so a lot of students are feeling overwhelmed by that. And then, as you mentioned, we've had an increase in school shootings. And now, all of the students have to do drills and lockdown drills and just doing those can actually cause a lot of anxiety, not just the shootings, but even just the drills themselves. And also, things like watching the news where they talk about all the shootings and they talk about all the gun violence. A lot of children are experiencing anxiety just from watching the news, as you mentioned.

And then you mentioned a big one, which is the social media. Today's children and teen are just constantly connected to social media in a way that they weren't in the past. And so their self-esteem and their worldview becomes really connected to responses to social media posts. And so they're comparing themselves and their lives and their social lives to what they're seeing people posting on social media.

And one reason that we probably saw an increase in anxiety disorders during the last couple of years is because when children weren't always in school and going out, they were on social media more, so they were experiencing that even more. So they're getting these disproportionate reactions to normal developmental experiences, like going through puberty and things like that, and they're seeing it through this kind of distorted lens of social media. So that really is playing a role.

Melanie Cole (Host): Well, I think it makes them certainly more worldly and global than we were. But definitely, it is adding to that ability to know everything all the time at every single minute. Now, when we're talking, Dr. Kondis, about anxiety, we all worry about stuff. But how is it different than every day worrying or depression? Can you kind of sort those out a little bit for us?

Dr Jamie Kondis: Yeah, that's a great point, because at least half of all children have some type of fear and worry, you know, things like being afraid of the dark when you're little or being afraid of dogs or being afraid of fires or thunderstorms or burglars, that's normal in kids to have these phobias. But when it truly becomes an anxiety disorder, it really starts to disrupt their life. They start to have recurring fears and worries about routine parts of everyday life, like just going to school or going outside. And they have real behavior changes. They start avoiding activities or school, their grades drop, they have trouble sleeping, they have trouble concentrating. And it can be tough with anxiety disorders. Because unlike some other disorders, anxiety disorders tend to be more internal, they internalize these feelings. So sometimes it can be hard for parents to really tell that their child has an anxiety disorder. But the key difference between just kind of regular fears that all children have is that they really become irrational. They're really overly exaggerated and unrealistic.

Melanie Cole (Host): Well, then, let's talk about those red flags and signs of anxiety and depression during all of these unprecedented times. Tell us the signs of mental distress that parents should be on the lookout for in our children and our teens.

Dr Jamie Kondis: Yeah, definitely. Well, one thing is does the anxiety lead to symptoms that you can see, like restlessness, fatigue, irritability, sleep disturbances, and is the anxiety or its outward symptoms significantly impairing their social academic or other functioning? Another thing is, does the anxiety occur more days than not and does it continue for a significant duration? For example, have the symptoms lasted at least six months? Or do the bouts of anxiety occur at least three to five times per week and lasts for at least an hour? And then, is it unrelated to something else? Was there a big life stressor? Did a family member die or something like that? That is going to cause some normal anxiety. So is this happening not in the context of a major life event, but just because of routine every day activities, are they having anxiety?

Another thing is that a lot of children with also have a ADHD or attention deficit hyperactivity disorder. So sometimes it can be difficult to sort out, well, are they having symptoms because of that or are they having symptoms because of an anxiety disorder? So sometimes it helps to see a physician to really sort out which one it is. Another thing to keep in mind is are there others in the family that have been diagnosed with anxiety disorders because anxiety disorders do tend to run in families, so thinking about if anybody else in the family has experienced something similar.

Melanie Cole (Host): What great points that you made. So before I ask you how we can help our children, because that is one of the main questions here, but we are all feeling all sorts of things at this time, some strange things that we've never felt before. As we want to help our children, how can parents manage our own emotional challenges so we can best help our children? It's always put your own mask on first, before you help the ones you love. How can we do that, Dr. Kondis?

Dr Jamie Kondis: Boy, that is a great point because I think everybody is experiencing an increase in anxiety and depression and worry right now due to so many things that are going on in the world. I think, as with any mental health disorder, we should always think about just supporting our general wellbeing because that is also an important part of anxiety disorder treatment, making sure we're getting enough sleep, making sure we're getting enough exercise, taking time to do something relaxing like meditation or yoga. Now, these are not substitutes for treatment if you truly do have an anxiety disorder, but these are all things that we can be participating and it can certainly support treatment and can support our general health and wellbeing.

Melanie Cole (Host): So then, what steps should we take to get our child the help that they need? First of all, what can we do at home to help our child if we start to notice this anxiety to help them manage their symptoms at home? And when do you feel it's important that we look for a professional?

Dr Jamie Kondis: Well, I think the key thing is if you're noticing any signs of anxiety in your child, or you're worried that something you're seeing could be related to anxiety is to talk with your pediatrician. You know, I was reading that according to the Anxiety and Depression Association of America, 80% of kids with a diagnosable anxiety disorder are not getting treatment, and they're actually highly treatable. The most effective treatment for anxiety disorders are a combination of cognitive behavioral therapy, which is called CBT, which focuses on lots of different things, relaxation strategies, positive self-talk, exposure therapy, whatever the child needs. And then, also some children need SSRI medications. So just getting into your doctor to get that diagnosis is really key. Your pediatrician might be able to make the diagnosis themselves. There are different symptom checklist tools they can use, or they might refer your child to a mental health professional, where they can be more fully evaluated. But really getting them in to see the doctor is really the first step if you're noticing any of those signs of anxiety or you're just worried at all.

Melanie Cole (Host): So what's going on in the mental health field right now? What kinds of options are there to help our children? Because I know televisits have really helped being able to see mental health professionals during COVID, and I think it's sticking around. I mean, it's a wonderful way to see a counselor, but they're hard to find now. There's definitely a lack of mental health counselors available right now because of this issue.

Dr Jamie Kondis: You're right, it is Tough to get in to see somebody. Definitely, if your child can do a televisit, that is easier. And actually for some children with anxiety, they do like doing the televisits because they don't want to leave their home and see someone in person. So that actually works better for some children with anxiety disorders.

Like I said, some children actually benefit from medications and a lot of pediatricians feel comfortable prescribing those medications. So even if you can't get in to see a mental health professional right away, you may be able to get some treatment from your pediatrician. So just because you may not be able to see a mental health professional right away, don't let that stop you from taking your child into the pediatrician and sharing these concerns.

The other thing we have to worry about in teenagers is that a lot of children with anxiety or other mental health disorders try to self-medicate by using drugs. either illegally obtained prescription drugs or illicit drugs. And so that's something to keep an eye out for as well, you know, watching your child for any signs of drug use and getting them into a professional if you suspect that that is going on too, because we definitely don't want kids to think that they have to be medicating themselves.

Melanie Cole (Host): What a great point. Certainly something that's so important to note. As we wrap up, talk to parents, Dr. Kondis. You're such a great guest with so much knowledge. Help us to help our children in these times with their anxiety and their worry in their depression and all of it together. Give us your best advice.

Dr Jamie Kondis: Well, I think that the best thing to do is just keep open communication with your children. Talk to them about their anxieties. Maybe they don't have an actual anxiety disorder, but maybe they just have some fears about everything that's going on in the world right now. So just talk to them about that.

Definitely a key thing to circle back to is monitoring their social media use, limiting that as much as possible, limiting their screen time, trying to get them out and have in-person interactions with peers as much as you can, if that's possible, because it's really that online back and forth that they have with other children that can really contribute to their anxiety. So I know it's hard, especially when kids are at home a lot, if they have to be because of lockdown or whatever, but really trying to limit that social media use. And then talking to your children about things like drug use and problems like that, making sure that you're being very open about communicating about those things too. And then, if you do suspect that they have an anxiety disorder, really trying to get them into the doctor right away and not waiting.

Melanie Cole (Host): Great advice and so important. Thank you so much, Dr. Kondis. You are a great guest as always. And for more advice on articles, check out the Mom Doc's website at childrensmd.org. That concludes another episode of Mom Docs with St. Louis Children's Hospital. For more health tips, follow us on your social channels. I'm Melanie Cole.