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Children and teens often don’t recognize their anxiety for what it is. Instead, they may feel out of control or like something is wrong with them. But anxiety in kids goes beyond the physical symptoms. Learning how to recognize their anxiety and triggers is an important development skill your child will need to learn. In this episode, psychologist Ethan Benore, PhD, shares insight about helping your anxious child learn to cope, strategies for dealing with difficult emotions and how to increase their self-awareness.

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How to Talk with Your Kids About Anxiety with Dr. Ethan Benore

Podcast Transcript

Speaker 1:

There's so much health advice out there. Lots of different voices and opinions. But who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough intimate health questions so you get the answers you need. This is The Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Nada Youssef:

I'm your host, Nada Youssef. Children and teens often don't recognize anxiety for what it is. Instead, they may think there's something wrong with them. Children and parents may focus on the physical symptoms of anxiety like stomach aches or headaches. The first step is to teach your child about anxiety and how to recognize it. And that's why self-awareness is essential. Here to help us navigate this topic is Dr. Ethan Benore. Dr. Benore is a pediatric pain management psychologist here at Cleveland Clinic Children's. He currently serves as Center Head for Cleveland Clinic Children's Center for Pediatric Behavioral Health. Thank you so much for being with us today.

Dr. Ethan Benore:

It's a pleasure to be here.

Nada Youssef:

So Dr. Benore, let's start by asking, how can you tell if your child's anxiety might be more than just passing worries and fear? What is typical versus what is a problem anxiety? What should we look for?

Dr. Ethan Benore:

It's a good question. So everybody has anxiety is how I like to start the conversation. I think there's three things that you want to pay attention to if you are starting to develop a concern for anxiety for your child. So the first is any notable change in behavior or other symptoms or complaints. So this could be physical complaints, headaches, stomach aches, nausea, trouble falling asleep, trouble staying asleep, short temper, irritability, or for some kids they become quieter and removed and particularly when they're pressed to do something or to go somewhere. And then all their efforts to avoid. A child's efforts to avoid something might actually be an indication that they're more anxious than is helpful for them. Second thing would be persistent worry, so always being worried about school, always being worried about eating a certain thing. So if the child is repeatedly mentioning concerns about the same topic, I would be concerned. And then if the child is clearly distressed by their worry. So people get worried sometimes and they can shrug it off and move forward. If your child is noting that they are also concerned about their own worry, then I would look further into it and try to get some additional resources.

Nada Youssef:

So can you give us some maybe tips and advice on helping children recognize their own anxiety?

Dr. Ethan Benore:

Sure. So in terms of recognizing your own anxiety, the first thing that I tell people is that feelings are not bad. So we want to be very open about expressing feelings. Feelings are just a quick way for our bodies to speak to us. So a feeling of anxiety means that there is a possible, and I'll underscore possible, threat or a challenge for the body. And so you need to prepare your body to respond to this. Sometimes anxiety can be good. If you think about if a friend is asking you to do something dangerous and you get that kind of feeling in your body that this might not be right, sometimes if you're challenging yourself and maybe you shouldn't be doing it, that anxiety or nervousness can be a good thing. However, sometimes anxiety is a false alarm. So one of the common examples that kids experiences is stress about a test. I usually get good grades, I might get a B or a C. Being upset or overly worried about that you're building up a lot of energy inside your body that you're not going to be using effectively. And so thinking about anxiety as a signal, but it can be a false alarm is important.

Nada Youssef:

So I know you mentioned earlier that some kids withdraw when they are anxious. So how do we teach our kids to open up more about their fears and worries without making them more anxious?

Dr. Ethan Benore:

I would say talk. Talking about feelings is important and I think we often don't do this. And I think sometimes for school children we expect that this will be covered, somewhere in school, in health class this will be covered. I think it's very important for parents to talk to their kids about feelings, not treat this as taboo. If you avoid talking about it it sometimes sets the stage that maybe I shouldn't feel anxious or maybe if I do feel anxious I shouldn't talk about it. And we really want kids to put their feelings out in the open so that we can help them understand what's going on and learn appropriate strategies to respond to this. I would also talk about your own anxiety in a safe way. So I might talk with my child about anxiety I had about giving a talk at work or about confronting a coworker. I wouldn't talk with my child about very serious threats like losing my job or serious illness. So trying to talk about how you experience anxiety and how you cope with anxiety in a safe way that the child can learn from you.

Nada Youssef:

Excellent. So can you talk a little bit about what steps we can tell them to take and to recognize their anxiety and move past these anxious feelings? What to think about? How to distract their own thoughts?

Dr. Ethan Benore:

Sure. So first step I would say is to label the feeling, really put words to it so that it's not just a sensation inside the body. There are great resources out there. There are several YouTube talks and videos about this. There's a nice feelings wheel that helps kids understand how to really describe what that sensation is in their body. So step one is label the feeling. Step two is validate. Help the child understand that it's okay to feel that way and you can recognize that they feel that way and you felt that way at various times. So label the emotion, validate the emotion, and then you can encourage different ways to cope with the emotion. It might be a young child might just play to feel better. A child might do any type of comfort activity to soothe themselves. Or your child might need to speak up for himself or herself. Or your child might need to be brave and really challenge themselves to do something even though they feel some anxiety.

Nada Youssef:

And young children might react differently to this than teens. Is there a different approach when talking to to young children versus maybe a reluctant teen to talk?

Dr. Ethan Benore:

I do. I do think there is some difference. With kids I think it's easier to be straightforward and teachable. This is what's happening inside your body. This is the word that we use to describe it. Anxiety, fear, worry, nervousness. And this is what I would recommend trying to do about this. I think with teenagers, but also with the tweens now, it's difficult. There's a lot more ambiguity about how they feel. There is some ambivalence, I feel two feelings or three feelings at the same time. And so it's important for them to understand that you can have multiple feelings at once. It's also important to give them a little bit of space to allow them to deal with it on their own first. What you're doing there is giving them an opportunity to develop self-efficacy, the idea that I had this emotion, I responded appropriately, my mom, dad were watching, they're supporting me the entire time, but I've got this. And so I would take that approach with a teenage.

              You had mentioned about reluctant teenagers talking with you. And one of the things that I would recommend, whether it's a child or a reluctant teenager, is for a parent to come at it with a sense of humility. So be humble. This is not about your child rebelling against you, it is about you joining your child in their struggle to manage their emotions. And I think oftentimes as parents we are very directive with our children. And so with emotions, when they're trying to understand this, if you cannot look at it as butting heads, but as really joining your child in their own struggle to understand their emotions, I think you'll get much further.

Nada Youssef:

I like that. So be relatable, but at the same time give them their space to cope with their own fears.

Dr. Ethan Benore:

Exactly. Exactly.

Nada Youssef:

So yeah. Can you go over the most common anxiety disorders in children that we as parents should be aware of?

Dr. Ethan Benore:

Sure. So there's a couple that I think parents should be aware of. The first is generalized anxiety disorder. And this is just when a child is overly worried about a variety of things. They may be unable to calm down. They may seem restless. They may be irritable. They may have some sleep difficulties. But it would be that general level of anxiety that seems to affect various aspects of their life. The second is more specific, so it would be considered a phobia. So this would be a specific item, a specific event, a place, an activity. Think about children who are afraid of dogs, children who are afraid of being alone or afraid of new things, new activities, new places. And the one thing that I would be concerned of or pay attention to what that is also there are phobias that might not make as much sense to the child or seem irrational and then there are some fears that are related to trauma. And so I do think looking closer into any potential trauma that a child experienced is going to be important if you're thinking about any avoidant or fearful behavior that a child is expressing.

Nada Youssef:

And when it comes to something like trauma, should we then take them to some kind of therapy or is there kind of more treatments for someone that's been exposed to PTSD or any kind of trauma?

Dr. Ethan Benore:

Oh, definitely. So first I would encourage, I would want to guard the child's safety and ensure that the child is safe and help the child understand that they are currently safe in the present moment. But then yes, there are very specific therapies for all of these anxiety disorders that I'm going over. Anxiety, because it is so prevalent, actually has a number of evidence based treatments for children, both medication, but also as a psychologist non medication strategies that are helpful.

              Other than a social phobia and we talked about trauma, another is obsessive compulsive disorder. This is when a child has repetitive worry with a compulsion or feeling compelled to do some sort of behavior to reduce that feeling. And then the last is a panic disorder. And I think panic is important for children and parents to understand because it is the feeling, the physical sensations of intense panic without the thoughts or the worry that go along with it. So people can get very distressed about the physical sensations when they don't really have a specific thought that they're worried about. They often describe it as someone pulling the fire alarm inside their body, but they don't really see a fire anywhere.

              And I do think it's important that people treat anxiety disorders seriously. There is 7% of children that experience anxiety disorders, which is about the same amount as children who experience asthma in the school setting. Much more than children that experience other medical conditions like diabetes or peanut allergies. 40% of us are going to experience anxiety disorders at some point in our life and I think childhood is an excellent time for children to start learning about their emotions, anxiety especially, and appropriate ways to deal with it.

Nada Youssef:

Excellent. And during this pandemic mental health has been declining for many and for kids. So what can we do to help our children stay healthy when it comes to body, mind, and soul? So when it comes to physical symptoms, emotional symptoms, and behavioral.

Dr. Ethan Benore:

Sure. The first thing to do is, it's easily said and it's often said, but in practice I think everybody probably needs to work on this a little bit more, and this is just good clean living. So this is make sure you're eating right, you're sleeping right, and you're exercising. I would encourage families to think about food as medicine. What are you putting in your body and how is that affecting how you feel? Poor sleep for children often increases stress, even physical stress, on the body and can make it harder for them to manage emotions. So ensure your child is getting the appropriate amount of sleep and not feeling disturbed or having any problems during the middle of the night. And then exercise is wonderful. It burns off some of the stress hormones that are built up when children are anxious and it also creates some of the helpful chemicals that can facilitate regulating or controlling people's moods.

              The second thing I would think about is regular practice of relaxation. And these could be lots of different activities. So there are kids who just feel relaxed when they're reading, when they're playing video games, when they're looking at their smart device. And yes, that's helpful to give them some space to feel calm and safe. It's not exactly the same as relaxation training. Yoga and mindfulness get a lot of play time on the media, but they are specific skills that you can teach children that would be helpful. And one of the things I think about when I think about relaxation is there's a common expression when I was growing up that parents who read have kids who read. So parents who take time to manage their own wellness, to do relaxation, yoga, anything like that, will have a huge impact on their child's interest and participation in these activities.

              I think the next that I would think about is developing a mindset for approaching anxiety. And so there's a lot out there on growth mindset for children. There's a lot of new research on the idea of thinking about yourself as constantly growing, constantly evolving, and handling all of these challenges that come your way, not as evaluative, but as opportunities to grow. And that's very helpful for kids. I also think for anxiety that the mindset of being brave. When you are brave you are doing something even though you're feeling anxious. And that's a very important step for kids to think about as they challenge themselves when anxious. And the last is a mindset of hope, that even though you are struggling now it will not last. The storm will pass and you can get through this. And so parent’s kind of modeling and encouraging an appropriate mindset for kids is going to be important.

              I had two others that I thought about as we were talking. One is encouraging self-reflection and discussion about feelings. Again, this is a journey that your child is going to be learning. So talking about feelings is helpful. Now we often talk a lot about math, a lot about science, talking about feelings is also helpful. Giving children space to kind of explore their emotions, whether it's art, whether it's journaling, are very, very helpful. And talk about both positive feelings as well as negative feelings. When I say that I have to remind myself feelings aren't bad, but talking about all of the variety of feelings that you have I think will help children as they learn to navigate that aspect of their life.

              And then the last one that I think about as a parent is to consider yourself being a good coach. Not just a coach, but a good coach. So when you see your child doing something good, call them out, be very specific about the behavior that you saw and that you're proud of them. That will give them a sense of self-advocacy and encourage them to do it more. When they're struggling, pull them to the sideline, give them a little pep talk, a little tip, then send them back in the game. And then periodically have these brief huddles where you just sit for two minutes, five minutes and have these teachable moments. I think it's very important that we don't pull children aside for long lectures. It's not how they're going to learn this. And then the last thing when we talk about a good coach for your child is to allow some mistakes. They're learning in this process and so not to harp too much when they're struggling, but again, use that as an opportunity to learn and grow.

Nada Youssef:

And a good coach is a good example. And living in the world that we live in right now, parents might be just as stressed or more than the kids themselves. And just like you mentioned, they mirror what we're doing. So maybe any kind of last words of advice for parents, what we can do to calm so we can be able to calm our kids because it kind of starts with self-care?

Dr. Ethan Benore:

Thank you for saying that. It does start with self-care. I do encourage parents to manage their own anxieties. And really one of the benefits of actually teaching your child anxiety is you're going to grow from it yourself. And so I love teaching relaxation exercises and some of these strategies to children. I find it very beneficial for myself as well. And so parents managing their own anxiety is going to be important. I think that the next tip for parents is that we're all going to struggle at various times so use your community, use your tribe, your resources. If you're going to have a bad week or a bad two weeks, lean on somebody and let them help you through that time. They're going to need you at another point in time as well. But taking time to take care of yourself, that is good care for your child.

Nada Youssef:

Thank you so much for your time Dr. Benore. Are there any last words of advice or thoughts you'd like to leave us before we end this podcast?

Dr. Ethan Benore:

One thing I'd like parents to know is that there's always helpful resources out there. One great place to start is the Anxiety Disorders Association of America, it's adaa.org. They've got some wonderful resources and I would encourage you to look more into this if you have interest or concerns. And the other thing that I often tell my parents and families is this is a journey and so good luck and enjoy the journey.

Nada Youssef:

Thank you Dr. Benore for being here today. It was a pleasure speaking with you. And if you'd like to schedule an appointment with Cleveland Clinic Children's behavioral specialists, please call (216) 448-6110. Thank you so much for tuning in.

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