Missed our June ADHDKC Parent Group meeting?
~ Or attended and want to revisit the great information shared?
We’re excited to share the recording of our June Parent Group presentation, “Anxious Brains and Tools That Help,” featuring pediatrician Dr. Jennifer Dilts.
In this engaging discussion, Dr. Dilts explores the powerful connection between ADHD and anxiety, helping parents better understand:
* Why anxiety and ADHD so often occur together
* How anxious brains process situations differently
* The role of avoidance and reassurance in anxiety
* Practical coping tools that help children manage stress and worry
* Strategies for supporting emotional regulation at home
* Evidence-based treatments for anxiety, including cognitive behavioral therapy (CBT)
* How ADHD and anxiety symptoms can overlap—and what that means for treatment
Parents especially appreciated Dr. Dilts’ practical, compassionate approach to helping children build confidence, resilience, and coping skills while navigating both ADHD and anxiety.
Watch or Listen Your Way
You can access this presentation in whichever format works best for you:
▶️ Watch the recording right here in our newsletter
📖 Read along with the transcript below
▶️ Watch on our ADHDKC YouTube channel
🎧 Listen as a podcast on your favorite podcast platform - look for ADHD KC Conversations
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We hope you’ll enjoy this valuable conversation and share it with another parent who could benefit from understanding the ADHD–anxiety connection.
Thanks for reading ADHDKC’s Newsletter! This post is public so feel free to share it.
Resources & Dr. Dilts Information
* Slides
* Meg Foundation - megfoundationforpain.org
* Dr. Dilts’ website - drjenniferdilts.com
* ADHD Moms Podcast - letstalkkidshealth.org/Podcasts
* Flusterclux Podcast - flusterclux.com
Chapters
00:00 Introduction and Group Overview
01:58 Understanding Anxiety and ADHD
04:43 The Nature of Anxiety
07:41 Anxiety in Children and Teens
10:31 Coping Mechanisms for Anxiety
13:23 The Brain and Anxiety
16:40 Avoidance and Its Consequences
19:27 Modeling Coping Strategies
22:30 Words Matter: Validating Emotions
25:38 Normalizing Anxiety
28:28 Practical Tools for Parents
31:31 Conclusion and Final Thoughts
34:26 Modeling Emotions for Kids
38:18 Understanding and Naming Anxiety
42:44 Techniques for Regulating Stress
49:59 Assessing and Treating Anxiety in Children
55:50 Navigating ADHD and Anxiety Together
Transcript
AI generated - excuse the mistakes
speaker (00:00)
Welcome everybody as you’re joining in. Dr. Danda, did you want to introduce yourself since you’re relatively new to the group?
Yes. I’m Caroline Danda and I am a psychologist. and I’ve got three kiddos that all have ADHD in some form. And so I recently joined the board of ADHD KC and very excited to help co-host the parent support group. And
glad to be here because it’s just a I it’s been a long time coming because this has been such a wealth of information. everybody, I’m just gonna go over the since the CHADD agreements here and then I’ll turn it back over to Kristen. just really be kind. Be kind, be respectful. you know, be yourself, don’t try to be anyone else. what we talk about in here, we want to maintain
confidentiality when appropriate. and then we are recording this. So it will go up on the website for people to be able to watch that as well.
But we’re glad everybody is here. We’re super excited for the turnout. And I’ll let Kristen continue on. All right. I make her do the yucky stuff. not really yucky, but just agreements. Not always fun. but I get to talk about things that are up and coming and I’m very excited. We have several great speakers lined up.
Next month will be the Smart Kids Paradox. You know, all of us who have known that kid who’s just not living up to his potential, so smart, but not doing great. Adam Tillove will talk about that. And then Sarah Ketsky will be talking about executive functioning strategies for teens the following month. And I know that will hit right as school is probably about ready to get going and parents are going to want to get their kids set for school. So that’ll be great timing. I also have the CHADD National Event Calendar.
Many of the CHADD chapters like ours will post their online things and you’re welcome to join any of those. And then the new book club that Dr. Danda is co-leading is going on now. The adhdkc.org groups page has a book club group and there’s a forum there that’s discussing chapter by chapter, and they’ll wrap it up at the end on August 6th.
with a Zoom talk about the whole book. So if you want to read ADHD 2 .0 or maybe just listen in on what everybody else who’s reading it is learning, I highly encourage joining that book club.
So Dr. Fer Dr. Fur Doctor Jennifer Dilts is a pediatrician in the Kansas City metro area. She practices with Bloom Pediatrics, which is direct primary care, but she doesn’t do primary care. She focuses on ADHD anxiety and migraines, which don’t sound like they go together, but they really do. And I’m super excited. I’ve gotten to know her really well.
Through multiple channels, and I’m excited to hear her talk tonight about anxiety and ADHD. So I’d love to take it away. Thank you. I am excited to be here. I also now get the honor of co-facilitating with Dr. Stuppy the Teen Group. And so we have a lot of fun each month in the teen ADHD KC group.
So we’re talking today about anxious brains and tools that help.
And as Kristen said, I’m Dr. Jennifer Dilts and I practice at Bloom Pediatrics here in Kansas City. And also as Kristen said, I treat anxiety, ADHD, headaches, migraine, and depression. And then I am also board certified in acupuncture and I do acupuncture for both kids and adults, which is really fun.
The overlap, ‘cause cause as Kristen mentioned, it it seems like kind of a strange mix, but part of the overlap for me, or a big piece of the overlap and why I like treating all these conditions, is because I love teaching kids about their brains and how brains work and giving them tools, demystifying some of this so that they can have agency and feel successful.
And I also, in a strange sort of way, like talking about hard emotions and negative emotions. We all have them. And so I think it’s helpful for our kids when we are able to talk about them and when we feel comfortable talking about them, then they are gonna feel more comfortable bringing up hard things with us. And the other thing that we know is that our kids, whether they’re little kids or teens, are really good at coming up with stories, and we want them to have helpful.
And accurate narratives. And this is really easy to think about for me with ADHD because when a child gets an ADHD diagnosis, then a lot of times they can replace an unhelpful narrative like I’m just stupid or I’m the bad kid with no, I have ADHD. I have a fast brain. It’s harder for my brain to take that pause sometimes.
And so the same thing with anxiety and other hard emotions, we want our kids to be able to understand what’s happening in their brains and how their own brains work so that they have helpful information and they’re not telling themselves other stories that that aren’t as true or aren’t as helpful.
And so today we’re gonna run through how anxious brains work. It’s really interesting to me when I dig into anxiety that whether you’re four years old or 64 years old, whether you’re afraid of spiders or you’re afraid of public speaking, anxious brains tend to behave in predictable ways. And there are things that both for little kids, teens, and adults tend to help anxious brains too. And so we’re going to talk about how anxiety works and
How we can help our kids with negative emotions, including anxiety, and then the most important part, tools that help with anxiety and with other difficult emotions, both for ourselves as parents and for our kids. And it may seem maybe like a little bit of a reach. I don’t know that we’re talking about this in the ADHD parenting group. This isn’t specifically an anxiety group. I also want to say that.
I know Dr. Natasha Berger came and and talked to you all and her book, Managing Childhood Anxiety for Dummies, is a fantastic book. You can go back and watch her presentation that she did for ADHD KC here a few months ago. I watched it and I I think that she and I I think our presentations will go well together. I wanted to make sure I wasn’t repeating for you a lot of the info that she talked about and I I think
They just kind of complement each other nicely. And what we know is that anxiety and ADHD are good friends, depending on which study, which which set of data you you look at,
up to half of kids with and teens with ADHD also have an anxiety disorder. So 25 to 50% is kind of how that shakes out. And that is significantly higher than kids and teens who don’t have ADHD. Their rates of anxiety is more like 2 to 15%, sometimes as high as 25% in teens, depending on again which studies you’re looking at. But what we know is anxiety is super common, just like ADHD.
And if you have one condition, you are more likely to also have that other condition. One of the landmark ADHD studies, the MTA study.
Also found that a third of the kids in that study had anxiety with their ADHD. And one thing that I find just heartbreaking because anxiety is so treatable is that statistic or studies show that about 80% of kids and teens who meet criteria for an anxiety disorder don’t receive treatment. So not only is anxiety super common, just like ADHD is, but a lot of our kids and teens aren’t getting appropriate treatment for it. And we’ll talk about what that appropriate.
treatment as towards the the end of the talk because there are so many things as parents that you all can be doing to to help your kids no matter where they fall kind of on that anxiety spectrum and then there are really good evidence-based therapies for kids who need extra help beyond what you’re providing as parents and
So if we advance my slide. Okay, so this you guys probably know who this is. This is anxiety from the inside out movies. You probably have seen the inside out movies. If not, watch them. They are really good. But I’m gonna have you guys humor me here for a minute. And if you feel comfortable, you can close your eyes and just think about for a few seconds here a time when you yourself felt anxious.
and try to recreate that scenario in your mind as far as where you were, what you were doing.
What the what the room was like, what was being said, if anything. And then think about how that felt to you in your body as far as any kind of physical emotions that that you had in that situation. And any kind of thoughts or narrative that were going through your head.
Okay, thanks for doing that with me. And you can open your eyes now. And anxiety is really normal. We all feel anxious at times. There’s a big spectrum. There are people like my husband who hardly anything gets him above a two out of ten on the anxiety scale. And then there are people like myself that are more just run anxious. And it’s not very hard for me to think of times that I’ve been anxious. what I spend a lot of time talking to.
my patients and their parents about as some anxiety is helpful and some isn’t. And my goal is never to even if I could magically make it so that someone was never anxious again, I wouldn’t want to do that for several reasons. And so I think it’s helpful for everyone to understand that some amount of anxiety is normal and is helpful. And the way I explain this to kids is I actually want you to be a little anxious or nervous when you’re in a parking lot because I want you to pay attention so that you don’t get
hit by a car.
It’s a little bit helpful if I’m nervous before a presentation because that motivates me to prepare for it and practice it. It’s a little helpful if you’re a little nervous before your soccer game because that makes you really alert and ready to go and paying good attention. And so it’s helpful to know that that a little bit of anxiety helps us to perform well. Also, if we never felt anxious, that means we’re never going out of our comfort zones, right? And so we want to be able to take risks, we want to encourage
Our kids to take healthy risks, and so some of that is is going to come with some anxiety. And what I’m always looking for with my patients is I’m I’m asking three questions. Is this anxiety developmentally appropriate? Is it expected for the situation? And is it interfering with things you either want to do or need to do? So developmentally appropriate is pretty easy to understand. There are a lot of things that preschoolers may be anxious about that we don’t still expect.
expect our preteens or teenagers to be anxious about. Like we know that preschoolers they may have a hard time separating from mom or dad, especially at the beginning of a new school year and when school is really new for them. They may be really anxious about the dark.
Or sleeping someplace other than their own home. And as kids get older, we expect that they won’t be as anxious about those things. And so if if I’m seeing a teenager who is still really anxious about going to school every day, that’s a different situation than if we’re dealing with that with a preschooler. Also, is it expected for this situation? Just like we talked about, there are some situations where it’s helpful and
Really expected to be anxious if someone goes through a really scary thing, if if they’re involved in a car accident or
they had a house fire or their parents are separating or something like that. We know that they’re going to be anxious. That’s expected. We’re going to help them through that. But that’s very different than a child who is really, really scared of someone breaking into their home or a car accident when no one that they know has gone through that and they haven’t gone through that. And then the third one and the biggest one is is anxiety interfering with the things you want to do or need to do? And so for our kids, this these are things like school.
and being able to do things with friends and being able to sleep well at night and and those kinds of things. And so if kids are a little anxious with those types of things, but then they’re able to work through that and parents are able to support them through that and they’re able to still do those things and they’re happy most of the time at those things, then that’s not really a kiddo that that I’m too worried about. But we’re we’re more concerned certainly when when anxiety is interfering with those kinds of things.
And so we know anxiety is common. It often starts in preschool years, and the younger the child, the more somatic are body symptoms that they’re probably going to have. And so the younger kids are typically not telling us that they’re anxious or stressed necessarily, but they may be talking about headaches and belly pain and nausea. And so these are really common symptoms of anxiety, as as you all probably know. And these things still happen when we’re
teenagers than when we’re adults as as you probably could think of when I ask you to remember that time you were anxious recently and how that felt in your body.
There are also multiple types of anxiety. It comes in several different flavors. So there is separation anxiety, which just as you probably can can figure out, has to do with when kids are separating from typically their parents and how hard that is for them. Generalized anxiety is a lot of worry about future things that may happen and how other people are thinking about them and and that kind of thing. Panic, again, is gonna be those somatic body symptoms.
school avoidance. I kind of wish it was named something different like school anxiety because a lot of times I these kids are not.
necessarily wanting to avoid school as as their primary intention, but they’re really, really anxious about school. And as we’re gonna talk about, anxious brains really like to avoid. And so it comes out as avoidance when kids are really anxious about going to school. And then the last one is social anxiety. So anxiety about being in groups and talking in public and being around other people.
And like I alluded to earlier, anxious brains behave in really predictable ways. And so the first way that anxious brains or the first thing anxious brains do is we tend to overestimate the chances of something bad happening. And then we tend to underestimate our ability to cope. And so though those two things together is is not a great combo. So what that can look like is if the teacher calls on me in school, I am gonna freeze up, I’m not gonna
Know what to say, I’m not gonna know the answer, and I’m not gonna be able to handle it. I’m gonna have to run out of the room. And so again, this overestimating the risk of bad things happening, whether that’s tornadoes or fires or mom forgetting to pick me up, and then underestimating our ability to handle that situation if it does occur. anxious brings want lots of certainty and reassurance. And you can probably think about examples of of when you’ve had that happen perhaps as a parent where
you you initially for an anxious kid, when they’re asking something, you will give them the answer like, Mom, is there gonna be a tornado tonight? And you’ll say, No, I don’t think so. And the kid will feel better for a few minutes. And then they’ll ask again, Are you sure there’s not gonna be a tornado tonight? No, no, I really don’t think so. and then they’re wanting more and more reassurance. So that that reassurance only helps them for a few minutes and then they’re needing that again and again, and they’re wanting to look at the weather app and they’re wanting to have
all these other ways to to feel safe, but unfortunately that constant reassurance is is not really helping that child to feel more safe or build their coping skills. So we’ll talk about how to handle that here in a little bit.
And then the other thing, and you guys know this, is that anxious brains are not always rational. And so this is the child that she always does well on tests. She is so well prepared. She has studied and studied and studied. She’s never not done well on a test, but she is still worried that this time is going to be the time that she fails the test. Or a preschooler that mom always picks her up from school. She doesn’t have any reason to think that mom’s not going to pick her up today, but she’s still really worried mom is not going to pick her up today.
And this is a picture of me when I was six years old and in first grade. And this is my reminder to talk about anxious brains wanting to avoid. And as you can see, I put the anxious brain to avoid avoidance is short-term relief and long-term yuck. And when I was starting first grade, I was really, really anxious. And I remember my dad, who did not have any training.
And child development or child education or anything like that. But he did something really helpful for me. Instead of letting me skip and go home when I was feeling really anxious, he would walk up and down the hallway with me those first few days of first grade. And he was without really totally understanding the science behind it, he was doing several things. One is this co-regulation that we’ll talk about here in a little bit, where because he was calm, some of that calm kind of rubbed off on me.
And also he was walking back and forth with me. movement can be really helpful when we’re anxious. And he was giving me the time and space to kind of take a breath and have enough time to feel comfortable so that then in a supported way I could do this thing that was hard for me and that this thing that was causing me anxiety, which was going into my first grade classroom. And it is really, really normal as parents when our kids are coming to us and they’re wanting to.
Avoid something we want our kids to be safe and comfortable and feel happy and secure. And so our initial instinct a lot of times is to want to say yes to what they’re asking, right? And so if this is a kid who’s anxious about school, this might look like mom, my tummy hurts. I don’t think I can go to school today. Are you sure? Are you sure you can’t go to school? It could be your anxiety. No, no, I don’t think I can go to school today. And so if this happens once, then initially the mom says, Okay, maybe you’re
Getting sick, we’ll stay home from school. And so what happens? That child feels better, right? That child is so relieved. They do not have to go to school. The parent feels relieved because the child feels better. But as you can probably guess, there the chances of this happening tomorrow and in future school days are really, really high because that child didn’t have to kind of push through that hard thing. They didn’t develop those coping skills, and they didn’t get to work on doing that thing that is hard. They didn’t get to work on doing something.
something when when they’re anxious. And so a lot of times, as some of you may have experienced, when kids want to avoid, they just keep avoiding and avoiding and it becomes a bigger gr bigger thing instead of a smaller thing.
And I’m gonna take you through parts of the brain here for for just a minute. so we have our kind of reptilian brain or brainstem, and this is the part of our brain that is develops first, and sometimes we call this like the lizard brain, and this is what is involved in kind of our autonomic nervous system. So our heart beating and breathing and that kind of thing, the things that we don’t have to think about. And then a little further.
Up here we have the limbic brain. So this is our emotional or our feeling brain. This is where the amygdala lives that’s in charge of emotions. And then this part that’s behind your forehead is the prefrontal cortex, or this is your rational thinking part of the brain. And I think it’s really helpful. Some of you may have seen this before, where you can kind of do the brain like this, where here is like your brainstem, here is your amygdala, your thinking or your feeling part of the brain, and then here is your prefrontal cortex. And we just
Talk a lot in ADHD, especially about how this prefrontal cortex part is developing at least. It was at 7:30, actually, I guess. And so this part of your brain is going to be developing for a really long time. And what we know about anxious brains is that
When we get really anxious, we talked about how rational how emotional, anxious brains aren’t always rational, right? And what happens when you’re in fight or flight is that sometimes we talk about kind of flipping your lid and that this
this rational part of your brain is offline. And so what’s running this show is your amygdala, the emotional part of your brain. And since this part of your brain is developing until your mid twenties, this part of your brain, the emotional part of your brain, is really strong compared to the the thinking logical part of your brain. There’s kind of this mismatch where the emotional part of the brain is so strong. And that’s why so many or at least one of the reasons why so many
anxieties come out in preschool aged kids because they’ve got this really, really strong amygdala, really strong emotional part of the brain, and this prefrontal cortex hasn’t caught up yet. The amygdala and Dr. Burger talks about this in her book, that the amygdala is really active at night. So this is one of the reasons why adults or kids sometimes things feel like a lot bigger deal at night. All of our anxieties tend to come up at night, that amygdala is really working is really active at night.
And of course we can’t think rationally when we’re in fight or flight, right? I do this with the kids where when you’re when you flipped your lid, your parents can tell you all the the right reasons and all this emotional stuff, and you can’t hear it if you’re if you’re in this emotional part of your brain. And so, this is really good from an evolutionary standpoint. If you’ve got a car coming towards you or you’ve got a tiger chasing you, you don’t want to analyze all your options and really have this big thoughtful,
discussion about it or or think about it a lot. You want to run, you want to fight or flight, you want to get out of the way, but fight or flight is not meant to be in for long periods of time. And it’s not great at you know for kids at school, kids that are having school anxiety or or having anxieties about other things that fight or flight isn’t working in our favor in in that situation.
And so this is really helpful, I think, for parents and kids to understand that anxiety feels really overwhelming, especially if you don’t really understand how it works. And what happens with anxiety is it tends to get worse before it gets better. So if you use my example of when I showed you my first grade picture, and when I so
kind of on this part would have been thinking about going to school and getting up that morning and going to school. And then I would have been at this panic peak when I was outside the classroom and I wasn’t wanting to go in and I was feeling really anxious and my dad was walking with me. And then I went in the classroom. I’m still up here at the top.
But after I am in the classroom for a few minutes, I sit down. I start talking to the person next to me. I get involved in whatever’s going on in the classroom. And slowly my anxiety gets better, right? I start going down kind of the the
anxiety hill. same with public speaking. I get really, really anxious before I speak in public and my heart’s beating really fast right before I start speaking. The first few minutes I’m really anxious, but I’ve done this a lot now. And so when I when I get into it, I know that after the first few minutes I’m gonna start calming down and I’m gonna be
through that hard part. And so what we need to help kids understand is that they’ve got to stick it out through this hard part before it gets better. And that’s part of why pushing through that avoidance, that need to avoid is really helpful because if kids are always able to avoid what they’re doing is they’re going up this hill. And then right when it’s getting the hardest is when they’re running back down the hill. That’s when they’re avoiding. And with practice they can learn, I can go over this this
Hill. I can do things even when I’m really anxious because I’ve done it before and I know it gets easier. That’s me with public speaking, right? The first time I did it, maybe I really thought I would pass out, but I’ve done it enough times now that I know yeah, I can ride this out because it’ll get better. All right. One more thing. We know that words order that words matter a lot.
But especially when we’re talking about anxiety, I think and anything mental health related, I think words matter so much. And sometimes in a re in a well-meaning way, we may have used the phrase kind of just anxiety. And I think this feels really invalidating to to kids and not intentionally on our part, but an example of this would be mom, I can’t go to school today, my stomach hurts.
And then the parent may say, I think that’s just your anxiety, honey. You’re gonna be fine. I know you can go to school. And then sometimes when kids don’t feel believed, you know, they have really real belly pain. They have real nausea, they have real headaches. whatever those symptoms are, those are real symptoms. That is their body’s way of handling that anxiety. that’s the way that it’s coming out in the body. It can be a little different for all of us, but instead of just anxiety, I think it’s more helpful.
a lot of times to validate that anxiety and then still move on to what what that child can do supported with that anxiety. And so instead you might say when the child says
My stomach hurts, I can’t go to school. Ugh, it sounds like you might be feeling anxious. That is really hard. I’m sorry you’re feeling anxious. You know what? Do you remember last week when you felt so nervous and your stomach hurt and we were able to go to school? You you had a peppermint and drank some water and we went to school and then you felt better. I think we can do that again. So we’re we’re not saying
it’s just your anxiety. We’re validating that it’s their anxiety and then still going on to something that isn’t avoiding. Another thing, and and we deal with this with ADHD too, of course, that I don’t love that disorder is in the is in the word. anxiety disorder is the medical condition, just like attention deficit disorder is the medical condition.
For for fairly obvious reasons. A lot of times kids don’t kids or teens, they don’t like being told they have a disorder. They don’t want hearing about they don’t like hearing about that disorder. And so even though that’s the medical term, I really try to move more into anxiety condition or your anxiety or your stress or your stress response. Something that feels a little more normalizing because we all have, again, anxiety to some degree.
And the other thing, thankfully, I think we’re getting a little better better at as a as a society, but still have some ways to go, is talking more about mental health instead of mental illness. Just like just like we talk about physical health and we’re working on our physical health, all of us doing these things to support our physical health, we can really be all be working on supporting our mental health, whether we have a significant amount of anxiety or not. So I just thought that was worth mentioning.
And the other thing I I talk a lot about with my my patients and their parents is we all have anxiety. It’s helpful in some situations to have some anxiety and our goal, my goal
So even if I magically could get rid of all of your anxiety, I don’t want your anxiety to be zero because again, I want you to have a little bit of protective anxiety. I want you to have a little bit of anxiety to help you prepare for things that are important to you, like soccer games, like presentations, whatever those things are. And I want you to be going out of your comfort zone and trying new things. And it is part of trying new things to be a little bit nervous. But what we want to do is make sure that anxiety feels manageable so that.
You’re able in a supported way to do these things that still cause some anxiety. And when I think about normalizing anxiety, I kind of have two images that come to mind. So one is this little alien that says, I come in peace and kind of peacefully coexisting with anxiety. And the second is this car analogy. So again, anxiety is part of
our brains and our emotions and we don’t have to completely eliminate it. We don’t have to ignore it. But instead what we want to do is make it a little bit smaller if it’s feeling really big and powerful for a child. And instead of letting it be the driver, we want to put it in the backseat where sometimes anxiety can still can still talk to us, but it it doesn’t, it’s not driving the car. And so I think this can be helpful, a helpful way for kids and parents to kind of think about anxiety.
And we talked about a little bit, avoidance typically isn’t helpful. And so then of course the question is, well, what can I do instead then? And instead, we’re gonna support our kids and help them navigate this anxiety. And so one way for that, and I’m gonna talk about specific examples here in a minute, is modeling for kids, being brave and working through hard emotions like anxiety and then limiting reassurances too. And this can be easier.
said than done, I know, but especially now that we know that anxious brains work this way and that they want lots of certainty and they want reassurance, I think it can be really helpful to when you’re noticing that in your kiddo, especially if it’s a kid that tends to be more on the anxious end of things.
You can say something like, you know what? You already asked me that and I already answered that. So we’re gonna we’re gonna move on to something else. Or sometimes I know parents will say asked and answered if it’s something that their child is kind of repeatedly asking, or we’re gonna get into in a minute, naming your your worry. And so the other thing you can sometimes say is, I think that’s your worry bully talking to you. I I think we’ve we’ve already answered that. So we’re gonna go on to something else, but just limiting those reassurances because even though it may seem like
a a helpful thing when it’s going on and on then it’s not helpful and that child is just focused on continually getting more and more reassurance. And sometimes
You guys may have seen these feeling wheels or emotion wheels. And you can get these on Amazon and other places. My kids are all teenagers now and they would run away if they saw me coming towards them with a with an emotions wheel. But they can be really, really helpful for several reasons. I love the idea of using this. You can obviously use it if your child is upset and they’re having a big emotion. You can help them kind of find where it is on this wheel and name it.
the other thing that’s helpful for though is just modeling emotions and building that emotional vo vocabulary in general. So if you have this on your kitchen table, then maybe a couple nights a week when you guys are eating dinner, everyone goes around and says one emotion they felt that day and and how they kind of dealt with that or what that situation was like. just again kind of modeling for our kids.
That we can feel different emotions and that that’s okay and that we can work. no, make a murder baby. And another thing I I think can be so helpful is talking about kids, modeling times that you felt anxious or nervous or scared or upset or frustrated and how you handled that. We’re gonna do that, of course, in age appropriate ways. but I think we forget sometimes that the kids in our lives, whether those are our kids,
or other kids that were around, they a lot of times think that the adults that they look up to have everything all together. They don’t think that we have have hard things that we struggle with. And so it can be really helpful for us to kind of model that messy middle for our kids and again in age appropriate ways, let them know how we how we deal with things when when we have hard things.
And another way to do this, you guys have have probably some of you have done this probably are highlights and lowlights. You can do this with your kid at dinner, you can do it at the
You can do it before bed. It doesn’t have to be every night. You can do it when you remember. That’s totally fine. And I think as adults, we really an important thing is don’t just ask your kids for their highlights and lowlights, but we really need to to as the adults model our highlights and lowlights too. And again, this can look like I was really sad when at work today this presentation that I’d worked so hard on.
I didn’t feel like people really appreciated how hard I worked on that. Or that could be, you know, I felt really embarrassed because I think I accidentally hurt my friend’s feeling today and I’m gonna go apologize to her. Or again, just so kids kind of understand that even grown-ups have hard feelings and we’re still saying we’re sorry and we’re still disappointed. that’s just such a great way to model that for them and we want
them to be able to come to us and know that we’re not scared of of talking about these negative emotions, including anxiety.
And another thing that can be helpful that I’ve sometimes done with kids, besides just asking kids where they feel anxiety in their body, I do that a lot in visits. I will ask them when you we’ll talk about times that they feel anxious or stressed, whatever word feels best to them, and I’ll say, Where did that how do you feel that in your body? And of course I get kind of this deer in the headlight look, but then we kind of start walking through it and I’m like,
You know, what did your heart feel like? What did your breathing feel like? What did your skin feel like? What did what did your muscles feel like? And it is just helpful, and I think it is especially helpful for our kids with ADHD and especially younger kids to have them start thinking about how anger or
other emotions, anxiety, stress, how those feel in their body, because especially for kids with ADHD and kids with anxiety too, a lot of times it just seems like they go from fine to exploding and there’s no middle ground. And what we’re really wanting to help them get better at, which and it gets better as they get older too, but what we want them to get better at is identifying that feeling when it first starts so that then they can do some of these techniques we’re going to talk about next. But
before they can do those techniques, they a lot of times have to recognize how that’s feeling in their body. So this can be really helpful to draw a picture and they can put where anxiety lives in their body or sadness or happiness or all kinds of emotions you can do that with. And this one at first may seem a little bit surprising, but I love naming anxiety. And I did not come up with this on my own. There’s another book I really like.
And I have some resources at the end for you, but there’s this What to Do When You Worry Too Much workbook that’s for like elementary age kids. It’s by Dr. Don Hubner. She goes through principles from cognitive behavioral therapy, which we’ll talk about here in a minute. But she has that in her book. I know other people do that too, where kids can name their anxiety and even draw what it looks like. And I think this is so smart. And there’s a few reasons why this works. Number one, it gives you a way to talk about this besides just saying my.
Anxiety. It’s more fun if you can name it something, and even more fun if it’s a funny name or the your child draws their anxiety and it looks like a furry monster or something. I’ve seen one example where a kid who was really worried about germs, his his anxiety was named germworm, and it makes it easier to talk about, right? Because then if that kid is asking again and again, is this food gonna make me sick? Are you sure it won’t make me sick? The mom can say, or dad can say, I think.
that’s germ worm talking. I I think he can he can take the back seat right now or just gives you another way to talk about it.
Again, anytime we can use humor, that’s great. So the sillier name or the sillier the anxiety looks, the better. And the other thing this really does is it separates the anxiety. This little furry monster is not me. He’s separate from me. And so that helps kids to be able to get some distance from the anxiety and make it seem a little bit smaller. And
The an another thing I really like to talk to kids and teenagers about is that we have a lot more control over our worry thoughts than we think we do. I tell them I was like 40 years old before I realized that I can control a lot of what I think about. And that if I have some worry thought that’s taking up a lot of space in my brain, I can actually kind of talk back to it or do things that help that thought not to be as big and not be taking over my brain so much. And I say, isn’t it great? You can learn about this.
When you’re eight or twelve, instead of having to wait till you’re forty like I was. And most of these techniques.
are going to be working at getting ourselves and our kid back into the present moment because anxiety is usually not really living in the present moment. It’s a lot of times forward thinking like what if there’s a tornado? What if there’s a car accident? What if the teacher calls on me and I don’t know the answer? All of these kind of what if future things. And then sometimes it’s past looking too, right? my gosh, I think everyone thinks I’m stupid because I said that or I think that friend is is
doesn’t like me anymore because of what happened at school today. So when we can get someone back into this present moment and into what their body feels like, that can be really helpful. And again, using this brain model, if someone is really upset and they’ve flipped their lid and they don’t have their thinking part of the brain working, they’re all in this emotional brain, we want them to get this thinking part back online. So movement can help. This is like when my dad was walking me back and forth in that first grade hallway.
Just that movement can really help. Getting outside, getting a change of scenery can be really helpful. And then there’s also this really cool concept that makes good intuitive sense to us that’s called dyadic co-regulation. And I’m going to read the definition because I just like it so much that what dyadic co-regulation is, is it’s this bi-directional moment-to-moment process where two people jointly manage, modulate, and synchronize their emotions.
emotional, behavioral, and physiologic states. So we can all think of times that we’ve done that. Basically it means we influence our kids and our kids influence us. And just like you can think of times when you walked into a room and someone was really uptight or really angry or upset and that emotion just kind of radiated off of them onto you. You can also think of times when or a friend or someone you really like that just has this really calm, warm, comforting presence
And you just tend to kind of relax and feel really good when you’re around that person. And that’s the same thing we’re continually doing with our kids, right? And sometimes, especially when kids are having really intense emotions, we can intentionally use this co-regulation.
And so this is the good stuff now. some of these are gonna be familiar to you, but I think talking through them is really helpful and you may find a different way to use it or a different one than than what you’ve tried before. I talk a lot with kids, especially teens, about regulating the stress response. Sometimes they don’t want to hear about anxiety and it can feel a little more neutral to talk about, yeah, we all have stress and our bodies respond to stress in predictable ways. And isn’t it cool that there are things we can do to
control that. So the first is belly breathing. the other thing I should say is of course a lot of times kids will tell me, yeah, I tried breathing once, it didn’t work. And
Number one, they probably tried it when they were already upset, right? And it’s not gonna work as well when they’re already in this amped up state and they’ve already flipped their lid. But I tell kids, yeah, you probably weren’t very good at soccer when you first started it. You probably couldn’t play the piano the very first time you sat down. What what got what got you better at those things is you practice, right? And you practice a little bit every day. And even though it sounds weird, it’s the same with breathing. The more you can practice these slow deep breaths at times when you’re calm,
The better it will work for you when you use it at other times. And I tell kids the cool thing about breathing is it’s just breathing. Nobody knows that you’re doing it. So you can do this belly breathing when you’re at school, you can do it on the soccer field, you can do it all different places, but it really works the best. If you practice it every day, build it into your nighttime routine, it can help with good quality sleep and falling asleep. But also if your body associates it with times when you’re calm, like before sleep, then it’s going to
Work so much better when you are doing it other times when you’re feeling kind of stressed or upset. So with belly breathing, it’s really great, especially for little kids, if they put a stuffed animal on their belly. So if they’re laying in bed or on the couch or somewhere and they’ve got a stuffed animal on their tummy, then what they can do is watch that stuffed animal kind of go up and down as they’re breathing. And when we’re stressed and not super relaxed, we breathe up here in our chest, right? And so we’re wanting.
kids to be able to do that slow deep belly breathing. I always think of little babies because you all might remember from when your kids were small, you can just watch their little tummies going up and down a lot of times when they’re really relaxed.
Another breathing technique I really like is cookie breathing. And this one works for a couple of reasons. One is it’s still this deep breathing, so we’ve got that going on. But the other really cool thing about this one is it’s getting a child out of their own head, out of their worry thoughts, and into something that they probably like better because we all like cookies, right? And so with this, you can tell your child, you might even have them close their eyes, and you can say, okay, let’s imagine you just took a cookie.
out of the oven. I want you to really picture what that cookie is. What type of cookie is it? it’s chocolate chip? Okay. And now I want you to think about what that cookie smells like. And you’re gonna do a big breath in and smell that cookie. and that cookie is so hot though. So we’re gonna need to blow on that cookie before you can eat it. It is too hot to eat. And so then you’re gonna guide them through
slowly breathing out. and so again they’re they’re breathing in and they’re smelling the cookie and then they’re breathing out and blowing on the cookie and you’re getting them to imagine with you something that’s more fun than whatever just got them all amped up.
And then the other one that that I’m sure some of you have heard of is 54321. And it’s always hard for me to remember which which sense goes with which number, but honestly, it doesn’t matter. And you could do a variation of it where it’s two things you see and two things you hear and two things you feel or or however you want to do it. But basically you’re just trying to get that kid to get still and really think about.
what they can what they can hear and see and feel and smell and taste. And again, you’re getting them back into that present moment and out of those worry thoughts.
There are some really good stuff online. I love the Meg Foundation. I the volunteer board chair for that group. It’s a great website. It’s Meg Foundation for Pain.org. I have them linked at the end of this in my resources section. But basically what what we do as an organization is we provide a lot of free science backed resources that help with mostly procedural pain and anxiety, so needle sticks, that kind of thing. But also we have some chronic pain stuff, especially
related to headaches. And so they have a good video called Breathing for Comfort with with Super Meg. So you can check that out. There are other good ones online too.
And especially for my older kids, a lot of times I will explain the science of breathing with them. Because again, they’re gonna say, I tried breathing, it doesn’t work, it’s all woo-woo, you’re just saying something that that you think is is gonna help, but it doesn’t really help me. And so a lot of times we’ll talk about how it’s actually a hack of your nervous system. And so I’ll talk to kids about how you’ve got your vagal nerve and it goes down the side of your neck on both sides, and your bagal nerve
Is responsible for activating your parasympathetic nervous system. And you may have heard of your sympathetic nervous system, which is your fight or flight. Sympathetic is a tiger’s chasing me. I gotta run, my heart rate has to go up, I’m really stressed. And your vagal nerve is for your parasympathetic nervous system. That’s the opposite of fight or flight. That’s the rest and digest. And so what’s really cool when you take deep breaths is that you are signaling to your brain and your body that things are okay. You’re getting
out of that emergency part of your brain and back into the calm thinking part of your brain. And again, the plug for it’s much more helpful if you do it every day, practice it regularly, at times you’re not stressed, then it works a whole lot better when you try to do it when you’re starting to feel stressed. And so sometimes explaining it in that way and kind of the science behind it gets more buy-in from our our teens.
And here’s another really cool thing. I know you have probably tried to get your kids to do things just like I have and they haven’t wanted to do them. And you may suggest breathing and your kid may say, I am not taking deep breaths with you. And that’s okay because number one, at that point you probably need to take some deep breaths. Remember the whole dyadic co-regulation. And so we can model for our kids, right? We can say, you know what, I’m starting to feel a little stressed.
I am gonna take two slow deep breaths because that will make me feel better. And then you may even say, I wonder, do you know what happens in your body when you take deep breaths? Do you know what actually happens? Maybe you’d be interested. I don’t know though. And so then sometimes you’ll they’ll get a little curious and and want to know, and you can talk about it it signals to your brain and body that you’re okay. It takes you out of that emergency part of your brain. It gets the speak thinking part back to working.
Another thing is you can say something like, Man, it is so cool. Did you know that whenever I need to feel more calm, I can just take a couple deep breaths and then I feel calmer. I don’t know, it might work for you. Maybe you’ll try it sometime. So there are ways to model this for our kids. And worst case scenario, they don’t want to do it themselves, but we are calmer and then we are able to influence them or approach the situation with them better.
So a little bit more now. I know we have a few minutes left. So a little bit more on what I do as a pediatrician who treats a lot of anxiety and a lot of ADHD. number one is a SCARED assessment. This is a standardized, freely available assessment tool for anxiety. It is validated for kids as young as age eight, and you can find it online.
It is there’s a parent version and a child version. And so I will use this when I’m th trying to assess how much anxiety I’m seeing. it also breaks it down into those different anxiety flavors we talked about, like generalized anxiety, school avoidance, separation anxiety, those kinds of things. So that’s the first thing I’m gonna do is
kind of get the lay of the land for how how much anxiety and what type of anxiety. Again, that question about how is it getting in the way of things that kids either need to do or want to do. And
in our kids with ADHD, we’re gonna look and we’ll talk about this more in a second, but thinking about like how much of this is ADHD, how much of this is anxiety, is there anything else that could be going on, like a learning disability? So really kind of broadly looking at the whole picture to help
assess what’s causing these symptoms because kids can have symptoms and it could look the same. A kid may be having a hard time paying attention in school and that could be ADHD, that could be anxiety, that could be something else. So really trying to think about what what is causing these symptoms. I’m going to do a lot of education about the brain and about anxiety. Talk a lot and and find out a lot about that child’s sleeping habits and their nutrition and exercise and those kinds of things. And then
anytime I can with all of my my patients, I’m going to recommend that they work on some cognitive behavioral techniques with a mental health therapist and sometimes medications.
And the thing I want everyone to know is anxiety is really, really treatable. Like we talked about at the beginning, it’s really common. And when kids have ADHD, a lot of times they also have anxiety. But the good news is there are really, really great treatments. And so if I could choose between medication or cognitive behavioral therapy, I’m gonna choose the therapy every single time because I want kids to have those skills and to be able to work through those situations. And so cognitive behavioral therapy.
therapy is really working on changing how a child is thinking about those things that are stressful or fearful and making him fearful. And then in a supportive way being able to work through those situations and do those things that they need to do and want to do without having to avoid.
And then a lot of relaxation strategies, self-regulation strategies like we were just talking about. And we all have these ants or automatic negative thoughts that are going through our head. And so working with a good therapist can really help with identifying those ants and replacing them with more helpful thoughts.
I also really feel like people should know that SSRI medications are indicated for kids as young as six years old and have really good evidence behind them for treating anxiety disorders. And I always tell kids if we’re talking about a medication, I never start you on a medication with the thought that okay, you’re gonna be on this for the rest of your life. The good news is most of the time we can use these med we can use this medicine for a period of time, six to twelve months, sometimes a little long.
And especially if a child has been working on skill building with a therapist, then a lot of times that child can successfully come off of that medication. And this data that I’m showing at the bottom of the slide is from the CAMS study, which was a really well-done multi-site study that looked at treating anxiety in kids with SSRI medications, cognitive behavioral therapy, or both. And what it found was that.
doing a combo of those two things in in 12 weeks. So that’s the other thing I think it’s important to know is we’re not talking about, you know
many, many months to years of therapy. We’re talking about 12 weeks. 80% of kids had a positive response and sixty-five percent of those kids had minimal or no anxiety symptoms after 12 weeks. So significantly reducing that anxiety in those kiddos. And even without medication, with cognitive behavioral therapy alone, 60% of kids had a positive response. So really, really treatable.
And a lot of times this fear thermometer can be helpful too or an anxiety scale. And I’ll I’ll do a lot of talking with kids about okay, if zero is no anxiety and 10 is the most anxious you could feel, that’s panic. How do different situations make you feel? Or where is your anxiety typically? And this is helpful in talking about the role of medications too, because if a child is always at a nine or a ten, they’re always feeling so panicked and so stressed, it’s gonna be really hard for them.
To use skills that they’re learning in therapy if they’re always so so stressed. And so in that case, it can be really good to start a medication while a child is also doing therapy. And the goal for the medication is to bring that anxiety down a few notches. So maybe from a nine or a 10, it brings it down to more like a six or a seven. And then that child has some bandwidth, some coping to be able to work on things in therapy.
And
Just my last couple minutes here, I’ll talk about specifically questions that I get a lot of times about ADHD and anxiety together. the first, just like I alluded to a few minutes ago, the symptoms overlap a lot, right? Anxiety and ADHD can look really similar. They’re kids that have a hard time sitting still, they’re fidgeting a lot, they have a hard time paying attention, they may have trouble sleeping, they may seem really rigid, like they can’t really tolerate a big range of things. So if something doesn’t go exactly how they want it,
It to go, that’s really hard for them. We see that both with anxiety and with ADHD. It can be hard to see other people’s perspectives sometimes. And then of course, these big meltdowns or kind of these big emotional outbursts, those can happen with both ADHD and anxiety. And I think it’s really helpful to get help from your pediatrician or your other trusted resource if you’re having a hard time knowing which is causing the most symptoms or if you’re just struggling.
Your child is struggling with both of those things because we can use tools like the Scarrot like the Vanderbilt assessment and just our clinical expertise to help tease out which one is the bigger player. And I think that’s important because the next question I get a lot is okay, if anxiety and ADHD are happening together, which one do we treat first if we’re going to do medications? And typically what what I do and what what most child psychiatrists
would recommend is we treat whichever one is causing the most problems. So it is not uncommon for someone to come to me for concerns with ADHD and they may really have ADHD, but I just have a sense that until that anxiety is better, we’re not going to make any progress with that ADHD part of things. So in that case, if we’re doing medication, we may start an SSRI first. On the other hand, if that ADHD is really the bigger player and yeah, they’re kind of anxious because they’re having such a hard time in school,
But really the ADHD is the main player, then it makes sense to treat the ADHD first with this stimulant medicine and see after we effectively treat that ADHD, how much anxiety we’re left with. Because we may not have much that we’re left with, or what we’re left with may work great for therapy. Or if we still have a significant amount of anxiety, then maybe it makes sense to start a second medication. And that brings me to my last point, which is, or the last question, is there a single medication that
Treats both anxiety and ADHD. And that is a common understandable question. And my answer isn’t very satisfying, probably, because it’s maybe but not always. Most child mental health and psychiatry experts that I listen to and have learned from will say that really.
Anxiety deserves an SSRI and ADHD deserves a stimulant medication. And there are some medications that can do an okay job sometimes of treating both, but unfortunately, a lot of times if we try to treat both with one medication that’s not either a stimulant or an SSRI, we may end up with kind of mediocre treatment with both. And I am really cognizant of never wanting to use more meds than we need, but
In a lot of cases, I think it would make sense to treat the main condition first with that first line medication. And then if we’re still having a lot of symptoms of that second condition, then you add in that second medication that is best at treating that second condition. And so that’s just kind of my framework and and what to tends to work best, but every child is gonna be a little bit different.
And I will include these in our in our presentation. I’ve mentioned a couple of them, What to Do When You Worry Too Much is this workbook that is great for elementary age kids. Outsmarting Worry is kind of the preteen and teen version of that book by Dr. Hubner. It’s really good too. These are all available on Amazon or other places that you get books. Anxiety Relief for Kids is a really good book by Dr. Frigget Flynn Bridget.
That’s written for adults to read to help their kids. And then I already plugged our Kansas City expert, Dr. Natasha Berger. Her book, Managing Childhood Anxiety for Dummies, is really comprehensive and really great. And there’s also a podcast some of you may have heard of. It’s called Fluster Clux. It is really good. It’s by a woman named Lynn Lyons. And then Shameless Plug for my own podcast called the ADHD Mond.
That I do with my co-host, my co-host, fellow pediatrician, Dr. Narissa Bauer. We have an episode where we had Natasha Bergert on to talk about her book. And we have another episode on of anxiety. And of course, we talk all about all things ADHD. And that is about.
It. Some great websites out there. I like childmind.org. I like mental health literacy. Healthychildren.org is really good. These are specifically for anxiety. This is a really good one from the Mental Health Literacy Foundation. Their website is great. They have other things. Big Five for Mental Health is great. That’s from them.
And then the Meg Foundation, which I talked a little bit about before. If you go to Meg Foundation and you search Imagine Action in the search button, you will find these recordings that were recorded by pain psychologist from Stanford, Dr. Jodie Thomas, and these are really, really good. So these are things that kids can listen to before bed or any time when they want to be less anxious or they want to feel calm during needle pokes or they want to feel more control of feel in the in control of their feelings.
So I recommend these to patients all the time. They’re really good. And I think that’s it. This is my contact info. And I will stop sharing my screen. And I am happy to stick around if anyone has questions. So let me stop sharing here. And there we go.
yeah, perfect. Resources in the comments. Yes. Thank you for doing that, Kristen.
Feel free to pop on. And if you have any questions, you can just shout them out, raise your hand. I think there’s even a hand raise or put them in the chat. It was a great presentation. I loved so many things. I could like go on and on about all the different things that just resonated about the anxiety and the ADHD. And I I was really thinking about something that really struck me is when we’re talking about that co-regulation for anxiety, it really reminded me of body doubling.
That people that we do with ADHD, so that it is, it’s like, I, you know, and that actually works very well, like with the anxiety too. If you’ve got so, you know, that’s why everybody likes to go in with a friend, or sometimes if somebody else is doing it, or you can see what the other person is doing, or you can model it. Like that helps with both the anxiety and the ADHD. So I was like, wow, that’s amazing. Thanks, thanks to make that connection.
Yeah, yeah, you’re right. It it definitely fits really nicely with body doubling, for sure. Yeah.
Anyone else have some questions?
my son’s 11, ADHD, autism, anxiety, depression. we actually found his eight first ADHD med spiked his anxiety when he was about eight, and we’ve never
We’ve changed medications and went from a pediatrician to a child psychiatrist, but we’ve never been able to quite bring it back down again. but
the therapist, the you know, all his entire care staff, right? It’s that we’re waiting for the brain to to develop and we’re waiting for the brain to get older. And like we’re just some of the meds were just drop by in time. We’ve tried several SSRIs. he his ticks get get way worse within 48 hours. So we have to stop them. so like we’ve we’re like whittling down like where there was hope, and then you’re just like, Nope, nope, nope. So
Do you find that with anxiety I’m an anxious person. He comes by all this, honestly. But like, do you find when it’s kind of linked to maybe other things, the brain development over time does help or the anxiety of not treated successfully just the brain development doesn’t really help with that?
I think brain development does definitely help. It’s it’s so of course everybody is is so different, so it’s hard to to give a one size fits all answer. But I think I think absolutely that brain development helps. I think working with with a mental health therapist, which you’re probably already doing, I I think really helps too. it is it is not uncommon that
If someone tried a stimulant and their anxiety spiked that at a later date and a different stimulant when conditions are different, sometimes we can retrial the stimulant.
We know, you know, even with ADHD alone that brain development is several years behind peers a lot of times. and so that’s what’s so hard is every kid is is different. But I I think we do we do see emotional maturation and improvement with anxiety a a lot of a lot of times.
Looks like we have a lot of thank yous, a lot of great presentations, which I will second all of those kinds of things. I will say too, I’m giving this presentation to a number of teachers. And it really makes me happy that a lot of people in our school systems right now are hungry for this education and are really recognizing
It’s importance and so that just makes me feel really hopeful that I think so many adults in our kids’ lives right now are just wanting to do everything they can to help and are recognizing that all across the spectrum, no matter where kids are shaking out, they are wanting to learn more about anxiety and how brains work, so that they can help the kids in their lives.
Fantastic. Yeah. I suppose if there’s no more questions, then we will remind everyone to please go to adhdkc.org, but that’s got all the events. so if you want to keep up, I know we’ve got parent events, I think scheduled all the way through most of the rest of this year already.
As well as women’s group. We have a women’s group. We have a general group. We have a teen group. Like there’s so many opportunities to be part of this community. so please hop on over there. There is the new book club as well. so there’s kind of something for everybody. And if there’s not, we can often create something. So sneak up and we hope to see everybody continue to be on this and join us and be part of this great community.
Anything else you want to add, Kristen? I think you covered it all. Thank you. So all right. Get everybody off and bedtime routines for the kiddos and dinner for those of you who haven’t eaten yet or whatever you need to do. Yeah. Yeah. All right. Thank you. Thanks, guys. Bye. Bye.
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