0:00:01.388,0:00:04.103
As a child, I had many fears.

0:00:04.507,0:00:07.061
I was afraid of lightning, insects,

0:00:07.085,0:00:09.650
loud noises and costumed characters.

0:00:10.373,0:00:13.720
I also had two very severe phobias

0:00:13.744,0:00:15.901
of doctors and injections.

0:00:16.552,0:00:20.406
During my struggles to escape[br]from our family doctor,

0:00:20.430,0:00:22.577
I would become so physically combative

0:00:22.601,0:00:25.877
that he actually slapped me[br]in the face to stun me.

0:00:25.901,0:00:27.147
I was six.

0:00:27.972,0:00:30.515
I was all fight-or-flight back then,

0:00:30.539,0:00:34.683
and holding me down for a simple vaccine[br]took three or four adults,

0:00:34.707,0:00:36.307
including my parents.

0:00:37.712,0:00:41.553
Later, our family moved[br]from New York to Florida

0:00:41.577,0:00:43.801
just as I was starting high school,

0:00:43.825,0:00:46.356
and being the new kid[br]at the parochial school,

0:00:46.380,0:00:47.533
not knowing anyone

0:00:47.557,0:00:49.849
and being worried about fitting in,

0:00:49.873,0:00:51.744
on the very first day of school,

0:00:51.768,0:00:55.637
a teacher takes roll and calls out[br]"Anne Marie Albano,"

0:00:55.661,0:00:58.236
to which I respond,[br][In a Staten Island accent] "Here!"

0:00:58.260,0:01:01.940
She laughs and says,[br]"Oh, precious, stand up.

0:01:01.964,0:01:04.588
Say D-O-G."

0:01:04.612,0:01:07.020
And I respond,[br][In a Staten Island accent] "Dog?"

0:01:07.044,0:01:10.847
The class broke out in laughter[br]along with the teacher.

0:01:11.282,0:01:12.804
And so it went,

0:01:12.828,0:01:16.063
because she had many more words[br]to humiliate me with.

0:01:17.230,0:01:19.413
I went home sobbing,

0:01:19.437,0:01:20.729
distraught

0:01:20.753,0:01:23.077
and begging to be sent back to New York

0:01:23.101,0:01:25.204
or to some nunnery.

0:01:25.228,0:01:28.541
I did not want to go back[br]to that school again. No way.

0:01:29.168,0:01:30.855
My parents listened

0:01:30.879,0:01:35.972
and told me that they would investigate[br]with the monsignor back in New York,

0:01:35.996,0:01:40.133
but that I had to keep going in each day[br]so I'd have the attendance record

0:01:40.157,0:01:42.893
to transfer to ninth grade[br]on Staten Island.

0:01:44.319,0:01:47.952
All of this was before[br]email and cell phones,

0:01:47.976,0:01:50.731
so over the next several weeks,

0:01:50.755,0:01:56.589
supposedly, there were letters being sent[br]between the Archdiocese of Manhattan

0:01:56.613,0:01:57.858
and Miami

0:01:57.882,0:01:59.575
and with the Vatican,

0:01:59.599,0:02:04.101
and each day, I'd go into school crying[br]and come home crying,

0:02:04.125,0:02:08.428
to which my mother would give me an update[br]from some cardinal or bishop

0:02:08.452,0:02:11.810
to "Keep her going to school[br]while we find her a spot."

0:02:12.714,0:02:14.612
Was I naive or what?

0:02:14.636,0:02:15.842
(Laughter)

0:02:16.488,0:02:20.180
Well, after a couple of weeks,[br]one day, while waiting for the school bus,

0:02:20.204,0:02:22.332
I met a girl named Debbie,

0:02:22.356,0:02:24.426
and she introduced me to her friends.

0:02:25.222,0:02:27.680
And they became my friends,

0:02:27.704,0:02:30.207
and, well, the Pope was off the hook.

0:02:30.231,0:02:31.250
(Laughter)

0:02:31.274,0:02:33.612
I began to calm down and settle in.

0:02:35.169,0:02:40.062
My past three decades[br]of studying anxiety in children

0:02:40.086,0:02:43.621
stems partly from my own search[br]for self-understanding.

0:02:43.645,0:02:45.201
And I've learned much.

0:02:46.439,0:02:53.373
For young people, anxiety is the most[br]common childhood psychiatric condition.

0:02:54.341,0:02:58.326
These disorders start early, by age four,

0:02:58.350,0:03:03.647
and by adolescence, one in 12 youths[br]are severely impaired

0:03:03.671,0:03:07.815
in their ability to function at home,[br]in school and with peers.

0:03:08.699,0:03:11.628
These kids are so frightened,

0:03:11.652,0:03:12.808
worried,

0:03:12.832,0:03:16.371
literally physically uncomfortable[br]due to their anxiety.

0:03:16.936,0:03:19.985
It's difficult for them[br]to pay attention in school,

0:03:20.009,0:03:21.620
relax and have fun,

0:03:21.644,0:03:22.797
make friends

0:03:22.821,0:03:25.319
and do all the things[br]that kids should be doing.

0:03:26.099,0:03:29.454
Anxiety can create misery for the child,

0:03:29.478,0:03:34.276
and the parents are front and center[br]in witnessing their child's distress.

0:03:35.874,0:03:39.601
As I met more and more children[br]with anxiety through my work,

0:03:39.625,0:03:43.994
I had to go back to mom and dad[br]and ask them a couple of questions.

0:03:44.018,0:03:46.161
"Why did you hold me down

0:03:46.185,0:03:49.060
when I was so frightened[br]of getting injections

0:03:49.084,0:03:50.552
and force them on me?

0:03:51.280,0:03:54.750
And why tell me these tall tales[br]to make me go to school

0:03:54.774,0:03:57.866
when I was so worried[br]about being embarrassed again?"

0:03:59.152,0:04:03.696
They said, "Our hearts[br]broke for you each time,

0:04:03.720,0:04:07.044
but we knew that these were things[br]that you had to do.

0:04:07.535,0:04:10.666
We had to risk you becoming upset

0:04:10.690,0:04:14.655
while we waited for you[br]to get used to the situation

0:04:14.679,0:04:17.206
with time and with more experience.

0:04:17.616,0:04:19.780
You had to get vaccinated.

0:04:19.804,0:04:21.526
You had to go to school."

0:04:23.081,0:04:25.120
Little did my parents know,

0:04:25.144,0:04:28.925
but they were doing more[br]than inoculating me from the measles.

0:04:29.568,0:04:35.328
They were also inoculating me[br]from a lifetime of anxiety disorders.

0:04:36.526,0:04:41.421
Excessive anxiety in a young child[br]is like a superbug --

0:04:41.445,0:04:44.805
and infectious, even multiplying,

0:04:44.829,0:04:47.042
such that many of the youth that I see

0:04:47.066,0:04:51.799
come in with more than one anxiety[br]condition occurring at the same time.

0:04:51.823,0:04:54.169
For example, they'll have specific phobia

0:04:54.193,0:04:58.349
plus separation anxiety[br]plus social anxiety all together.

0:04:59.020,0:05:00.577
Left untreated,

0:05:00.601,0:05:05.389
anxiety in early childhood[br]can lead to depression by adolescence.

0:05:06.146,0:05:10.512
It can also contribute[br]to substance abuse and to suicidality.

0:05:12.187,0:05:14.239
My parents were not therapists.

0:05:14.263,0:05:16.166
They didn't know any psychologists.

0:05:16.709,0:05:22.572
All they knew is that these situations[br]may have been uncomfortable for me,

0:05:22.596,0:05:24.185
but they were not harmful.

0:05:25.112,0:05:30.380
My excessive anxiety would harm me[br]more over the long term

0:05:30.404,0:05:33.720
if they let me avoid[br]and escape these situations

0:05:33.744,0:05:37.496
and not learn how to tolerate[br]occasional distress.

0:05:38.330,0:05:41.706
So in essence, mom and dad were doing[br]their own homegrown version

0:05:41.730,0:05:43.307
of exposure therapy,

0:05:44.236,0:05:47.528
which is the central and key component

0:05:47.552,0:05:50.426
of cognitive behavioral[br]treatment for anxiety.

0:05:51.446,0:05:56.450
My colleagues and I conducted[br]the largest randomized controlled study

0:05:56.474,0:06:00.426
of the treatments of anxiety[br]in children ages seven to 17.

0:06:01.307,0:06:06.650
We found that child-focused[br]cognitive behavioral exposure therapy

0:06:06.674,0:06:11.154
or medication with a selective[br]serotonin reuptake inhibitor

0:06:11.178,0:06:14.093
are effective for[br]60 percent of treated youth.

0:06:14.962,0:06:20.349
And their combination gets 80 percent[br]of kids well within three months.

0:06:20.958,0:06:22.698
This is all good news.

0:06:22.722,0:06:24.845
And if they stay on the medication

0:06:24.869,0:06:28.742
or do monthly exposure treatments[br]as we did in the length of the study,

0:06:28.766,0:06:31.347
they could stay well[br]for upwards of a year.

0:06:32.675,0:06:36.409
However, after this treatment study ended,

0:06:36.433,0:06:40.592
we went back and a did[br]a follow-up study of the participants,

0:06:40.616,0:06:44.696
and we found that many of these kids[br]relapsed over time.

0:06:44.720,0:06:48.935
And, despite the best[br]of evidence-based treatments,

0:06:48.959,0:06:53.318
we also found that for about[br]40 percent of the kids with anxiety,

0:06:53.342,0:06:56.185
they remained ill throughout[br]the course of the time.

0:06:57.291,0:07:00.914
We've thought a lot about these results.

0:07:01.977,0:07:03.542
What were we missing?

0:07:04.638,0:07:08.163
We've hypothesized that because[br]we were focusing

0:07:08.187,0:07:11.669
on just child-focused intervention,

0:07:11.693,0:07:15.861
perhaps there's something important[br]about addressing the parents

0:07:15.885,0:07:18.146
and involving them in treatment, too.

0:07:19.989,0:07:23.633
Studies from my own lab[br]and from colleagues around the world

0:07:23.657,0:07:25.931
have shown a consistent trend:

0:07:26.776,0:07:30.915
well-meaning parents[br]are often inadvertently drawn into

0:07:30.939,0:07:32.660
the cycle of anxiety.

0:07:33.361,0:07:36.798
They give in, and they make[br]too many accommodations for their child,

0:07:36.822,0:07:41.287
and they let their children[br]escape challenging situations.

0:07:42.094,0:07:44.055
I want you to think about it like this:

0:07:44.587,0:07:48.920
Your child comes into the house[br]to you crying, in tears.

0:07:48.944,0:07:51.191
They're five or six years of age.

0:07:51.215,0:07:54.134
"Nobody at school likes me![br]These kids are mean.

0:07:54.158,0:07:55.941
No one would play with me."

0:07:57.023,0:07:59.509
How do you feel seeing[br]your child so upset?

0:08:00.628,0:08:01.788
What do you do?

0:08:02.646,0:08:08.075
The natural parenting instinct[br]is to comfort that child, soothe them,

0:08:08.099,0:08:10.928
protect them and fix the situation.

0:08:12.164,0:08:16.779
Calling the teacher to intervene[br]or the other parents to arrange playdates,

0:08:16.803,0:08:18.984
that may be fine at age five.

0:08:19.359,0:08:24.517
But what do you do if your child[br]keeps coming home day after day in tears?

0:08:25.182,0:08:30.006
Do you still fix things for them[br]at age eight, 10, 14?

0:08:30.594,0:08:32.668
For children, as they are developing,

0:08:32.692,0:08:37.318
they invariably are going to be[br]encountering challenging situations:

0:08:37.342,0:08:40.996
sleepovers, oral reports,

0:08:41.020,0:08:43.171
a challenging test that pops up,

0:08:43.195,0:08:47.128
trying out for a sports team[br]or a spot in the school play,

0:08:47.152,0:08:49.074
conflicts with peers ...

0:08:49.706,0:08:53.121
All these situations involve risk:

0:08:53.145,0:08:56.487
risk of not doing well,[br]not getting what they want,

0:08:56.511,0:08:58.988
risk of maybe making mistakes

0:08:59.012,0:09:00.636
or being embarrassed.

0:09:01.616,0:09:03.827
For kids with anxiety

0:09:03.851,0:09:06.603
who don't take risks and engage,

0:09:07.555,0:09:11.542
they then don't learn how to manage[br]these types of situations.

0:09:12.080,0:09:13.235
Right?

0:09:13.259,0:09:17.455
Because skills develop[br]with exposure over time,

0:09:17.479,0:09:21.520
repeated exposure to everyday[br]situations that kids encounter:

0:09:22.680,0:09:24.569
self-soothing skills

0:09:24.593,0:09:28.368
or the ability to calm[br]oneself down when upset;

0:09:29.067,0:09:30.494
problem-solving skills,

0:09:30.518,0:09:33.792
including the ability[br]to resolve conflicts with others;

0:09:34.631,0:09:36.523
delay of gratification,

0:09:36.547,0:09:38.775
or the ability to keep your efforts going

0:09:38.799,0:09:42.387
despite the fact that you have[br]to wait over time to see what happens.

0:09:43.270,0:09:46.361
These and many other skills[br]are developing in children

0:09:46.385,0:09:48.523
who take risks and engage.

0:09:49.325,0:09:52.455
And self-efficacy takes shape,

0:09:52.479,0:09:55.863
which, simply put,[br]is the belief in oneself

0:09:55.887,0:09:59.306
that you can overcome[br]challenging situations.

0:10:00.650,0:10:05.856
For kids with anxiety[br]who escape and avoid these situations

0:10:05.880,0:10:08.732
and get other people to do them for them,

0:10:08.756,0:10:11.809
they become more and more[br]anxious with time

0:10:11.833,0:10:14.455
while less confident in themselves.

0:10:15.328,0:10:19.368
Contrary to their peers[br]who don't suffer with anxiety,

0:10:19.392,0:10:24.239
they come to believe that they are[br]incapable of managing these situations.

0:10:24.768,0:10:28.631
They think that they need someone,[br]someone like their parents,

0:10:28.655,0:10:30.214
to do things for them.

0:10:31.769,0:10:37.712
Now, while the natural parenting instinct[br]is to comfort and protect

0:10:37.736,0:10:39.112
and reassure kids,

0:10:40.207,0:10:44.383
in 1930, the psychiatrist Alfred Adler

0:10:44.407,0:10:46.706
had already cautioned parents

0:10:46.730,0:10:49.770
that we can love a child[br]as much as we wish,

0:10:49.794,0:10:52.196
but we must not make that child dependent.

0:10:52.838,0:10:57.123
He advised parents to begin training kids[br]from the very beginning

0:10:57.147,0:10:59.192
to stand on their own two feet.

0:10:59.964,0:11:04.051
He also cautioned[br]that if children get the impression

0:11:04.075,0:11:08.767
that their parents have nothing better[br]to do than be at their beck and call,

0:11:08.791,0:11:11.525
they would gain a false idea of love.

0:11:13.189,0:11:17.050
For children with anxiety[br]in this day and age,

0:11:17.074,0:11:19.698
they are always calling their parents

0:11:19.722,0:11:24.218
or texting distress calls[br]at all hours of the day and night.

0:11:24.242,0:11:29.762
So if children with anxiety don't learn[br]the proper coping mechanisms when young,

0:11:29.786,0:11:31.888
what happens to them when they grow up?

0:11:33.055,0:11:37.900
I run groups for parents[br]of young adults with anxiety disorders.

0:11:39.034,0:11:42.728
These youth are between[br]the ages of 18 and 28.

0:11:43.561,0:11:45.893
They are mostly living at home,

0:11:45.917,0:11:47.933
dependent on their parents.

0:11:48.798,0:11:52.647
Many of them may have[br]attended school and college.

0:11:52.671,0:11:54.135
Some have graduated.

0:11:54.907,0:11:57.616
Almost all are not working,

0:11:57.640,0:12:00.400
just staying at home[br]and not doing much of anything.

0:12:00.928,0:12:04.194
They don't have meaningful[br]relationships with others,

0:12:04.218,0:12:06.645
and they are very,[br]very dependent on their parents

0:12:06.669,0:12:08.799
to do all sort of things for them.

0:12:09.802,0:12:12.788
Their parents still make[br]their doctors appointments for them.

0:12:13.729,0:12:17.178
They call the kids' old friends[br]and beg them to come visit.

0:12:17.202,0:12:19.626
They do the kids' laundry[br]and cook for them.

0:12:20.098,0:12:23.874
And they are in great conflict[br]with their young adult,

0:12:23.898,0:12:28.213
because the anxiety has flourished[br]but the youth has not.

0:12:29.285,0:12:32.191
These parents feel enormous guilt,

0:12:32.215,0:12:33.906
but then resentment,

0:12:33.930,0:12:35.661
and then more guilt.

0:12:36.662,0:12:38.709
OK, how about some good news?

0:12:39.661,0:12:44.523
If parents and key figures[br]in a child's life

0:12:44.547,0:12:48.883
can help the child, assist them[br]to confront their fears

0:12:48.907,0:12:50.933
and learn how to problem-solve,

0:12:50.957,0:12:54.182
then it is more likely that the children[br]are going to develop

0:12:54.206,0:12:58.376
their own internal coping mechanisms[br]for managing their anxiety.

0:12:59.729,0:13:03.737
We teach parents now[br]to be mindful in the moment

0:13:03.761,0:13:07.420
and think about their reaction[br]to their child's anxiety.

0:13:08.613,0:13:10.138
We ask them,

0:13:10.162,0:13:14.220
"Look at the situation and ask,[br]'What is this situation at hand?

0:13:14.669,0:13:17.121
How threatening is it to my child?

0:13:17.145,0:13:20.120
And what do I ultimately[br]want them to learn from it?'"

0:13:20.812,0:13:23.904
Now of course, we want parents[br]to listen very carefully,

0:13:23.928,0:13:27.847
because if a child is being bullied[br]seriously or put in harm's way,

0:13:27.871,0:13:29.448
we want parents to intervene,

0:13:29.472,0:13:30.761
absolutely.

0:13:31.738,0:13:36.050
But in typical, everyday[br]anxiety-producing situations,

0:13:36.074,0:13:38.426
parents can be[br]most helpful to their child

0:13:38.450,0:13:41.998
if they remain calm[br]and matter-of-fact and warm,

0:13:42.022,0:13:44.785
if they validate the child's feelings

0:13:44.809,0:13:46.821
but then help the child,

0:13:46.845,0:13:50.888
assist them in planning how the child[br]is going to manage the situation.

0:13:51.627,0:13:53.520
And then -- this is key --

0:13:53.544,0:13:57.226
to actually have the child[br]deal with the situation themselves.

0:13:59.092,0:14:03.792
Of course, it is heartbreaking[br]to watch a child suffer,

0:14:03.816,0:14:06.723
as my parents told me years later.

0:14:07.389,0:14:09.131
When you see your child suffering

0:14:09.155,0:14:13.920
but you think you could swoop in[br]and save them from the pain of it,

0:14:13.944,0:14:16.340
that's everything, right?

0:14:16.364,0:14:17.807
That's what we want to do.

0:14:19.000,0:14:21.542
But whether we are young or old,

0:14:21.566,0:14:27.033
excessive anxiety leads us[br]to overestimate risk and distress

0:14:27.057,0:14:30.098
while underestimating our ability to cope.

0:14:31.700,0:14:36.920
We know that repeated exposure[br]to what we fear weakens anxiety,

0:14:36.944,0:14:39.719
while building resources and resilience.

0:14:40.639,0:14:42.538
My parents were on to something.

0:14:43.158,0:14:46.676
Today's hyper-anxious youth[br]are not being helped

0:14:46.700,0:14:48.990
by overly protective parenting.

0:14:50.149,0:14:54.695
Calmness and confidence[br]are not just emotions.

0:14:55.179,0:14:58.928
They are coping skills[br]that parents and children can learn.

0:14:59.912,0:15:01.088
Thank you.

0:15:01.112,0:15:04.400
(Applause)