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As a child, I had many fears.

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I was afraid of lightning, insects,

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loud noises and costumed characters.

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I also had two very severe phobias

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of doctors and injections.

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During my struggles to escape
from our family doctor,

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I would become so physically combative

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that he actually slapped me
in the face to stun me.

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I was six.

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I was all fight-or-flight back then,

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and holding me down for a simple vaccine
took three or four adults,

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including my parents.

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Later, our family moved
from New York to Florida

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just as I was starting high school,

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and being the new kid
at the parochial school,

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not knowing anyone

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and being worried about fitting in,

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on the very first day of school,

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a teacher takes roll and calls out
"Anne Marie Albano,"

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to which I respond,
[In a Staten Island accent] "Here!"

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She laughs and says,
"Oh, precious, stand up.

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Say D-O-G."

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And I respond,
[In a Staten Island accent] "Dog?"

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The class broke out in laughter
along with the teacher.

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And so it went,

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because she had many more words
to humiliate me with.

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I went home sobbing,

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distraught

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and begging to be sent back to New York

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or to some nunnery.

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I did not want to go back
to that school again. No way.

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My parents listened

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and told me that they would investigate
with the monsignor back in New York,

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but that I had to keep going in each day
so I'd have the attendance record

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to transfer to ninth grade
on Staten Island.

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All of this was before
email and cell phones,

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so over the next several weeks,

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supposedly, there were letters being sent
between the Archdiocese of Manhattan

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and Miami

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and with the Vatican,

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and each day, I'd go into school crying
and come home crying,

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to which my mother would give me an update
from some cardinal or bishop

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to "Keep her going to school
while we find her a spot."

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Was I naive or what?

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(Laughter)

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Well, after a couple of weeks,
one day, while waiting for the school bus,

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I met a girl named Debbie,

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and she introduced me to her friends.

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And they became my friends,

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and, well, the Pope was off the hook.

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(Laughter)

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I began to calm down and settle in.

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My past three decades
of studying anxiety in children

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stems partly from my own search
for self-understanding.

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And I've learned much.

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For young people, anxiety is the most
common childhood psychiatric condition.

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These disorders start early, by age four,

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and by adolescence, one in 12 youths
are severely impaired

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in their ability to function at home,
in school and with peers.

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These kids are so frightened,

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worried,

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literally physically uncomfortable
due to their anxiety.

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It's difficult for them
to pay attention in school,

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relax and have fun,

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make friends

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and do all the things
that kids should be doing.

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Anxiety can create misery for the child,

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and the parents are front and center
in witnessing their child's distress.

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As I met more and more children
with anxiety through my work,

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I had to go back to mom and dad
and ask them a couple of questions.

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"Why did you hold me down

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when I was so frightened
of getting injections

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and force them on me?

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And why tell me these tall tales
to make me go to school

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when I was so worried
about being embarrassed again?"

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They said, "Our hearts
broke for you each time,

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but we knew that these were things
that you had to do.

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We had to risk you becoming upset

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while we waited for you
to get used to the situation

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with time and with more experience.

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You had to get vaccinated.

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You had to go to school."

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Little did my parents know,

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but they were doing more
than inoculating me from the measles.

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They were also inoculating me
from a lifetime of anxiety disorders.

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Excessive anxiety in a young child
is like a superbug --

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and infectious, even multiplying,

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such that many of the youth that I see

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come in with more than one anxiety
condition occurring at the same time.

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For example, they'll have specific phobia

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plus separation anxiety
plus social anxiety all together.

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Left untreated,

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anxiety in early childhood
can lead to depression by adolescence.

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It can also contribute
to substance abuse and to suicidality.

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My parents were not therapists.

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They didn't know any psychologists.

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All they knew is that these situations
may have been uncomfortable for me,

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but they were not harmful.

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My excessive anxiety would harm me
more over the long term

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if they let me avoid
and escape these situations

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and not learn how to tolerate
occasional distress.

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So in essence, mom and dad were doing
their own homegrown version

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of exposure therapy,

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which is the central and key component

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of cognitive behavioral
treatment for anxiety.

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My colleagues and I conducted
the largest randomized controlled study

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of the treatments of anxiety
in children ages seven to 17.

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We found that child-focused
cognitive behavioral exposure therapy

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or medication with a selective
serotonin reuptake inhibitor

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are effective for
60 percent of treated youth.

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And their combination gets 80 percent
of kids well within three months.

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This is all good news.

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And if they stay on the medication

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or do monthly exposure treatments
as we did in the length of the study,

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they could stay well
for upwards of a year.

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However, after this treatment study ended,

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we went back and a did
a follow-up study of the participants,

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and we found that many of these kids
relapsed over time.

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And, despite the best
of evidence-based treatments,

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we also found that for about
40 percent of the kids with anxiety,

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they remained ill throughout
the course of the time.

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We've thought a lot about these results.

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What were we missing?

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We've hypothesized that because
we were focusing

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on just child-focused intervention,

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perhaps there's something important
about addressing the parents

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and involving them in treatment, too.

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Studies from my own lab
and from colleagues around the world

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have shown a consistent trend:

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well-meaning parents
are often inadvertently drawn into

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the cycle of anxiety.

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They give in, and they make
too many accommodations for their child,

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and they let their children
escape challenging situations.

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I want you to think about it like this:

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Your child comes into the house
to you crying, in tears.

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They're five or six years of age.

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"Nobody at school likes me!
These kids are mean.

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No one would play with me."

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How do you feel seeing
your child so upset?

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What do you do?

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The natural parenting instinct
is to comfort that child, soothe them,

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protect them and fix the situation.

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Calling the teacher to intervene
or the other parents to arrange playdates,

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that may be fine at age five.

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But what do you do if your child
keeps coming home day after day in tears?

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Do you still fix things for them
at age eight, 10, 14?

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For children, as they are developing,

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they invariably are going to be
encountering challenging situations:

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sleepovers, oral reports,

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a challenging test that pops up,

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trying out for a sports team
or a spot in the school play,

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conflicts with peers ...

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All these situations involve risk:

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risk of not doing well,
not getting what they want,

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risk of maybe making mistakes

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or being embarrassed.

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For kids with anxiety

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who don't take risks and engage,

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they then don't learn how to manage
these types of situations.

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Right?

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Because skills develop
with exposure over time,

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repeated exposure to everyday
situations that kids encounter:

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self-soothing skills

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or the ability to calm
oneself down when upset;

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problem-solving skills,

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including the ability
to resolve conflicts with others;

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delay of gratification,

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or the ability to keep your efforts going

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despite the fact that you have
to wait over time to see what happens.

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These and many other skills
are developing in children

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who take risks and engage.

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And self-efficacy takes shape,

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which, simply put,
is the belief in oneself

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that you can overcome
challenging situations.

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For kids with anxiety
who escape and avoid these situations

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and get other people to do them for them,

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they become more and more
anxious with time

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while less confident in themselves.

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Contrary to their peers
who don't suffer with anxiety,

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they come to believe that they are
incapable of managing these situations.

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They think that they need someone,
someone like their parents,

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to do things for them.

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Now, while the natural parenting instinct
is to comfort and protect

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and reassure kids,

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in 1930, the psychiatrist Alfred Adler

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had already cautioned parents

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that we can love a child
as much as we wish,

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but we must not make that child dependent.

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He advised parents to begin training kids
from the very beginning

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to stand on their own two feet.

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He also cautioned
that if children get the impression

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that their parents have nothing better
to do than be at their beck and call,

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they would gain a false idea of love.

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For children with anxiety
in this day and age,

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they are always calling their parents

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or texting distress calls
at all hours of the day and night.

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So if children with anxiety don't learn
the proper coping mechanisms when young,

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what happens to them when they grow up?

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I run groups for parents
of young adults with anxiety disorders.

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These youth are between
the ages of 18 and 28.

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They are mostly living at home,

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dependent on their parents.

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Many of them may have
attended school and college.

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Some have graduated.

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Almost all are not working,

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just staying at home
and not doing much of anything.

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They don't have meaningful
relationships with others,

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and they are very,
very dependent on their parents

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to do all sort of things for them.

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Their parents still make
their doctors appointments for them.

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They call the kids' old friends
and beg them to come visit.

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They do the kids' laundry
and cook for them.

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And they are in great conflict
with their young adult,

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because the anxiety has flourished
but the youth has not.

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These parents feel enormous guilt,

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but then resentment,

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and then more guilt.

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OK, how about some good news?

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If parents and key figures
in a child's life

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can help the child, assist them
to confront their fears

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and learn how to problem-solve,

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then it is more likely that the children
are going to develop

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their own internal coping mechanisms
for managing their anxiety.

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We teach parents now
to be mindful in the moment

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and think about their reaction
to their child's anxiety.

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We ask them,

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"Look at the situation and ask,
'What is this situation at hand?

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How threatening is it to my child?

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And what do I ultimately
want them to learn from it?'"

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Now of course, we want parents
to listen very carefully,

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because if a child is being bullied
seriously or put in harm's way,

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we want parents to intervene,

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absolutely.

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But in typical, everyday
anxiety-producing situations,

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parents can be
most helpful to their child

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if they remain calm
and matter-of-fact and warm,

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if they validate the child's feelings

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but then help the child,

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assist them in planning how the child
is going to manage the situation.

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And then -- this is key --

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to actually have the child
deal with the situation themselves.

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Of course, it is heartbreaking
to watch a child suffer,

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as my parents told me years later.

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When you see your child suffering

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but you think you could swoop in
and save them from the pain of it,

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that's everything, right?

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That's what we want to do.

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But whether we are young or old,

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excessive anxiety leads us
to overestimate risk and distress

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while underestimating our ability to cope.

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We know that repeated exposure
to what we fear weakens anxiety,

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while building resources and resilience.

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My parents were on to something.

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Today's hyper-anxious youth
are not being helped

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by overly protective parenting.

256
00:14:50,149 --> 00:14:54,695
Calmness and confidence
are not just emotions.

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They are coping skills
that parents and children can learn.

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Thank you.

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(Applause)