Fear is
something that everybody experiences. We all have fear,
and fear is a normal response to a threat. The difference with anxiety
is that anxiety is more diffuse. It’s not specific to a threat. It’s more global and it’s more vague and general. A fear of elevators
could be rational if you know that the elevator
reached the maximum capacity or you know for sure
that it’s been failing or is shaking strangely, that’s rational, and avoiding that is normal. But anxiety would be for someone
to be afraid of elevators, even though it’s a perfectly functioning
elevator you know has been recently installed and checked and
technically is flawless, and you still have anxiety about that.Anxiety disorders are a large family
with several individual disorders, but it’s important to know
that sometimes they happen together or you may have one
and a little bit of another one. But the most common are panic
disorder, social anxiety disorder, we have also generalized anxiety
disorder, separation anxiety disorder, and the last one is selective mutism. It’s a rare disorder
that is mostly seen in children. In psychiatry,
probably the most successful group of illnesses or disorders
that we can treat successfully are anxiety disorders.
The treatment of choice is therapy. Multiple therapies are validated by research that can be effective. In addition to that,
we can use medications that are just as needed,
for example, panic attacks.Many people use a type of medication
called benzodiazepine. There’s a family of anti-anxiety medications. They can work for someone
who has only sporadic attacks, but not for someone who has chronic,
what is called generalized anxiety disorder, because it’s easy
to become dependent on those medications. The other mainstay type of treatment
in terms of medications is antidepressants, specifically the so-called serotonergic
antidepressants. Some of them, for example,
are sertraline or paroxetine and these medications
increase the transmission of serotonin in the brain and can alleviate
some of the symptoms of anxiety. When we are
thinking of treatment for anxiety disorders without medication,
we have therapy, but also we have self-help. So we can do a lot with self-help. Probably the most effective
are all kinds of activities that tend to reduce the activation of the stress response system in the body. So the stress response system releases
several chemicals, like cortisol and adrenaline,
but also changes the heart rate, breathing, and so forth. And so there are many activities,
including meditation, yoga, tai chi, and sports in general,
aerobic exercise, that can down-regulate the activation of the stress
response system.In addition to self-help, another type of non-medication,
non-pharmacological treatment for anxiety disorders
is therapy. Counseling. And several types are specific for anxiety and they’re being developed through
research and they are highly effective. One of the most common and most well-known is cognitive behavioral therapy,
which is a systematic training of the patient to identify certain thoughts and beliefs
that can be challenged, and the challenging
of switching reframing, and changing those thoughts can alleviate anxiety. The main coping skill for anxiety
is avoidance. Unfortunately, avoidance
is the worst thing that we can do because it will perpetrate
and make it chronic.The more we avoid something,
the more powerful that fear becomes, or that anxiety. Therefore,
one of the treatments for anxiety is to try not to avoid
the triggers, is to expose ourselves as much as we can tolerate that. For example,
if public speaking is a source of anxiety, some of us can get trained
and go to Toastmasters,
and go to a setting where we feel safer and slowly
and progressively expose ourselves. Because the brain learns not to react. With more practice, we lose that fear. If you believe
that you have an anxiety disorder, I would say the first thing to do
could be a screening for that. That could be done by your primary care
physician or yourself. One of the most common tools to screen for anxiety disorder
is called General Anxiety Disorder-7.GAD-7. And that’s widely available
in the public domain on the Internet. And if you have a suspicion
of an anxiety disorder, I would go to your primary care doctor. Alternatively, you can go to a therapist
because this, can be very effective and the therapist would be prepared
to tell you, “I think you need medication in addition to therapy.”.
ᵃⁿⁱᵐᵃᵗⁱᵒⁿ ˢᵗᵘᵈⁱᵒ ᴏɴᴇ-ᴛɪᴍᴇ ꜱᴘᴇᴄɪᴀʟ ᴜᴘɢʀᴀᴅᴇ ᴅᴇᴀʟ – ᴍᴀʏ ᴇxᴘɪʀᴇ ᴏɴᴄᴇ ʏᴏᴜ ʟᴇᴀᴠᴇ ᴛʜɪꜱ ᴘᴀɢᴇ. ꜱᴋɪᴘ ᴛʜɪꜱ ᴅᴇᴀʟ ᴀᴛ ʏᴏᴜʀ ᴏᴡɴ ʀɪꜱᴋ ᴀꜱ ᴛʜᴇ ᴘʀɪᴄᴇ ᴍᴀʏ ᴅᴏᴜʙʟᴇ ᴡɪᴛʜᴏᴜᴛ ɴᴏᴛɪᴄᴇ!
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Fear is
something that everybody experiences. We all have fear,
and fear is a normal response to a threat. The difference with anxiety
is that anxiety is more diffuse. It’s not specific to a threat. It’s more global and it’s more vague and general. A fear of elevators
could be rational if you know that the elevator
reached the maximum capacity or you know for sure
that it’s been failing or is shaking strangely, that’s rational, and avoiding that is normal. But anxiety would be for someone
to be afraid of elevators, even though it’s a perfectly functioning
elevator you know has been recently installed and checked and
technically is flawless, and you still have anxiety about that. Anxiety disorders are a large family
with several individual disorders, but it’s important to know
that sometimes they happen together or you may have one
and a little bit of another one.But the most common are panic
disorder, social anxiety disorder, we have also generalized anxiety
disorder, separation anxiety disorder, and the last one is selective mutism. It’s a rare disorder
that is mostly seen in children. In psychiatry,
probably the most successful group of illnesses or disorders
that we can treat successfully are anxiety disorders.
The treatment of choice is therapy. Multiple therapies are validated by research that can be effective. In addition to that,
we can use medications that are just as needed,
for example, panic attacks. Many people use a type of medication
called benzodiazepine. There’s a family of anti-anxiety medications. They can work for someone
who has only sporadic attacks, but not for someone who has chronic,
what is called generalized anxiety disorder, because it’s easy
to become dependent on those medications. The other mainstay type of treatment
in terms of medications is antidepressants, specifically the so-called serotonergic
antidepressants.Some of them, for example,
are sertraline or paroxetine and these medications
increase the transmission of serotonin in the brain and can alleviate
some of the symptoms of anxiety. When we are
thinking of treatment for anxiety disorders without medication,
we have therapy, but also we have self-help. So we can do a lot with self-help. Probably the most effective
are all kinds of activities that tend to reduce the activation of the stress response system in the body. So the stress response system releases
several chemicals, like cortisol and adrenaline,
but also changes the heart rate, breathing, and so forth. And so there are many activities,
including meditation, yoga, tai chi, and sports in general,
aerobic exercise, that can down-regulate the activation of the stress
response system. In addition to self-help, another type of non-medication,
non-pharmacological treatment for anxiety disorders
is therapy. Counseling. And several types are specific for anxiety and they’re being developed through
research and they are highly effective.One of the most common and most well-known is cognitive behavioral therapy,
which is a systematic training of the patient to identify certain thoughts and beliefs
that can be challenged, and the challenge
of switching reframing, and changing those thoughts can alleviate anxiety. The main coping skill for anxiety
is avoidance. Unfortunately, avoidance
is the worst thing that we can do because it will perpetrate
and make it chronic. The more we avoid something,
the more powerful that fear becomes, or that anxiety. Therefore,
one of the treatments for anxiety is to try not to avoid
the triggers, is to expose ourselves as much as we can tolerate that. For example,
if public speaking is a source of anxiety, some of us can get trained
and go to Toastmasters,
and go to a setting where we feel safer and slowly
and progressively expose ourselves.Because the brain learns not to react. With more practice, we lose that fear. If you believe
that you have an anxiety disorder, I would say the first thing to do
could be a screening for that. That could be done by your primary care
physician or yourself. One of the most common tools to screen for anxiety disorder
is called General Anxiety Disorder-7. GAD-7. And that’s widely available
in the public domain on the Internet.And if you have a suspicion
of an anxiety disorder, I would go to your primary care doctor. Alternatively, you can go to a therapist
because this, can be very effective and the therapist would be prepared
to tell you, “I think you need medication in addition to therapy.”.
100 Hot BooksComputers LaptopsExplaindio Agency Edition FREE Training How to Create Explainer Videos & SELL or RENT them! Join this FREE webinar | Work Less & Earn More With Explaindio AGENCY EDITION 
(lively music) – I'm Pamela Wu and with me today is Dr. Breanna Winder-Patel
a clinical psychologist at our world renowned MIND Institute. MIND as we call it here
performs research on and provides care for
neurodevelopmental disorders. Today we're going to be
discussing how to help adults and children both with and without neurodevelopmental disorders in this time of coronavirus anxiety and lots of routine changes as well. Dr. Winder-Patel thanks for being with us. – Thanks for having me. – Many of our viewers
have been experiencing a lot of anxiety since
the coronavirus began. What have you been
seeing in your practice? – Yeah so before we get started
I just wanna mention that Dr. Meg Tudor is also a
psychologist at MIND and we work together on getting
these materials ready and then in this effort
of you know physical or social distancing
she wasn't able to come. So there's probably more
things we're gonna develop over the days to come about this and she's kind of equally involved.
So I wanted to mention that and she has a similar
practice to mine at MIND. What we're seeing is that
you know this is a time of high-anxiety for a lot of people. What underlies anxiety is we think of, has a lot to do with fear of uncertainty and worries about uncertainty, and obviously there's a
lot of uncertainty for us at this time. So we would expect people to
have some anxiety that's higher and that's a way that
we're sort of designed to look out for dangers. Some people are having some
anxiety that's even excessive for what's going on. And we have you know a mechanism called the fight, flight or freeze mechanism, that we all have for when
we're in a true danger. And it's important for
that to go off if like a bus is coming towards
you or something like that.
But it's not, we have that go off as like a false alarm sometimes and I think that's happening some. So what we're seeing in our
practice is some of the kids are talking about the coronavirus in ways where they're pretty anxious about it. But actually some aren't as
anxious as they usually are because the things that make them anxious, like separating from their parents or interacting with peers. They're not doing right
now, they're kind of at home in their safe space. It's a lot of transition
to move to the video visits so that's been part of what
we're trying to work on to continue to provide care. – What can parents tell
children who are anxious about the coronavirus? – Yeah, so we want children to have you know specific
fact-based information. So there are a lot of
myths kind of going around and information that can
be really scary for kids, and it's best to not completely
keep them in the dark.
But give them some information
so they understand like the true honest effort that
they're parent is giving to let them know about it. So for example, we would
want kids to know things like you know we would want
them to understand that people have viruses all the time and that the difference with this virus is that we don't want so many
people to get it at once, so that the hospitals and the
doctors are just too busy. So we're all really working
hard to stay at home from school and home from work to give
them the space they need to work on this virus. And for a lot of kids that's
kind of enough information obviously, it depends on their cognitive and language level. But it's not something we need
to be talking about all day.
So you know it can be,
provide some information try to get in there and
see if there's any myths the kids are walking around with, and then move on to something
more fun and relaxing like movie or a family game. – So it's not just you sort
of delivering this information to your child, but you said to sort of ask if they are thinking of any
thing that we know to be myths. So it's really like encouraging
a discussing and maybe would you ask a child say. Honey what do you know
about the coronavirus? – Yes, because we don't wanna
assume that they're having certain thoughts about
it that they're not. I had one child actually
convey to me that, and this is a child with
autism that the biggest worry was the visual image of what
everyone's putting up there that the coronavirus,
you know the depiction of what the virus would
actually look like.
– Oh the ball? – Yeah. So if you think about that ball you know, it is a scary looking ball
with red pointy things coming out of it. You know and the child's fear wasn't about getting the virus or dying. The fear was about like,
that thing looks really evil and I don't want that inside of my body. So they're interpretation
of what's going on really to this virus, was a
little bit different than what you would expect.
And so you have to really see you know what is your own child thinking
about versus assuming that everybody is just
worried about getting it, 'cause that might not be it. – That's really interesting information that parents would wanna tease out. – Yeah. – Well since schools are closed and there is an important
focus on the social distancing, which is why we're sitting
not closer together. We're sitting this far apart
at this table right now. What would be helpful
for parents to include in their daily routines with
their kids being at home? – Yeah so since this is
a time of uncertainty we would want to be able to provide them with the most kind of
structure and routine in ways that they're familiar with, so that they feel like
they know what's coming. So we would encourage parents
to try to put some routine in place at home like
similar wake up times, knowing when meals are coming. You know knowing if
school work is expected at a certain time and when
the fun time is gonna come.
We also, you know, I'm
hearing a lot of information about parents who are
expected to work from home in addition to taking
care of their children, in addition to teaching their children. And it's just so entirely
unrealistic to put the pressure of some like idealistic
schedule on these families. So I think the idea is to
try to keep some structure for the child. But also to be really
flexible and kind of you know easy on yourself that
that's not gonna happen in a perfect way everyday
and we're expected to all do things that are
really unfamiliar to us.
You know it might be a time if the child is really struggling to do the
traditional way of learning. Maybe it's a time to focus
on experiential learning that's where we think of
teaching them hands-on things like how to measure the
ingredients for you know what they're making, or going outside for a walk
and trying to identify trees or flowers that we know of. You know that type of learning
is really important too and parents are actually
doing that a lot of the time they might not realize that. And the other thing is
to think about you know are there things that you
really loved as a child that were really meaningful
and maybe this is a time to do it. Like you know I was a big
fan of like making forts and doing scavenger hunts
and all of these things. And at the end of this we want
kids to be able to look back and not feel like wow
that was so much tension the whole time.
We want it to be able to be like well, it was kinda stressful for everyone but I had some really great
experiences with my family and I learned, and now I
have some great memories. So it's a balance and we have
to be kinda easy on ourselves at this time. – That is such good advice
I think so many families need to hear that right now. – Yeah. – We've been talking about
routine you talked about sort of developing a flexible schedule 'cause kids
like to know what's coming. A lot of children and people, adults too with neurodevelopmental disorders
really thrive on routine and for a lot families their home life has just been completely upended by this. So what are some of the special challenges for families who have
a member of the family with a neurodevelopmental disorder? – Yeah. Well I mean I think
the biggest one is that you know in our world in
my field we talk about we don't expect the parents
to be the therapist.
We expect if you need a
therapist you go to a therapist. And the same with parents being teachers, if you're not a teacher that's a really big
responsibility to put on a parent. And now like parents
are everything. (laughs) – Yeah they're right. – Right now for children with
neurodevelopmental disorders that have in-home services
that have been suspended. They're not getting that support
they need and they're not getting those therapists and
they're kind of mean to be the therapist and the teacher. So I think the challenges
are that really the support.
A lot of times individuals with
neurodevelopmental disorders have a lot of extra
therapies and interventions that aren't happening right now. So we would encourage
parents to you know keep with those strategies as they can, and see if there's other
resources they can get through you know if they have any
option for video visits with the provider, and you
know there's a resource we're going to mention
that the MIND Institute, faculty of the MIND Institute developed that might be helpful as well. So I think it's the extra
challenges are probably related to you know really feeling like they were so used to that routine and
what they did everyday, going to school going to therapy and having trouble understanding you know why is this so different and why don't we have a choice right now.
– So again just kind of
being supportive of them trying to include things
they really enjoy. Include their special
interests in their day. One thing we talk about is
that if a child has a special interest in something it
could help you explain the pandemic to them. So for example if they're
really into superheroes you could say well the
healthcare workers are kind of like Iron Man, and their job right now is to go after this thing that they're trying
to you know fight against, and we need to give them
to space to do that. And you know eventually,
you know Iron Man defeats the Mandarin just like we're helping the healthcare workers defeat the virus. So sometimes pulling in
their special interests can give them some feel
like they have some control and some better understanding. But it's really just about
trying to keep the routine the same but also being
understanding that you know, that's a huge expectation. – Absolutely, you mentioned
that sometimes kids might not be as scared as we think they are.
Because we're so immersed in the news and so there is a lot
of fear among adults, but kids might not be as scared. For kids who are scared though
like the one that you said was scared of the scary
red ball entering his body. What can parents do to support those kids and give them a feeling of security? – Yeah great question. So one of the things that we
think about with thoughts. If we're having a lot of what if thoughts, that's usually a sign
it's an anxious thought. Because we're asking like
what if the bad thing happens and we don't know yet
cause it's uncertain, it's in the future. So if you're hearing a
lot of what if thoughts from the child, you know
it's a tendency for parents to just say like oh don't
worry or it'll be okay.
But for some kids that
reassurance doesn't work and part of why that
doesn't work is because they have this thought
and it's not going away. So we have a strategy of getting
the child to look for proof for their thoughts. So you know if your thought
is what if I'm going to get very sick and die.
Looking for proof would be
saying things like oh you know is anyone in my house sick? Are we responsible with
the physical distancing you know that we're doing? Are we washing our hands? Do I have any proof that I'm actually in a
true danger right now? And if that proof isn't there,
then we have to question is anxiety telling us the truth. So we talk about externalizing the anxiety and being able to decide
whether to listen to it or not. So if you look for proof and you realize you don't really have any, that the anxiety is telling you the truth. Then we encourage children
and adults to do something called change the channel in your mind, that's what we call it. So we teach little kids,
your mind is like a TV and if you're kinda stuck
on the anxiety channel and it's not helpful for you.
We have to kinda let that
channel go and switch it over to something that's calming and relaxing. I, this week was like I need
to find something personally to change my channel, and so I found the book called Joyful. It's about you know looking
around in the physical world and understanding how
it impacts inner-joy. So if I'm having these thoughts that are not helpful right
now I change my channel to either thinking about
the ideas in the book or even like If I can take a break, going and listening to it. I may or may not have
been hiding in my closet listening to it last night. (both laughs) – Change it to the joyful channel. – Right right. So it's you know things
like this that adults need to implement too because
we have the worries as well but we also have many
of us the responsibility of taking care of our children.
– Yeah. That leads me actually
to my next question. How important it is for
adults to sort of model this calm behavior for kids? Because I feel like they
really pick up on our energy that way if we're really anxious. – Yeah they do, they're
just little investigators. They're very observant and aware more than what we often realize. And I think that there's
specific ways they could model some of these skills right now. We think a lot about how
problem solving is helpful. So if you have a problem and
it can be solved you're going to feel less anxious.
So an example would be if a
parent is trying to switch over a doctor's appointment or
a class to a video visit and they can do that. They could model for the child,
oh mommy had this problem, we're not able to go to the
visit so here's what I did to problem solve it and
wow I feel better now that I did that. If you can't problem solve something, really the other option is to
cope with it in healthy ways. So again like try to switch
over to a video visit, it didn't work.
Well, I did what I could and now I just need to change my channel to either listening to music, or playing a game with the family. 'Cause it's not gonna help me
to keep worrying about that. So that's something you
know that parents can model and really this idea of problem
solve something when you can and cope in healthy ways when you can't is probably helpful for
all of us right now. – Yeah. – And so it's something
that parents you know can model when they
can for their children. But also realize that again
they're not gonna be the perfect teacher and therapist
and everything right now because we just think that's unrealistic. – What additional challenges
might there be for people with autism or other
neurodevelopmental disorders that we haven't talked about yet? – I think that you know
the one that I mentioned is that piece about some
individuals with autism have heightened visual
abilities and visual memory.
So this piece about you know
that child seeing that image of the you know the way they're
depicting the virus looking really stuck with him. And maybe not in a way that it would stick with other people. So we have to be careful of
what they're being exposed to right now because it's just a lot of information that's confusing. And both on the side of the visual stuff can be difficult for
them because if that's something that gets stuck in their mind it can be hard to shift off of it. On the other hand, you
know you can do things to help support the visual
strengths right now, like having children
draw how they're feeling rather than talking to them about it. That's something that
we do a lot in therapy with kids with autism to you
know get their perspectives on how they're doing. The other things it sort of
just depends on the child. There's actually an area of
anxiety that we're researching at the MIND Institute. It was developed by a
psychologist named Connor Kerns and it's called fear of change, and it's something that we see more often in kids with autism.
So it's this idea of being
anxious about changing routines or change in schedules. So the kids that were
already having difficulty in that area are probably
really struggling right now. They probably never had an
experience in their life where their schedule has changed
to such an extreme degree. And you know parents have
to just do their best to make them comfortable
and help them cope and help them find things
that will reduce their anxiety like providing a visual
schedule for them at home, you know that's reasonable and help supporting them in those ways. – When is it time, at
what point should someone go see a professional when their anxiety has gotten the best of them? – So we have a, in the
one interview we do.
We talk about when anxiety gets turned on like a light switch and you
can no longer turn it off is where you're kinda hitting that point of thinking wow, this is at that level that we might really need
to do something about it. And if in the other concept that we think a lot about is interference. So if you just get anxious and
you kind of think about it, your parent gives you
reassurance and you feel better that's one thing. But if you get anxious and then you know you can't even get on the
phone to talk to grandma 'cause you're so anxious
and you can't even you know walk outside because you're so anxious. It's that level of interference that often makes the decision of that like is this to that problem
point that we'd really need to seek care. I think what's going on right now is that it's more typical than not to
feel some anxiety you know. So we would want to you
know help support kids during this time and then
see once this calms down is the anxiety still staying high, and to help them seek support if so.
– We're not suppose to
leave our homes right now unless we are on essential business or running an essential errand. You can still see a provider
here at UC Davis Health without having to leave your home. Can you talk to us about video visits and how many more video
visits you've been seeing? Yeah, so we, because we're
not seeing patients in person our staff in the MIND Institute
and also in psychiatry worked really hard to get
everything transferred over to video visits. It's a way of doing tele-health that we can do through MyChart. And so all of my therapy patients have been transferred over. It's a little bit strange
at first you know, I see some little kids and they're sort of my big head pops up on the
screen and they're like ah.
(both laughs) – Right on their tablet
or their I-phone at home. – Yeah they're like in
their bed or whatever. And so parents have been great
about like supporting them and do you want me to stay
here 'cause often you know I have a portion of the session
with the child just alone. So again it's that idea of flexibility. We have to do a lot of
things that don't feel like our usual way of doing things. And most of them have been really great and the patients that I'm,
you know I've been underway with treatment and we're
in the middle of it. We already have goals
we're setting you know they understand the format. It's just that they're
sitting at home rather than being in person. Anxiety therapy has a big
focus on what we call exposure, so it's about facing the
things you're scared of, and Dr.
Meg Tudor and I do
a lot of these exposures with patients when they come in. So that's a little tricky
because we would do the exposures with the patient first. Like a child who's you know
very very scared of germs and doesn't wanna touch doorknobs. We would work with them
and encourage them you know to touch a doorknob with us. So if they're not with
us in person you know we are being creative
about how much we can ask the parents to do at
home and how can still get that really important
part of therapy addressed.
But we feel like at the very
least if we can be supportive and continue to work on our
goals that would be one part of consistency in their lives right now. – Yeah. For those of you who are interested in learning more about video visits. You can contact UC Davis
Health, contact your provider at UC Davis Health. You can find instructions
online on how to do it as well and through what we
call My UC Davis online. It's the app or our
providers call it MyChart. So you can learn more that way. It's a really really great resource. Let's keep talking about resources. You are involved in something
called the STAAR Study. – Yeah so the STAAR Study
is, it stands for specifying and treating anxiety and autism research. So it's specific to kids
eight to 14-years-old who have autism and have
significant anxiety. So right now there is
you know a lot of anxiety going on in a lot of people,
that'll probably go down when this gets better. For kids that we're
looking for for this study it would be kids who have
more higher level of anxiety that's kind of persisting and
we have this treatment study.
So the study is that if they qualified for the screening criteria
they would be randomized to either cognitive behavioral therapy or medication group which is sertraline or pill placebo group. And they would see us in the office, the main part of the study is 16 weeks and then there's follow ups. So we right now, since we're
not seeing people in person, we aren't doing any of the,
starting any of the visits but we are doing the phone screens and we're trying to you
know capture information on families that would be interested now, and then we would be able to bring them in when it's safer.
So if people are interesting in that study the contact person is Taron Heckers and her phone number is 916-703-0119. – So if you're interested
you can learn more that can be available to you. – Okay, yeah that's great. – MIND has a new web platform too for, that contains resources
for families and caregivers of kids with autism and it's
really excellent for shelter and place time. – Yes, it is called helpisinyourhands.org. So that's actually the
website helpisinyourhands.org, and it's a free website that was developed by doctors
Aubyn Stahmer and Sally Rogers of the MIND Institute. And it was developed to help caregivers with skills to assist them in working with their children with autism. So it's based on the
early start Denver model. Which is something that that's the model they've been working on and
researching for a long time. – Is that the early intervention? – Yes. So this is targeted towards children who are like zero to three
years of age very young children and the website has these video modules that can kind of show
you how you could work on some of these skills
with your child with autism or showing signs of autism.
And I signed up on it today to you know that a thorough look,
it's very easy to sign up. It can be used on I
believe I-phones, I-pads lots of devices and again
it's completely free. – Is there anything else
that you'd like to add for our viewers who are dealing with anxiety,
sheltering and place? – Yeah I mean one other
resource that you know, I don't know if we'll be able to post. But Dr. Pakyurek is our division chief of child and adolescent psychiatry. And he was interviewed by KCRA on you know how psychiatry is handling this as well. I think similar to us we're
switching to these video visits. And I think other things are
really there's the lovely part of social media right now
is that parents are posting a lot of really creative
things that people can do with their kids at home. You know some examples I've
seen are you know I mentioned my favorites of my scavenger
hunts and my forts. But there's a website where
celebrities will read books to your children.
There's another website where
a famous children author will do doodle, do a doodle that your, and it's kind of you know
he's doing it kind of live and your children can do it, and there's zoos that are showing animals. So we don't want people to
you know slip into doing a massive amount of screen
time because we want kids to get physical activity, and to get these productive activities. But there's been some
pretty creative ways set up for children to access you know learning and maybe have some time on screens that could be really
fun and really unique. – And productive and comforting
to kids and parents alike. – Yes yes.
– [Interviewer] So someone asked that their granddaughter's anxiety is surfacing in the way of controlling
behavior regarding her classwork. Do you have any suggestions
on how this person can help their granddaughter prime
in order to be ready to do classwork at home
versus in the classroom? – So you know I think one
thing that can be helpful is before classwork has started
to bring right before it an activity that's likely to
be more relaxing or settling. So you know depending
on what options you have within the boundaries of your house. But swinging on a swing
or jumping on a trampoline or doing something physical
like that to kind of calm the body and mind and get
it ready for the work.
The other thing is maybe
it's just confusing what's expected at home or the work times are a little bit longer than
what the child's used to. So maybe starting out with
just doing like a few problems and saying we do a couple
minutes and then we take a break and we get a fun reward to help start this you know new process that she's
probably not used to doing. – So really, I mean it's just
a time of change for everyone. – Yes, yes. – And your message of flexibility
I think is so important. – Yeah and you can even get really specific about flexibility. So I've talked to a few kids
on my video visits this week about like that do you know
what flexibility means, and couple of them were like nope. (laughs) And I'm like well, it means
you know when there's something that we're used to doing one way and we really are encouraged
to do it another way to sort of be willing to try.
You know for the sake of
maybe yourself or the family. So you can even say to kids like you know, something I might say is well this morning I had to be flexible when my child was like tapping on my face and asking me to sing Old McDonald before it was wake up time. – How fun for you. – So yeah. So I was flexible this
morning so now I'm asking you to you know sit down do this
or you know eat your lunch at a time you're not used to. Let's see if you can get
some flexibility points. And you can you know reinforce
them by giving them points for it and making it kinda like a game like who can be the most flexible today. Because they think that's
so much of this adapting and being flexible is just not
something where you know kids are like really used to working on. And so if we explicitly
describe it to them and then give them a chance to try it, that might help as well. – For more coronavirus information
from our reliable sources here at UC Davis Health, please visit
health.ucdavis.edu/coronavirus.
Thanks again for being with us. (soft music).
(lively music) – I'm Pamela Wu and with me today is Dr. Breanna Winder-Patel
a clinical psychologist at our world renowned MIND Institute. MIND as we call it here
performs research on and provides care for
neurodevelopmental disorders. Today we're going to be
discussing how to help adults and children both with and without neurodevelopmental disorders in this time of coronavirus anxiety and lots of routine changes as well. Dr. Winder-Patel thanks for being with us. – Thanks for having me. – Many of our viewers
have been experiencing a lot of anxiety since
the coronavirus began. What have you been
seeing in your practice? – Yeah so before we get started
I just wanna mention that Dr. Meg Tudor is also a
psychologist at MIND and we work together on getting
these materials ready and then in this effort
of you know physical or social distancing
she wasn't able to come. So there's probably more
things we're gonna develop over the days to come about this and she's kind of equally involved. So I wanted to mention that and she has a similar
practice to mine at MIND. What we're seeing is that
you know this is a time of high-anxiety for a lot of people.
What underlies anxiety is we think of, has a lot to do with fear of uncertainty and worries about uncertainty, and obviously there's a
lot of uncertainty for us at this time. So we would expect people to
have some anxiety that's higher and that's a way that
we're sort of designed to look out for dangers. Some people are having some
anxiety that's even excessive for what's going on. And we have you know a mechanism called the fight, flight or freeze mechanism, that we all have for when
we're in a true danger.
And it's important for
that to go off if like a bus is coming towards
you or something like that. But it's not, we have that go off as like a false alarm sometimes and I think that's happening some. So what we're seeing in our
practice is some of the kids are talking about the coronavirus in ways where they're pretty anxious about it. But actually some aren't as
anxious as they usually are because the things that make them anxious, like separating from their parents or interacting with peers. They're not doing right
now, they're kind of at home in their safe space.
It's a lot of transition
to move to the video visits so that's been part of what
we're trying to work on to continue to provide care. – What can parents tell
children who are anxious about the coronavirus? – Yeah, so we want children to have you know specific
fact-based information. So there are a lot of
myths kind of going around and information that can
be really scary for kids, and it's best to not completely
keep them in the dark. But give them some information
so they understand like the true honest effort that
they're parent is giving to let them know about it. So for example, we would
want kids to know things like you know we would want
them to understand that people have viruses all the time and that the difference with this virus is that we don't want so many
people to get it at once, so that the hospitals and the
doctors are just too busy. So we're all really working
hard to stay at home from school and home from work to give
them the space they need to work on this virus. And for a lot of kids that's
kind of enough information obviously, it depends on their cognitive and language level.
But it's not something we need
to be talking about all day. So you know it can be,
provide some information try to get in there and
see if there's any myths the kids are walking around with, and then move on to something
more fun and relaxing like movie or a family game. – So it's not just you sort
of delivering this information to your child, but you said to sort of ask if they are thinking of any
thing that we know to be myths. So it's really like encouraging
a discussing and maybe would you ask a child say. Honey what do you know
about the coronavirus? – Yes, because we don't wanna
assume that they're having certain thoughts about
it that they're not. I had one child actually
convey to me that, and this is a child with
autism that the biggest worry was the visual image of what
everyone's putting up there that the coronavirus,
you know the depiction of what the virus would
actually look like.
– Oh the ball? – Yeah. So if you think about that ball you know, it is a scary looking ball
with red pointy things coming out of it. You know and the child's fear wasn't about getting the virus or dying. The fear was about like,
that thing looks really evil and I don't want that inside of my body. So they're interpretation
of what's going on really to this virus, was a
little bit different than what you would expect. And so you have to really see you know what is your own child thinking
about versus assuming that everybody is just
worried about getting it, 'cause that might not be it. – That's really interesting information that parents would wanna tease out.
– Yeah. – Well since schools are closed and there is an important
focus on the social distancing, which is why we're sitting
not closer together. We're sitting this far apart
at this table right now. What would be helpful
for parents to include in their daily routines with
their kids being at home? – Yeah so since this is
a time of uncertainty we would want to be able to provide them with the most kind of
structure and routine in ways that they're familiar with, so that they feel like
they know what's coming.
So we would encourage parents
to try to put some routine in place at home like
similar wake up times, knowing when meals are coming. You know knowing if
school work is expected at a certain time and when
the fun time is gonna come. We also, you know, I'm
hearing a lot of information about parents who are
expected to work from home in addition to taking
care of their children, in addition to teaching their children. And it's just so entirely
unrealistic to put the pressure of some like idealistic
schedule on these families. So I think the idea is to
try to keep some structure for the child. But also to be really
flexible and kind of you know easy on yourself that
that's not gonna happen in a perfect way everyday
and we're expected to all do things that are
really unfamiliar to us.
You know it might be a time if the child is really struggling to do the
traditional way of learning. Maybe it's a time to focus
on experiential learning that's where we think of
teaching them hands-on things like how to measure the
ingredients for you know what they're making, or going outside for a walk
and trying to identify trees or flowers that we know of. You know that type of learning
is really important too and parents are actually
doing that a lot of the time they might not realize that.
And the other thing is
to think about you know are there things that you
really loved as a child that were really meaningful
and maybe this is a time to do it. Like you know I was a big
fan of like making forts and doing scavenger hunts
and all of these things. And at the end of this we want
kids to be able to look back and not feel like wow
that was so much tension the whole time. We want it to be able to be like well, it was kinda stressful for everyone but I had some really great
experiences with my family and I learned, and now I
have some great memories.
So it's a balance and we have
to be kinda easy on ourselves at this time. – That is such good advice
I think so many families need to hear that right now. – Yeah. – We've been talking about
routine you talked about sort of developing a flexible schedule 'cause kids
like to know what's coming. A lot of children and people, adults too with neurodevelopmental disorders
really thrive on routine and for a lot families their home life has just been completely upended by this.
So what are some of the special challenges for families who have
a member of the family with a neurodevelopmental disorder? – Yeah. Well I mean I think
the biggest one is that you know in our world in
my field we talk about we don't expect the parents
to be the therapist. We expect if you need a
therapist you go to a therapist. And the same with parents being teachers, if you're not a teacher that's a really big
responsibility to put on a parent. And now like parents
are everything. (laughs) – Yeah they're right. – Right now for children with
neurodevelopmental disorders that have in-home services
that have been suspended. They're not getting that support
they need and they're not getting those therapists and
they're kind of mean to be the therapist and the teacher.
So I think the challenges
are that really the support. A lot of times individuals with
neurodevelopmental disorders have a lot of extra
therapies and interventions that aren't happening right now. So we would encourage
parents to you know keep with those strategies as they can, and see if there's other
resources they can get through you know if they have any
option for video visits with the provider, and you
know there's a resource we're going to mention
that the MIND Institute, faculty of the MIND Institute developed that might be helpful as well. So I think it's the extra
challenges are probably related to you know really feeling like they were so used to that routine and
what they did everyday, going to school going to therapy and having trouble understanding you know why is this so different and why don't we have a choice right now.
– So again just kind of
being supportive of them trying to include things
they really enjoy. Include their special
interests in their day. One thing we talk about is
that if a child has a special interest in something it
could help you explain the pandemic to them. So for example if they're
really into superheroes you could say well the
healthcare workers are kind of like Iron Man, and their job right now is to go after this thing that they're trying
to you know fight against, and we need to give them
to space to do that. And you know eventually,
you know Iron Man defeats the Mandarin just like we're helping the healthcare workers defeat the virus. So sometimes pulling in
their special interests can give them some feel
like they have some control and some better understanding. But it's really just about
trying to keep the routine the same but also being
understanding that you know, that's a huge expectation. – Absolutely, you mentioned
that sometimes kids might not be as scared as we think they are. Because we're so immersed in the news and so there is a lot
of fear among adults, but kids might not be as scared.
For kids who are scared though
like the one that you said was scared of the scary
red ball entering his body. What can parents do to support those kids and give them a feeling of security? – Yeah great question. So one of the things that we
think about with thoughts. If we're having a lot of what if thoughts, that's usually a sign
it's an anxious thought. Because we're asking like
what if the bad thing happens and we don't know yet
cause it's uncertain, it's in the future. So if you're hearing a
lot of what if thoughts from the child, you know
it's a tendency for parents to just say like oh don't
worry or it'll be okay.
But for some kids that
reassurance doesn't work and part of why that
doesn't work is because they have this thought
and it's not going away. So we have a strategy of getting
the child to look for proof for their thoughts. So you know if your thought
is what if I'm going to get very sick and die. Looking for proof would be
saying things like oh you know is anyone in my house sick? Are we responsible with
the physical distancing you know that we're doing? Are we washing our hands? Do I have any proof that I'm actually in a
true danger right now? And if that proof isn't there,
then we have to question is anxiety telling us the truth.
So we talk about externalizing the anxiety and being able to decide
whether to listen to it or not. So if you look for proof and you realize you don't really have any, that the anxiety is telling you the truth. Then we encourage children
and adults to do something called change the channel in your mind, that's what we call it. So we teach little kids,
your mind is like a TV and if you're kinda stuck
on the anxiety channel and it's not helpful for you.
We have to kinda let that
channel go and switch it over to something that's calming and relaxing. I, this week was like I need
to find something personally to change my channel, and so I found the book called Joyful. It's about you know looking
around in the physical world and understanding how
it impacts inner-joy. So if I'm having these thoughts that are not helpful right
now I change my channel to either thinking about
the ideas in the book or even like If I can take a break, going and listening to it.
I may or may not have
been hiding in my closet listening to it last night. (both laughs) – Change it to the joyful channel. – Right right. So it's you know things
like this that adults need to implement too because
we have the worries as well but we also have many
of us the responsibility of taking care of our children. – Yeah. That leads me actually
to my next question. How important it is for
adults to sort of model this calm behavior for kids? Because I feel like they
really pick up on our energy that way if we're really anxious. – Yeah they do, they're
just little investigators. They're very observant and aware more than what we often realize. And I think that there's
specific ways they could model some of these skills right now. We think a lot about how
problem solving is helpful.
So if you have a problem and
it can be solved you're going to feel less anxious. So an example would be if a
parent is trying to switch over a doctor's appointment or
a class to a video visit and they can do that. They could model for the child,
oh mommy had this problem, we're not able to go to the
visit so here's what I did to problem solve it and
wow I feel better now that I did that. If you can't problem solve something, really the other option is to
cope with it in healthy ways. So again like try to switch
over to a video visit, it didn't work. Well, I did what I could and now I just need to change my channel to either listening to music, or playing a game with the family.
'Cause it's not gonna help me
to keep worrying about that. So that's something you
know that parents can model and really this idea of problem
solve something when you can and cope in healthy ways when you can't is probably helpful for
all of us right now. – Yeah. – And so it's something
that parents you know can model when they
can for their children.
But also realize that again
they're not gonna be the perfect teacher and therapist
and everything right now because we just think that's unrealistic. – What additional challenges
might there be for people with autism or other
neurodevelopmental disorders that we haven't talked about yet? – I think that you know
the one that I mentioned is that piece about some
individuals with autism have heightened visual
abilities and visual memory. So this piece about you know
that child seeing that image of the you know the way they're
depicting the virus looking really stuck with him. And maybe not in a way that it would stick with other people. So we have to be careful of
what they're being exposed to right now because it's just a lot of information that's confusing. And both on the side of the visual stuff can be difficult for
them because if that's something that gets stuck in their mind it can be hard to shift off of it.
On the other hand, you
know you can do things to help support the visual
strengths right now, like having children
draw how they're feeling rather than talking to them about it. That's something that
we do a lot in therapy with kids with autism to you
know get their perspectives on how they're doing. The other things it sort of
just depends on the child. There's actually an area of
anxiety that we're researching at the MIND Institute. It was developed by a
psychologist named Connor Kerns and it's called fear of change, and it's something that we see more often in kids with autism. So it's this idea of being
anxious about changing routines or change in schedules. So the kids that were
already having difficulty in that area are probably
really struggling right now.
They probably never had an
experience in their life where their schedule has changed
to such an extreme degree. And you know parents have
to just do their best to make them comfortable
and help them cope and help them find things
that will reduce their anxiety like providing a visual
schedule for them at home, you know that's reasonable and help supporting them in those ways. – When is it time, at
what point should someone go see a professional when their anxiety has gotten the best of them? – So we have a, in the
one interview we do.
We talk about when anxiety gets turned on like a light switch and you
can no longer turn it off is where you're kinda hitting that point of thinking wow, this is at that level that we might really need
to do something about it. And if in the other concept that we think a lot about is interference. So if you just get anxious and
you kind of think about it, your parent gives you
reassurance and you feel better that's one thing. But if you get anxious and then you know you can't even get on the
phone to talk to grandma 'cause you're so anxious
and you can't even you know walk outside because you're so anxious. It's that level of interference that often makes the decision of that like is this to that problem
point that we'd really need to seek care. I think what's going on right now is that it's more typical than not to
feel some anxiety you know. So we would want to you
know help support kids during this time and then
see once this calms down is the anxiety still staying high, and to help them seek support if so.
– We're not suppose to
leave our homes right now unless we are on essential business or running an essential errand. You can still see a provider
here at UC Davis Health without having to leave your home. Can you talk to us about video visits and how many more video
visits you've been seeing? Yeah, so we, because we're
not seeing patients in person our staff in the MIND Institute
and also in psychiatry worked really hard to get
everything transferred over to video visits. It's a way of doing tele-health that we can do through MyChart. And so all of my therapy patients have been transferred over. It's a little bit strange
at first you know, I see some little kids and they're sort of my big head pops up on the
screen and they're like ah.
(both laughs) – Right on their tablet
or their I-phone at home. – Yeah they're like in
their bed or whatever. And so parents have been great
about like supporting them and do you want me to stay
here 'cause often you know I have a portion of the session
with the child just alone. So again it's that idea of flexibility. We have to do a lot of
things that don't feel like our usual way of doing things.
And most of them have been really great and the patients that I'm,
you know I've been underway with treatment and we're
in the middle of it. We already have goals
we're setting you know they understand the format. It's just that they're
sitting at home rather than being in person. Anxiety therapy has a big
focus on what we call exposure, so it's about facing the
things you're scared of, and Dr. Meg Tudor and I do
a lot of these exposures with patients when they come in. So that's a little tricky
because we would do the exposures with the patient first. Like a child who's you know
very very scared of germs and doesn't wanna touch doorknobs.
We would work with them
and encourage them you know to touch a doorknob with us. So if they're not with
us in person you know we are being creative
about how much we can ask the parents to do at
home and how can still get that really important
part of therapy addressed. But we feel like at the very
least if we can be supportive and continue to work on our
goals that would be one part of consistency in their lives right now. – Yeah. For those of you who are interested in learning more about video visits. You can contact UC Davis
Health, contact your provider at UC Davis Health. You can find instructions
online on how to do it as well and through what we
call My UC Davis online. It's the app or our
providers call it MyChart. So you can learn more that way. It's a really really great resource. Let's keep talking about resources.
You are involved in something
called the STAAR Study. – Yeah so the STAAR Study
is, it stands for specifying and treating anxiety and autism research. So it's specific to kids
eight to 14-years-old who have autism and have
significant anxiety. So right now there is
you know a lot of anxiety going on in a lot of people,
that'll probably go down when this gets better. For kids that we're
looking for for this study it would be kids who have
more higher level of anxiety that's kind of persisting and
we have this treatment study. So the study is that if they qualified for the screening criteria
they would be randomized to either cognitive behavioral therapy or medication group which is sertraline or pill placebo group. And they would see us in the office, the main part of the study is 16 weeks and then there's follow ups. So we right now, since we're
not seeing people in person, we aren't doing any of the,
starting any of the visits but we are doing the phone screens and we're trying to you
know capture information on families that would be interested now, and then we would be able to bring them in when it's safer.
So if people are interesting in that study the contact person is Taron Heckers and her phone number is 916-703-0119. – So if you're interested
you can learn more that can be available to you. – Okay, yeah that's great. – MIND has a new web platform too for, that contains resources
for families and caregivers of kids with autism and it's
really excellent for shelter and place time. – Yes, it is called helpisinyourhands.org. So that's actually the
website helpisinyourhands.org, and it's a free website that was developed by doctors
Aubyn Stahmer and Sally Rogers of the MIND Institute. And it was developed to help caregivers with skills to assist them in working with their children with autism. So it's based on the
early start Denver model. Which is something that that's the model they've been working on and
researching for a long time.
– Is that the early intervention? – Yes. So this is targeted towards children who are like zero to three
years of age very young children and the website has these video modules that can kind of show
you how you could work on some of these skills
with your child with autism or showing signs of autism. And I signed up on it today to you know that a thorough look,
it's very easy to sign up. It can be used on I
believe I-phones, I-pads lots of devices and again
it's completely free. – Is there anything else
that you'd like to add for our viewers who are dealing with anxiety,
sheltering and place? – Yeah I mean one other
resource that you know, I don't know if we'll be able to post. But Dr. Pakyurek is our division chief of child and adolescent psychiatry. And he was interviewed by KCRA on you know how psychiatry is handling this as well.
I think similar to us we're
switching to these video visits. And I think other things are
really there's the lovely part of social media right now
is that parents are posting a lot of really creative
things that people can do with their kids at home. You know some examples I've
seen are you know I mentioned my favorites of my scavenger
hunts and my forts. But there's a website where
celebrities will read books to your children.
There's another website where
a famous children author will do doodle, do a doodle that your, and it's kind of you know
he's doing it kind of live and your children can do it, and there's zoos that are showing animals. So we don't want people to
you know slip into doing a massive amount of screen
time because we want kids to get physical activity, and to get these productive activities. But there's been some
pretty creative ways set up for children to access you know learning and maybe have some time on screens that could be really
fun and really unique. – And productive and comforting
to kids and parents alike. – Yes yes. – [Interviewer] So someone asked that their granddaughter's anxiety is surfacing in the way of controlling
behavior regarding her classwork. Do you have any suggestions
on how this person can help their granddaughter prime
in order to be ready to do classwork at home
versus in the classroom? – So you know I think one
thing that can be helpful is before classwork has started
to bring right before it an activity that's likely to
be more relaxing or settling.
So you know depending
on what options you have within the boundaries of your house. But swinging on a swing
or jumping on a trampoline or doing something physical
like that to kind of calm the body and mind and get
it ready for the work. The other thing is maybe
it's just confusing what's expected at home or the work times are a little bit longer than
what the child's used to. So maybe starting out with
just doing like a few problems and saying we do a couple
minutes and then we take a break and we get a fun reward to help start this you know new process that she's
probably not used to doing. – So really, I mean it's just
a time of change for everyone. – Yes, yes. – And your message of flexibility
I think is so important. – Yeah and you can even get really specific about flexibility. So I've talked to a few kids
on my video visits this week about like that do you know
what flexibility means, and couple of them were like nope.
(laughs) And I'm like well, it means
you know when there's something that we're used to doing one way and we really are encouraged
to do it another way to sort of be willing to try. You know for the sake of
maybe yourself or the family. So you can even say to kids like you know, something I might say is well this morning I had to be flexible when my child was like tapping on my face and asking me to sing Old McDonald before it was wake up time. – How fun for you. – So yeah. So I was flexible this
morning so now I'm asking you to you know sit down do this
or you know eat your lunch at a time you're not used to. Let's see if you can get
some flexibility points. And you can you know reinforce
them by giving them points for it and making it kinda like a game like who can be the most flexible today. Because they think that's
so much of this adapting and being flexible is just not
something where you know kids are like really used to working on.
And so if we explicitly
describe it to them and then give them a chance to try it, that might help as well. – For more coronavirus information
from our reliable sources here at UC Davis Health, please visit
health.ucdavis.edu/coronavirus. Thanks again for being with us. (soft music).