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\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div><\/div>\r\n\r\nThey’re told that it’s not a real threat. So\r\nI’m curious how you see that intersecting with the decisions\r\nto pursue exposure, what other options there might be? Absolutely. So, I think as I\r\nread that question, I think one thing that I want to think about\r\nthere is that we are not telling kids whether or not the threat\r\nis real and I think that’s where people tend to fall into that\r\na trap of gaslighting, right? because in for gaslighting\r\nsomebody is like, oh, this is a threat, this is a problem and\r\nother people are dismissive of it and say, “No, it’s not\r\nwhat are you talking about.” right? and when it comes to\r\nanxiety for you, we are not weighing in on whether something\r\nis threatening or not. Our job is to better help them be able\r\nto examine the evidence themselves. and sometimes we do\r\ncome to the conclusion jointly that actually, this is a\r\ndangerous situation. There is a real threat here, in which case,\r\nthere’s a different intervention that needs to happen in order\r\nto, to ensure one’s safety, right, but I think that is\r\nreally key.\r\n\r\nWe do not want to fall into the trap of weighing\r\nin and saying, This is no big deal. Just get over it. That is\r\nproblematic if there is a true threat and it is very\r\nproblematic, even if there is not a true threat, right,\r\nbecause it’s also super invalidating for people who are\r\nlike, actually, this is really hard for me, right? So either\r\nway, that’s problematic for us to say, this is no big deal.\r\nThis isn’t a problem. We want to – our goal is to help them\r\nevaluate the situation and really pull in more evidence. Kendra Read: One of the things\r\nthat Jen noted earlier is that youth and actually people with\r\nproblematic anxiety tend to interpret the information around\r\nthem in ways that are either extra picking up on threatening\r\nsituations or misinterpreting things, so we just want to be\r\ncareful and for into – for when we think about racial\r\nmicroaggressions, this may not be misinterpretations and often\r\nare no misinterpretations. So, we want to be really fair and\r\nsaying, in laying out the evidence for what’s, what’s\r\nhappening. So, we can be really clear and not behaving\r\nconversations where we’ve already arrived at a decision\r\nand we’re just teaching you, that’s where or dismissive in\r\nsome way.\r\n\r\nAnything you would add to that,\r\nJen? Jennifer Blossom: I think, to\r\nthe point that you’re making one of the things that we think\r\nabout when approaching a situation that kiddo or family\r\nis describing as anxiety-provoking, just kind of a\r\ndecision tree that we work through and initially you ask is\r\nthe fear realistic? So when I think about the question that\r\nwas asked, and the consequences of racism? The answer to that\r\nwould be yes. Right? The fear is realistic in that situation and\r\nwhen that situation arises, then we work on figuring out is this\r\nsomething that kiddo should know how to manage? If there are\r\nspecific things that we want them to know how to manage, then\r\nwe want to give them the skills to do that. So, that’s kind of\r\nour initial decision point there and I think that that’s where we\r\nwant to be thoughtful of the experience of racism, there’s\r\na very real reason why that would be immediately threatening to\r\nsomebody. So that’s, that’s the lens in which we would approach\r\nit. Yeah, totally agree. Totally\r\nagree. All right. So, in terms of what teachers can do,\r\ntruthfully, we want teachers to work with students and families\r\nas issues come up to encourage this idea of approach\r\ninstead of avoidance.\r\n\r\nI think Jen and I have both read a lot\r\nof different, you know, IEP or 504 plans that have clauses in\r\nit that end up accidentally reinforcing avoidance and then\r\nour feedback is, is around how to turn this piece around so\r\nthat we’re actually moving toward the feared situation and\r\nlearning more adaptive responses, rather than\r\nencouraging avoidance, just in order to reduce that experience\r\nof anxiety and in many ways, we use a school to home note, which\r\nI’ll show you in a second. I’m sure many of you have used\r\nvariations of these notes for different behavioral concerns\r\nthat have come up in classrooms and the application of this to\r\nanxiety is not really so different but as you work with\r\nyouth with anxiety, I really think about how to be supportive\r\nand what it actually means to be supportive to somebody with\r\nanxiety and that means to approach situations with this\r\nan important combination of both validation and confidence. It’s\r\nthe “I know it’s hard and I know you can do it.” combination.\r\nOftentimes, we see people fall into traps where they’re just,\r\nyou know, holding on to one of those two pieces of that\r\nequation.\r\n\r\nSo either just validating like this is so hard\r\nand kind of getting stuck in the admiration of the difficulty, or\r\nholding on to the confidence piece of like, buck up, kid,\r\ncome on, you can do it, this is no big deal, and both of those\r\nalone are problematic and in terms of moving anxiety\r\nintervention forward, so we really need the combination of\r\nboth of those to build a supportive environment. Kendra Read: So just, you know,\r\nas I mentioned, this is an example of a school to home\r\nnote, as we apply it to anxiety and I would imagine, you know, I\r\nkind of took the framework from this directly from our ADHD\r\ndisruptive behaviors clinic, which shows you just how similar\r\nthe behavioral approaches can be. So essentially, we just want\r\nto set a behavioral goal with a family around anxiety, obviously\r\nthis example is for a younger child. If you look at the smiley\r\nfaces and all of that, we want to set like a really specific,\r\nobservable, time-limited, you know, smart goal around an\r\nanxious anxiety or brave behavior. So for this child,\r\nthis example child, their goals are around, walking into class\r\nindependently, whispering to the teacher three times throughout\r\nthe day, and raising their hands during specials and then we want\r\nto make sure that we’re giving them opportunities to reach\r\nthese goals, tracking their progress and then finding\r\nhaving some way of coordinating that information back to parents\r\nso that they can or other caregivers, so they can really\r\nreward and reinforce their youth progress toward more brave\r\nversus avoidant behaviors in the school setting.\r\n\r\nJennifer Blossom: Kenda, if you\r\ncould just go back to the last slide there is relevant to one\r\nof the questions that came in asking about what age you can\r\nuse these principles with kids and, as noted, as Kendra noted\r\nhere with the smiley faces, this is a school to home note that’s\r\nreally designed for, you know, kiddo as young as in\r\nkindergarten, what we know is that you can employ these\r\nstrategies, you can use these approaches with kids as young as\r\nthree, you know, oftentimes, we’re then talking more to the\r\nadults in the kid’s life.\r\n\r\nSo, talking to the teachers, talking\r\nto the parents or other caregivers, that these skills\r\nand these strategies still work well, even with really young\r\nkids and that oftentimes, if we can catch them that early, we’re\r\njust setting them up for better success so that we can really\r\nleverage the strengths of that of those brains that are wired\r\nmore towards anxiety and help them meet their goals. Absolutely, thanks, Jen and I\r\nwould say that actually, our anxiety programs go down to age\r\ntwo at Seattle Children’s, and all the way up through age 18\r\nand beyond. I mean, not at Children’s but these principles\r\nare universal, regardless of age and there are just some\r\nadaptations in terms of exactly how you would apply this for\r\ndifferent age groups. So as Jen mentioned, for kids, I would\r\nsay roughly seven and younger, I’d be working much more with\r\nparents than with kids directly. That’s really different than\r\nthose then you know, it’s a different kind of story or\r\nopportunity for those of you in school settings.\r\n\r\nSo we can talk\r\nmore about that in the question and answer period if you would\r\nlike. Kendra Read: Okay, as I\r\nmentioned, in terms of supporting youth with anxiety in\r\nschool settings, we tend to see some common pitfalls, of tending\r\nmore toward accommodation versus approach in anxiety-provoking\r\nsituations in formalized 504\/IEP plans and I -accommodation is\r\nthis good word, bad word. In a school setting, it tends to have\r\na really positive connotation. In the anxiety world, it has a\r\nreally negative connotation. So, accommodation means essentially,\r\nyou know, being complicit with a child’s anxiety and helping them\r\navoid anxiety-provoking situations. So when Jen and I\r\ntalk about accommodating anxiety, we’re thinking of, you\r\nknow, parents who will never ever go out on a date night\r\nbecause their child doesn’t want to be alone or who will never\r\neat at the same table as their kid because their child can’t\r\nhandle it, different things like that.\r\n\r\nSo just want to note that\r\nwe use that word really differently across our different\r\nsettings but in general, it has it all goes back to that\r\napproach versus avoidance difference. So, a lot of problematic\r\npitfalls that we run into are things like these\r\ncontra-indicated accommodations, like extra time, not calling on\r\na student or allowing, directly allowing avoidance of certain\r\nspecific activities.\r\n\r\nExtra time is a really tricky one and I know, we have a lot of conversations about this all the\r\ntime, it comes from a good place of wanting youth who may be\r\ndistracted by their anxiety to have more time to, you know,\r\nmanage that, when in reality, what tends to happen when we\r\ngive you extra time, when we give youth with anxiety extra\r\ntime is that they tend to spend that time worrying or engaging\r\nin more anxious behaviors more avoidance, so it ends up not\r\nbeing a helpful intervention in the end. My internet connection is a\r\nlittle unstable.\r\n\r\nSo, apologies if I’m breaking up. As I mentioned, things like\r\nrelaxation strategies, strategies, and journaling are\r\nnot bad things to do, but they’re also not helpful. So we\r\nwould not want those to be considered the primary\r\ninterventions for anxiety in any setting and really, it also\r\ncomes down to really requiring this partnership from all\r\nparties, from teachers, specialists, caregivers, so that\r\nthere is a clear plan for what we’re working on and how we’re\r\ngoing to be approaching this in a situation that is supportive\r\nto the child, so involving that combination of confidence and\r\nvalidation. The “I know it’s hard, and I know you can do it,\r\nand here’s what we’re going to work on” and I think sometimes\r\nwe’ve, you know, heard from school-based personnel who feel\r\nkind of reticent to approach exposures in their setting thing\r\nlike, “Well, I’m not a therapist, maybe I shouldn’t be\r\ndoing this.” but in reality, we all have ownership and agency in\r\nthis in this behavior change and this change about problem\r\nproblematic anxiety, even if you’re not a quote-unquote\r\ntherapist or psychologist, we need youth to practice exposures\r\nin all settings in order for this to generalize to all\r\nsettings.\r\n\r\nSo, it’s really important that these things are\r\npracticed in the school setting as well. Okay, Jen, come back for our\r\nQ&A. Jennifer Blossom: So, we have\r\nbeen working with a lot of people internally at Seattle\r\nChildren’s, as Kendra mentioned, I was there. The working\r\nremotely, as I’m sure many of you are just over a month ago,\r\nas well as many, many people throughout the greater WWAMI\r\nregion and there’s been a few common questions that have come\r\nup that we opted to highlight here and I’m also aware that\r\nthere have been a number of questions that may have been\r\ncoming in over the Q&A section. So, thank you so much for\r\nsending those in, please feel free to continue sending those. So, my thought is that we’ll\r\njust jump right into the question and answer questions\r\nthat are coming in. So I think one, one question in which I’m\r\nseeing kind of a few iterations are going back to this idea of\r\nthe 504 plan and how we develop a 504 plan that acknowledges and\r\nintegrates the evidence-based recommendations for anxiety and\r\none of the ways that I think about that is really getting\r\nconcrete on some of the goals in the school setting and instead\r\nof providing, providing kind of a blanket statement, like more\r\ntime to finish something is figuring out where the child\r\ncurrently is, what are they currently able to do and where\r\ndo we want them to be? and then how do we find those steps to\r\nget them towards that ultimate goal? So, how can we phrase\r\nsomething that allows them to take steps towards participating\r\nin the class? You know, being able to complete that assignment\r\nwhen they’re asked to, in particular, think about a\r\na child who might have difficulty speaking in the classroom, one\r\nof the questions that came in was relevant to whether we can\r\napply these principles to selective mutism and the answer\r\nis certainly yes, Kendra and I do this a lot.\r\n\r\nKendra has a\r\nspecialty clinic that specifically works with families\r\nand helping kids learn how to speak in settings that they feel\r\nuncomfortable doing so. So, thinking about a 504 plan in\r\nparticular with a selective mutism kind of focus, if you\r\nhave a child who is completely nonverbal, who is not able to\r\nspeak out in the classroom, oftentimes what happens is we\r\nfind that teachers are jumping in or providing answers for\r\nthem. Other students might recognize again, well-meaning\r\ncompassionate people jumping in providing answers for them, what\r\nwe want to do is help, help encourage the child to start to\r\nbe able to answer the question themselves. So, a 504 plan might\r\nsay something like – initially might say something like respond\r\nto nonverbal. So, being able to shake your head yes or no,\r\nthat’s still providing some kind of information in engaging in\r\nsome kind of communication. If there’s a complete absence of\r\ncommunication, then it might be being able to whisper an answer\r\nto the teacher.\r\n\r\n
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\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div><\/div>\r\n\r\nSo we can think about what is the steps\u00a0and how can we integrate them into the 504 plan? So that\r\nwe’re getting the student and supporting them to\r\nbe able to answer a question in the middle class when, when\r\nother students’ peers are there. I would just add that, you know,\r\nI know that 504 plans often we can’t change them as quickly as\r\nwe would like to change behavioral goals. So, sometimes\r\nI encourage schools to phrase a 504 accommodation or an IEP\r\nthe goal, you know, honestly, IEP s with their, like the goal\r\nframework kind of lend themselves a little bit more to\r\nthis idea but the idea that we’re going to gradually be\r\napproaching and, you know, moving from totally not speaking\r\nto respond, you know, 80% of the time to the teacher in at\r\nleast a voiced response. So, you know, if you put your hand on\r\nyour throat, you feel your hand vibrating, right, and we just\r\nstate in the plan that we’ll be identifying weekly goals.\r\nThe teacher will be providing, enough opportunities for the child\r\nto reach their goal, and we’ll be providing support for the\r\nchild to try again and just kind of discuss what the\r\ncommunication plan from school to home looks like because that\r\ncan – that looks different for every school that I’ve worked\r\nwith, depending on what’s feasible.\r\n\r\nThere’s no one exact\r\nright way to do it and that gives us a little bit more\r\nflexibility to work on those successive shaping steps of\r\nmoving from, you know, just, you know, shaking our head, no, to\r\nmouthing no, to then whispering, to then talking. So, the\r\nexposures in school said, that’s one example. Kendra Read: There are exposures\r\nin school settings that can look so many different ways.\r\n\r\nIt just\r\nreally depends on the different situations. So sometimes we are,\r\nyou know, as the adults in the situation, setting up some\r\nsocial opportunities, for one child to talk to another,\r\nsometimes it’s like, okay, just so you know, I’m going to call\r\non you during this part of the day or sometimes I – a lot of\r\nkids have, are so anxious about making any mistake or they redo\r\nand redo and redo their work or they, you know that or there\r\nwork has to be perfectly neat.\r\n\r\n
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\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t<\/div><\/div>\r\n\r\nSo, then we have them turn in\r\nwork that they finished with their nondominant hand or they\r\ndefinitely made a mistake in there on purpose and they’re\r\ngoing to turn it in and see what is so bad about this, what is\r\nthe worst thing that happens when I turn in a mistake? So\r\nthere are all sorts of different exposures that you do in a\r\nschool setting and it just so depends on the specific fears\r\nthat the child is endorsing. Okay, so let’s, there was a\r\nthe question at the top about PTSD and anxiety, and whether or not\r\nthey can co-occur or would not be concurrently diagnosed,\r\nand absolutely PTSD and anxiety disorders can co-occur 100% they\r\ncan be diagnosed at the same time, we just want to be careful\r\nthat we’re not to double-counting the same symptoms and\r\nwe want to be clear that not every anxiety disorder, you\r\nknow, anxiety disorders don’t come about because someone\r\ndefinitely experienced a traumatic event.\r\n\r\nRight. You\r\nknow, fear of spiders doesn’t mean they’ve definitely\r\nexperienced like a horrible situation with spiders, for\r\nexample, or for selective mutism. This is one of the big\r\nones, where there’s this myth that they’ve experienced a\r\ntraumatic event and that’s why they’re not speaking. Not true,\r\nbut for PTSD, you know, that is like one of the only DSM\r\ndiagnoses where we know exactly that there was an event that\r\nprecipitated the onset of this disorder.\r\n\r\nSo, it is common for\r\nyouth who have are just getting anxious. Pre-traumatic event say\r\nthey have social anxiety. A traumatic event happens they get\r\nin a really bad car accident and they can’t get back in the car\r\nanymore. They have true PTSD related to the car accident, and\r\nthey have social anxiety. So these two things were not\r\ndouble-counting, but they are happening at the same time. Okay, Jen, I’ll let you pick\r\none. Jennifer Blossom: So, I’m seeing\r\na lot of questions and just getting some clarification\r\naround skill-building and why we are recommending against using\r\nstrategies like relaxation or journaling and so in particular,\r\njust thinking about why Kendra talks about relaxation in\r\nterms of the message that sends or the threat of the physical\r\nexperience of anxiety and the general idea is that we want\r\nkids to have that physical experience of anxiety and know\r\nthat does not automatically mean that the worst is going to\r\nhappen or that they’re not able to handle those feelings.\r\nThere are many situations we’re experiencing that physical\r\nanxieties, really helpful.\r\n\r\nIn the beginning, Kendra was\r\ntalking about, you know, if you’re preparing, if you have a\r\ntest on Friday, and I have no anxiety about that, then I’m\r\nprobably outside playing with my dogs not sitting – in front of a\r\nbook trying to understand the material, right? In some ways,\r\nanxiety is really helpful and adaptive. What can become\r\nproblematic is when anxiety is so high about the test that I\r\ncan’t even think about opening the book, because I’m so worried\r\nthat I’m not going to be able to, to learn what I need to\r\nlearn.\r\n\r\nSo, we really want to help, help kids and help\r\nstudents figure out that I can notice that I’m experiencing\r\nsome of that anxiety but I can still do the things I need\r\nto do. I feel anxious about the test but I’m still able to sit\r\ndown and focus on the material and study the way that I need\r\nto. When we tell them, “Oh you\r\nnotice that your heart is racing or you notice that your muscles\r\nfeel tense. Let’s take a moment and sit back and spend some\r\ntime breathing.”. What we’re doing is we’re sending the\r\nmessage that bad anxiety is really something to be worried\r\nabout or scary that they aren’t able to handle those feelings\r\nand then what happens is when they walk into class to take\r\nthat test, and they’re feeling those same feelings, they think\r\nthey can’t handle it. So, what we want them to do is practice\r\nhandling and practice tolerating. When I think about a\r\nstrategy, like journaling, one of the things that I think about\r\nis that, you know, anxious brains again, they do a really\r\ngood job of thinking.\r\n\r\nThey’re constantly thinking, they’re\r\nconstantly coming up with the what-ifs, what if, what if,\r\nthat’s what gets in the way of sleep, that’s what gets in the\r\nway of paying attention in class. So, if we ask somebody to\r\nwrite down all of those thoughts, and those what-ifs,\r\nwe’re not necessarily giving them the skills or the\r\nstrategies to still be able to do what they need to do and in\r\nIn some cases, we may be letting those what-ifs allow for\r\navoidance because now they’re writing about those what-ifs\r\ninstead of doing that thing, that’s hard and this is\r\nsomething Kendra and I have just recently started talking about\r\nkind of how can we rephrase and reframe thinking about exposure\r\nand practice based on your fear as the coping skill. I think\r\nthat’s one of the things that can get lost or is confusing is\r\nthat when we think about facing your fears that we’re ignoring\r\nthat, that is still is learning a coping skill because what I’m\r\nlearning is that when I feel anxious, I can still do what I\r\nneed to do.\r\n\r\nWhen I feel anxious, I can still pick up that book\r\nand sit down and read the first paragraph when I feel anxious, I\r\ncan still open my computer to start writing that essay. That’s\r\na coping skill and the way that you build that coping skills by\r\ntaking those smaller steps until you’re able to do that thing\r\nthat’s really hard. What would you add to that? Kendra Read: I would just want\r\nto add about there’s this piece that we call expectancy\r\nviolations.\r\n\r\nWe also want kids to have those learning experiences,\r\nto see that the thing that I expect to happen, really doesn’t\r\nalways happen, or even if it does, it’s not as bad as my\r\nbrain is assuming it is. This is the coping skill and I think a\r\nlot of people get wrapped up in the toolbox, and I need to give\r\nkids all these other things to do when they feel anxious but\r\nthe thing we need them to do is to practice staying in the\r\nsituation, and quote-unquote, riding the wave. So, I’m seeing\r\nsome other questions about like, what do we do in situations?\r\nLike when a kid is anxious, what do I do? and really, when that\r\nhappens for me, like all day long, I just want to – I sit\r\nwith them and I say, okay, so you’re experiencing anxiety,\r\nwhat’s happening in your body right now? How are you feeling\r\nit? What’s your number? I want them to practice rating on\r\na scale from say, zero to 10, how anxious they feel.\r\n\r\nSo,\r\nthat’s one way that they can build some mindfulness of saying\r\nlike, okay, I’m at like a seven right now and I’m noticing that\r\nmy stomach really hurts and that’s like, okay, so what are\r\nare you thinking at this moment? I’m thinking, I’m totally going to\r\nfail this presentation, I’m going to bomb it, everybody’s\r\ngonna laugh, etc, etc.\r\n\r\nAnd say like, okay, well what is\r\nhappening in this situation is anybody laughing? Like, well, I\r\ncan’t hear that anybody’s laughing. So maybe they’re not.\r\nMaybe they are in their own homes, but nobody’s mics are on\r\neverybody’s automatically muted. So, if I don’t know, if they’re\r\nlaughing, how will it ever change my life? So, just some\r\nthinking through some different situations like that to think\r\nthrough that expectancy violation, violating what we\r\nexpect – the anxious anticipation of what’s going to\r\nhappen. Okay. Jennifer Blossom: I see, I think\r\nwe, I hope we answered some of the questions about the Final\r\nFour Planner IEP is about how we can approach it. I see some\r\nquestions about like homeschooling and one on one\r\nthe school supports, and how do we help families understand this\r\nand man, is it hard, you know, I just want to validate that like,\r\nas much as we do this for a job, we don’t convince every family\r\nthat this is the important way to go and we really try to, to\r\nbring them in and discuss how, you know, you know, one of the\r\nother programs run at Children’s like a school avoidance program,\r\nwhich is not running this fall because most schools are remote.\r\nSo, there’s no brick and mortar school to avoid for most of our\r\nstudents, but what I tend to see is that the families that pull\r\nout into homeschooling because of anxiety, those kids tend to\r\nhave really escalating very problematic anxiety, very\r\ninterfering anxiety that continues for years.\r\n\r\nSo it does\r\nbecome a really big problem and so I just want to describe that\r\nthe trajectory that I see for them before they make that decision\r\nand be very clear that homeschooling online homeschool,\r\nwhich like we’re all pigeonholed into that right now\r\nbecause of COVID or most of us are, so we’re not making that\r\ndecision because of anxiety but when we do make that decision\r\nbecause of anxiety, it is contraindicated. It is\r\nproblematic in terms of changing this cycle. So it’s very, very\r\nmuch not recommended. ] Kendra Read: Jen, do you have a\r\nthe question you wanna? Jennifer Blossom: Yeah, I was\r\njust searching through the Q&A’s and I see a lot of questions and\r\nthinking about how we can adapt some of these recommendations\r\nand approaches, particularly for older students.\r\n\r\nSo, thinking\r\nabout high school students, and thinking about, there were some\r\ncomments about the student kind of report card can be more\r\nchallenging with a high school student and I think, you know,\r\nin some ways, really just kind of working, working with the\r\nstudent and figuring out kind of what’s going on for them at\r\nschool and at home. I think one of the things that we know that\r\ncomes up commonly when working with families is that oftentimes\r\nparents are not necessarily as attuned to some of the things\r\nthat may be coming up at school for their kiddos, Kendra and I\r\nhave worked with families where, you know, after kind of years of\r\nschool difficulty and some anxious avoidance in high\r\nschool, that’s when the parent found out about kind of what was\r\ngoing on. So I think, really making sure to work as a team.\r\nIn some capacity, I think something that can happen\r\ndevelopmentally is when working with younger kids that there’s a\r\ntendency to exclude them completely as if they can’t\r\nunderstand these principles. When, as Kendra says two and\r\nthree-year-olds, even if they’re not coming in for the treatment\r\nthe session, they get the idea that was brave, awesome job, right.\r\nSo we can still be working with them directly and integrating\r\nthese strategies with really young kids and in the same way\r\nwhen you’re working with high school students, just as you\r\nwould reach out to parents for, for other types of concerns, if\r\nyou were seeing chronic absenteeism or if there was a\r\nlot of missed work but bringing parents in to support high\r\nschool students are a really helpful and great opportunity\r\ntoo as much alignment as we can get with practicing some of\r\nthese strategies both in and outside of school, I think can\r\nbe really helpful and effective and when we think about some of\r\nthe types of anxiety that we see, more commonly, social\r\nanxiety is much more common in adolescence.\r\n\r\n