[Music] good evening and welcome to this special mental health edition of doctors on call I'm Mary morouse a psychotherapist with Insight Counseling of duth and I will be your host for our program tonight on Child and Adolescent mental health this is the first of four special mental health episodes that we will be airing throughout the season of doctors on call Future program will cover the topics of grief and loss couples and family mental health and Stress and Anxiety our program is here to answer your questions about mental health issues that may affect you your family or friends please call or email your questions and we will do our best to address them the telephone numbers and email addresses can be found at the bottom of your screen our expert guests this evening are Dr dallard a licensed psychologist with duth Psychological Clinic Dr Jud Judith Christensen a psychiatrist with St Luke Psychiatric Associates and an Mian a licensed professional clinical counselor and founder of Mian Mental Health Services our phone and email uh questions are being received this evening by members of the PBS North staff who will bring them to me here in the studio now let's begin with a discussion of Child and Adolescent mental health thank you all for being here tonight I'm very excited to have such a great colleagues on on here tonight so let's start with you um Dr dealler tell me a little bit about uh your practice and uh the the kind of work that you do sure I do Psychotherapy with adults and couples at the duo Psychological Clinic and then I do assessments with children and Adolescence at Northwood Children's Services okay wonderful Dr Christensen so I'm a Child and Adolescent psychiatrist actually the only one in our group uh I am exclusively in the outpatient setting so I see kids pretty much ages for and up and I do initial assessments and then follow up with them for medication management and uh often times uh working alongside their outpatient therapist at the same Clinic okay wonderful thank you and an I'm an Mian um I founded create Wellness Center for Child and Adolescent therapy and I see primarily kids three and up in my practice I am a registered play therapist so I practice I play therapy but I work with a wide variety of difficulties that come into my practice anywhere from anxiety trauma depression and a lot of big feelings so I have a wide variety of young people I see wonderful what a what a great group tonight so um adolescent Child and Adolescent mental health is very much in the news at more um now than I believe has has ever been which is such a good thing um we're talking about it more which is very good thing and I and I appreciate that what s and Dr D I'll start with you what sort of Trends do you see that you've seen that are kind of happening now whether it's postco or not but what sort of Trends do you see in your practice right now uh two Trends come to mind I do think even though we're knock on wood past the worst of coid there's a a lag effect in the effects of coid on family functioning I think there's been an increase in probably anxiety presentation that I see from the kids who I work with and also sort of an awareness that um uh child's academic progress got disrupted to some degree in coid a positive trend I see is we're all talking more candidly and openly about mental health problems the stigma around um or embarrassment around talking about it is diminishing and that's that's a fabulous Trend yeah I I agree Dr Christensen tell me about the trends you've seen well I'd have to say a lot of similarities um anxiety disorder seemed to have really flourished uh a little throughout coid and thereafter um thankfully I would say the uh amount of depression that I was seeing during the more acute part of the pandemic seems to have eased up and I really believe that's a function of being a kids being able to interact and connect once again those were incredibly hard times for kids I mean we talked about it a lot in the office over virtual visits and I just spent that time thinking this is a uh this is a a notable almost like a sentinel event in child development for all the kids who are living through this pandemic yeah absolutely Ann tell me a little bit I agree I I feel like we were talking about Co and although the lockdowns and virtual ual school and kind of in and out in person versus virtual is we leaving that in the past there is such huge gaps in development social skills and I think any kid that was in kindergarten and up once those pandemic years started is still seeing the effects of lower self-esteem due to academic gaps are not getting things I'm hearing that whole Collective classrooms and grades are behind and then all the Social Development pieces and and things that were missed and I think one of the big things I'm seeing as a part of that is when everybody was in less contact with one another there was actually some lowered anxiety for not having to do the hard things of life like being in the social situations or taking the hard tasks there was there was some ease with that and I'm seeing kids really struggle to go back and move into the hard things it seems really really difficult for them yeah that's a that's a great Point too of of people kind of you you got used to um kind of being comfortable with being comfortable yeah as opposed to learning to be comfortable with being uncomfortable and getting through those things because there was um there were a lot of times depending on the school and the age of the child that they didn't really have to deal with a lot of uncomfortableness yeah of of schedules or things like that um um so kind of going um along with along with that what sorts of things can parents when they're dealing with a child um one of their children and their their child is struggling when when do you say now is a good time to come in like when what's that kind and of course obviously it's it's it's different for every child but just kind of some some general things from from parents saying you know I'm worried about my my child that's you know whether or not to try and figure out if this is developmentally appropriate or it's time to come in and and and see um a higher level of care such a relevant question I I think I often start with um when I talk with parents what have you tried and how much have you communicated with your child about the difficulty and how's that gone so we'll try to um maximize the family's ability to cope with it and problem solve on their own then the next question might be have you talked with with other relevant adults like teachers or bus drivers or neighbors or coaches Etc and then if those things haven't worked and if there is significant impairment you know if the difficult is getting in the way of age typical tasks making and keeping friends achieving academically Etc then maybe it's time to engage a professional okay okay doc Dr Christensen can you I would agree with that uh sort of using the impairment and functioning as the defining line and I say that because if you take a look at the big book of Psychiatry a lot of the symptoms that can fall under different diagnostic criteria will happen without necessarily meeting that diagnostic criteria if we don't see that functioning in of sorry that impairment in functioning so I really talk a lot with patients about looking at the Continuum of being a human being so sometimes we might have a bit of sadness we might be a little bit anxious before the test that's in the realm of typical but boy if that ious now has you locked you go to write that test your mind is blank you can't remember a thing you come out of there like Shell Shocked uh you can't make any decisions those are the signs I'm like okay maybe we've stepped over into the the land of getting a little extra help on on the team okay great and do you have some things to add to that for for your practice I think that those are all the things that I look for in my practice as well and one of the questions that I'll ask parents and families is how long has this been going on for your child I I tend to find that things that are a little bit more shorter termed like I'm having some stress because of my sports season it's hockey season tryouts were coming I was pretty anxious about that but after I got into my season the anxiety went down maybe it was a problem that I call a family problem a problem that the family can solve but if the duration is longer that's really when I'm thinking that therapy might be helpful and I like to talk with parents I'm very numbers based I'll say if there was a pie chart of your child's life what percent of the pie would be focused on this problem so how often would they be anxious what percent of the pie would they take up and as they answer those questions it becomes a little bit clearer is this a smaller slice of the pie can the family handle it are we moving through it or has the piece grown to be almost their entire day right so those are a couple questions I ask yeah great great thank you um very much and I know sometimes the some of the things I see are just um you know things that are just um very small blips but but um seem bigger because we don't have the skills to kind of again kind of deal with the some of the some of the smaller things let's um um talk about a little bit about um anxiety so we we'll pull out anxiety what sorts of things like again in a very general sense do you are you seen with kids coming in with anxiet and then what are like some like tools that you feel like are have been helpful with some of your clients with anxiety so anxiety is a feature of human functioning and we'll always see anxiety but I feel like the sorts of anxiety that maybe have shown up more in the last couple of years are various forms of social anxiety a lot of kids in adolescence asess we talked about had changes in school they might have changed schools they switched to Virtual function virtual schooling they had a different way of interacting with peers and now that they're back in classrooms and back in with teams Etc it may be hard to just pick up in the way you related to peers in the past so I feel like social anxiety showing up more I also feel like more generalized worrying um part of what happened in Co is I think our kids heard a lot more about adult fears and hearing about adult fears when you're young and don't have the tools to think them through can provoke anxiety because it's hard to know how to stop your thinking about financial difficulties or job difficulties or illness difficulties so I would say I think I see more of those okay yeah okay great I would say I am seeing a lot more anxiety and distress around academics I don't know why but it just really does seem like there was that window of time where kiddos were in distance learning and they were it was sort of like oh we're trying to figure this all out together and it was a bit more relaxed T and then somewhere around a year maybe like a year now it's as if schools sort of snapped back to like it's like we never there was never even a pandemic like let's hit this and it's been jarring for a lot of students they feel very overwhelmed they seem to be struggling more than what I'd seen in the past for being able to figure out their time management uh and that's probably also Complicated by the fact that much more of their education is being provided using iPads Chromebooks being you know using online when these devices for a large part of their life probably were mostly just for for fun going you know playing Roblox going on Netflix so now they have to do schoolwork on their entertainment device which of course sort of lurs them away every now and then and then they are getting down on themselves like why can't I just get my work done well I mean I didn't have to worry about the computer I used in like 1994 being so fun that I wasn't going to write my assignment so I didn't even have computers when I I so yeah so I think that um kind of that blurring that line between these you know the technology piece um is great right there's so much at people's fingertips but it's really easy to flip from one screen to the other when we're trying and that that that you know that that Netflix tab is open right next to our our math and who wants to I you know I'd rather watch Netflix than do a math worksheet myself um so and it's a little also a little sneaky to get around parents too when they come in oh we're doing our work yes yeah I um really am noticing with a lot of young people with anxiety that there is this almost thought that any anxiety or stress is a bad thing and I like to work with a lot of young people on the fact that stress is actually a great thing stress is a little bit of Stress and Anxiety is what keeps us thoughtful about others it helps keep us motivated it helps keep the important things at the top of the stack and anxiety is just essentially I call it this flashing red warning sign that something in our life isn't quite the way that we want it to be and if we can accept that this is my body trying to tell me something and what might it be trying to tell me it might be trying to tell me that I'm not so prepared for the things that I would like to do or it might be telling me that I'm not feeling so confident in my friendships and once we understand the message and the story that anxiety has to tell then we can start to solve problems and I like to work with young people in saying that you know anxiety and stress can be a good thing at times but it doesn't mean that we should pull out of situations that we should avoid things how do we both end how do we both have anxiety and persist in the things that are safe and positive and good for us to do so I think sometimes that reframe for the kids and teens that I see is incredibly helpful because going back to co years there was a lot of times where I could maybe turn off my screen or I could walk away from a lecture or I wasn't in the situation at the lunch table at school where I was kind of forced to develop the skills to regulate through these things and I think you know kind of going back to that time that you know all of our kids were all of our kids were home um during those those kind of those coid and those lockdown years um you know parents were more of right literally helicoptering over because they were at the kitchen table and everyone was home all day not everyone all day all the time obviously so between helicopter parenting and then snowplow parenting getting everything out of the way for for for for their children so we don't um so they don't get anxious so they don't get depressed and so so we can kind of take care of that how do you know how do we as parents kind of manage that like how do we know when helicopter is is helping um I have a bias I'm not a fan of of online grading that the parents get alerts every time that they're child doesn't turn in an assignment um because that doesn't allow my bias is it doesn't allow the child and the teacher to have that connection and to be the child to be able to figure it out by themselves my own bias not a fan um but that is but that's what we have that's what all the parents can do so this helicoptering kind of going over the kids and then kind of getting everything out of the way how do we help parents um love their kids of course um and care for their kids and also kind of you know kind of uh Empower their kids to be able to deal with the flexibility to deal with the anxiety can you speak on that I know big like a big question right big question I think a good way into it is to really go into the metaphors when you're helicoptering or snowplowing you above or ahead of your kid when you're walking with your child you're side by side and you're available for consultation or co- problem solving but you can keep assessing whether you or your child should be leading on this particular problem another metaphor that I find Productive is manageable versus overwhelming adversity when a child is facing manageable adversity like it's midterms and I have an F on this class I care a lot about then we want to help them problem solve on their own so that they can take steps on um to address the problem by studying more Etc overwhelming anxiety paralyzes our child's ability to address the problem and that's when we need to take a more active role but probably still not helicoptering or snowplowing but walking with more firmly gotcha youd like to add to that well I'm a pretty big fan of the U sort of like the team approach where I get to be in the background aware but not always needing to intervene so the example you gave of those alerts that you can get I don't pay attention to the alerts about once a week I'll say to myself okay I should probably like check in and make sure that things are going okay but what I do is each evening I'll say like okay how are we doing like do you think you have any outstanding work and maybe they say like no and I like oh okay okay you know you know do you want to like just you know check on that I'm not going to be on top of you because I have a day job and so my my job is not managing that you get all your work done I do think it is my job to give you a gentle reminder I mean my kids are younger my twins are 11 so I'll just say I just want you to make sure that you've done what you think you need to do to be certain that you've got your work done so I like that scaffolding it's sort of like being the the coach but I don't want to be out there in the game or at bat for them I want to be the person that they can sort of go to for advice but I'm like you got this so great great and I think with parenting I love how you said parents are doing the helicoptering this pillowing because they care so much they care so deeply about their child and they want their child to succeed so it's coming from this really great place a couple of things a couple of lenses that I usually use when I work with parents the first is is the child developmentally able to do the task that we're expecting them to do there are different ways as a parent I will come in and support my 5-year-old that when he is 16 I will not be doing those same things and so is the child developmentally able to do the task that we want them to do or need them to do and I love the coach metaphor if if they're able to we're on the sidelines where that coach and if they're not then we're in the role of teacher and I think really helping parents understand what is what is my role with my child the other lens that I click into is is it a safety issue if it is an issue of safety that is absolutely when parents should come in intervene Cor in the situation but if the child is developmentally able to do the task it's safe for them to do the task there's no safety issue then as parents I like to think that the role is we are either a secure base for them to for their child to launch out into the world and do the things they need to do or we're a safe haven for if they went out into the world it didn't go quite the way that they wanted it to we can provide that nurturing and soothing and kind of asking ourselves what hat does our child need us to to Weare because one of the things that happens unfortunately when we get the helicoptering and the snowplowing and this is with very good intentions with parents but the child will get the message under under the surface that my parent doesn't believe that I'm capable they don't believe I can do it they don't believe I can succeed and we really want to help kids know how awesome and capable and wonderful they are so when we have that coach metaphor of on the sidelines it's safe that's when we can Empower kids to to do the things they need to do and have those great experiences yeah I think one of my favorite uh memories of like with my kids and a coach is my one of my kids messed up big time um during during a game and um the coach put them right back in because it's like yeah you messed up but you you got this you you can do this and I think that if we kind of keep that going with parents it's like no I I think you can do it I don't I think I got you health and safety always always the line but I think you can do this and if not I'm here so I like that that kind of goes along with this like how do relationships with um parents affect children um or teens So like um again a viewer question so kind of like having the the what are the different kind of ways to have relationships with your with your children and teens yeah to reiterate and's point which I thought was spoton is De the developmental place a child is in makes all the difference MH so parents are typically going to have more of a role in helping kids maybe find and make friendships and keep them when they're younger and are gradually going to pull back over time um maybe again monitoring for safety and is this peer friend or group of friends generally pro-social and have values that are consistent with our families or not so I think developmentally you're engaged early developmentally and you pull back generally as a parent okay and another another question how do cultural differences affect kids in different households and how are those circumstances approached Dr Christensen that is a great question because I I could even speak to it you know as a kid growing up uh culturally I would say that my parents my family they were not um fans of things like the Ye Old sleepover and I remember being at a a team meeting with my colleagues and we were talking about um sleepovers and how important they are for you know Child Development and friendships and I was like like hold on guys I just want to let you know that like not everybody feels okay with those like some people that's like they will never have their child go to sleepover I never did a sleepover as a child meet right here and they're like their jaws dropped they and I said it's just sort of like you know a thing I I think most uh you know African-American or you know Caribbean families have a bit more of a reserved stance on something like that so that could potentially impact that social um sort of scene for a kid because you know there's a lot that goes on I think that interestingly you know for my kiddos who you know my parents are aware yes I let them go to sleepovers um and I I think that it's a really cool thing because I'm I'm really interested in how different households interact and how kids get to have like a lens into what a family life can be like other than the one that they've always known at home so it is interesting it there's going to be some things that we're going to believe oh every kid does that and it'll turn out that maybe that's not the case based on some cultural differences yeah yeah always good to you know I think even if you weren't able to do sleep over having dinner or something going over to somebody else's house and going wow they all eat dinner in front of the TV or they sit down with linen napkin like wow this is different and I think that that's culturally you know good for for for any for for any child um so um anything else you'd like to add to that I I think that you would definitely covered that that piece of it's it's really I think important for every family to understand like what cultural values make us our family and how can we hold those to be true and how can we celebrate how other families might do things but kind of have this sense of family cohesion of this is what makes us us this is what's special and good about our family and kind of holding that that there are so many ways that you can be in a family yeah great thank you I want to thank our panelists Dr Dandy Allard Dr Judith Christensen and Anne Mian for their time and expertise tonight and for those of you who called in or emailed questions please join Dr Mary Owen next Thursday for a program on indigenous Health when her guests will be Dr Arie Vino roxand deil and Ricky defo I'm Mary Morehouse for the guests and crew here at PBS north thank you for watching good [Music] night [Music]