Anxiety, OCD,or Autism: Differenciating Between Diagnoses in Children

Welcome to the Anxiety Society Podcast.

We're your hosts, Dr.

Elizabeth Mackinbell and.

Cali Werner, both therapists and individuals that have navigated our own anxiety journeys.

Have you ever wondered how we became a society that is so defined by anxiety?

Tune in as we discuss, learn, and dive into what anxiety is, how we perpetuate it, and how we can stop it.

This podcast will be real, raw, and unfiltered, just like the anxiety that plagues so many of us.

We are here to push boundaries, challenge the status quo, and deep dive into topics that are sure to make you uncomfortable.

If you're ready to step outside of your comfort zone and explore the unfiltered truth that will help you change your entire relationship with anxiety and get back to living your life, you're in the right place.

This is the Anxiety Society Podcast.

We live it, we contribute to it, and together we can change it.

And there's one thing that I need from you.

Can you come through?

Welcome back to the Anxiety Society Podcast.

Today we are joined by Dr.

Eric Storch, who is a mentor, colleague, and friend of mine that I am so excited to have on because I feel like our listeners are going to be so excited to hear from you for so many different reasons.

Like, we'll definitely break down different diagnoses, but also.

So your ability to talk about how to help their kids if they have anxious kids is a hot topic that everybody wants to know the answers to.

So thanks for joining.

We're so, so excited to have you.

Thrilled to be here.

I forgot to also mention, I want to throw in one extra part of your bio, Eric, that you are an incredible karaoke enthusiast.

Oh, yes.

We've sang many duets together.

One.

You and Eric.

Yes.

I had not that courage yet for.

That exposure, but I'm so proud.

Proud of y'all.

Yes.

So this will be a really good topic, and I think it is going to always have to start off with what we like to call our anxious moment.

So, Eric, I was telling you a little bit about that earlier, but we jump in and we, at this point in time, just gotten out of the holidays.

And so we have probably got a lot of those brewing that we could share, but we will just pick one.

And Liz said she is going to start us off.

Oh, I did okay.

No, I did not.

But here I am.

Okay.

So I actually have a crazy anxious moment today that I'm gonna share.

So I, Matt and I traveled for, like, our last trip before the twins come, and often when I travel, I get an IV when we get back being this pregnant just to, like, have some hydration and whatever.

And we have this anyway.

It's like a mobile place.

This is.

A lot of people do this.

I know everyone's gonna tell me I shouldn't do it.

I won't again.

And so I get this iv.

I'm fine.

Like, no problem.

Matt's like, I'm gonna get one too.

Okay.

I'll get some extra Hy.

Gets vitamin drips, whatever.

He helps me with bedtime.

We put the kids to bed.

It's like, nope, everything's normal.

Like, no issues going on.

Matt tells me he's gonna go move the car and run an errand.

Comes back upstairs, 20 minutes later.

I was unpacking, and he's like, liz, something's really wrong.

And he was in.

I'm not.

I shouldn't laugh.

This is terrible.

It was crazy.

But full shock.

Like, literally, his body was convulsing.

He, like, his whole body was tensing up.

His blood pressure dropped.

He spiked a huge fever.

Anyways, four days later, however long, he's still in the hospital.

He was in full sepsis, shock.

And it.

My gosh, talk about anxiety.

I still have anxiety over it.

But it is so hard to navigate when someone you love is struggling and you're not.

Like, you're not a medical professional.

You know this isn't normal, but you also don't know what to do.

And he's being a male, being like, I don't need to go to the hospital.

No, I'm okay.

And I'm like, you have to go to the hospital.

This is not okay.

We have to figure this out.

Thank God he's okay.

He's gonna be fine.

But, ugh.

I just.

I hate medical stuff.

But what I will say is that, for me, those sort of incidences, despite the fact that they're horrible and you hate them, they kind of, like, put life and anxiety in check a little bit.

Right?

It kind of makes you be like, yeah, all these other things I get anxious about, or, like, I worry about, like, don't really matter when someone's life is what matters, you know?

So, yeah, I love that because I think it's so true.

I always tell people, well, if you're actually, like, preparing for all of these what ifs, all you're doing is deterring your life more.

And when some of those scary what ifs do happen, you actually have this different kind of response due to your adrenals and all of these other things, and you work through it, and so were you the strong person.

For Matt, I think that I.

Yes and no.

It, like, complicated everything because the doctors wouldn't let me go up there until they knew it wasn't viral or contagious and it was bacterial, so they didn't have to worry about it.

But it's just been.

It's been tough, but I think.

I think it's just harder in general when you have kids because you can't.

I mean, Eric, you know this.

But, like, you have to split responsibilities.

So I can't, like, be at the hospital supporting him.

So you feel like you're, like, neglecting him, but you have to be home with your kids and what do you do?

So I don't know if I've been strong, but I'm here.

I'm alive as well.

I navigated this.

You're still doing the podcast today.

I would say that means you handled it.

So.

Yeah.

Point of anxiety, though, is that sometimes these really scary things that, of course no one wants, when they do happen, they put other things in total perspective.

Yeah, for sure.

Okay, I will go next.

Mine is not.

I do not really want to follow that.

I do not know what would be more anxiety provoking.

You do not need to.

Yeah, I think so.

Mine is.

This happened yesterday.

We had my parents come over for a very delayed Christmas gathering.

And my husband has been painting our cabinets this beautiful color.

And it's taking a while.

And I understand why.

There's a lot of corners and just areas that you have to crawl into to get to all the.

The cabinets and it.

He's very good at any project that he does, but it does take a while.

And my family has, including myself, made some comments about how long these things are taking.

Some just jabs here and there.

We had a heart to heart about communication styles and how that was not super helpful for him to make some of these jabs about how long it was taking.

And I was super worried that my parents were going to say it again after we had this heart to heart that, okay, this is not helpful.

We are going to move forward.

And so I was just kind of on edge for half the time, like, oh, I hope my parents do not make a comment about.

Because we laugh about it sometimes but wouldn't have been the time.

So, yeah, you're just like, you're anxious about what someone else might say.

I hate that.

Yeah.

And the way I worked through it was, you know, just having some acceptance, leaning and leaning into it, and we actually had a great time.

Nobody said anything about the cabinets and everybody was happy and even if they.

Did, it would have been fine.

It would have been fine.

Uncomfortable for a little.

Yeah.

Yeah.

So that's mine.

And.

Well, it's all throughout.

And I.

So I tried out for an over 50 soccer league.

Yes.

How'd it go?

Well, they.

First of all, they were making exceptions for people that only qualify for the under 30.

Right.

They were letting you.

Yeah, I know.

They were letting you add on a couple 20 years or so.

So I haven't played in three and a half years.

And this comes from a guy that, you know, Callie, as a former athlete, like, you know, I played my whole life.

So I get out there and I'm nervous.

I've never met these guys before.

I'm sort of wondering, how am I playing in the over 50 league right now?

Because again, you know, I'm at least not 50.

And I was so rusty that arguably I was better than a cone in the goal, which is my position.

Better than nothing.

Better than nothing.

You know?

Yeah.

You know, it was there, but.

But.

But the way I dealt with it was just put myself out there and appreciate that every day I cannot get any worse than that.

And that when I come home, people that love me will continue to love me and won't care how many goals I gave up or how awfully in pain I was because no one really cares about how uncomfortable a dad is and so on.

So has it been fun?

You know what?

It's been fun and quite revealing.

One of the things I learned most is that I can't see.

So if you want me to play in the evening, you're gonna get a completely different goalkeeper than someone in the day.

An eye doctor appointment.

I think there just hits this time where you go from being able to read a menu right in front of you to having to hold it out.

At a distance that no eye doctor can fix.

Yeah.

And I just think it is what it is, part of it.

Yeah.

I always laugh, though.

Eric.

For those who want to know this fun fact, Eric and my husband Matt co led or co coached Eric's son's soccer team.

I knew this.

Matt is like, Eric super competitive and shows up and I think.

I can't remember how old the age range was then.

Was it like six to seven year olds?

Yeah, it was.

It wasn't very old.

So, like, Matt shows up with like a clipboard and a whistle and cones, and Eric's like, mat six and seven year olds.

He's like, yeah, I know, but like, we're gonna be really good, right?

Anyway, they were not Very good.

But they had a lot of fun and it was very humbling because Eric, Matt then taught our Olivia's soccer, which was three and four year olds this year.

And I think that it helped prep him, although he was still so mad after everything.

A little intense.

Couldn't understand why they can't figure this out.

I'm like, why are they picking flowers over there?

Yeah, well, one kid kept eating his drawstrings and Matt was like, if he does this again, I can't.

I was like, what are you gonna do?

Like he's three years old, it's fine.

Amazing.

So, okay, well, thank you for joining today.

As you guys know, Dr.

Storch is an incredible psychologist who works at Baylor College of Medicine and has spent his entire career dedicated to understanding both research and the treatment side of obsessive compulsive disorder, anxiety disorders and so many related disorders.

And I have so many questions and so many things to talk about.

So I'll kind of give like an overview I would love and then we'll just dive right in.

But you know, we talk a lot, we've talked about ocd, we've talked about anxiety before.

But I would love for you to spend a second, Eric, talking about how, especially like with kids, how do you differentiate if it's just anxiety versus if it's ocd?

I think, I mean there are a whole bunch of different aspects to help sort of distinguish.

I mean, first and foremost is just the nature of OCD relative to these other anxiety problems.

Now here's the good, I think is that whenever I do a training trying to teach clinicians how to treat kids with ocd, I come off and I'm like, look, you guys are going to get like five for one.

I'm going to teach you how to treat OCD and you can use this to treat kids with gad.

Social phobia, separation anxiety, food phobias, specific phobias, whatever it is.

I don't know if that's five, but the point is that really it's sort of the original trans diagnostic from a treatment and conceptual standpoint.

So of course ocd, you have all the same symptoms that you see in adults you do in kids, albeit maybe with a kid flavor.

Like I saw a 7 year old recently who had intrusive thoughts about sexual topics and she just imagined, you know, penises and vaginas where a 17 year old might think of something very different.

You know, and so there are all sorts of examples like that, you know, parents are much more involved in kids symptoms with reassurance, accommodation, confessing and the like.

You know, perhaps relative to adults.

But in general the symptom profile looks really similar.

And the conceptual piece, the functional piece, operates exactly the same.

And kids as in adults, as well as for other types of anxiety based conditions, whereas a trigger, you misinterpret that trigger, you want to stay safe, so you do something like a ritual or avoid it, you feel better, but you don't ever learn that the feared outcome isn't going to happen or you can deal with it.

So that's sort of the broad rubric that I think about these things.

And again, that differentiation to your, your point about question and I'm sorry about OCD and other stuff.

It's really that symptom topology that's coming up.

Yeah, so with ocd it tends to be more specific around like these bizarre intrusive thoughts.

Right.

And these repetitive behaviors.

But at the same time, one of the things I talk about all the time, as you do, is that anxiety is still at the core of all of it.

And the treatment is very similar.

But of course there's a little bit of nuance here and there.

What about autism?

You know, autism, I know you've done a lot of work in the field and autism is something that we, we've talked a little bit on the podcast about how we feel like we're seeing more autism than previously.

We definitely, at least in our experience, we are seeing a lot more comorbid autism with anxiety disorders.

And I know you do incredible research in that field.

And so I would love to just dive in and learn more.

Yeah, like about both statistics, like all of it.

But then also, how do you differentiate?

Because I know for me doing advocacy work, I'll get a lot of people that'll say, hey, I think my kid has ocd.

Can we hop on a quick call?

And I'll say, sure.

And a lot of times it actually is more autism than ocd.

So would love the audience to get to hear how you differentiate the two.

Yeah, and it gets tricky because, you know, we so much what we do is like a clinical diagnosis and so you don't get the precision that you would, you know, through like a surgical, you know, procedure or medical test.

Yeah, exactly.

Start stats about 50 or 60% of kids with relatively high functioning autism.

So we define that as an IQ of about 70, and that's an arbitrary piece, but again, some sort of starting point.

About 50 or 60% will have clinically significant anxiety.

Of those, about 35% will have a true diagnosis.

Of autism.

I'm sorry, of ocd.

Now, when I say true diagnosis, I'm not talking about a kid's really excited about Pokemon or always wants to talk about dinosaurs.

It's not ocd.

We're talking about OCD that looks very similar if not identical to someone without autism who has ocd.

You'll see a lot of repetition.

Things need to be done in a rule governed fashion.

We're talking about in supervision today, a kid with perfectionism and they were insistent, just like a kid without autism, that this makes them better at what they do.

So they need to do it this way.

Even though it's taking them three times as long as their peers to do a task.

That piece is a, it's frequent, but the symptom profile is very, very similar.

I think what sometimes sort of powers the high rates of OCD and autism is that the cognitive pattern where there's a, it's much more black and white.

So it's sort of like if I'm thinking it, then I'm doing it.

If I'm thinking of an intrusive thought or having an intrusive thought that I could kill someone on impulse, then it's not abstract, it's now that I'm about to do it, there's heightened risk of this at apply.

Right.

And I, I, well, I understand why so many parents get it misconstrued because a lot of those repetitive behaviors look like they would be compulsions and, and it's confusing because to the parents, I, yeah, it is getting in the way of their everyday performance or things that they want to do.

But when I've worked with autism, it's more of this individual almost likes doing these behaviors.

It brings them comfort.

And that's a great, that's brilliant.

And it's a great way of, of really distinguishing in many cases what's core to the autism as opposed to what's really OCD co occurring with autism.

And you know, we've all used those terms ego, syntonic.

Like people like it, they're not distressed by it, they seek it out, they enjoy it.

Those are some clear variables that align with something being more consistent with an autism diagnosis, whereas an OCD is much more upsetting.

The person doesn't like to, you know, have these, you know, have these thoughts or engage in these behaviors or if they're disrupted, then they get upset by it.

Now there is a little bit of an overlap, that gray area.

And, and so you see this perhaps a bit more in autism than you do in non autistic kiddos where.

Where there.

There may be kind of variable insight, but things are done in a very kind of methodical or intentional way.

And in that way is impairing.

But for the child, they're not distressed by this, but the world around them is sort of struggling with it.

It's not working for school or with peers or in the family.

And so that's where really talking to a professional can help you differentiate is this is really sort of more kind of anxiety compulsive versus, you know, aligned a bit more with autism.

At the end of the day, that flexibility is key.

Yeah.

I'd love to give a case example for us to just kind of talk through to make sense of.

When I was working with a kid in the past, they had to eat the same thing for lunch and dinner every single day, no matter what the schedule was.

It was hard for them to be flexible outside of that.

So you can imagine that would get in the way of their ability to go out and hang out with friends or participate in sporting events, doing all these other activities.

But they also had ocd.

They had harm intrusive thoughts.

They had need for symmetry or exactness tied to ocd.

And the parents really wanted them to work on this aspect of the eating lunch and dinner because it didn't fit into their routine.

Right.

They weren't able to do a lot.

They were limited.

But I was pretty positive that piece was the autism because they didn't see it as a problem.

The individual didn't, and they liked it.

They had some joy in it.

Am I hitting on that correctly?

That's exactly.

That's a perfect example.

And one could argue, I mean, on the one hand, the food preference may be driven by their preference, whether that's autism or just a preference.

On the other hand, it was sort of impairing.

It was going to get in the way.

And so that level of insight, whether it's in a kiddo with autism or not, can really sort of take something that, you know, is impairing and obscures.

Is this just preference or is it something else?

Right.

I tend to let that impairment drive treatment targets.

I have a question too.

So I think that one of the things we get asked a lot is, okay, so what is how does treatment look different?

Right.

And I'm often recommending, like ABA treatment for autism.

Obviously, I'm recommending ERP with an OCD specialist who knows how to work with kids for OCD with kids and.

Or anxiety disorders, CBT work.

But curious if you're giving the same recommendations and if there are any providers that do some comorbid ABA CBT interventions.

So I don't know about the ABA CBT piece per se.

What I do love about aba, though, which aligns very much with the treatments we all do, is it's very much based on the functionality.

And what does ABA stand for?

Applied Behavioral Analysis.

And so it's really thinking about what are the functional determinants of a particular set of behavioral patterns.

And so maybe it's reduction of distress, which of course is core and OCD or anxiety.

Maybe it's reinforcement, whether it's social, whether it's access to things you want, but it starts targeting the functionality in teaching the parents how to also be partners in the therapeutic process.

I think to that point I raised earlier about how does it look different?

That's one of the biggest points.

Of course, when we treat kids, it's a family affair, whether it's an autistic kiddo or not.

But when we're working with someone with autism, we're really always engaging people around them to help support them.

Sometimes that helps address that.

There's a little bit of a variation in the reports that you get from a kiddo, from a parent or so on, and smooths that out.

One of the things we've seen empirically is that gains that you see in therapy when we've worked with autistic kids with OCD or anxiety have been a little more slippery.

So, like a kid who's doing well, six months later, there might be, excuse me, back at square one.

And so a little bit more support or family engagement can be really helpful.

And one thing that I found too, as a clinician, as I've consulted and, you know, have worked with a lot of comorbid autism and OCD is that for me, I think it's having a good understanding too, that with autism, it's going to be much more concrete behavioral interventions, less ambiguity, less abstract.

But also the outcomes or the goals might be very different.

Right.

For someone with ocd, my goal is that you leave ritual free, that you leave, like, without any OCD symptoms.

Where some of my patients with comorbid autism, they actually may really want or need to hold on to some of the rituals, but can they become functional versus dysfunctional?

So I think so.

I think so.

I think, you know, meaning when someone.

Like, I'll give an example, but if I've had a patient before with autism and OCD and they had contamination ocd, and so for them, they still wanted a very clear shower routine.

Yes, we needed to remove, like, OCD rituals from the routine, but it still was rigid in the sense that they wanted to know, okay, what do I do first, what do I do second?

And that they were fine with that.

Where with someone with ocd, I might want them to get rid of all the rules and sometimes skip a routine or, like, do it differently or purposely do your shampoo last versus first, that sort of thing.

Yeah.

More willing to settle with functioning over freedom for someone with.

Or just, like, still wanting to keep more strict structure.

Yeah.

Is that a.

What do you think?

I think absolutely.

That's a really important potential difference here.

And, you know, when we were talking about your anxiety moment, Liz, and you mentioned putting, you know, kids to sleep, you know, at nighttime, there's a very helpful routine.

Yes.

Coming off of spring break today was a disaster to get my kids back to school.

And it's because we are out of routine.

So everyone's tired, cranky, whatever.

And so there is that part where routine is really helpful, especially with young people.

And we see it more relevant when we work with kids with autism or adults with autism, too, is, hey, this is cool.

Especially if it's not causing problems and that impairment is sort of that driver.

Yeah.

Yeah.

We've had patients even here with autism and ocd, where we will help them create a shower plan of what to do first, second.

And it, like, we laminate it, put it in the shower where they can see it.

And they're not doing OCD rituals, but they just.

They want to know because they need a routine.

Right.

Like, that's very important to them where with someone.

And maybe part of that could be IQ as well.

Right.

Like, it just helps them function a little bit better if it's in front of them.

But with someone with ocd, if they were like, okay, I want a list to follow and they didn't have autism, I would be very strict of like, no, we're not doing that.

That'll turn into another ritual and could become unhelpful.

Yeah.

Is it appropriate to educate someone with autism?

And if so, how do you do it?

On how.

Okay, some of these behaviors might be negatively impacting you.

Is that a good approach to even take?

Yeah, I think so.

And in terms of really reflecting on how they want their life to look like, what are the values that they have and how are these rituals, just like any other person with or without autism, is interfering with that.

And so that's sort of a driving piece of all of our interventions is, okay, well, here's where you Want to be whatever that is.

Here's these things that are keeping you from there.

How can we pull apart some of this stuff to get you to this point?

And you know, sometimes you have to be thoughtful about what those goals are and flexible, just as we would with anyone who presents to our clinics.

So I want to pivot to anxiety because I think this will take up so much time and it'll be so important.

But there are no parents who can say they don't know what anxiety is.

Right.

Like you deal with it either yourself or with your kids.

And you've been working with kids with anxiety for decades.

And I know that you've really looked into a ton of research and background between different interventions, whether it's interventions that involve the parents without the kids, the parents with the kids, the whole family system.

But I would love to hear just a little bit about your research, your background, like where you are today as far as if somebody presents with an anxious kid, what are some of the first things you tell them that are critical when they start to think about or consider engaging in some sort of treatment for what's going on?

I love that question, Liz.

So, so the first thing I try to do is objectively I'm optimistic, I'm hopeful.

Tara Paris and I, another close colleague, wrote a commentary on a study of Norway and Sweden.

And they followed.

They treated 269 kids with OCD with actually sort of like lay therapists with supervision.

So not Kelly Warners.

I mean, these were people that went to a training and then got supervision and then they followed them over time.

And three years later, 90% were doing great, 75% were in remission, about 15% were still had mild OCD.

And then about 10% were not doing well.

So 90% were killing it on a CBT based intervention.

And if that didn't work, you did a little more CBT or maybe you added some sertraline.

But.

But this is naturalistic stuff.

So no medication.

Some of them did have meds, but a very small number would have meds.

But this intervention alone was behavioral.

Say that again.

Sorry.

This study was like, was looking at the behavioral intervention outcomes, not medication.

Yes.

So it started with behavioral intervention and then after 14 sessions, if they didn't do well, they either got more CBT or they, it had Zoloft added.

And then from there it sort of became really open naturalistic stuff.

But most had CBT as their only thing or together with an antidepressant.

And, and so I start with stuff like that.

Like we know we now know it works.

Now, here's the thing.

As a parent, this is all about you applying it.

So the more that you commit to this, the better it goes.

I also contrast to other things.

So think about, well, having kids.

We would talk about kids today.

So when you decide to have kids, it's not a, yeah, we're going to have it, and then it's just going to raise itself and so on.

It's going to be a lot of work that goes in there.

And there's a lot you put in that work because you're ready, you want it, you're investing in it.

And so here we're sort of saying it's a lot less work than having a kid.

It's a lot less work than getting in shape.

All we're talking about is doing this series of things so that you can do all these other things you really want to do.

And so I set up the expectations, but I also set it up in a way that really sort of contrasts it with what happens if you don't do it.

And let's think about it in the overall context at play.

And then we start going as a family on this, you know, kind of working collaboratively in developing a new skill set for how to interface with anxiety triggers in a different but adaptive manner.

So what I see more often than not is that anxious kids often come from anxious parents, or at least there's some anxiety going on in the family system.

How critical is it, do you feel that the parents are also, if they are really struggling to not enable anxiety.

Right.

Or to not give in, how often are you also encouraging them to seek their own treatment?

Yeah, it varies.

I'm trying to make an assessment of is it adaptive, I.

E.

For the therapy or not.

I love the story from grad school where I'm oblivious.

If someone had a crush on me, I would never know.

Which probably is because no one ever has.

So accurately, like, detecting the world.

But.

But I picked it up.

This one mom of a kid I was treating totally had her, like, I could pick it up.

It's like, go to my supervisor.

I'll supervise her.

Like, I'm so anxious about this.

It's obvious.

His response was, eric, this is great.

What do you mean?

She'll do whatever you want to do to support her kid.

And I was like, oh, okay.

So kid got better.

The exposure, all this good stuff.

And here's the point is that she also had some anxiety, too, but that anxiety was adaptive in her engaging in the treatment process for a kid.

Because she didn't want her child struggling this way.

And there's a little bit of that adaptive element of anxiety that was coming in, fueling that.

On the other hand, you do see plenty of times where parental anxiety is problematic and those are the instances where, you know, you have to, you know, have them engage in their own treatment and even throughout.

Sometimes it's other stuff, you know, sometimes it's a parent who has problems with organization or attentional capacities.

Now I would make the argument that that doesn't get the same attention as like a parent, a parent with anxiety or OCD gets, but these are other constructs that we need to be thoughtful about in terms of applying to treatment.

Like you have a parent who has ADHD that's untreated and they can't get their kid to session on time and so you're missing out on session content or they can't help apply some of the therapeutic concepts.

So it's again, it goes back to that function of what's the presentation, how is it supporting or not the treatment and then how do we intervene accordingly to level it out 100%.

So a question I have, I'm going to go off the deep end for a second, but it'll all be related is because I get this question all the time, but how much do you think foods or sugar?

Or we'll talk about sleep later because we know the impact of sleep probably a little bit better.

So we'll start with just foods and sugar play a role in kids behavior or kids anxiety.

I did a little experiment last night.

So my, this was a, I, this was not a well received experiment by my significant other.

But sorry, Jim.

Yeah, but I was interested.

So my two weeks ago my eldest had a back procedure and, and so I spoiled her to death.

And one of the things I particularly spoiled her on was she loved Sour Patch kids.

Same.

So yeah.

Do you have a favorite color?

Red.

Okay.

Oh, see, this will work.

Red dye 40.

Here I am.

Yeah, I like red as well.

We love blue.

So I picked out all the blue ones from these like compound bags.

But now we have every other kind, which of course she's too good for.

Right?

But someone needs to eat them.

Yeah, if I have any red left, I'll bring some.

But with my 9 year old I was like, I wonder how many I can give her until she starts getting jazzed up.

Which was probably not a good idea.

Sunday night by the way, after holiday break, before they need to go to school the next day wasn't the best.

Parenting moment I Didn't let her play with knives or weapons.

That was good.

Yeah.

So, long story short, she was pretty hyped up, and that didn't bode well for bedtime.

Now, the joking aside, I mean, I think eating well is relevant, you know, do I think eating well is a cause or significant in the equation of OCD exacerbation onset or exacerbation?

No, I don't personally, nor am I a dietary expert either.

I do think, however, that things like having an adequate diet and.

And then sleep, which you reference, can really exacerbate problems totally.

And.

And so sometimes that can be as short term as, you know, someone gets hangry and they just can't control themselves responses.

And so that exacerbates profile, you know, or it has a more compounded effect over time.

So, again, relevant part of the equation, for sure.

I agree, by the way, we talk about this all the time, that I think, you know, Callie's much more healthy than I am.

But, like, you know, I think all these things are important and they're good and they can make you feel better, but they're not treatment, and they're also not probably the cause of anxiety or OCD.

Yeah, I 1000% agree.

I also kind of just think back to this example when I had taken some time off from running, and this was when I was like, in the midst of really heavy training, and I had taken a couple weeks, and because I wasn't used to it, I started getting restless leg syndrome, like, really bad at night before I would go to bed.

And that restlessness feeling led to stress, which in turn started to feed my ocd because that ERP piece wasn't fully in place.

And so I think that's such a good indicator of how, like.

Yeah, of course, if you eat a huge meal and you're bloated and you're gonna have a hard time going to sleep at night, you're gonna be sleep deprived the next day, which leads to stress, which then leads to.

Yeah, if you're struggling with ocd, it's not gonna be a great day for your ocd.

Yeah.

And I.

I think sleep is something that is even different.

Right.

Like, we can all agree that if you are sleep deprived, your capacity is just that much lower.

Right.

I mean, I think about this always, like, being a mom, but, like, postpartum, I can't tolerate as much as I can, you know, when I'm getting eight hours of sleep or whatever it might be.

And that's just.

That's to be expected.

One thing I always talk about though, is that.

So I do a lot of presentations.

I just did one recently at my kids school and I was talking a lot about how behavioral interventions start when your kids are actually really little.

Right.

Whether you're teaching them that they can climb up something at the playground that they're really scared of and they think they can't.

And you're trying to encourage them and you're trying to validate them or you're sleep training your kids or whatever it might be.

Right.

But we do these behavioral interventions really at young ages.

And it's interesting because I always say like I can often tell the parents that don't do any behavioral interventions early on and it's not in a bad way.

Right.

But it's these, it's parents that are not.

You're not letting your kids feel distressed, you're not letting your kids feel anxious.

You don't have a lot of tolerance for it.

And so I would love to hear your thoughts because we talk about this so much on the podcast, Eric, just about how important it is to allow kids to feel anxious, to feel upset, to validate that, but to also let them feel that versus rescuing and fixing it for them.

I'm with you right there.

You know, I think in difficult times and in good times, kids and adults learn how to deal with things.

And if we never give anyone any sort of variability and experience, then it's really hard for them to learn how to cope with adversity, which is inevitable.

Adversity isn't bad.

I mean, think about when you went to a camp or I tried out for the over 50 team first time.

I didn't know anyone, but I knew enough from past experiences that I could be sufficiently social that it doesn't world's not going to end if I stink, which I did.

And so again, it's those experiences that really help empower you.

And I think if we keep kids from that.

Yeah.

They're going to fail to develop that.

And you said it as well, Liz.

It's being supportive, being encouraging, you know, acknowledging the difficulty of a situation, but also acknowledging your confidence in their ability to deal with it.

I think these are all things that parents can really do effectively to empower their kids and hopefully get them out of the nest so they can have that second honeymoon, which I know you're a couple years away from.

Just a few, no big deal.

If it ever happens with my sister's like my sister, you guys cannot believe that I'm gonna have four kids under four.

But she Loves to just give me reminders.

So, like, we'll be at dinner and she's like, just so you know, like, pretty soon, if we ever wanna go to dinner together, we now have to have a private room.

Cause you have nine people that you're gonna be traveling with.

Such an inconvenience.

Oh, if you ever fly again, you need a whole row.

Cause now you have four kids and two adults.

I'm like, thank you.

Thanks for the reminder.

That's funny.

Yeah.

So, I mean, Callie will let you hop in, but I would love to hear Eric from you of just like, what are your biggest takeaways?

So if a parent is listening and they have a kid who has anxiety or who struggles with, you know, feeling anxious at different times, whether it's bedtime or school or whatever it might be, what are some of the, like, biggest themes that you feel you're constantly educating parents and families on?

I think the first is that anxiety is a normal piece to it, a piece to development.

A second is that as a parent, you didn't do anything wrong.

And you can also change the way that you're doing things to help support your child as well.

Third, since you brought up the bedtime would be a book my parents read to me and me to my kids.

Love this book, Going on a bear hunt.

And it's all about people, family, who comes across different obstacles on their quest to find a bear, which is an awful idea.

But they're.

I love bears though, by the way.

Yeah, yeah, they are very, very nice.

Pandas are very cute, I will say, is one particular type.

But.

But what.

What I love about that book is whatever the obstacle was, they.

They sort of identified it and they recognize they can't escape from it.

They have to go through it if they want to achieve their goal.

And so really kind of that message of, hey, like, let's think about what these goals are.

Even if your goal is, your child's goal is different because they're a little one.

And really their goal is, can I sleep with mom and dad?

May not be the goal of mom and dad, but you can set the goal because you're the parents and you know what's best for them in that moment is, you know, hey, this small steps towards a more adaptive, flexible approach can be really a nice strategy for trying to deal with some of these things.

I love it.

Yeah, me too.

I have to share a funny story about sleeping with mom and dad.

When I was really young, probably not like as young as I should have been, but young.

My Parents had a bed where they had the footboard at the end and the headboard on the other end.

And they had told me, you cannot sleep in our bed tonight.

And I was so scared because I would like, watch movies and stuff that I shouldn't have at.

At that age, I think.

And I remember before they got in bed, like they were showering, brushing their teeth, doing all those things.

I got in between the footboard and the mattress and I laid there for like an hour.

And I just waited until they got the lights off and went to sleep.

Oh my gosh.

And wiggled my way in and I slept in the bed that night.

Oh my gosh, that's so wild.

And I feel like it's so different.

Cause now I'm like, okay, like, I would definitely know because.

Because I'm like constantly checking the camera to make sure my kids are fine and in their bed.

But oh my gosh.

Yeah, I don't sleep in my parents bed anymore.

Just so.

That's no sense to hear, Kelly.

People do grow out of it, it turns out.

Yeah.

No, but it is true.

It's this.

I think that I talk about this a lot on the podcast.

But like, Olivia, who's three versus three and a half versus Grace, who's two and a half, has way more anxiety than Grace.

Like just in general.

They're just made up different.

You can tell Olivia's cautious, she's anxious.

She thinks things through.

Where Grace is complete opposite.

Enough said there.

And it.

But it is, it's.

The tactics you do have to take are different.

Like, I can tell Grace, like, you're going to bed.

Good night.

Where with Olivia, like, I need to prep her on things a little bit sooner.

But like, we can still have the same outcome.

But like Olivia, I do think one thing I'll say is that even, like, don't underestimate the power of your kids.

You know, of how smart they are, but also how proud they can be of themselves.

Because last night she was like, mom, I've slept in my own bed every day for like so many days.

Has it been five days?

And I was like, it has.

Because she has this habit of her and Grace share a room that she'll crawl in Grace's bed.

And Grace hates it.

Grace will be like, I want my space.

I don't want anyone in my bed.

And so.

But this morning you could tell it was the first time.

She's so proud of herself, but she's not even asking anymore.

Right.

And you can build that confidence that they can do hard Things and that they can be proud of themselves at such a young age.

And it's just so critical to do for development.

Yeah.

I don't mean to ask a loaded question as we're wrapping up, but really good question for two parents.

Do you feel that it's harder as a parent to parent in today's day than it was before?

And I think I'm asking that because I think about how there are so many ways to track your kids now to know what they're doing at all times.

And I think all of that leads to more anxiety.

But love your thoughts.

I'll go first.

I mean, I have no idea because I didn't raise them in the old days.

So I think that when we baptized our kids, I remember my pastor asked me that question.

He was like, are you afraid to raise your kids in this world?

And I was like, yeah.

And he was like, well, don't worry.

Every parent of every generation has always felt that way.

And so I loved that he was like, that's normal.

Like, stick to your values, your morals, you know, bring him to church, those sort of things.

But his point was that, like, people have always been scared no matter what generation.

I think the hardest thing for me is technology is that we don't let our kids have a lot of screen.

Have screen time or certain.

And it is very hard, like when you travel and certain things, if other people are getting it, to not expose them to that.

And I find that to be difficult of like, oh, how do I not fall into some of those social norms?

But I want to stay strict, but I also don't want to be this like, strict parent that doesn't let my kids have access to anything.

So I don't know what are your thoughts, Eric?

But I feel like we're also behavioralists.

So I have so many friends that are like super into gentle parenting and certain things that just doesn't have a lot of research behind it.

And I'm much more into like, what is evidence based?

What are healthy behavioral interventions?

What's a healthy divide?

And so I think that we're probably also feeling that a little bit less.

What do you think?

Yeah, yeah, no, I.

You said my number one concern.

And it, you know, it just gets trickier as they get a little bit older too.

So, you know, the stuff becomes more and more addicting and then the access just becomes ubiquitous and it's a never ending battle.

And so I think that's probably my biggest concern.

On the other hand, I think we are.

There have been some positives in this era versus I'm the old guy when I was raised.

So bullying back when I was a kid was rampant.

I mean all the time everyone got it.

And I think we see that exists some ways different, but it's less than it was, it's not as readily allowed.

This is one example.

I think we're seeing things like teenage pregnancy actually down relative to when I was in high school.

And so there are some positives where kids are, you know, have their heads on, you know, perhaps a little bit more adaptively than they did when I was a kid.

But, well, education is better around things like that too, and more accessible.

Right.

Like you think about teen pregnancies, you think about bullying.

Like I feel like that's something that we even get pushed on social media.

Like you're getting fed that education around what to do and how to prevent it and how to help your kids notice it so early now.

Yeah, absolutely, absolutely.

So it's hard, I think, whether it's now or 30 years ago, you know, I think your pastor gave brilliant advice on every parent's been worried.

And you know, the good thing is you do the best you can.

And if you feel like something's out of your skill set, whether it's having an anxious kid or you know, a kid with, you know, who's sad or whatever it is you seek out counsel from, you know, whether it's mental health professionals, religious leaders, close friends and confidants to try to figure out what the best strategies are.

100%.

Well, thank you for everything.

I love the insight, the knowledge, the quick tips.

As we wrap up, I would love for you to leave just kind of a final piece of advice for parents.

If they're listening, thinking, I'm curious, if I need to seek mental health treatment, should I bring my kid in?

Is their anxiety bad enough that they need a provider?

What do you tell people?

Like, how do you help people gauge when they should seek out treatment and should it be them with their kids?

Should it be the parents alone?

Like what should that look like?

I'll quote my father in law, little kids, little problems, big kids, big problems.

So right away what I mean is, you know, when the problem small, it may not be massive, but if you can catch that, then that's going to be a good thing.

So second is when it's impairing, seek out help before it becomes even more impairing.

That's the nature of anxiety, which we all of course know is becomes a snowball getting bigger and bigger as it goes down the hill.

So we want to stop it as early as we can on top of that.

And then, yeah, trying to find folks that know how to treat anxiety, like everyone in our kind of group right here, people who dedicate their careers to it because they will know it inside and out.

And that's, I think, the benefit of a specialty model where you get people who they're really kind of cutting their teeth on this and are experts in it, as opposed to more of a generalist piece.

Any tips or tricks or whatever we want to call it for people, fads, et cetera, for people to look out for.

So that's kind of the right path.

But anything that you would say, be cautious of.

And just so I'm understanding cautious of.

In terms of, you know, I always tell people, be cautious of going down all these rabbit holes around what your kids should eat, drink, giving them celery juice, changing, you know, putting this red light in their room versus, like evidence based interventions.

Yeah, celery juice.

Oh, boy.

Yeah.

So here's sort of the good thing.

Whether it was 50 years ago or today, these behavioral principles for understanding anxiety really, really work.

And they can be integrated in a very compassionate yet massively effective approach for dealing with anxiety.

So while these things, whether it's diet or so on, may be aligned with your interests and values, and that's terrific, really trying to invest in the stuff that's been shown to have the biggest effects, I think is going to get you the best bang for your and your child's luck.

100%.

Excellent.

Well, that's all I had.

This was amazing.

Thank you.

Thank you.

Yes.

So great to have you.

Hopefully we'll have you on again.

I love getting to learn, getting to hear from you, and us being together to chat about all the things we care about, which is helping families and individuals know that there is help available.

And I love when you said the first thing you start with is that message of hope because so many parents listening have started to lose that.

And it's critical that they remember that these interventions really do work and can get people totally functional.

Thanks.

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