Navigating Anxiety in 2e Learners: Therapy Options and Home Strategies

One of the top concerns from our REEL community is how to support anxiety in 2e (twice-exceptional) learners, with 65% of survey respondents sharing that their child struggles with anxiety. With so many treatment options available, how can parents decide which path to take? Join our expert panel of psychologists and therapists to explore several effective approaches. Dr. Kari Berquist will discuss the SPACE program, Dr. Bradley Siu will introduce DBT (Dialectical Behavior Therapy), and Toni Ratzburg, LMFT, will share insights on integrative perspective therapy, , where therapists interweave different approaches based on the specific needs and personalities of the client. This approach is focused on the relationship, collaboration, and the strengths of the client and clinician. The panel will also cover when to seek professional therapy versus techniques that can be implemented at home. We'll leave ample time for your questions to help you feel confident in choosing the best support for your child.

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Read the transcript here

Welcome everyone to the final real Speaker series. Event of 2024 navigating anxiety into e-learners, therapy options and home strategies. We're so excited to have our guests here and to have you here just in case you're not familiar with real. We are a local nonprofit that strives to ensure Silicon Valley. Twice exceptional students thrive in school, and we host events such as this for parents.

And we also do professional development for educators. So if you're here. You're probably familiar with twice exceptionality. But just in case we'll talk about the definition we like to use that comes from bridges. We think of 2 e.

As learners who have both distinguishing strengths, high abilities or potential in one or more areas and complex challenges, such as dyslexia, adhd autism, and anxiety among others, and these combine with what we like to call to make a green learner. So they are exhibiting the strengths and the challenges at the same time, and you can't teach to one or the other. You have to meet the learners at both ends of their of the spectrum, and so it makes them quite a complex learning profile which can cause anxiety. And so we'll be talking more about that tonight. If you visit our website at real 2 e.org.

We have recordings of all our previous events. We have a lot of articles that were written by various experts. We have downloadable guides and many things all organized by topic for you, so that you can learn more about whatever interests you about twice exceptionality. and just to let you know about some of our upcoming events. We have a bi-monthly parent support group that the dates here are the next ones that we will be meeting in.

We are going to have a panel of writing experts talking about writing solutions for 2 E-learners in January we will celebrate neurodiversity celebration week with an amazing student panel. and we are also going to have someone speaking about executive functioning at home and in school. About specifically for twice exceptional learners. You can Rsvp for all these events at real 2 e.org. We are also part of a group of organizations that is hosting the Neurodiversity Speaker Series, who is going to host an event about thinking differently, about social uses of media for neurodivergent youth.

You can attend this talk and see all the recordings of the previous talks that have been hosted. There's some really amazing speakers on there at neurodiversityspeakerseries.org. In addition, real hosts, a Google group that now has 800 parents in it who ask and answer questions for each other, suggest resources, and vent and commiserate together, so you can feel free to join our group. I think Kelly will put the link in the chat for you. You can also follow us on Facebook, Instagram, Linkedin, and all of our previous recordings are on our Youtube Channel real in partnership with our educational advisors.

Created a model that talks about how these 4 petals can help your 2 e-lear learn at school and thrive, and we bring this workshop to school. So if you'd like us to present at your school about this, or learning different simulations, or many other topics related to 2 E learners. Please let us know. We also wanted to let you know that we have a free 46 page guide to Iep specifically for twice exceptional students. It is for the California Bay area, although most of it is applicable anywhere, and it has a lot of great resources to overcome the challenges in getting ieps for twice exceptional learners.

And we are very lucky tonight to have 3 amazing speakers. And so I would like to just give you a brief bio of each one, and then we'll get started. So Dr. Carrie Berquist has worked with neurodivergent children and their families for over 20 years. She is a pediatric, developmental behavioral psychologist with training from Uc.

San Diego, Claremont, Graduate University and Stanford School of Medicine. She is a licensed psychologist in the State of California and a Board certified Behavioral Analyst. She's a private practice in Menlo Park, and is an adjunct clinical assistant professor at Stanford University School of medicine in the Department of Psychiatry and Behavioral Sciences. She's also a former consultant and advisor to technology based companies in the area and on the editorial board for the Journal of Autism and Developmental Disabilities. Her clinical work focuses on teaching parents of autistic children and those with neuro differences of all varying lived experiences how to facilitate meaningful change in the home, at school and community settings across the lifespan.

Her approach to therapy is an individualized, strength-based approach that combines developmental theory and naturalistic teaching strategies based on the principles of behavioral science. Dr. Berquist believes in collaboration with children and parents to develop meaningful goals from a neurodiversity, affirming lens whenever possible. Dr. Berquist uses children's passions and interests to learn and grow.

Dr. Bradley, Su. Is a licensed clinical psychologist and owner of gifted support services in San Mateo. He brings the compassionate and healing approach to his work with individuals, couples, and families of all ages, with his wide range of experience and inviting style. Dr.

Su. Creates connections that resonate with clients from children to seniors. He has a deep understanding of the complexities that individuals face, particularly those related to neurodiversity, minorities and trauma. Dr. Sue's training in neuro and biofeedback nutrition, coaching and cultures emdr.

He strongly understands the dynamic interplay between biology and experience which he incorporates into his therapy practice. This knowledge is a crucial aspect of his work, helping him to understand how our biology and our experiences influence our development. and Toni Ratzberg is a marriage and family therapist who focuses on supporting gifted and twice exceptional individuals. She is the founder of beacon wellness team, a consulting group based out of San Jose and Redwood City, that brings like-minded mental health professionals together in order to empower children, teens, and parents and families through tailored, affirming, inclusive and creative therapy beacon wellness team also focuses on providing a healthy and supportive environment where clinicians can learn, grow and heal, so they can live an authentic and fulfilling life and be better able to support their clients. Tony has helped create therapist training programs, school-based therapeutic programs and is passionate about advocating for the use of sensory-based interventions within therapy.

In addition, she is one of 4 gifted siblings, and the proud mom of 2 Tui children, ages 12 and 9 years old. So thank you all so much for joining us tonight. and I believe that Dr. Brad is going to kick us off. So we.

Awesome. PIN, spotlight, you. Oh, okay, I get this. Okay. Well, thank you all.

Thank you for the introduction. I really appreciate being here. Okay. And as we jump in. We're talking about anxiety.

There's so much to cover, and I just want to take a moment for everyone here who is just taking the time to spend with us, to learn, just to take a deep breath. to become a part of the moment. And this breath is also for me, too, as I'm about to jump in. And as we talk about taking a deep breath, I just want to highlight. One thing is that oftentimes, when we say, take a deep breath.

Our breath in is only as good as our exhale. So I like to help people understand that exhaling is actually more important than the inhale. So take a deep exhale and a big inhale. Okay, so I'm excited to launch into this. And as I talk about anxiety with 2 EI want to bring together 2 critical areas of focus that can help us understand the landscape of anxiety in twice exceptional children and teens or twice exceptional individuals of all ages.

These are young people who not only have exceptional cognitive abilities, but also face unique neurodevelopmental challenges, and this creates a distinct profile that makes them more vulnerable to heightened anxiety. Okay, so the 2 perspectives that I'm going to be jumping into is, first, st the underlying physiological mechanisms that shape their nervous system and the neurological responses. And then, on the other end, the broader social, cultural, and existential factors that contribute to their anxiety. So hopefully, this offers a holistic understanding of why this population might be struggling with how struggling with anxiety, and and maybe some avenues, and how we can support them, or at least just understand them better. So when we think about anxiety and twice exceptional kids, it's easy to focus on their cognitive strengths and challenges.

But to truly grasp what's happening. We need to dig deeper into their physiological and neurological aspects. So the 1st thing I want to talk about in terms of their physiology and neurology that's wired differently is that they respond more intensely to stress and stimuli. So, for example, we know that we so 1st thing I want to leverage is Dr. Dabrowski's work on over excitabilities.

So in many 2 E. Individuals that exhibit this over excitability, there's a heightened response across various domains, such as intellectual, emotional, and sensory overexcitabilities. So these heightened sensibilities, sensitivities can be a source of strength. but they can make them also really susceptible to anxiety, so intellectual sensitivity. So they have a relentless drive for knowledge, constantly thinking through complex problems, anticipating potential issues.

But the flip side is that with this ability to think quickly and think deeply. It leads them into a cycle of rumination because their minds work. So spark so quickly. Okay, then emotional sensitivity. So they might be more emotionally reactive.

And this is just all wired within. You know their nervous system. So with this over, maybe over expressiveness of emotionality, without the emotional self management skills that you know, really, executive functions are required to execute on a self management skills. Then what happens is that they become overwhelmed easily. So this intense feelings start to escalate into anxiety.

and then sensory sensitivities or sensory overexcitabilities, being hyper, aware of all their sensory stimuli from what they hear what they feel. What they, what what's touching their skin can lead to, you know, quickly to overload, or their nervous system. So there's a couple of other things that are important to think about in terms of what's unique about this population when it comes to anxiety, is that there's a negativity bias. Now, we all know that that the brain naturally skews towards noticing potential dangers. This is the.

This is more prominent in twice exceptional kids as they're amplified that this is amplified because of their ability to recognize patterns, their ability to have internal algorithms that memorize anxiety, notice the patterns and conditions that that created this unwanted event. And then, when that when when they put those things together, they're quickly able to recognize. Oh. you know, 3 years ago this was something that led me into an unwanted situation, or I was embarrassed, or I felt bad, and I, recognizing this pattern again. So, in order for me to prepare.

you know. For this danger. my nervous system is going to start to react. And also with the analytical mind, it unfortunately also means that they're analyzing themselves, and analyzing usually means self judgment, self criticism, self evaluation, that oftentimes just continues to go and go. And again, it requires executive functioning to put the brakes on this type of analytical self, evaluative cycle.

I am. Let's see, one of the other things that that's important to talk about is the vagal nerve and vagal nerve tone. So for many twice exceptional kids, they have lower vagal nerve tone. So that's the 10th cranial nerve that is responsible for relaxing and calming the body. Okay, so it makes it harder for their bodies to get out of fight or flight, and it leaves them stuck in this state of anxiety.

The other thing about the vagal nerve tone is this gut brain connection is the information from the gut. So what's happening in the abdomen? The tension, the discomfort. It sends the messages up to the brain. Okay?

And then telling them that they're in an uncomfortable situation. Further triggering anxiety. And the way the vagus nerve is is that the vagus nerve communicates in both directions. So it's 1 of the few nerves that actually goes up and down where there's there's a lot of like sensory information where it'll send information up this way from my body to my brain. So the vagus nerve is also responsible for sending information from my brain to my body.

And that's basically in the form of it's okay for me to relax. It's okay to calm down right now. Okay, so if that's a little bit underactive or less developed. Okay, then it's harder to to, you know, to get those messages down to the body. Okay.

The other area that I want to talk about that is particularly important when it comes to gifted twice exceptional individuals is that they have a heightened sensitivity and awareness. Okay, around the social, cultural, global influences, political influences, political happenings all around, you know, not only in America, but all around the world. So they understand that this world is is really. you know, well connected. They have information from, you know, all across the planet right now.

So, with easy access to real time information. Today's twice exceptional kids are constantly exposed to global news that includes climate change, political situations that I mentioned, or systemic and social injustice. And as they're absorbing all this information and also internalizing it, and it's hard for them to process or to make sense or to make meaning out of this. So this awareness, so the gifted ability to understand complex ideas leads them to feel really helpless. And of course that turns into anxieties that I understand all these things that's happening.

I'm absorbing all this information. Maybe at a rate that's, you know, vastly accept accelerated compared to their their peers. So therefore they're they're experiencing and just much greater amount. The other thing is twice exceptional. Individuals have this ability to contemplate.

Okay, and that's to think. to think deeply and with contemplation comes also questioning. So they find it difficult to make meaning out of their lives. So they're searching for meaning. But of course, with all the stuff that's happening globally.

So how do I make sense of this? And their minds for seeking information and seeking resolution, continues this pattern of of I want to continue to think about it. All right. So as we bring all these pieces together, okay. we have these physiological mechanisms that are inherent in the twice exceptional individual.

We also have this intersection now of their ability to think deeply, and to contemplate, to absorb information, and to receive information all around the world that makes them really powerless and helpless. And it really pulls from meanings like, what what's going to be left of this planet? and these are deep things that they spend a lot of time thinking about. So with all those things. Their susceptibility to anxiety is just.

You know, that much higher I am. So that's those are my thoughts on why, twice exceptional individuals, you know, you know, fall into this anxiety category much more readily. Alright. So I want to hand it back to you guys. Thank you so much.

I all of the things you said really resonated with me and my own children. So thank you. And then next up we have. We are already starting to get some interesting questions in the chat, and next up is Tony talking about when to look what to look for in a therapist when you might need a therapist, so I will let Tony take it away. And, Tony, you are still muted.

Just so, you know. There we go. Forgot to click that button is everything sharing. Okay, can you guys see it? Okay, great.

I just 1st want to thank everyone for being here tonight. Real for inviting me and it's an honor to get to be part of this tonight. My goal tonight is to share a few different ideas that can really help on that journey. When you're trying to figure out what to do to help support your child and what to do in the moment when they're feeling anxious. So I'm going to 1st look at a little bit of what can you do for anxiety at home.

And then what do you start looking for in a therapist things that might be more successful than others, and then share a little bit about the perspective that I take in my practice, which is what I call integrative therapy and kind of like Dr. Brad. I thought I could use a little bit of calming myself a little grounding. So I thought we would start with an activity. This one is a very classic grounding activity that we do a lot with clients and a lot of times it's called 5, 4, 3, 2, 1 but what you do right now is just kind of look around.

Notice 5 things that you can see in your space that really you weren't paying attention to before we started talking. And before I brought this up. you know. Following same kind of idea is 4 things that you can feel or you can touch. and 3 things that you can hear.

This one might be tricky, depending on where? Where you're doing the meeting. But 2 things you can smell and then finish up with one thing you can taste, and you don't have a taste in your mouth. You can always take a sip of water, and just kind of notice what that feels like as you swallow it. So Hi.

go ahead and see. There we go. Okay, I thought we should start with just things to do at home. I will tell you. My slides have a lot of text in them, because I just couldn't figure out what to take out.

But they're they're definitely very wordy. So I can share. So people can look at it later. It's I don't want to talk all the talking points, but I'd love for you guys to be able to to look at it more closely in the future. So one of the things I really think is important to hit on 1st is you've got to take care of yourself.

If you're not taking care of yourself, you can't take care of your child, and yes, you can, soldier on for a long time, but you're also not modeling healthy management and self-care. So if you take care of yourself, you're better able to take care of them. and you can also use yourself as a tool to let your children overhear you working through your emotions or your challenges, that lets them start to play with ideas, internalize it, just start to think about it, and they learn from what you're doing. They also realize that, hey? Some of these emotions I'm experiencing actually pretty normal.

They're not so scary. So that's kind of you. You start, you start with it, you take care of you, and then you can start thinking about what can we do to help with their anxiety, and an easy thing you can do is take one of their interests and try to connect it to it. My favorite example of this is, if they love Harry Potter, Ron, and Hermione are fantastic anxiety characters, and there's seen in the movie scenes in the books, and a lot of times. They'll talk about it if they like the characters.

You can also relate a lot of the pokemon pokemon to different anxiety and feelings as well. So something I want to share, which actually, I think I did share in a previous talk we did with real. But it's something I love to do to help kids and teens practice in social anxiety, coping and learn advocacy skills. And it's taking them out to hot cocoa. And so you start where they go in and you model how to place an order.

They get this fun delicious time in connection with you. And then they start to learn. Okay, what do I do? How do I? You know, how do I do that?

They start to practice it. You have them start to order it, interact with the Baristas, you know. Say hello to people, and then get them to where they can make their own order and build on it where they actually you know, make purposeful mistakes, or they can make changes while they're ordering it. Just, you know things where they have to go. Okay, it's not always exactly the same way, but I can handle it a lot of times.

You can get their buy in for something like that, because it's fun. They're going out, and they're doing something with you. The other thing I like to stress is to use play and humor when you can. You can help them make it fun to, you know, or more fun to confront emotions or to talk about them. But you have to be really careful.

You don't want it to fall into the part where they feel like you're teasing them. But a lot of kids really respond to, you know something lighter and like, you know oh, here, you know, here's anxiety again. Decided to show up today. so keeping it light helps. See?

I'm trying. I don't want to spend too long, because I know we have a lot of great stuff, but when you're supporting your 2 E. Child with anxiety, focus on their strengths first, st and then that helps them feel safer to take risks and to practice things, but it also honors who they are. And you can kind of take any information you find out there from these kind of presentations or from books and say, You know, what is it that my child needs? Okay?

And I just want to take a moment to focus a little bit on. 2 things, I think, are very important for our children, and that's connection and co-regulation with connection. It's something they all want. They all want to have a connection with their parents, and that might look different sometimes it might be a 2 second Hello, and other times. It's like a couple hours of here we are.

We're playing together, and we're doing activities. If you help with connection, they're going to feel safer. They're going to feel like they belong. They're going to learn a lot more, and they're going to learn to adapt to things. If they have that secure attachment with you.

It's easier to get them to try uncomfortable things with you. And also, when things are really hard and you don't know what to do. Go back to connection. Say, what can I do there? And that can help your child?

Co-regulation is also an incredible tool that parents have. But it's a really hard tool, because it's often at the end of the night when we're stressed and we're tired that our children need us to be the most regulated to help them. But if we do our own work we take care of ourselves. it can be fantastic. Co-regulation is really letting them borrow your regulated feelings so that they can learn to cope and manage with their emotions.

I've got a QR. Code here in the slide, but I also think I sent a link over. I think you can get that into the chat. It's just a short article that I created with Gina Garcia, another marriage and family therapist, and it's more details of how can you do co-regulation? Okay, now, I'm going to jump into therapy, and I think it's important to acknowledge that everybody here is probably at a different space.

You know, if you're a parent, you are might be in a season of parenting where you're like, okay, noticing this is happening. Thinking about it. I think it's hard for my kid. I want to think you know, what can I do? And then others might be on this other side where they're going.

I just did an assessment, and I have a million recommendations that I have to sift through, and I just don't know where to start which one to prioritize. And there's probably a few people, too, who are kind of like, Hey, been through all this stuff, and I'm just sure not what else. You know. What else do we do? How else can I help my child?

Because it still still needs some adjustment? So when you're starting to think about what to do. And you're considering therapy. You want to consider a few different things, how they're experiencing anxiety. What is that physical experience of it?

Has it changed? Is it impacting their quality of life, keeping them from being able to do things they like? It's easy for us as adults to guess what they might be feeling. But we want to engage and really ask them how they're feeling with it. And I think I put it there first.st Yeah is, if they ask you for therapy, please please follow up with that.

A child doesn't ask for therapy unless they think that it could help them, and on the other side of it. If you say my child would benefit from someone other than me a safe place, a person that they can talk to. That's another good reason to move towards finding a therapist. And the most important thing, if you're ever concerned about your child's safety. So whether it's self harm, suicidal thoughts.

Anything like that. You've got that. That's a big indicator that's a huge green light to say, go talk to someone, try to get some more support around them. You think I'm gonna there we go. I just want to touch on the fact that there's a lot of different approaches to therapy.

And everyone. even within, like, maybe the same approach puts their own spin on it because we're all unique individuals. And it's also important to remember that not everyone has training or experience, with twice exceptionality or neurodiversity, and they might look at things in a very different way. So when you get recommendations or you're looking, what should I do for anxiety? How to help my child?

Something I know, I hear in my practice a lot is that the 1st thing parents find is. Cbt, that's what everyone tells them. Go, do. Cbt, go do. Cbt, and what I actually find with Cbt is, it can be great for some people, but it's not always the best approach for someone who is neurodiverse, and that's because it might encourage them to mask.

It might bring up a huge, strong resistance from them, so they either want to write off therapy. They don't want to talk about it, or they're just kind of like. No, don't go there, and I don't want to spend my time trying to get someone to want to do the method. I want them to do the work that they want to do. So be careful when you're going with things you want to think about, who's making recommendations, research things research.

If you if you find an approach, and you know, throw it into Google and say, how does this work with someone who is twice exceptional or ask another professional? And they can tell you like what they have seen, what they've noticed and what they think about it. There's no simple answer for what the best treatment approach is. But I think neurodiversity, affirming care is essential. If you have a twice exceptional child, this is what you need to be looking for, because it really looks to empower your child.

Let them know their strengths, and then that can help them navigate their challenges and affirming care really looks as neurodivergent. It's like a natural variation of our human brains. It's not a disorder, it's not a deficiency. And you're going to see interventions that will emphasize acceptance, strength, compassion, and support, because that's the root of what this is. It's tailored to their needs.

It's tailored to who they are, and it considers how they access information and how they experience their world. So if you're looking for care, also try to consider finding what neurodivergent voices recommend and what they've thought. So this might be your child if they've had some experiences, or you can find great articles and blog posts and conversations from neurodiverse people who say, Hey, when I was a child, this is what I went through, and this is what it felt for me. And so just, you know, slow the process down when you're trying to figure it out and take a little bit of time to research it and think about who your child is and what they would feel best with. Okay, I need to take a breath.

I'm sorry, you guys, I'm talking fast. So when we're trying to find a therapist, it can be really hard and really frustrating, especially right now. There is a mental health crisis. We don't have a lot of availability of professionals. And I keep hearing from people that they don't even get phone calls back sometimes when they're trying to find someone and just ask to say, like, Do you have availability?

So it's hard. And then that might make you want to just jump and say, Okay, the 1st person who does have space. Let's get my kid in there. Let's just get it going. Let's make progress with it, but I think it's really important to find the right fit for your child.

If it's the wrong fit, it can have heavy consequences. And you know that might be that they won't go back to therapy, or they won't engage with it. So trying to find the right one is so important, and they best way you can do that is, you ask yourself and your child if you can feel connected, this person, and you can trust them. If the answer is, no, they're not the right person for you. And that's okay.

There's a lot of people in this world, and there's a lot of therapists in this world, and so finding someone who does connect and that you can trust is very important. It's also important that if you don't trust the therapist, but you feel like your child does or might work. You've got to really stay mindful of that, because you don't want your child to pick it up from you, and then start to question therapy or question their trust of the therapist is incogruent. If you can be with your child the better. It is the other thing you want to think about is a therapist who will listen and collaborate with you, not someone who's going to tell you everything that you should do so when they're listening and they're responding.

You also want to make sure they're communicating in a way that works for you and for your child. It's really important as parents that we have access to the therapist. Even if we're we're not in the room every time that they're together, we need to know that we can pick up that phone. We can send an email. We can call them.

And you know, there's a long list here of other things, too. But I do want to mention that if you get through all of this you find a therapist and say, Okay, I think this checks the boxes. They're affirming they're listening. They seem to get this. This feels really good.

Then I would honestly start to consider, okay, what are their experiences and what are their accomplishments. I wouldn't even go there until you check off the other things, because I think that is so important to find someone that you can trust and can build that relationship. The other thing to think about when you're finding a therapist is you want your child to be able to go in and not be masked. and yes, there's times they might protect themselves. They may not be fully open.

That might be a session that might be a season, but if they want out of therapy. They're going to figure out how to do it, and if they can figure out what the therapist wants to hear, they can make that happen. The therapist is going to say, Oh, all is great. You don't need to be here. And then your child actually probably in a worse space.

Because now they're like, Okay, well, I went to this professional. They didn't get it. Now who can help me? What do I do? So that's another reason, looking at someone who you can connect with you can trust, and that gets it.

A few red flags to work to look at. I'm kind of laughing, because there's a lot of these on here that I took off. But there's so many things to to think about. But one of the big things is, if someone dismisses your child's experience or your experience. The classic example would be like, all children are gifted.

So I don't take into account giftedness or you know I don't deal with this. I don't think about this. You just want to make sure that you agree with what they're saying. You also want to check yourself. It says someone who says, I've seen it all.

I know how to do it, or they're really rigid in their approach. They may not provide the flexibility that your 2 child needs to be successful in therapy. You, if they're not willing to get, take feedback, or they start to get defensive. If you ask questions, or you kind of push back share some ideas. That's another red flag to say, Okay, this might not be the right person for me.

Once you've found a therapist, then you've got a couple of steps that you do, and this will be, you know, unique to your situation, but also the professional that you're talking with. We all have our own process, but in general it's going to start with an intake or a consultation conversation. You're going to share some information. There might be some assessments and questionnaires. the professional gathers information and you share information and you ask information about them.

You go. This feel, does this feel right? Is this aligning correctly? And if it is, and you say, Okay, this is a good fit. Let's go forward.

Then you're actually gonna also start to do more paperwork and get to do a little bit more historical because a lot of times we like to know a little bit, but we like to get to know the child for who they are and what they bring into the room. We don't want the entire download history of who they are the 1st time we meet them. so you also need to take some time to decide. What is this going to look like? Is it going to be individual therapy which would be a therapist?

And your child is family therapy as a group of peers. And then what's the frequency look like? Is it once a week, once a month, or do they actually need a higher level of care of that? And the therapist should guide you through this process. They should give you a recommendation.

They should talk about it, and ideally you do what's in the best interest. Sometimes scheduling is an issue trying to make everything work. And so you have to get around it. But if you feel like this person is hearing the need, and being present with you, they'll let you know if they need to adjust anything with their frequency. See if there's anything else I wanted to share with this part that's pretty good.

Oh, I did want to mention with parents involved in therapy. It's really up to you. You can talk about it. Some therapists will naturally include you. Bring you in, for some check-ins have regular parent meetings, others won't, and others will kind of let let it roll out and play out, depending on what's going on and what your child likes.

So if you have a preference, if you say I really want to be involved. Talk with the therapist before you start, define what that is, or if at some point you have like kind of a question like, Hey, I want to change this up. That's okay to ask, too. Sometimes we just don't know if therapy is working. And as a parent we go.

Is this the right approach. What are we doing? You know? And we feel like, Okay, well, we've invested a lot. We want to stay the course.

But is that the right thing to do. So when you start to feel like that, I always recommend talk to your child. See how they're feeling about it. If they're feeling similarly, or if they're completely different, that's going to inform what you do. It's also a great time to have a meeting with the therapist, and just say, What do you think?

Here's what I'm hearing? Here's what I'm seeing, and if you've chosen that right therapist, they're going to be open to having that conversation with you. They're going to want that conversation because we don't want to waste your children's time. We want them to get the skills that they need, and to feel confident and be able to go out and do their life. Something to please keep in mind is that with twice exceptional individuals, therapy can sometimes look different.

The pacing might be different. It might be slower. There might be some times where things are going, really, really, intensely. And then they pull back. And that.

That's okay. That's a normal part of the process. But if you do start to feel like you need to make a change. And you've gone through things. You talk to everybody.

That's okay, start looking for a therapist or start exploring it. And also consider, is there something you could do? Could your own therapy. Help your child. If if you were to engage in that.

then just a few more thoughts to share with you guys is integrative therapy. So this is an approach that I use in my practice. And really what it does is, it interweaves different elements of therapeutic approaches, so that I can create a tailored experience for my client. So it's not just, hey, what are their interests? But it's what makes sense to them.

What do they relate to? What do they like. It's very strength based. It's client-centered. And so there's a strong emphasis on the therapeutic relationship.

And the connection, I see it very aligned with neuroaffirming practices because it's really honoring who the person is. It's leaning into that instead of the mode of operation. We, when we're working like this, we're going to observe what are their reactions. We're going to kind of test things out, or we're going to present them with ideas. And we're going to ask them what they need, what they like, so that they get the most time or the best use out of their time with us.

Oh. okay. And let's see, so integrative therapy. It's affirming it's inclusive. It's culturally sensitive.

but it also really leaves room for both the client and the clinician. And often parents that you know, just acknowledges we're all learning, and we're all growing. And it requires some vulnerability and everyone to be able to do that because you have connection and trust things happen, and sometimes we have to talk through that. And it's a great, it's a wonderful learning experience for everyone, but especially the child. That's part of it, because it's part of being human is to normalize our strengths and our challenges.

So one of the reasons I think this approach works really well with twice exceptional people is because it really helps reduce their masking in the sessions. It lets them be them. It lets them have some control, or some say they're guiding it. They're co creating what their treatment looks like with us, and we're providing information for them. It also honors who they are.

A few ways I've used this approach would be use like a walk and talk where I've got them outside of the office. And we're able to not only process or talk about skills. But we're out in the community. And so there's a lot of different elements that are going on. And so we can use mindfulness to help them increase their self awareness.

We can help them do some self soothing or grounding when they're in a public setting, and we're doing it in the moment while it's happening. it can also sometimes look like a client is getting their own coping skill development happening by looking at their motivation and their values. So then we can bring in some sensory based activities that help them self soothe. They start creating some habits around that. And then, as therapy continues, we give unconditional positive regards that they feel really safe to be encouraged to explore anxiety.

And so we're pulling all these pieces in different ways. And we're pacing along with where they are. One fun way I've combined this is with a very active people who come into my office. I will have them take like a ball that can stick to the wall. I don't even know what you would call that, but they would throw it, and it will stick to the wall and they love it.

It's fun. And so there's this play element. But then I'll combine like, Okay, I want you to think about something. And so we'll think about an emotion, or we'll think about an experience that maybe they haven't been able to or haven't wanted to process with words yet. So say, okay, think about what happened at school last week, what your mom was talking about.

Now I want you to throw the ball as if your emotions were coming out of that. And so now they're using it. So it really can pull in the play therapy as well for children. Okay. that's all I've got for you guys here.

But I know you got Dr. Brad and Dr. B. Who are going to follow up some amazing approaches that also work great for twice exceptional people, and I just thank you for taking the time to be here and look forward to hearing the rest of the afternoon. Thank you so much, Tony.

That was amazing. very helpful. Lots of questions come up in the chat. and Dr. Brad is back up next, and then Dr.

Berquist. Okay. so I'm going to talk about Dbt, and that's dialectical behavioral therapy. And Dbt is so big. And there's just so much into it.

I just couldn't possibly cover everything it is. So I'm just gonna go over some highlights and and hopefully land on some takeaways for you guys. 1st of all to introduce Dbt, it stands for dialectical behavioral therapy. It's a type of cognitive behavioral therapy, and it's originally designed to help individuals who were experiencing intense emotions that were difficult to manage. And it's particularly helpful for those who are 2 E, it's a structured approach with a lot of skills and tools.

It's actually a skills based approach. And it's almost to a fault where, if it's a pure Dbt it, the therapy is really talking about only about skills and how skills should have been implemented? Or how can we expertly implement a skill in a given situation or future situations or past situations? Okay, but let's jump back in to to Dbt. So, as I mentioned, Dbt comes out of Cbt, that's cognitive behavioral therapy.

and one of the basics of cognitive behavioral therapy is that cognitions and behavior. So that would be challenging the way we think with cognitive distortions or thought distortions. So that's Cbt dbt. focuses and integrates dialectical thinking that is balancing the opposite. So dialectics are opposites and the big opposite for Dbt is balancing acceptance and change.

So, holding 2 truths. Any 2 truths simultaneously opposed to seeing one thing as as interfering with the other thing, just simply understanding that both things are are true. Okay, so as I mentioned, is balancing acceptance and change, which I'll I'll I'll talk a little bit about that. But let's talk a little bit about some. you know, dialectics that we hold just in everyday life, and the dialectic might be so say I've eaten dinner of.

I've had a number of slices of pizza the pizza tastes great. I want. I'm really full. And I want another slice of pizza. Okay, those 2 truths.

Okay. in a more in a more therapeutic context. That might mean the dialectic might mean that I am really wanting to succeed. But I'm really and I'm really. you know, paralyzed by fear.

So I said. But but with Dbt we replace the but with, and because we're holding both, not seeing both as opposites, so we can understand that there's for many of us, you know, in in our lives. We really want to do well. But there's so many things that are getting in the way that we're things that we're afraid of, things that we think might be you know, in opposition to wanting to do well in traditional therapy. We would think that.

Well, if you are afraid of doing well, we really need to spend a lot of time just working through the fear, and once we work through the fear, the pathway would just all of a sudden appear. And that's not true. Right? With dialectical behavioral therapy, it's like you want to do. Well, we can talk about that.

And you're really afraid about it. We can talk about that because those things are you know can exist perfectly together. And that's how actually, reality is. So let's talk about some so that's dialectics. Okay?

So as I mentioned, Dbt is about skills and the core skills are mindfulness. Okay? So that's awareness becoming more aware. And another way of of talking about mindfulness and awareness is just noticing. Okay, it's just increasing our ability to notice things distress, tolerance.

And that's a real big one. It's big in Dbt and and why it's so helpful now is because in the current in the current you know, the current thoughts is that we've become as parents. We've become really concerned that distress equals trauma. So if I have a lot, if my allow my child to experience distress, I might be allowing them to be traumatized. So then we have a multiple generations of parents saying, Well, maybe I should really just remove distress.

So at least I can solve for potential of trauma. So so we have. You know. you know so many children and teenagers now. kind of not really experiencing as much as much everyday distress or or age appropriate or developmentally appropriate distress.

And when I talk about distress in this way, I really do also mean Hermetic Stressors right? And Hermesis. The idea that this stress stressor or strain is actually going to make me stronger. So distress tolerance is really appropriate for this population. And emotional regulation is another big core area is what skills can we use to emotional, emotionally self-manage.

And I replaced the word regulation with self-manage, because self-management is really our management of emotions is such a more active approach than regulation. Like we, we regulate like we create rules. That's where we have regulations around the the city, county and state and the country. We create regulations. We don't create regulations with ourselves, we create management.

The only thing we can do with emotions is manage our emotions. Regulations like really sounds so constricting. And then it leads into all these other things around the you know, around the the misuse of the word regulation. But a big core principle is emotional self-management, and the other core principle is is interpersonal effectiveness. Okay, so I'm going to jump in a little bit into Let's see, I just want to talk about 2 things.

because I want to make sure we save time for all the other speakers and the and the questions and the 2 things I want to talk about. That might be great takeaways that come out of Dbt is is the the skill called riding the wave and riding the wave is where, just just as it sounds when you're in the ocean. Okay, maybe on a on a boat, and the wave goes up or on a surfboard, and the wave goes up. and then what happens is, the wave goes up as the wave passes. Then you just go back down.

Okay. So riding, the wave is about allowing emotions to come through. Okay, observing these emotions and then allowing it to pass. So 1 1 key principle that I teach. you know I teach regularly.

That's related to this, for parents is is simply, as as parents are. you know, practicing distress, tolerance, practicing, riding the wave. One thing that we want to do is to allow time for the wave to come up and the wave go down is just one simple concept, and that is under react. Okay. What?

What happens often is that when it comes to. you know, parents and parenting, you know. Of of course, our children are under a lot of distress. They might be struggling. We, we think they're dysregulated.

But in reality, what's happening internally is they're seeking regulation. So what we want to do is under react so that they could get to regulation themselves. Okay. As parents, we only think we only see the dysregulation. But we're missing.

That piece is that the dysregulation is and attempt at getting to regulation. So if we jump in so quickly to support or to maybe even empathize, then we're gonna throw off that you know that that ability to learn self management. Okay, so riding the wave. okay. underreacting is important.

and those things both fall into the category of increasing distress. Tolerance. Alright. Okay. let's see.

Okay, was there another one? Let's see. Okay. okay, all right. I think I'm gonna hand it over to Carrie.

Oh, wait. I'm going to talk about. Oh, medications real quick. Right? Okay.

So I just want to acknowledge I was just going to be a brief portion about medications. You know it's understandable that so many of us have questions about medications and and medications really pose this hope right? This hope that that we think that we're gonna be able to just reduce the, you know. You know. Just reduce the symptoms, create a better lifestyle.

So it's natural, for you know, almost everyone to consider the possibility. Okay. But but, as was mentioned in the very beginning, just to clarify our roles as therapists, we don't prescribe or manage medication. So it's really outside of our scope to talk very specifically about medications. But you know I can talk a little bit about you know when to seek medications.

And it really is when when we think about, you know, as a holistic and integrative provider, we think about, you know, medic. Considering medications. If all the foundational strategies don't seem to be really producing, you know the results along the journey. Okay? And and that means optimizing for sleep, optimizing nutrition, optimizing therapy.

And if it doesn't reduce the severity of symptoms now, when we're talking about severity of symptoms, we're not just saying, oh, that we hope that my child's going to feel better. Maybe we hope that my child's just going to be happier. We're really looking at this this one piece is that are the symptoms getting in the way so much that it's causing an impact to everyday functioning? Is it getting in the way so that a child's not able to do what they what they are capable of doing for for their age. So if it's going to school that the symptoms are getting in the way of of going to schools, the symptoms getting in the way of of interacting with with friends and family.

Now this is very. This is a little bit different from my kids able to do all these things. They're just not enjoying it, and that that because they're not enjoying it, I'm really nervous or concerned, that it's going to turn into this, this and that other thing. So therefore, we're thinking about medication. It's really, if it's getting in the way to the degree that it's impairing those things, not just comparing the enjoyment.

Okay. of course, there's so many things to to consider, and I don't want to just take that my statement there, and saying, That's you know, the bar which we should we should have. It's really also to do with the length of time. Now, if someone is, you know, having those symptoms that I'm describing, but it's over many years. Then I wouldn't just say, Oh, well, you know, Dr.

Brad said. There, it's fine that they don't enjoy it. We we really want to think about a big picture here, too, and a long term trajectory. The other thing that I just want to validate in your consideration is that everyone has personal beliefs about medications. Everyone has personal fears about medications.

You could have religious or cultural values or belief. You should work with a psychiatrist or a pediatrician that's going to honor all those things. One of the things that. you know that's disappointing to see is that is that where where families get arm twisted, say, well, you know, depression's like a broken leg, and you have to kind of believe that that, you know. I don't think that arm twisty thing is kind of really a good way to kind of join around the the possibility that medication is going to be really helpful.

But but really a person that's going to be able to honor. Say, I get it. I understand you should be concern. You should be hesitant any you know any in a, you know, empathic or validating psychiatrist to be. I understand, too, I would be in that same place, and all the questions and concerns that you have, you know, are valid.

So it's a lot to navigate. Those are just some of the thoughts of you know of, what I have and how I've you know, helped families kind of navigate through the decision making process about. When is it time to to add this to? You know the the you know the toolkit? Alright.

So let me. Thank you so much, Doctor. Welcome! Was super helpful. And next up we have.

Dr. Burke was speaking about space, and there's been a lot of questions in the real group about space recently. So it's starting to get more popular. Thank you. Let me just figure out how to alright my gosh, my desk!

Oh, I don't want that. Bye! Bye! Alright, I'm gonna talk about space. I'm really excited to talk about space because it is a new treatment that I've been doing over the last 2 years.

And I really, I'm a parent trainer, parent, educator by trade, and this, I think, is, you know, especially going after and we talk about surfing the urge and riding the wave. You know, that is basically what space is. Is helping parents learn how to ride the wave and help their child learn how to regulate themselves. and I think it's been really helpful for kids who have definitely not responded to more of the like Dvt or Cbt. Or some of these more traditional like individual therapies.

no, of course, it's not gonna wanna work. Okay, there we go. All right. So what is space treatment? So space stands for supportive parenting, for anxious childhood emotions.

And it's an evidence-based treatment developed by Dr. Ellie Leibowitz of the Yale Child Study Center. It's as effective as cognitive behavioral therapy or Cbt, which, as you've been hearing tonight, it's actually one of the gold standards for child anxiety treatment. I would say, Dbt, and acceptance and commitment therapy are also very much in play, and those are the more individual based therapies. But this is different because it's a parent-based therapy.

So, and space has been shown to be effective. For anxiety. Ocd arfid restrictive. That's the restrictive eating and failure to launch. And parents are the ones that actually go to the session.

So chat children do not participate. and it focuses on actually changing the way parents respond to their child's anxiety. So the child does not have to be a willing participant, and I know this is a big issue. That and I think I saw this in the chat is, you know, and I think tony spoke to this as well is that you know, if the child is not willing to participate in therapy like therapy probably won't be very effective because they're not bought in and they might not want to. Maybe they they don't think there's anything wrong, or maybe they are fine with just how things are.

And so when you're not a willing participant, those individual therapies are not really going to work. Very okay, so willingness is the key to change. But this therapy, you know, the child does not have to be willing participant. Just the parent has to be willing to participate. And there are no demands actually placed on the child to do something except with failure to launch.

That's the one exception. All right? So what's the theory behind space? So space is based on the theory that child anxiety is actually an interpersonal event between the child and the parent. So humans are mammals right, and mammals are hardwired to protect their young and children are hardwired to signal to the caregiver to their parents that they need help right, and that the parents need to step in when they're distressed.

particularly when the child is a baby or an infant, or a young child who can't really take care of themselves. Right? Something bad's happening. Baby's gonna be crying like, Help me help me right? And just similarly, parents are hardwired to respond to detect fear and distress cues in their children.

And they also provide this regulation and soothing, which is what we were just talking about. Kind of this cool regulation helping the child manage their anxiety. So there are 2 main ways that kids cope with uncomfortable emotions. I actually like Dr. Brad's self-management because I do self-management.

I believe in self-management, but all the literature is self-regulation and emotion regulation. So like, I am right behind you about like being on the charge of probably changing that but self regulation requires that willingness that I was just talking about, and if your child is not willing to take the deep breath and to like, do the things that they need to do or find something that helps them manage those really tricky, intense emotions, especially the 2 kids have. Remember, they tend to feel their emotions bigger than other people because they're more sensitive. It requires practice. They have to practice these skills, and they have to practice them when they're not dysregulated, because if they don't practice them when they're not dysregulated, they definitely can't use them when they're dysregulated right, and it requires a child to actually learn a new skill.

And again, if you don't have willingness. not certain that self regulation is going to be developed. So what other systems do they have co-regulation parents helping them regulate their emotions or the environment? And, as I just said, it is absolutely essential. In the early years, when children are very young for their parents to help co-regulate them.

However. if the child becomes over reliant. just like Dr. Brad said, it prevents the child from learning self-regulation. If they can't feel that distress and then figure out, what should I do?

They're never going to learn how to self regulate. It absolutely helps in the short term child gets on the bus. I saw that comment, too. The child gets on the bus. The child goes right.

But it the cycle actually continues. and it doesn't help in the long term. So what is the relationship between anxiety and self regulation? So just like Dr. Brad said, at the beginning of this whole talk is that we tend to see anxiety is higher in this neurodivergent population.

Okay? So in the general pediatric population, we see 5 to 10% have an anxiety disorder in the neurodivergent community. We have autism, Adhd learning disabilities. We see it's much much higher right autism population. It's 40%.

Adhd, it's 25 to 50 and learning disability. It's 29 ish. right? So we definitely see this higher level anxiety. And what we also know about anxiety is that when you have high anxiety and pediatric anxiety disorders, you have low self regulation.

Dr. Leibowitz actually wrote this amazing chapter on this. And it's not in his newest book, but it's in this other book, and it is amazing. It's like you. Could.

You could substitute it, for you know, inflexibility you could. You could substitute for anything but this understanding of how anxiety impacts one's self-regulation. And we see it in these 2 E children and neurodivergent children, we see high anxiety. And we see low self regulation, right? Because we need those executive functioning skills.

Okay, so here comes the accommodation, family accommodation. So family accommodation. You're going to think about it as kind of co-regulation now, in the early years, as I said, it's very appropriate. You know, an accommodation could be like a parent orders for the child, because they can't develop mentally or due to stranger anxiety, which is normal and protective. However, as the child matures the child will begin to order for themselves, they'll be able to self regulate.

Maybe the child will feel nervous, but use the strategies to order their own food in a restaurant. It's funny, because actually, Tony mentioned this as well. And then we have the anxious child now. The anxious child will have the same exact accommodation of this child on top. But maturation alone does not lead to self-regulation.

The actually the so the family accommodation will persist because they won't, they just won't do it. So the parents will keep ordering for the child what to eat, despite the child's ability, because the child feels too anxious, too distressed, because it's expected. It's a rule that they've always followed. and early in the child it was absolutely adaptive. Parents need to do this, they have to do it.

But now it's actually preventing the child from being independent. Okay. alright. So what are the aims of space? So the aim of space is to help children get better at handling any anxiety or distress.

It's the feeling that I can handle this feeling. I can get through this situation and not have my parents rescue me and take it away. So the goal is we. The aim is that to to help them handle the feeling. and the number one is because we can't get rid of fear.

Nor do we want to. We have this natural, you know. We need to know when danger is happening, so we can't get rid of anxiety. That is an unrealistic expectation to get rid of anxiety number 2. We can't control our thoughts and feelings that's not possible.

So anxious thoughts and desires to have things, a certain way will always happen. So we have to just know how to handle. Okay. So the 2 main goals of space are to increase support and to decrease accommodation. I want you to think about these little weights as anxiety.

The feelings of anxiety. So support is to show the child. Hey, man, I get it. Anxiety is rough, but I think that you can handle it. and I know it's tough.

But look at me. I'm also showing you. I can handle it, too. But I'm not going to help you. You can handle, even though it's hard.

decreasing accommodations is by, is the combination of Oh, this parent goes. Oh, I don't think my child can handle this anxiety, so I need to come in and help them. So let me help you, dear. So the goal is to decrease those kinds of accommodations that are not helpful. All right, increasing support.

So support in space is very formulated. It has 2 components. The 1st is acceptance and validation of the uncomfortable feeling and confidence that the child can handle the feeling, not do the thing, not get through something. the feeling handle the feeling, and that's what support is in space. So here's an example of a supportive statement.

I know it's hard when you have to order for yourself, but I believe that you can get through it. And that's what we call a supportive statement. Okay, family accommodation. So family accommodations are anything a parent says or does or doesn't say or doesn't do to prevent or stop uncomfortable feelings in their child associated with anxiety. So these are 2 examples.

So one, we have what we call participatory, and one is modification, so participation and modification accommodation. So the 1st one is the is the modification. So the little kid says, No, you know, eat cereal, only eat cereal right? So then the parents like, oh, no, I'm not having these good feelings. They're gonna yell at me every time I eat my cereal, so maybe I'm going to eat my cereal before the Kid wakes up.

Maybe I'm going to eat eggs. Maybe I'm going to eat something else. So the parent might start accommodating and not eating cereal in front of the child, and that would be the accommodation. Okay? And for this parent they might say, I don't care how many degrees you have.

Nothing prepares you for a teen who finds their phone didn't charge overnight. Okay? So a parent might begin to, because the child gets very dysregulated. They can't get out the door. It's oh, my goodness, it's a 5 alarm.

Parent might charge the child for the phone, but might charge the phone for the child. and I have done both of these in space. These have definitely been 2 accommodations I've addressed. Thanks. Here is so I use young Sheldon a lot in in in my in my treatment.

Because there's so many family accommodation. Good examples in that show. Hey? Here's what happened. Was Sheldon choked on a sausage or something in the morning.

And he started not eating food, not eating solid food. And so his mom decided, okay, well, we're gonna figure something out. So I'm gonna accommodate. So this is a video of her accommodating his anxiety about eating solid food. Can you hear it?

You're actually cutting the crust off before you blend it. I left it on his tuna sandwich yesterday. He said he could tell. Only drank half of it. Mayor, you think this has gone on long enough.

No trouble, but it'd be better if I had 2 blenders. Be better if you stopped coddling them. Well, I don't know what else to do. I suggested that we take him to some kind of professional, but you said he'd outgrow it. Well, if you're looking for a psychiatrist, I bet my new fella's related to one.

What do you think? Not? Sure. If we take him to a shrink, it feels like we're admitting something's wrong with him. He hasn't had solid food in 5 weeks.

Thank you. Okay. needs a few more Cheetos. Okay? So the example there of the accommodation is that she's obviously blending as food.

She says that she even needs 2 blenders to make her job easier. She's cutting the crust off his food she's putting in there. She's checking it. Those are all what we would call an accommodation for the child who's experiencing anxiety. And that is how it happens.

Some event could happen, and then it gets to that point. And the and a parent just doesn't know what to do. Right? So what I believe is happening is that there's this parallel process happening for parents. So on the one side, we have the child who's feeling uncomfortable.

and then they say, Help me, or they're upset, or they're getting dysregulated, and they get the parents to help them take away the feeling they avoid the feeling or thought, and it maintains the anxiety. But what's happening for the parent is that the parents having an uncomfortable thought or feeling about the child having an uncomfortable thought or feeling, they want to avoid the dysregulation for themselves and for their child. They help try to take away that feeling, so they avoid the dysregulation, and that maintains the accommodation. And so we have this, what we call an accommodation track. where the child begins to have distress or worry thought about how things should be expected, and then it becomes a family accommodation.

So, for example, the most common accommodation that I have that I see is answering repeated questions. Okay, so, for example, this kid, this parent, this kid, is very anxious about being late. Am I going to be late? The parent says, No, we won't be late. You'll be okay.

Am I going to be late, and then the cycle continues until they get to school, and the parent goes made it. It stopped asking me these questions. Then the the parent, the child becomes reliance on the parent for regulation, the child will begin to think. The only way I can be okay is if Dad answers my questions and tells me I will be okay. The symptoms continue.

And then the child continues to have the worry thought and the worry thought actually can get worse. I really hope I won't be late if I have to ask 30 times. Okay. One of the questions that was given was, that are all accommodations unhelpful? No.

when it is meant to avoid more or cope less, it is unhelpful if it reinforces your child's belief that they can't cope with anxiety, or avoid situations that are likely to trigger it. It is also unhelpful, or there's no path towards independence. So here's an example of the wanting to know what time it is. excuse me. your child wants you to reassure them several times a day.

You won't be late. A helpful accommodation would be. say, you respond one time each day about the time, and you provide your child access to a watch. Sorry, I'm telling you I'm overcoming a cult. It was all this talking alright, an unhelpful accommodation, for this is you respond every time your child asks a question, and you reassure them they won't be lit right?

So who should consider space. No parents who are providing any family accommodations to help their child cope with anxiety. Children who are unwilling to participate in individual therapy. This isn't a requirement for space. You could be in therapy in individual therapy, and also be having doing space at the same time.

Haven't seen individual therapy make much progress. sometimes reducing family accommodations shown to impact the success of the traditional treatment. So like non-responders of individual treatment, it could be because their accommodations were too high. And so we have to get those accommodations down, and then they'll respond better to traditional treatment. The other thing that's really cool about space and family accommodations is that you see, gains in non targeted areas.

So, for example, it could be like an a gain in an area that's like not related to a family accommodation, but it's related to their anxiety. So, for example, maybe, like they stop engaging and checking, or something that's not even related to the parent. But we see improvement in their functioning as you reduce family accommodations. Other considerations. So working with a provider that is neurodivergent, informed, and experienced, I think this is extremely important.

It goes back to what Tony was saying. Space really needs to be adapted and modified and made to be more neuroaffirming. I have made some accommodations to the way I do space in order to make it more affirming, because we definitely do not want to be trying to mitigate certain restrictive behaviors that are actually meant to kind of cope with anxiety. And they actually are self regulation strategies. So we don't necessarily want to do that.

And a trained person might not who isn't understanding of neurodivergent individuals might not understand that. It can be used for insistent on sameness and tolerance of uncertainty. So I have developed a protocol for using space for inflexibility and or insistent on sameness. And I actually have started a research study at Stanford, and we just got for the approval. So we are recruiting for individuals.

But the child has to be autistic, and between the ages of 6 and 10. But if you're interested. So it doesn't. It doesn't address anxieties per se. But it is focusing on this, you know.

Insistent on sameness. And you could email the study at this email address. All right things to do and not to do so. These are kind of like my takeaways. So one educate yourself.

Learn more about space and see if it's something that your family wants to pursue, to try out supportive statements, using statements that have both validation and confidence in the face of distress, are helpful, even if you still accommodate. According to Dr. Lee Bowitz, he actually said that if he could do one thing, it would be to like, meet with all the pediatricians, and just talk about supportive statements. If you only had like 5 min he would teach him about supportive statements. if you listen to this talk.

and then you just realize that you're doing accommodations. Do not stop. Start removing these accommodations. Okay, it is just one of the biggest errors is removing accommodations without having proper supports and pieces in place. So remember, you're gonna have to ride this wave of dysregulation.

If you don't have what you need to ride that dysregulation, you know you don't know what the plan is that it might be very hard to follow through, and it can make it could maybe make it worse. So we don't want to remove accommodations. And you definitely shouldn't do multiple at a time. all right modeling, so model, using supportive statements on yourself to your child state when you feel anxious, and how you manage that feeling which Tony also talked about earlier modeling. I just can never stress enough how important it is to speak out loud, how you're thinking and feeling, especially individuals who have difficulty with perspective taking they need to hear what you're thinking, all right, getting training.

So finding a provider to help you learn space techniques. you can do it in about 12 weeks. Alright, this is the website for space treatment.net where you can find providers. This is his Ted Talk, which I think is really good. That gives you a little bit more explanation.

And this book is the most child, friendly or parent friendly book. So the one on the corner that's in blue is the one that was really meant for parents. alright, that's it. Thank you. Thank you so much.

That was amazing. And we got a ton of questions. So I'll probably start with some of those. Kelly, are you able to put our 3 speakers in the spotlight. Kelly or Abby?

So some of the questions that we got about space? What ages is space appropriate for? And is it? What about if a child has sensory sensitivities? Is it accommodation which is helpful or not helpful?

So space. I mean the youngest I've used it with is 3 and then it can go up to because of failure to launch it definitely goes into the young adult. young adults. I've primarily my practice only goes to 18. So I but I've used it from 3 to 18.

If they're younger, it's it's really not something that you can necessarily use. But you can always adapt it using pictures and visuals and use it with kids who are even not not as verbal and have had some really good success. As well. What's the other question about space? Sensory sensitivities?

Is it an accommodation to accommodate sensory sensitivities. No, you absolutely should accommodate sensory sensitivities. So that's not. That wouldn't be so, for example. So we one way, I would deal with it in space would be that I would want them to be independent with their sensory accommodations, meaning like, if they need to bring headphones somewhere, it's making them more responsible for bringing their headphones, being, you know, instead of relying on the parent to always be responsible and thinking about those things.

But absolutely we need to address the sensory sensitivities. And one last question about that is, does space still work? If only one parent is doing it? Or does a whole family have to be involved. Space does work if just one parent doesn't.

No, so I mean, obviously, it's better if everyone's involved. But if just one parent is doing it. Oh, what I will actually to go back to the sensory sensitivity in the book there is an actually like very non nerve affirming sensory, you know example in there, and I just don't agree with how they address it. So that's 1 of the important things where somebody who's traditionally trained in space would consider doing the sensory. Like, yeah, we're just gonna let the blender go as loud as it can be.

And all this other stuff. So so. So that is something you have to be aware of that in the book. It actually has an example that is not great. Didn't say so.

Look out for that. So we had a bunch of questions asked in advance of the talk. And then someone I'm going to blend them together. Someone asked the space work for kids with the Pda profile. How do you reduce demands and pressure while also not accommodating?

And I would love for Tony, Dr. Brad to weigh in on Pda as well, because that's a common topic we hear about on real. So I'll let Dr. Burke with start about space, and Pda. Yes.

Yes, Pda, I have had some cases where it has been extremely effective. And of course we take them away slowly and methodically, and and everything. But it absolutely has been a game changer like, because these kids have really, you know, intense, insistent on sameness and and anxiety. You know, we want to make sure that we help them so that they become really proud. What's really cool about space is that I've also seen how proud kids are of themselves.

and how much more confident they are things they just didn't believe that they could do just so much stronger functioning a lot better. And you know, space has also been used for school refusal. You know, failure to launch, they also say, is, you know, a symptom of lots of kids who've had school refusal have failure to launch. and a lot of the research on failure launch is really severe anxiety, you know. And so, where these other traditional treatments just haven't been very helpful because you don't place demands on the child.

You are just setting your boundaries as a parent. It's like, I will not do this anymore. I will not do this anymore. I will no longer respond in this way, or I'm no longer going to do XY, and Z. And so that's really what they do.

they? They don't always like that. They're the parents are doing those things, but eventually they are able to do it themselves. And and I've just seen like a massive change in their self confidence, which is the coolest part about space, is their. Does anyone else want to touch on Pda.

Yeah, let me. can you guys hear me? I don't know if my. oh, okay. yeah.

So in in a separate note, when I think about. You know, Pda. I do think about the idea. you know. If it is.

you know, demand avoidance. Is there a way to move the the demand which I'm going to replace the word to ask, can we move the ask a day in advance? Can we make it transparent? Can we make them predictable. And what I'm wanting to help reduce is the nervous system reactivity.

And then that behavioral training that when I you know, I might say, and you know, people with whose parents could really resonate with this was that I was actually asking my kid if they wanted ice cream, and they were like, No, why are you asking me? Is like. is like, Okay, and why would a child be yelling and screaming? If a parent's asking them if they actually want something that they want is because of this behavioral reaction that's been ingrained through the interaction. So if I can take these demands and move them outside of a conflictual time plan on them to say, Hey.

you know, can we talk about these things? And I'm not asking you now, but asking you for for the next day. and I'm not suggesting that that's going to be magic, or it's going to remove any you know, any conflict, or all of a sudden, Pda is going to go away. But what we're doing is doing those 2 things, making the ask transparent, and the secondly, is removing that train interaction, that when something comes out of my mouth as a parent, that my my child already is starting to already is gearing up to scream back, or to say no, or to throw something. Those are just my thoughts about that, you know, interventions or or approaches, and even maybe some ways to think slightly differently about that that behavioral piece around it.

I would echo what you've both said, and I think my approach has always been to really try to investigate what's going on. You know what is happening in the body, what's happening with the emotions, but also with the parents. So this is a time where I definitely like the parents to be involved in the work. Even if we're traditionally doing individual therapy working with Pda, I think it's so important to look at all of the different dynamics of what's happening, and a lot of the support does go to the parents so that they can feel better, and they can there then help them through the moment. All great advice, and I'm taking notes for myself, and so I wanna acknowledge that it is 8, 30, and it is the official wrap up time.

We have so many questions that if you guys are okay but no pressure at all. If you have to go, I want to honor your time. If people can stay 10 more minutes. I'll keep asking questions. But if anyone has to go, I completely understand.

Yeah, okay, I appreciate that. So we have some questions. It was asked a little bit tongue in cheek, but it's actually a really good question. How do you ride the wave when there's barely any time to be prepared for the school bus. Yeah, so one of the thing I I did reply, but I'd like to expand on it.

And and in my reply I said that. you know, time constriction is a real and time pressure is just a real phenomenon for anyone living or most everyone living in the Bay area. And it really is going to get in the way of of what we have, you know, access to and and certain things that are more involved when when we're late or needing to be somewhere. There's no time to do pros and cons lists, or to, you know, even even be mindful if you know the child's gonna be late, and then you're gonna be late. And then, you know, the 3rd child's gonna be late.

We just we just totally understand and empathize that. You know that, you know, riding the wave at that moment. Isn't you know the ideal, you know, approach. So we would pick riding the wave where we can just allow for time and space for a child to experience. You know, experience that emotion.

and an experience of emotion is just what emotions are designed to do is designed to just allow us to feel. We oftentimes think that emotions are designed for us to solve. Or it's information. It is that. But it really is.

Emotions are just designed for us to feel so if the child's feeling something just allowing them to feel okay. But what do you do? So I don't want to leave you with just this idea that okay, there's nothing we can do, what it's fairly similar to what I just kind of mentioned is that you know, if if there's something that's going on at the moment of leaving, what can we do? The night before the day before, or even the weekend before. Is there a collaborative, you know, to to leverage some other ideologies?

A collaborative problem solving approach is that, you know when. So this is a Saturday morning conversation. or or Sunday morning conversation not, you know. Monday or Tuesday morning is like, you know, when this happens, what ideas should we have? What should we put into place?

So that, you know, when you're feeling this way? We could. you know, have these tools, or, if appropriate, and and not many of these conversations don't necessarily work. It takes a few tries, because a 7 year old's not necessarily going to be able to to be able to express themselves, or even know to say, you know what kind of things are getting in the way of you, you know, getting, you know. Leaving for school.

Is there something that we could do? The you know, the day before the night before? Is it that you want more time with this? Do you want more? And I don't want to suggest that you're asking and doing all this, you know.

Sherlock Holmes kind of investigating all these different pieces, but it is really about just opening up a dialogue. You know. Well, in advance. and the final thing that's hard to say is sometimes it is. It is a distress, tolerance, not not on the parents, but distress, tolerance.

It is a stressor for the child that they have to, they that that is a developmental, developmentally appropriate stressor, that they need to learn the skills and tools to navigate. And it might be just being patient through. And of course, when I say, being patient also means being late. Enough times just to allow for them to develop that ability to to just sit with the distress without the pressure of you know, being on time, without the demands, without you know the sense of of the fact that when I get upset I'm disappointing all the people around me. So so yeah, I know that's a long answer.

It's really I I try to be as specific as possible. Thank you. No, that's a great answer. someone asked. Can kids get over anxiety?

Or is it just about accepting that? It's part of who they are. But that was a great question. Who would like to jump on that one. Tony?

You have the smile. I was. Gonna say, I mean exact like when I said in my talk, right anxiety is, it's never gonna go away like it's part of who we are, as people right, and I think you know from what we were talking about, it's like, but how do you manage when anxiety comes. And are you gonna manage those feelings in it? You know?

you know, especially if you have these things that you want to be doing. But you have this anxiety and this, you know. And so, you know, we talk a lot. I mean, I know Dvts like that act like that like we talk a lot about. What do we care about?

How can we allow anxiety to be there and still do the things we want to do and have the life we want to live. And and even when anxiety shows up right? It's anxiety is never going to go away. If you could improve or lessen the like symptoms, or the you know. If it's been like your your world has gotten smaller, is kind of like how we talk about it is like as your functioning got less as your life gotten smaller.

And how do we expand your life so that it's a meaningful life that you want to be living. And you're not just. you know, shrinking your world because of anxiety. And so that's really that definitive line of like when anxiety is paralyzing versus and and really impacting the quality of your life. And when is it like there?

Because, like. it's just there, and it always will be. And it's part of us just like happiness and sadness, and all those other wonderful emotions that we have. And and that's really like more. How I would talk about it with your child.

As that, like the the goal is never to get rid of it. It's it's just how do I manage it and live the life I want. I love that we have a couple questions about diet. That I'll weave together. How much can diet be the cause of anxiety and dysregulation and then there's a question about arfid it.

I think Dr. B. You said space can be good for arfid, but then, later, that we shouldn't use space on sensory issues. So I just wanted to clarify that. So our fed like, there's 3 different categories of what our fed like.

There's different kinds of permutations of what our food shows up as it could be, like phobia of new food. It could be sensitivity of like certain and things like that. But then there could also be these other components of like trauma that you had with the food like kind of like young Sheldon and so there are different components. And so there's like the sensory issues. And then there's other things.

So they're they're not all the same and so, but a lot of kids who who have arfid they just. They're not meeting their nutrition and things like that. So we have to think of, you know, especially if it's like neophobia like fear of new foods. Or I have rules around foods. Or I just don't eat new things.

And we definitely want to use something like space or other strategies to help the the child be able to expand their their diet, especially if they're not meeting their their weights. They're not, you know, growing. You know those kinds of things so that feels more of like, it's not just sensory, that's like the bottom answer, or like the. But it can be like in some ways. And so like, you need a professional in order to like, actually diagnose or figure out what's going on, and what would be an appropriate treatment for your child.

I'm going to close on a super timely question. I'm glad Dr. Brad mentioned sensitivity to current events, political and geopolitical. How can we help 2 kids who are deeply troubled by the recent election cope with their anxiety about how it may cause suffering to people animals and the planet. Tough, tough question.

Anyone want to weigh in. I can jump in with how I've been working with people over the last week or so, and a lot of it is validating their feelings like letting them know that it's okay that those feelings are there and asking them what they need. And I let them be the guide. This has worked for for many different ages. But you know, what do you need right now?

And if it's okay, I need a sense of safety. Okay? And I'll ask, Hey, should what should we do? Should we look at it and try to find reasons that you can feel safe? Should we find people you can talk to at home and and co-create that with them.

But not take away that this is really hard, or that they're having those feelings, and that they're scared, just leaning into what they want then, and that it's okay that the feelings are there. All right. Thank you all so much. We have a bunch of other questions. But I want to honor everyone's time, and it's getting quite late.

And so to everyone who's here, we will send out slides and the recording and contact information for our 3 speakers. Thank you all so much for being here tonight. I learned a lot from this talk, and I'm sure everyone else did, too. And there's a lot of kudos in the chat. So thank you all so much.

You've helped a lot of people tonight, so have a good night. Thank you. Thank you.