I, in a prior life, spent about ten years in our k twelve education system in public schools in Washington, DC, and I specialize in working with students with moderate to severe intellectual disabilities as well as emotional behavioral disabilities and spend a fair amount of time learning about the inner workings of our systems that support our children, especially in our low income and needier communities. And I am joined today by former TEDMED speaker, Anne Marie Albano, and I’ll let her give full introduction of her work.

Thank you, Lindsay. It’s really a pleasure to be back to TEDMED. I’m Anne Marie Albano. I’m a clinical child and adolescent psychologist. I’m also a professor at Columbia University Medical Center. It’s really a delight to be here to talk to you. I’ve worked in the field for too many years studying anxiety and depression in youth, the way that it manifests and the way that we can treat it and help our children to thrive.

Thank you so much for taking the time to join us, Anne Marie. I really appreciate that you shared a lot of your more recent lecture notes and and work that you’ve been sharing with communities and especially working with schools and different programs there. I’m excited to talk about all that great work that you’re up to. I first want to rewind a little bit and kind of go back to when you gave your TEDMED talk in twenty twenty. I just would like if you could spend a minute or two talking about the mental health challenges that kids were battling before COVID.

We have been studying anxiety, depression, and these conditions in kids for a good thirty years, and we knew much. The main thing we knew is that anxiety disorders are real. They start early by the time a child is four or five years of age, and they pick up prevalence. They become more and more common in children all the way through adolescence.

So whereas about six to nine percent of preschoolers are suffering with an anxiety condition, you get upwards of fifteen to twenty two percent by the time kids are graduating high school. The longer they suffered with anxiety, the more likely they were to develop depression by early adolescence as a girl or depression came on a little bit later, fourteen, fifteen years of age for boys. And then they can combine and make things worse because substance abuse can come into the picture. So we knew all these things. We were very worried about kids, but at the same time, there were very good therapeutics, cognitive behavioral therapy, interpersonal psychotherapy, and medications that were developed for kids.

But we had a ways to go to work some further on on these, especially the psychotherapies because we knew then that we can treat children in the short term, but they still needed more help to maintain their gains and continue to progress over time. And that’s what my TEDMED talk was actually about, involving families and paying attention to development.

When we look at that snapshot in time, like, before we introduce a global pandemic and a global crisis, you’ve talked a bit about how we’re working to address these challenges. In what ways were we falling short and what lessons hard lessons had we been already learning?

Really, we were focusing on just the child or just the teenager, and this was pretty much the way therapy was done. Parents were would bring their child to a therapist. They might have an initial meeting with the therapist, and then it’s like lock them out. You know?

So we weren’t dry cleaners, but it was kinda like that. Drop the youth off. We’ll take care of the problem and return them to you. And what I think a lot of the data showed and what we learned is you have to have parents involved in the process.

Now mind you, we know that there are parents. They themselves could have difficulties. There may not be parents in the picture who are really capable or even present for the youth, so there are things we could do there. But we needed the adults to be in the room and participating in a way that gave kids confidentiality, but allowed us to work with the environment, the primary environment that that the kids were growing and living in.

We also knew and we found out that actually if we bring our treatments to schools, we also then can get even a better response in that we’re in the environment where children are confronting things that trigger their anxiety on a day to day basis.

And our kids prior to the pandemic and still now were worried about achievement.

They’re worried about their social relationships, especially in the age of social media and the way things get sent around and there could be bullying things that happen through social media and such. They were worried about these things as much as they were worried about everyday worries. Am I good enough? Am I smart enough?

Can I get along here? Am I going to be successful in the future? So we learned bringing treatments to where the kids are could make a very big difference. These are just some of the things that we learned and knew prior to the pandemic.

Can we spend a few minutes talking about the complexities Yeah.

Let’s also bear in mind something here.

When everything else is held constant in terms of a child or the as we’re looking at children and teenagers, and constant meaning their physical health status, their family, race, gender, various things are held constant. What we know is that poverty is really the number one risk for mental health problems in kids. When children are, anxious about their security and there aren’t the resources for them, they don’t know where they’re gonna eat next. They don’t know who’s gonna take care of them or if they’re gonna be safe.

You know, these are critical. And so schools were a place of such support for many, many, many youth. They get meals there. They, get adults there who can help focus on getting their needs met for them and protect them in ways that maybe the parents again couldn’t.

In addition, we just know in the larger majority too that kids, let’s say, who were who are minoritized, are at higher risk for experiencing the consequences, the psychological consequences of a pandemic and the shutdowns that happen. So a lot happened to shake up, the foundation from which kids, at least through the course of any given day, can step out, see a mentor, a teacher, a coach, a friend. These things were not present during COVID. And then what we know is that anxiety and depression in youth doubled through the course of the pandemic.

So we have to pay attention to this psychological footprint that was left. Our kids are struggling.

They’ve lost a lot of time and not just their milestones of, like, a prom or a graduation, but they’ve lost a lot in terms of opportunities to develop skills through the day to day interactions that we all experience when we leave our house and go to school or an internship or see friends.

Something that I found so striking that you had shared with us is Gallup and UNICEF did a poll across a bunch of youth in recent years and while they’re anxious, they’re hopeful.

When we think about designing interventions for anxious yet hopeful for the future, kiddos, what does that look like? How do you tap into that really valuable energy that they have?

It’s a wonderful question and something that adults really need to listen to. When we’re talking about designing interventions for kids, one of the things that we really need to do first and foremost is involve the youth in the design of the interventions.

What is it that our youth want us to help them with, and how do they want us to get the help to them.

One of the things, for example, we are working with is developing virtual reality environments for youth to come in and work on their anxiety. They’re helping us to create and design virtual school environments and the situations that come up so that we know how to tailor the interventions we teach them for managing anxiety. So that’s first and foremost. Listen to the kids and involve them.

And then as I said earlier, we’ve gotta get these strategies and these therapeutics to them. Kids came to therapy through the telehealth types of, mechanisms that people were using. They came. They actually showed up, and they were there in ways that they weren’t before, because it was more accessible and they could fit us into their day.

So this is important. We have to deliver the treatment to the kids when they can get to it. And a big thing too is making it relevant for who they are in this moment of time. What’s relevant for a ten year old is not the same for a fourteen year old, for a twenty year old.

So our therapies have to flex developmentally with the kids and not just be taking something we know that works and slap it into some childish language. That doesn’t fly.

And if you could just help educate us a bit around diagnostic tools and ways that kids are currently able to be identified as needing additional support or resources or things along those lines.

I think one of the other things that has happened, it started before the pandemic but really has blown up since, is there’s a lot of wonderful online resources that allow kids and also parents to do some sort of self test and self quizzing about how they’re doing. How are they feeling? How are they functioning? Are they meeting the things that they wanna meet in terms of their goals, their roles, being a student, being a family member, what have you? I always talk about, Anxiety Canada. What a fantastic website for our friends, up north that’s good for everyone, for parents and kids, and they have an app called Mindshift.

Many of the youth I work with download and use Mindshift because it helps coach you in the moment. There’s the Anxiety and Depression Association of America. There’s so many online ways that parents and youth can check-in on themselves and then have tools at their fingertips.

These online apps and programs are pretty good with helping you clue in, but then there’s times when you need to get a professional involved.

Everybody experienced a lot of really big shifts all at once together during COVID nineteen. What are different types of shifts or themes that we can kind of help adults clue into, hey, if a shift happens in this area, it can increase stress and anxiety for kids?

Well, I think this is another excellent question and point here. And that is during the course of the pandemic, we were all sitting somewhere and staying in a place, whether you were stuck at home or healthcare workers who were in the hospitals.

Think about the way as adults that our lives were restricted. We weren’t moving. For many adults, we felt it. You gained weight. You were more irritable. You didn’t sleep as well. Now think about a day in the life of a child.

Kids get up. They’re going to school. They’re running around playgrounds. They’re going in between classes.

They’re mixing it up in various ways. There’s usually an activity afterwards, whether it’s a sport or a club or what have you. We lost movement. And movement, especially for the developing child, is so critical.

It’s critical for their emotional well-being as well as physical. And so studies show during the pandemic that families who had access to a public space with greenery, a park, if they had access within a ten minute walk of their house, their kids did much better compared to those who didn’t have that kind of access. And also the parents themselves did better emotionally, and they all got along better. So we know we have to pay attention to the full whole child.

Their physical self impacts their emotional selves.

With that, talking about communities and ways that communities are designed to support children’s development, what are community interventions or community designs that you would encourage our listeners to think about?

When you think about the saying, it takes a village, it does take a village, not just the people, but also the space and everything that comes with the environment. And the big thing that we have to bear in mind as adults is we really need to remember that children who are growing up in areas where resources are scarce and difficult to come by are suffering the most. At the same time, just think about kids.

They need community response. We need to be taking care of them in various ways, and that means resourcing schools so that mental health can be delivered or at least be accessible in schools for those kids to make it easier for them to speak to someone and get some help. We also have to make sure that we’re backing off on the pressures that kids have been experiencing pre pandemic and post, focusing on achievement and grades and test scores. Let’s get over it.

They need to focus on developing and taking the time in childhood really to explore and to make mistakes and to try one thing and try another thing. So communities need to be responsive by allowing there to be all kinds of internships, partnering with schools on this. I love the fact when there are hubs or clubhouses and mentoring programs that engage, like, high school students with younger students, community members with kids, these kinds of things help kids thrive. The community can come together in such a big way, but a lot of it really can be done through the school and partnerships with schools.

Kids are watching adults all the time, and they also watched us try and cope with the pressures and stress and anxiety. Can you talk about what we might be accidentally teaching our kids through our behaviors and how we cope or or manage stress?

The idea that our children, our teenagers, or and young adults are watching us is so critical because they are, and they’re learning all sorts of responses from us that are helpful and not.

We know from lots of data that the developing fetus actually responds to the internal environment, you know, by, seven, eight months. They’re responding to the the mood and emotions of the mother, for example, and also the environment around them. So with that in mind, other research has shown that youth really pick up on what adults are saying and adults’ moods and actions, and it affects them. It can affect them in a positive way, in a proactive problem solving way when needed, and it also can affect them in a very negative way. Our youth are not happy with the way we’ve responded to a lot of issues that have directly impacted their health and well-being.

From climate to school shootings to the way we responded to the pandemic, the kids are worried that the adults in the room are too busy bickering and not paying enough attention to their needs and creating a world that is safe and secure for them. And so they’re turning to their public figures, youngsters who are taking stances from the Parkland kids to Greta.

They’re paying attention, and they want their voices heard, and they want us to make better decisions for them.

We are, unfortunately, in a mental health crisis for our youth in America, especially those who have disadvantaged backgrounds or are minorities. What makes you hopeful for the future of our youth’s mental health?

What makes me hopeful is that more and more, they are seeing other kids and also younger adults who look like them, who are making meaningful statements and taking meaningful actions to address issues.

Issues of, bias, issues of limited access to resources that are so critical. I’ve been seeing youth, especially through the pandemic, get together and do things on behalf of their community that helps them, but also just helps people in the community who otherwise would be left alone. A lot of these kids had limited means, but they stepped outside of themselves to help someone else. And they did that based on watching other kids who look like them do similar things.

When I was a teacher, one of my favorite books to teach was about how to fill your bucket. And there’s also actually a version for adults, but the concept being that your bucket fills up when you also fill other people’s buckets. And it’s amazing the impact and both from the person who is receiving kind of the act of service or support as well as the person giving and or providing it. Can you expand a bit more on how schools or families or communities might provide more opportunities to fill our buckets?

So getting used to the idea that things may happen, but there are things that you can do. What’s in control is your behavior, your reactions, and your ability to be flexible in thinking and problem solve and participate.

This alleviates anxiety for kids, for all of us, and helping kids to get involved in acts and and programs that, again, are giving to others or solving problems that affect them too that gives them a very good sense of control, but also of self efficacy and participation in the broader community.

When that happens, they see themselves as part of something bigger, and they don’t feel alone and unsupported.

Kids can get involved with many different types of organizations in one’s community. These are service organizations.

I love watching the kids, for example, in the public parks in New York City who are part of cleanup, who are part of, doing pop ups, where people come and the kids are taking them around the park, doing science experiments with younger kids, all kinds of things. There’s all types of organizations when you just think about it. You have to sit and just be creative in your mind, with the youth to see what they’re interested in and what they’ll invest their time in. When that happens, they get edified, They get hopeful, and they feel really validated that they’re not just being managed by adults, but they’re participating in their own growth and the growth of those around them.

I’d like to ask you just to expand on how social determinants of health, specifically for our youth, are impacting their access to resources right now.

Right now, we could think about in some parts of the country where water is not available or clean water is not available. You have kids who may be living in poverty. In addition, we know that our kids have great empathy for others. So they worry about the kids who may be suffering. Kids who may or may not look like them, they worry about these things.

What are some key things that the adults can do to continue to foster and support that empathetic, viewpoint and lens?

As adults, the very first thing we need to do is take stock of, are we taking care of ourselves?

Are we getting enough sleep? Are we managing stress that happens in multitasking and all the things we need to do? Are we getting enough physical activity so that we’re at our best to recognize when something causes an emotional reaction in us?

Again, because our kids see that.

If we can model for our children managing the everyday stressors as well as the big things. And when I say model it, I mean, you’re at home and maybe you’re getting dinner ready, your partner’s not home yet, the kids are there, you get a call or you see a text, I’m gonna be late.

Are you immediately upset because you gotta get dinner on the table because you have something to do and you’re or can you recognize that arousal and can you out loud say, you know, mom or dad’s gonna be late.

Let’s put dinner aside and we’ll eat now and focus on managing and coping in the moment and how you work through it. By showing kids how we deal with everyday things, they will pick that up. It helps them develop empathy rather than just complaining and yelling and then that defeats the idea of developing empathy and understanding one another. It’s okay to get upset, but the way you present it and work through it is what we need to show our kids we’re doing well in consideration of everyone around us so that they learn how to do that.

It helps them really build their vocabulary if you’re naming like, wow. I’m a little frustrated but we need to change the plan and that’s okay, right? And being able to just say that sentence out loud is, it’s amazing how much it teaches that cognitive flexibility and that life flexibility for our kids. And so I know flexibility is something that you’ve spent a lot of time learning about, researching, and and and talking about. Can you expand a bit on that psychological flexibility that we wanna have our kids to have?

Psychological flexibility is our ability in the moment to recognize we might be stopped, we might be frightened, we might not be able to do what we wanna do. But you know what? We’re able to ride through that and adapt our resources to deal with whatever the present stress is. And if it’s gonna be ongoing, to change the way we’re managing things so that we take care of ourselves, the needs around us, and we could move forward in a healthy way.

If we get stuck and just, like, you know, just keep drilling down that this isn’t good, this isn’t good for me, it’s never gonna get better, why can’t we go back to the old way, whatever it might be, you then develop more and more stress. You’re more and more irritable. It doesn’t change things, and actually other people in the world moves on. And you are really in a state then of not just it’s not denial. It’s just like outright, you know, distress that doesn’t get resolved.

So psychological flexibility is so critical because, again, it it helps us to deal with little things, changes in routines or plans get stopped, and also the big stuff that might take us off track for a little, you know, longer such as pandemics and all, but it allows us to move forward. So problem solving is critical.

Okay? That is that’s the number one skill we all have to learn and being able to then adapt to new circumstances as we move forward.

One of the tools that we used to use when I worked with students who really struggled with emotional regulation, was asking them the question when they would get upset or frustrated or have a negative emotion about something. Ask them to classify it. Is this a big deal? Is there a fire? Am I in pain?

Big deal or is it a little deal? And just having them do that first decision tree, allowed them to then either if it’s a little deal, we’ve taught coping skills or things like that, and it’s, oh, you can manage this and that’s it’s okay to be frustrated, but it’s manageable versus a fire, you need an adult.

Yes. You know, when you think about it, the simple little things that happen in school, let’s say, where a fifth grader is asked to go help the first grade teacher with some art activity with the kids or something. And even within your own home, your older kids are helping the younger kids out. When you think about things like that, it is a way of teaching kids to look at themselves where they are now, that they have the abilities to affect someone else’s life, these first graders or whoever it may be. The more we could do that as we’re moving along, the better they’ll become at recognizing other people’s people’s emotions, recognizing ways to relate to one another, but also feeling, again, empathy for others, flexibility in the way that they’re thinking, and also empowered that they really they they’re competent human beings who, you know, who have something to contribute.

If you had kind of the the toolbox that you’d like adults to fill up for kids, for the tools they can use in different challenging situations, we talked about problem solving, for example, as a tool in that toolbox. What are kind of the top tools you would put in kids’ toolboxes?

Oh, this is a great question, and I’m glad that you asked about skills and what kids need.

Problem solving skills are critical, and that’s something that you’ll work on with your kids from earliest stages.

Another very big skill is self soothing.

And, you know, think about this, whether they need their little stuffed animal in bed to fall asleep at night when they’re younger, to they like to talk before falling off when they’re, you know, in middle school or what have you, Self soothing is critical because it teaches them how to put themselves back to a state of calm so that they can reason appropriately.

And so it’s important to teach that by demonstrating again that there’s routines that might help us to, be soothing ourselves, nighttime routines to wind down, ready routines in the morning to get going to school, what have you. But also self soothing helps them when they’re bored.

And that way they’re not running towards mom and dad all the time saying, play with me. What can I do? I’m so bored.

Self soothing helps them to be present in the moment with themselves and calm themselves, entertain themselves, and have a life of the mind that is stimulating to them. We also want them to have very good social skills, and that’s why it’s important to have them in situations with multiple people and different types of people, younger, older, people in authority, peers, people that they are directing in various ways, asking for things, asserting themselves.

And it’s important all these skills, social skills, soothing skills, problem solving skills, because they have to also have experience with disappointment, experience with embarrassment, experience with not knowing the answer.

You have to learn how to manage it in the moment, and that doesn’t mean you don’t cry about it later if it’s something that’s really important or critical to you or disappointing to you, but you’re dealing with it in a way that helps you then move forward.

Ann Marie, it has been such a delight to be able to chat with you, learn from you, and hear about all the great work that you and your colleagues are doing and the impact that is ahead of us and all the good things that we can remain hopeful for and put our energy towards. Thank you so much for joining us today for our TEDMED conversation.

Oh, this was all my pleasure. Thank you for having me again, and I wish you well.