Real Talk: Community Health Care in Action
A community health initiative brought to you by Frontier Nursing University and Woodford County Chamber of Commerce to improve community health and increase healthcare awareness.
Learn more about Frontier Nursing University at frontier.edu.
Real Talk: Community Health Care in Action
Anxiety and OCD in Children
Quincy is joined by Dr. Latoya Lee, Board Certified as a Family Psychiatric Mental Health Nurse Practitioner, to discuss anxiety and OCD in adolescents. Listen in to learn about the symptoms of anxiety and OCD in kids and what you can do as a parent to help manage and treat those symptoms. Have you heard of the 333 Rule? Give it a try with your kiddo after listening to this week's episode!
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SPEAKER_00:Welcome back. This podcast is a community health initiative brought to you by Frontier Nursing University and the Woodford County Chamber of Commerce to improve community health and increase healthcare awareness. In today's episode, we are talking about anxiety and OCD in children, particularly young children, with Dr. LaToya Lee. Dr. Lee is a board-certified family psychiatric mental health nurse practitioner. She earned her doctoral degree from the University of Kentucky in 2017. She is a member of the American Nurses Association and the American Psychiatric Nurses Association. Dr. Lee practices here in Kentucky and takes a holistic whole body approach to medication management. She helps patients across various age groups, including adolescents, young adults, and seniors find balance and relief from mental health challenges through compassionate and personalized care. Dr. Lee, thank you so much for joining me today. Can you tell me a little bit about your background before we get started?
SPEAKER_01:Yes, so as she said, I earned my doctorate degree at the University of Kentucky. It was a DNP program, and it was a BSN to DNP, and I did I did it part time. It took me five years. And before that, I also have a degree from the University of Louisville in psychology. I started working at a psych hospital in Louisville. Louisville and I saw a psych nurse practitioner and at first I thought I wanted to be a therapist and once I saw her I fell in love it was a therapy plus medicine married together and it was a one month before my graduation with my bachelors of psychology degree and I called my dad and I said I know what I want to be when I grow up and he said what and I said I don't want to do therapy anymore I'm going to He said, well, you're going to graduate in a month. So I don't know what you're going to do. So I looked it up and the University of Kentucky had a BSN program and that then you could bridge into a nurse practitioner position. So I was like, I'm going to go back to school. And he said, again, you're going to graduate in a month. And how that's going to happen is going to be up to you. So I like to call myself a professional student. Right. We're continuing to learn every day.
SPEAKER_00:Okay, so we recently were talking and I asked you what you're seeing more of in practice with kids. And you mentioned OCD and anxiety. And so that's what really sparked this episode. So tell me about that. What is OCD? What's anxiety? And how is it presenting in these younger kids?
SPEAKER_01:Yes. So anxiety, it's fairly common in children. Right now, it affects about 15 to 20% of children and adolescents. It is more common in female children more than males, but in males it presents a little bit different. So commonly when you see somebody with anxiety, it's it's the classic case is excessive worry or fear or. They're very clingy. They're dependent on mom or dad or whoever their safety person is. But for boys, it can be more irritability, anger, a little bit more tantrums, withdrawals, meltdowns, as you see. And both of them, they're going to avoid behaviors because that behavior or whatever they're avoiding is what's causing some of their anxiety. Mind you, if that's a social setting, grocery store, a lot of times what I am seeing right now is kids going back to school. And I think that that stems from COVID and where they were out of school for about a year. And a lot of them, were at home in their safety place and transitioning to go back to school has been difficult for those clients or patients that I have that have anxiety.
SPEAKER_00:Okay, so before we move on to OCD and what that is, you mentioned some symptoms of anxiety being clingy, dependent on a parent, and even like the meltdowns for the boys.
UNKNOWN:Yeah.
SPEAKER_00:what, what age group are we talking about now? Because it also, I know what's age appropriate. And so identifying that before saying, Oh my gosh, my one year old has anxiety, but really, I mean, that's an age appropriate behavior.
SPEAKER_01:So, so if you're talking about somebody that is a little bit more clingy and dependent, you're going to see that in young children, but it's very excessive because usually you'll see, um, a young child that's five to, let's say, nine. They're gonna be a little bit more clingy, but once they get comfortable, They let go. They loosen up. And if you can't even go to the grocery store or do all these things and they're just like glued to your leg and it's all the time, you're going to be like, hmm, what's really going on here? Okay. And then they're also, they'll start to have those tantrums where they don't want to get out of the car. They don't want to go inside. They start to cover up their face when people talk to them. That's what you're going to see in that younger group. For the older group that more that non to 220 it's going to be more of that withdrawal I don't want to go to the store with you mom why you don't want to go to the store yeah there's too many people in the store so that's that avoidance that's that withdrawal and then when they get there they're just mean to everybody because they don't know how to express that yeah and especially for boys you know because you know they already got a little bit of that testosterone at that age and so they're going to be a little bit more irritable they're going to be a with you um and so that's that's kind of the difference but it's when it starts messing with the function of their daily life and it's a consistent problem all the time you have to start thinking is this more than normal
SPEAKER_00:right okay so when it's disrupt causing a disruption yes
SPEAKER_01:and so and that's the same thing with them avoiding school they don't want to get out of the car And then that's when you will start to not just see the emotional behavior, you start seeing the physical symptoms of the anxiety. I have a stomachache. My stomach hurts. And you're like, why does your stomach hurt every day right when it's time to go to school? Right. And they know if they have a stomachache and they're sick, they don't have to go. And so you'll see a lot of that is they have a lot more sick days than normal. But when you let them go home, magically the stomachaches go away. Yes. And I don't need no Sprite, Mom, or ginger ale. I don't need to go to the doctor. I just don't need to go to school. And then when it starts to spill into school, that's when you're going to start getting a lot of the calls from teachers from the teachers because again that's when you're going to say oh little Johnny's not really concentrating very well it's because they're anxious they're having a lot of anxious thoughts they're worried about their peers looking at them they're worried about if they look different they're worried about if they don't know the answer to the question yeah and so they're not concentrating very well and then they're not again avoiding they're avoiding their other peers they only want to play with one person if they can't play with that one person they have meltdowns at school school so you really have to if they're that school age try to get the teachers involvement okay so
SPEAKER_00:that's the anxiety side of it yeah and what is OCD in children and what does that look like
SPEAKER_01:anxiety and OCD kind of go hand to hand they're kind of go together so OCD or obsession compulsive disorder they're going to have more of those obsessive thoughts and you know they it's the worry but it's like on 10 so they're always you know they get one thing in their head and they can't get it out and so they're just always worried about this and this and this but what if this and what if this doesn't happen and and then you're also you especially when they come to see me, I'm going to ask them, where do those thoughts go? What happens with those thoughts? And so they start to think, if I don't do X, Y, and Z, then something bad will happen. OCD in children can also look like they have to have a very strategic routine every day. And if they deviate from that routine, they have meltdowns. They have a breakdown. They have a very specific nighttime routine and if they don't get to do all those steps they make you do it all the way over and
SPEAKER_00:is it because does it stem from feeling that something is going to go wrong if you're not following that yes
SPEAKER_01:very much and they want to be in control because if you're in control of the situation you know what to anticipate next okay and you won't have that anxiety of what what's going to happen because you are in control and you know what's supposed to happen. So anxiety
SPEAKER_00:is a symptom of OCD.
SPEAKER_01:It coincides together because there's different types. You can, you can have the ones that like to count a lot. You got the, the normal ones that you kind of see on TV, the hand washing, you see that in kids. And it's again, that control situation and, and they're germaphobic. And when they take that germaphobic to the next level and their hands start to turn red and, and, and things like that, you're going to think, is this more of a OCD compulsive behaviors?
SPEAKER_00:Okay. Yeah. So it's, it's not that, Oh, I don't like germs, but it's whenever it goes to the next level, that's OCD. Yep.
SPEAKER_01:And so, and, and then they can feed off each other. You know, you know, I have anxiety because I don't get to do my routines or I do my routines and it still causes me anxiety type deal. Um, right now they're doing a lot of research on, um, on autoimmune type responses. It's called PANDAS and it coincides with strep throat. And so if you get a lot of strep throat infections, they think it's causing some kind of autoimmune and you're more predisposed to have OCD and anxiety. We don't know why. They're still doing research. But I have those patients that are coming in, and that's one of the number one questions I ask when the parents are saying they're having this, they're having this. And then I say, have they had a lot of history of strep throat? And if that's the case, then I know that we're already on that path for the OCD, for the anxiety. How
SPEAKER_00:do you get tested for
SPEAKER_01:that? There's no real test. And here in Kentucky, I have to send them to the University of Cincinnati. And they have a whole specialty clinic on that. And when they have flare-ups, the OCD gets worse. The anxiety gets worse. So that's why they're talking about it. it's an autoimmune something gotcha so and and they you will just see like if they get sick that stressor and then the ocd the anxiety gets a little bit worse
SPEAKER_00:so whenever they're not sick or not having a flare-up then it's not as bad but it's still there very much very much that's super interesting and it's just fascinating like how far we've come with research and what we know now and what we're going to know in like 10 to 20 years on something like this.
SPEAKER_01:Yes. Yes. Even, even if, if we're getting off subject, but if I have adults with anxiety or OCD, you know, I asked them, did you have a lot of strep throat as a kid? More than 90% most of the time say, yes, I did. That's funny. Why did you ask that? And then I tell them that and they're like, Oh yeah, But it's one of my questions on an intake always. Wow.
SPEAKER_00:That's fascinating. Okay. So how are parents identifying this? You kind of ran through some of them.
SPEAKER_01:Sometimes it's the school. A lot of times the school are saying, you know... This isn't going to work. Something's going on. But then the parents, especially if we're talking about OCD and routines, it's interrupting their daily function. So then they're like, what am I supposed to do? What am I supposed to do? And then if it's anxiety and you can't go where you need to go, you can't move the way you need to move and they're declining socially because they're just so enclosed and fearful to do new things. Then that's when you'll you will eventually see those patients in my clinic. Now,
SPEAKER_00:if I'm a parent and I am seeing some changes in my seven-year-old, and I'm assuming I'm probably going to get a referral from my primary or pediatrician to come and see you, how do I prepare my kid to come and see you?
SPEAKER_01:I like to tell them that, just tell them that we're just going to go to a normal clinic to a normal doctor's visit. Make sure there's no shots involved. Because that's the number one thing. You can tell they have anxiety and they're very apprehensive when I call their name and don't want to come. That's exactly what I say right up front. There's no shots. And they're like, there's no shots? Yeah. I said, come on, I got toys. Kind of a little bit of that stranger danger, but I'm a nice stranger. But I'm like, I got toys. I got candy. Yeah. Shouldn't do that, but
SPEAKER_00:that's what works. And what does the visit look like for the kids?
SPEAKER_01:So right up front, I tell them, I try to sometimes get on their level and talk to them. And I said, I just have a lot of questions I'm going to ask you. I'm going to have some questions to talk to mom about. And then we're going to come up with a plan afterwards of how we can get you feeling better. And so I tell them it's going to be like 60 minutes, but after I get my questions, you're more than welcome to play with my box of toys and things like that. And so I ask parents before they come, they have a form that they need to fill out of all the questions. And I want to know from utero till now, how did we get there? And so I want to know about birth history. I want to know about family psych history. I want to know how they were as a baby. And then when do these symptoms start what makes them worse what makes them better and then again as you said I like that holistic approach so I want to know how they're eating sleeping because that's very much a big component
SPEAKER_00:right and so you mentioned family psych history how closely is that related
SPEAKER_01:it is very related and and so when you start talking to people you you'll see there has to be a genetic component when everybody you know grandma great-grandma And mom has anxiety. So there we are. OCD is the same way. There's usually some kind of family member, one or two, that has OCD. And then that's also a tricky thing. So if you live with a parent that has OCD, you might pick up on some of those behaviors. Okay, I was wondering that.
SPEAKER_00:And so for you, is that kind of like... working to kind of treat the whole family. Like if you're seeing a mom, I see family groups.
SPEAKER_01:Yeah. Okay. Okay. Cause what happens is, is mom brings, you know, little Mary in there and she's like, you know what? A lot of this resonates with me. Can I come see you too? And so then I'm seeing mom and then, you know, I'm seeing grandma and, and things like that.
SPEAKER_00:Well, and I feel like if you're treating the kiddo and mom is still doing those behaviors, it's just, And
SPEAKER_01:so that's what you come with kids. Sometimes you have to treat the parents with the kids because we have to figure out what's going on at home or if there's a parenting thing or something that we need to work on too.
SPEAKER_00:Right.
SPEAKER_01:So
SPEAKER_00:this might be an absolute silly question, but are there any preventative actions we can take? I mean, perhaps... looking at yourself as a parent, like, am I doing something too?
SPEAKER_01:Yes. So if you have anxiety, if you have OCD, you need to take care of yourself because your kids feel that, you know, and that's something that I, even when I have pregnant patients, what your kid or baby needs is a happy mom or dad. Right. Because everything that your kid learns is from you. That's, that's your whole job. Your whole job is to, to teach this kid how to be a successful mom. whatever that would be, loving, caring an adult. That's what your job is when you have that kid. And so they learn from your behaviors. And so if you're not mentally healthy, how do you expect the kid to be mentally healthy?
SPEAKER_00:Right. So one more question on this. What are some strategies or methods of coping? So we get a diagnosis that my kid is anxious or has OCD. What are some things that we can do at home?
SPEAKER_01:Okay.
SPEAKER_00:Are we talking about non-medicines? Well, actually, not last question. So in addition to, I guess, the treatment, let's go to there
SPEAKER_01:first. So a lot of parents are like, I don't want to put my kids on medicine. Yeah, I don't either. But if it's extreme, that's probably where we'll go if we're not, again, functioning. First, we're going to do therapy. And can we do some therapy? The best type of therapy would be CBT, which is cognitive behavioral therapy, it gives them the techniques of what happens when I am anxious. You know, how to retrain the brain at that point. There's a grounding technique I modify for kids, but it's called 3-3-3. You have the kids to sit down and identify three different things that they see. Identify three different things that they hear. three different things that they can feel that's going to help them get back in the present instead of that anxious mind.
SPEAKER_00:Um, for adults, five, five, five.
SPEAKER_01:Yes.
SPEAKER_00:Okay. For
SPEAKER_01:adults, it's five, five, five. Okay. And so you're, you know, you're grounding yourself and, you know, putting your feet on the floor and then you're using more of the five senses. What can I hear? What can I smell? What can I taste? What can I touch? What do I see? Okay. And so then that kind of, okay, calm and, It's never too early to teach them breathing techniques. Take a deep breath, hold it, take another deep breath. That's the best thing for any kind of tantrums. And then I also want them to get on eye level with your kid and say, you're okay, I'm okay. Kind of Tell me what's going on, what you're feeling, and what has triggered this. How can I help you work through this? Because you don't want to be I need to save them because what's going to happen when you have to go to work? What's going to happen when they have to be at school? What's going to happen at grandma's house? They have to learn the techniques on how to self-soothe and cope their self. And that's exactly what the therapist is going to do. There's CBT for kids. There's play therapy with the CBT. Highly recommend it. Here in Kentucky, we have equine therapy. And you can go in and do things with it. the horses it's highly recommended yeah
SPEAKER_00:so okay so lots of treatment options yes and and we don't have to just jump to medicine we
SPEAKER_01:do not have to jump to medicine unless we feel like it's some kind of very specific like we're having anxiety attacks and extreme phobias you know we can't
SPEAKER_00:do what we need to do. Is it something where if we have to go to medicine, is it something that they're on for life or is there ways that we can treat with medicine now and then work on strategies to wean off of that? It's
SPEAKER_01:always your goal to get to some kind of remission. So hopefully, no, it's not a long-term medicine that you'll have to be on for life. But if we're talking about genetics, you know, genetics is genetics. If everybody in your family has anxiety, but the best thing is if you're going to catch it early we can give them those coping skills or tools in their toolboxes i say that they can use so maybe we don't need as much as medicine or um we can eventually get off medicines right
SPEAKER_00:yeah yeah i think that's i feel like that's probably the goal for a lot of parents
SPEAKER_01:it is it is you know it is mind altering medicines but if we're talking about a genetic thing that's just you know if if we were talking about your heart right and you need this medicine to live, we wouldn't be having any questions. But for the stigma of mental health, you know, they're like, oh, but this is exactly what I tell all my patients is your brain is one of your biggest organs. If your brain's not functioning, how's everything else going to function? Right. So if, like I said, if we're talking about your heart, you'd be like, give me all the pills. If it's your brain, you still need that because your brain is telling your heart what to do, what your lungs have to do and everything else. And so I think it's just getting away from that stigma of mental health.
SPEAKER_00:And then what can we do at home? Which I think you mentioned the 333. Yes. And then
SPEAKER_01:also what we really can do at home is we need to work on our diets and sleep. So sleep and anxiety go hand in hand. So that's one of the questions that I ask. How well are they sleeping? Are we having nightmares? Are they sleeping throughout the night? Do they have a good bedtime? Kids need sleep. They do not need to be up at night. They need a routine. So what is their routine? They need to be, you know, young kids needed to be in a bed by 8 8 30 they need all the sleep they can get them teenagers they need all the sleep they can get because they don't like to wake up early in the morning but if you can get your sleep regulated it's kind of like a reset and and so I do a lot of sleep hygiene weighted blankets are great for anxiety also mood and attention and concentration so I highly recommend that but food food is my newest biggest kick I on things. If we don't have a clear gut, those toxins are going to cloudy up your brain. You're going to have more mental health symptoms. So if we're not eating good foods, if little Johnny's eating McDonald's three times a day, we need to get a more well-balanced diet. So I'm a big component on vitamins if we're not getting a good balance, because it's hard to get kids to eat certain things. But we do need our fruits and vegetables. All right. Any last thoughts? No. I mean, just be there for your kids. Ask them the questions that they need to know. Really, you know, take into account what the teacher has to say and know that there's several different options. It's not just all about medicine. It might be that we just need to do some modifications at home and with behaviors. And... we're going to improve on these kids' mental health one day at a time. Yeah. And it'll make a
SPEAKER_00:difference for their
SPEAKER_01:life. It will. It will. And that way, you can really catch it early before it... gets worse later on in life.
SPEAKER_00:Well, thank you so much for joining me today. Thank
SPEAKER_01:you.
SPEAKER_00:We'll see you all next time. This podcast is brought to you by Frontier Nursing University and the Woodford County Chamber of Commerce and is part of the What's Up Woodford Network.
