Dr. Leigh Weisz: 11:33
It sounds like Ferris Bueller’s Day Off this category.
Dr. Karen Lynn Cassiday: 11:37
Yeah. You know, I think. Yeah. Ferris Bueller’s Day Off is a great illustration. Yeah.
If anyone has never heard of that, it’s worth a watch. Very entertaining and illustrative of this category.
Dr. Leigh Weisz: 11:49
So is the third category. This is so interesting. It’s not is it? Is it at all related to like learning disorders or really truly not that group.
Dr. Karen Lynn Cassiday: 11:59
Yes. They’re more likely to have ADHD and learning disorders. Okay. We see the mistake that is made. Is that because they’re not directly oppositional, you know, they don’t do bad behaviors.
They’re not kids that people identify as difficult. They are just quietly falling through the cracks. And and the dilemma oftentimes is that parents don’t know how to engage them. And you know, and then also I ought to mention a fourth group which is Autism Spectrum kids. And we see that group is at very high risk.
And it’s for all the reasons I just listed. So I may not be socially engaged. So by the time I’m in high school or middle school, it school just it’s awkward. It’s uncomfortable. There’s nothing there for me.
Or there’s certain types of assignments, particularly, you know, ones that require narrative writing that are very difficult for me or I. I get laughed at when I ask the, you know, yeah, question the literal, you know, I miss I misunderstood things literally.
Dr. Leigh Weisz: 13:13
Right.
Dr. Karen Lynn Cassiday: 13:14
And or I’m having overwhelming anxiety or depression because one of the things we see with kids on the spectrum is the way they experience emotion. It’s like an on off button. So there isn’t that gradient or that build up. And so their felt experiences, all of a sudden I’m overwhelmed with this fear or this whatever. And then typically they aren’t able to describe it.
Yeah. So people aren’t sure how to help, and the group that is probably most at risk is girls for avoidance because they usually aren’t diagnosed.
Dr. Leigh Weisz: 13:48
You mean on the autism spectrum? Yeah, yeah.
Dr. Karen Lynn Cassiday: 13:51
So autistic where I get a lot of school refusal and then find out it’s girls who are high functioning. They’re good students. They obey all the rules. But they’re on the spectrum. And they they don’t have what we would consider friendships that provide emotional safety.
They’re terribly interested in relationships. They don’t have a teacher or a coach that they connect to, and they’re just sort of adrift. Yeah. The boys are more likely to be recognized and to get supports through special education. But the girls, oftentimes that’s the way we start recognizing that.
So that’s sort of the flavor that.
Dr. Leigh Weisz: 14:30
But so I’m hearing you say there are I mean, a myriad of reasons that someone might, you know, try to avoid or refuse altogether to go to school, and based on their age, based on their gender. You know, you really have to almost be curious and be a detective to figure out what is underneath that behavior. Because it’s it really can be a number of different reasons, but there often is a really valid reason that they’re struggling with something and they really need help.
Dr. Karen Lynn Cassiday: 15:00
Yeah. And I think this is one thing that I think that is difficult for parents is because oftentimes if your child is avoiding school, typically it doesn’t start out with it just happens once. But parents at each episode are thinking, this is the last time. If I comfort them, if I give them this special day off, or I give them a mani pedi day. And just to chill, then that will help.
And almost always, what we see is a progressive pattern where starting in kindergarten or the early years, where when there’s something difficult they avoid and then it just keeps getting worse. It is. The difference would be with panic disorder or a sudden onset of OCD. We see all of a sudden, boom, someone’s around middle school age and they were great. And then now it’s really difficult.
And the same with social anxiety disorder, but with specific phobias. That usually starts around age seven.
Dr. Leigh Weisz: 16:04
I was I was going to say so yeah. Are there certain ages or again, developmental stages where you see kind of school refusal spiking, you know like really common entry for this behavior.
Dr. Karen Lynn Cassiday: 16:18
Yeah. So we see around kindergarten first and second grade, oftentimes if we’ve got school refusal you’re going to find separation anxiety disorder or specific phobia I’m scared of thunderstorms bees dogs, and it’s seasonal, or it’s related to the presence of or fear of vomiting. Every fall. Every winter. Then what we see is OCD and OCD shows up earliest in boys.
So if we’re looking at males, we can see that starting in kindergarten sort of evenly all the way up through the years. Okay. If we’re looking at panic disorder, we typically see females and we’re looking at those early and mid teen years where it starts to come out. Autism spectrum. Typically what we’re seeing is if it’s, shall we say, a more complicated version, then we see that happening usually second, third, fourth grade and around where social relationships become more than just my friend is the one that does what I do.
It’s based on social preferences. And then social anxiety disorder, then equally in boys and girls. Then that middle school and high school age group, it starts to crop up for sure.
Dr. Leigh Weisz: 17:44
And so what you’re what you’re saying. You were kind of alluding to this a little bit earlier, that, you know, when parents see that their child is struggling and does not want to go to school, the ones the parents who say, okay, like, let’s just take the day, we’ll have a mental health day, or we’ll go do something together. And they think it’s just kind of benign, like a one time thing. You’re saying it typically isn’t resolved with that one time. Tell us a little bit more.
Just kind of like in terms of the parents listening, what should parents do when they hear a child is hysterical and cannot go to school? Words like that. What is the best, you know, best thing for them to do at the outset? And then over over time when they see that, yes, indeed, it is a pattern.
Dr. Karen Lynn Cassiday: 18:29
Yeah. Well, there’s a couple of things. So number one, the worst thing you can do is to have them not go to school. Okay. And that is very hard for me to say because I realize your kid could be having a meltdown.
They might be vomiting out of anxiety or doing, we’ll say dramatic behaviors are telling you that they want to kill themselves. They want to kill you. We’ve had that too. And so parents get fooled. And so the first thing is, if I were a parent, one thing I’d want to vow is that unless my child meets the American Academy of Pediatric Criteria for illness, which is a fever over 100.1 Fahrenheit, vomiting more than three times, diarrhea more than three times.
Because that’s when we start going. That is an illness as opposed to anxiety, right.
Dr. Leigh Weisz: 19:27
Or somatic kind of somatic.
Dr. Karen Lynn Cassiday: 19:29
Yeah I like that word. It’s semantic as opposed to an actual organic illness. Then my kid has to go to school. And the problem is, if it’s a parent, if your strategy of parenting is to always comfort when a child shows distress and you’ve never used an effective timeout or effective active ignoring when they’re having an emotional meltdown, then you are caught off guard and you don’t have a way to handle it. So what I’d actually say if you want to prevent it, then we see now that using a gentle parenting strategy where you don’t insist your child manage frustration without your help, and you don’t allow them to calm themselves down without your help, and you don’t insist they do things that are frustrating, then you’re setting them up for school refusal.
Wow. And you’re also setting them up for failure in life. We now know that from longitudinal data, right? I know this sounds very controversial right now, but if we want to follow science and all the top thinkers and movers and shakers, you have to teach your child starting as soon as they have their first tantrum, that you can survive big feelings. You can survive frustration and disappointment and.
Dr. Leigh Weisz: 20:52
Absolutely.
Dr. Karen Lynn Cassiday: 20:52
Fear.
Dr. Leigh Weisz: 20:53
Absolutely. I was going to say this reminds me of Jonathan Haidt, who wrote, you know, the recent book. Oh My gosh, The Anxious Generation blanked for a second. He talks about how children are like trees, that they need to be exposed to some level of stress, whether it’s wind or weather or challenges for children to be able to grow strong and resilient. So for the tree trunks that you know are able to stay, and it’s it’s so interesting that, you know, we as parents are always trying to make our kids feel better, you know, and it’s it’s naturally wired in us to care and to not want them to be distressed.
But what you’re saying, of course, and what we know is true, is that that’s the only way for them to practice being able to be okay, you know, without us. And so as much as it’s distressing to see your kiddo be like, I can’t go to school, I can’t do this, my homework isn’t completed or whatever the case may be, that we have to be able to push them to go.
Dr. Karen Lynn Cassiday: 21:54
And so and so another way to put this is if your child is avoiding school and they don’t meet those American Academy criteria for genuine illness. And I’d say I’ve found moms and dads actually almost always know it’s not real illness. They’ve got a feeling it’s it’s very easy when your kid’s really sick, they look and act fundamentally different than when they are having a tantrum because they’re scared. Yeah. And it’s you need to consider it an emergency.
An emergency where the critical care is. I have to get them into school. And so there’s two different ways to do that as a parent. And we you know, my practice, we actually go into the home and help and we consider it an emergency. Someone’s got to get in right away.
Not during school. So they have an excuse to miss because we don’t want to perpetuate. That is you drag them. If they’re little, if they’re under £100, then you drag them into the car. You get a neighbor, a friend, someone, and you just say, we have to get to school.
And you also tell them, look, honey, you’re just scared. And you say, just scared because you’re kind of indicate it’s just an emotion. This is not it’s a false signal. And you don’t have to explain that because your kid can’t process much. But what you want to show is I’m calm, I’m comfortable with your discomfort, and you must go to school and you take them, and then you get someone to meet you.
If you can, or you leave them in the car and you go get the vice principal or the whoever who can help you get them into the building. Yeah. If they weigh more than £100, then you have to make sure there’s nothing in the home that’s reinforcing. So it means they can’t go to practices that day. If there were things they can’t socialize, they have no phone.
They have no iPad. They have no computer. They if you need to, you take the cushions off the sofa.
Dr. Leigh Weisz: 23:57
You take meaning if you really can’t physically get them to school, make sure they’re doing nothing fun whatsoever at home.
Dr. Karen Lynn Cassiday: 24:05
Absolutely. And that there’s no place to comfortably lie down? Yeah. No place to comfortably sleep. The windows are open.
The. You know. And if you need to, you play old school music. They can’t stand. You know, I found rock and roll often is perceived as that or good old country western at a high volume.
And you don’t argue, you just say, this is the way it is. You don’t get Starbucks, you don’t get aspirin, Tylenol, ibuprofen, tummy mints. You just say, no.
Dr. Leigh Weisz: 24:39
Nurturing, no DoorDash, you know, no comfort items. Yeah.
Dr. Karen Lynn Cassiday: 24:43
The things that my parents accidentally do hoping, well, I’ll get you this. The idea is and to say if you get yourself in the car or to the bus stop, or you walk your fanny there and you’re in school, then after school, we can talk about and do any of these things. Yeah. What you see is no.
Dr. Leigh Weisz: 25:08
Contingent on the behavior that you really are needing them to do.
Dr. Karen Lynn Cassiday: 25:13
And then you tell them, of course you don’t want to go. Your anxiety or your depression is telling you you can’t do it. And it’s a lie, Of course you can do it because you have to show confidence in their coping, right? You empathize and say, yeah, of course you’re scared. Of course you don’t want to do it.
You’re having an anxiety attack, or you’re thinking about, you know, what’s going to go wrong at lunch or whatever. And then the thing you want to do is as fast as possible, you want to get help. So you want to talk to whoever you can talk to at the school. That has to do with special ed and say, hey, I got a kid that’s having some kind of problem. They don’t want to come to school.
I need your help.
Dr. Leigh Weisz: 25:57
And before it gets too far gone.
Dr. Karen Lynn Cassiday: 25:59
Exactly. Because oftentimes parents go after it’s been going on for months and months. Wow.
Dr. Leigh Weisz: 26:05
Right.
Dr. Karen Lynn Cassiday: 26:06
Makes it worse. And then find a therapist for sure.
Dr. Leigh Weisz: 26:09
Someone who really has expertise in this area.
Dr. Karen Lynn Cassiday: 26:13
Either help you as a parent, be tough and, you know, show your kid how to do this or who can help you and your kid together, right? At our practice, the parents have to be involved. Or the caretakers, because it’s a family issue. Absolutely. When your kid won’t go and the idea is you don’t want to struggle with your kid other than.
Dr. Leigh Weisz: 26:36
You don’t want to engage in a power struggle every day to get them to go to school. Yeah.
Dr. Karen Lynn Cassiday: 26:40
You need to get help and you want to communicate to them. Of course you can do this. It’s. It’s okay if you feel scared. We all have times where we have to do stuff even though we’re petrified or we’re feeling sick or, you know, whatever.
Right.
Dr. Leigh Weisz: 26:55
I’m hearing I got I had the pleasure also of interviewing Dr. Eli Lebowitz on the podcast a while back. And what I’m hearing you say reminds me of what he kind of taught us, which was that formula, sort of the first half is empathy. So I understand you’re scared, you know, and I know you can handle it. That vote of confidence in their ability to cope. And it’s so funny.
I wrote, I remember typing out the one phrase, you know, and just thinking, oh my gosh, we could use this for lots of different occasions, you know? But it’s teaching your kid. What you’re describing is that, you know, it’s uncomfortable to feel scared or ashamed or hurt or, you know, fearful all these different things. And. Right, we kind of have to figure out how to get past it and handle it because it’s going to happen again and disappointed and all these different emotions.
Dr. Karen Lynn Cassiday: 27:46
Yeah. Yeah. And and then, you know, I think the other thing that I want to tell parents is we know for sure that one of the reasons the rates of school refusal has gone up or school avoidance, we kind of call it school refusal because it’s not an actual diagnosis. It’s a phenomena of many problems. Right.
Dr. Leigh Weisz: 28:06
Well, because you’re saying it could be so many other underlying reasons why, right.
Dr. Karen Lynn Cassiday: 28:10
Is that, you know, 30, 40 years ago. Education was deemed so important that, of course, you wouldn’t miss because the parents of many kids had grown up on a farm, that they were one step away from a lifestyle where education was your way out to a better life, where we’re several generations removed from that. And also the style of parenting was, why would your kid? Why would you ever allow a child to do something that was bad for them? Right.
And that if it meant giving them a whooping, if it meant dragging them, there was just parents had a different quality of a.
Dr. Leigh Weisz: 28:54
Different authority, for sure. Firmness.
Dr. Karen Lynn Cassiday: 28:57
We’ve gotten really confused, and we’ve confused the idea of attachment with friendship. And we’ve confused the idea of empathy with friendship, where my hope is, you know, as my children become, you know, they’re they’re all young adults now, but as you come there, they might choose me to have a friendship type relationship. But when they’re young, my goal wasn’t friendship. It was to make them effective adults. Which meant, you know, we’re kind of at odds all the time because it’s inconvenient.
And I’ll give you an example. I had one son that hated quiche. I don’t know why, but he did. And every time we had quiche, he would complain and complain and complain and whine and make a big fuss and have a tantrum. And the way I handled it was that Ellie Liebowitz way.
I’d just say, of course you hate quiche. You’ve always hated quiche. However, you have to eat it.
Dr. Leigh Weisz: 29:51
This is what we’re having tonight, right?
Dr. Karen Lynn Cassiday: 29:53
Get into his mouth. You know, giving me, like, death glares and complaining and muttering curse words that I couldn’t quite hear. But I looked at like, he’s eating it. Fine. That’s okay.
I don’t need him to have a happy attitude. I need him to eat dinner.
Dr. Leigh Weisz: 30:08
Right. And you not to make 12 different items for all your kids.
Dr. Karen Lynn Cassiday: 30:12
Yes. And so I would encourage all parents who are listening. Whether your child has issues with school refusal or not is to realize, okay, my real goal is to get them to do all those things they find difficult so that when I’m not with them, they’re independent. And and that my goal is not for them to be happy about it. Right.
Dr. Leigh Weisz: 30:36
My goal is to be happy all the time. It’s to be functioning right. Hoping.
Dr. Karen Lynn Cassiday: 30:41
Yeah, for them to be grateful that I made them do this. Because my observation is most most of us didn’t develop true gratitude for our parents work until we had children, and probably until they were toddlers or teenagers. Did we deeply understand, oh my God, because I look back and I’m like, wow, you know, I’m lucky I’m alive and wasn’t shipped off to the, you know, like juvenile detention center because I was a handful, not in a Misbehaved bad kid way, but just. I had a lot of opinions and a lot of defiance. Yeah.
Toward some of the things my parents wanted. But I learned to do it. And so the idea would be, say, let go of the idea of your kid being happy with you or agreeing with you on these kinds of things, and give yourself the authority to be the wise one. And what I’ve seen is I think parents have less confidence in themselves now because they’re looking at all these different opinions, and there’s a lot of vociferous and ardent people who are saying, you know, I only do gentle parenting. I’ve never done a time out.
And Dr. Karen Cassiday’s belief is your children probably have temperaments that are nicer than my children’s were, and that might have worked for you. But I can tell you as a therapist, it’s not going to work for most kids.
Dr. Leigh Weisz: 32:09
Right? Right.
Dr. Karen Lynn Cassiday: 32:10
For most kids.
Dr. Leigh Weisz: 32:11
Yeah, well, and I, I want to go back to what you said before about how if a, if a parent has a child who’s refusing to go to school, you’re viewing it as an emergency. And I thought that word was really powerful. Because you’re saying, you know, you have to correct this. You have to get in before it becomes a habit. That’s how I interpreted it.
But can you say more about that? Like, how often is it just a one time versus, you know, becoming a slippery slope? And at what point do most people truly ask for help in terms of intervening?
Dr. Karen Lynn Cassiday: 32:49
Well, I think the first thing is that it doesn’t matter who the kid is, it is always an emergency because we see if we have one incidence of school refusal, the rate of having a second is astronomical. And after the second time the amount, you know, goes way, way up. I mean, it’s it’s an ascending curve. Wow. Mathematical terms.
And so what you do that first time is critical. So that’s one thing because one thing we see is that if children have good resilience they don’t avoid school. So I think what I’m I want parents to understand is my child picks avoidance as a strategy for anything. I have a child who has lack of resilience and I have plenty of kids. I see where they have learned to be resilient, and they have a terrible anxiety disorder, and they’re not avoiding school or camp or anything.
They’re just suffering through it and white knuckling their way through. And I look at that and I go, whew, okay, I’ve got a tough cookie here. I’ve got a kid that understands certain things need to happen no matter how I feel. Whereas if we see someone picking avoidance, that is a danger signal not just for school attendance, but for the development of their social emotional well-being.
Dr. Leigh Weisz: 34:13
Yeah.
Dr. Karen Lynn Cassiday: 34:14
And so that’s why we call it an emergency. It’s about it’s signaling something more than just the disorder that you’re dealing with.
Dr. Leigh Weisz: 34:21
Right.
Dr. Karen Lynn Cassiday: 34:22
Because it is not inevitable that kids avoid school if they have an anxiety disorder or depression.
Dr. Leigh Weisz: 34:30
Well, and if they rely too heavily on avoidance as the strategy, obviously not a great strategy. I often think about what are they going to do when they have a job? How are they not going to get fired? How are they going to keep work? You know, how are they going to deal with relationships when they get stressful?
Like that avoidance is not a great strategy long term.
Dr. Karen Lynn Cassiday: 34:50
Or college or it’s it’s the phenomena that’s behind ghosting. Interesting arrangement. We see 40% of parents now are going to have a child that inexplicably estranges them where there’s no family pathology.
Dr. Leigh Weisz: 35:06
Wow.
Dr. Karen Lynn Cassiday: 35:07
It’s an avoidance strategy. It’s saying. And what we see when we do surveys of older teenagers and college and young adults is that they mistakenly think if something makes me unhappy, it’s a threat to my mental health. Okay. And so, kids, if we let them avoid, then they’re going to accidentally say the situation is the threat, school is the threat.
Or the thing that happens at school is the threat as opposed to the threat is how I handle myself.
Dr. Leigh Weisz: 35:41
Right?
Dr. Karen Lynn Cassiday: 35:41
Because we want kids to learn that. We call it agency. You know, the idea that I. How I handle things, my beliefs, my attitudes are the single most important thing in the world and that my mind is the most powerful tool ever, and that I can learn on the job to do things that make things go better. And we see when someone has that perspective.
They’re hopeful, they’re optimistic, and they know that even when no one’s around to help me, it’s up to me and I can count on myself. So internally, they have integrity and reliability, and that’s what creates self-worth. Self-esteem is a measure of your accomplishments, and that’s a shallow thing. But self-worth is where, you know, I have integrity, and I can be the kind of person I can rely on and admire, and I can achieve things that really matter deeply to me.
Dr. Leigh Weisz: 36:41
Yeah.
Dr. Karen Lynn Cassiday: 36:42
And this is how you get it.
Dr. Leigh Weisz: 36:43
Is by doing stuff.
Dr. Karen Lynn Cassiday: 36:45
Like going to school every day. Unless you’re really sick, right?
Dr. Leigh Weisz: 36:50
Or I love it.
Dr. Karen Lynn Cassiday: 36:52
Forced to go apologize to the neighbor who you just insulted instead.
Dr. Leigh Weisz: 36:57
Of being.
Dr. Karen Lynn Cassiday: 36:57
Sent to a therapist to talk about your anger issues.
Dr. Leigh Weisz: 37:01
Yeah.
Dr. Karen Lynn Cassiday: 37:02
You know, that’s because sometimes that’s what parents will do is they’ll they’ll think. Some my child has to feel good or ready to do something instead of actually, we have to learn. We’re never really ready. We just have to learn to start.
Dr. Leigh Weisz: 37:18
Right?
Dr. Leigh Weisz: 37:18
Absolutely. Oh, these are wonderful. Again, I love that there’s such hands on examples that every parent can kind of relate to. So so thank you for that. I’m going to shift gears towards school in terms of if parents have a kiddo who does have a diagnosis, let’s pretend it’s anxiety, but I know it could be another.
And they have either a 504 plan or an IEP plan, and their kiddo is struggling with school avoidance or school refusal. What are common interventions or accommodations that a parent might ask for in the school setting that you’ve seen to be effective?
Dr. Karen Lynn Cassiday: 37:55
Yeah. And so it’s going to kind of depend on the problem. So let’s say a kid is has a phobia. You know, there’s something like thunderstorms, bees, bugs, vomit, whatever. Then it’s really helpful for the school to know and to have the idea that, okay, if this happens, then we want to be ready to know what do we say to the kids?
So we want to teach the staff to say things like, oh, I know you’re scared. You heard a kid threw up in the second grade. Of course you’re scared, but I know you can handle it. And then if possible, we want to give them. What are some coping strategies this kid could use to slow down or gentle their breathing, to get distracted by doing something engaging or pleasant in the moment so they can, like, redirect their attention, or to say, well, you can’t go home, but you don’t have to go by that room right now while they’re cleaning it up, even though it’s recess.
And so to make it so that we keep them in the building, that’s the first strategy I was.
Dr. Leigh Weisz: 39:06
Going to say. Like, is it is it okay? I know it’s not perfect, but is it better for them to be able to, you know, have a place within the school they could go if they need a break versus going home?
Dr. Karen Lynn Cassiday: 39:17
Yeah, that that’s a better choice. You know, we want to think what are gradual steps. It’s to think the first thing we want to cut off is leaving the building. Yeah. Or talking to the parents.
So we don’t want that to happen. I’d rather have them talk to the school nurse or their teacher or the whoever’s on the special ed team where we’re teaching them to use resources. Okay. And then the other thing would be to also make sure the staff has an array of things that can help distract or help them slow down. And deep breathing is not one of them.
Okay. People say take a deep breath. And if you take a deep breath, you do a deep exhale and you lower carbon dioxide in your blood, and that makes you feel more weird and anxious. So we want kids to take a slow, gentle, quiet breath. So no deep breathing.
Wrong wrong wrong. There’s a lot of misconception about that. And then if with some kids just having a coping buddy. So with younger kids or middle school kids, sometimes if we’re just we can say, okay, we have preferential seating. They just feel better.
They’re more distracted so they can be with this person at recess or lunch. That’s fine. And then ultimately what we’d like is an exposure protocol. So it would be, okay. School’s over.
Could you walk by that classroom and you can hold your breath if you need to, but let’s just walk back and forth a couple of times, and then you can go to the bus or you can go to your car.
Dr. Leigh Weisz: 40:55
As opposed to like taking a circuitous route to avoid that classroom.
Dr. Karen Lynn Cassiday: 40:59
Route? Yes. Or can we go near the field where they said there were bees at recess? Or can we look out the window and look at the thunderclouds? And and then the other thing is, ideally the child would be getting some therapy for that.
I realize schools can’t encourage that. But as a parent you certainly could. Yeah. So that would be one strategy. Another one would be if it’s social anxiety then we want to figure out where is it tough.
So is it lunch. Is it recess. Is it PE. Is it a certain class. And then we want to come up with what are solutions to that problem.
So if someone has no one to eat with then can we find some of those really helpful kids where we get an invite and they have a lunch munch? Right?
Dr. Leigh Weisz: 41:49
Or because some of those kids might go home mysteriously right before lunch every day?
Dr. Karen Lynn Cassiday: 41:56
Oh, yeah. Yeah. Or they’re in the bathroom the whole time pretending to have a bowel movement.
Dr. Leigh Weisz: 42:01
Terrible. Yeah. That’s the. That one breaks my heart more than, for whatever reason, more than the rest. When I hear those stories of the kids eating in the bathroom stalls, which happens in every town.
It just it just gets to me like, oh, we gotta do something.
Dr. Karen Lynn Cassiday: 42:15
To spend a half hour in the, you know, the boy’s room or the girl’s room. Yeah. So and I found there’s always kids who are empathic and understanding. They just need to be given the cue. Like, hey, this person doesn’t have a lunch buddy.
Would you please help them and make the introduction right? Or if there’s a resource room. They can at least start by eating lunch there until you can develop some friendships. And that would be a main thing that I’d want a school to do is who can we pair them up with? How can we make social introductions that they aren’t able to do themselves?
If it’s a panic disorder, a lot of times having a place where you can go to take a moment to slow down. No calling parents. Yeah, and just give them a quick five minutes. Yeah. And walk them back to class.
Dr. Leigh Weisz: 43:05
Yeah. And it could even just be getting a glass of water. You know something? Getting getting fresh air with someone for for five minutes.
Dr. Karen Lynn Cassiday: 43:12
Yeah. And just a real quick because we see the average panic attack doesn’t last longer than 90s to three minutes. And if we can get someone to just breathe through their nose gently and quiet, we can just cut it down. And so that that would help. And then sometimes I.
Dr. Leigh Weisz: 43:29
Interrupt you for one second. Can you do an example? Like can you show us when you say breathe gently and quietly what that looks like versus the deep breath? If you could kind of demonstrate.
Dr. Karen Lynn Cassiday: 43:39
So gently and quiet would be your mouth is closed, you’re just breathing through your nose. And then you’re when you’re breathing, you you can barely feel the air go in the back of your. And your belly is going up, so your belly button is going out to the opposite part of the room. The count of one 1002 1000, three 1004 1000. Down 1000 to 1003 1004 1000.
Belly button up 1000. So just like that, I had my mouth closed.
Dr. Leigh Weisz: 44:16
Of course. Right.
Dr. Karen Lynn Cassiday: 44:18
Closed. And just breathing through the nose. Kids crying. Get them to do some good blows. Right.
So through their nose that’s what it would look like. And then another thing is if a kid is overwhelmed by lining up, getting ready, waiting for the bell, and this is more likely with shy or socially anxious kids, or with kids who are on the spectrum than a late arrival. So being able to come in after the crowd has come in without penalty or early arrival All.
Dr. Karen Lynn Cassiday: 44:51
Going to come in before.
Dr. Karen Lynn Cassiday: 44:53
And get situated. And I found spectrum. Kids tend to like that better. Yeah, it’s all organized and and I don’t feel like I’m standing out because I’m in after the crowd.
Dr. Leigh Weisz: 45:06
And how for that example, because I could see that being really successful and again, much better than the kiddo not coming to school. There’s still a little bit of avoiding that chaotic scene, but you’re saying that’s that’s an acceptable kind of amount of of avoidance.
Dr. Karen Lynn Cassiday: 45:22
Yeah. Because the idea is we’re, you know, we’re trying to solve the problem that’s causing the school refusal, and we’re trying to show them, okay, you can be in school. And then the idea is we need to do exposure training or figure out how can I help this person manage the crowd. Social. Just there need to be someone that they can meet every day.
So they’re with them in the crowd. Yeah. Sensory overload If we have like those little in ear earbuds that it blocks the noise, if it’s visual, if we have them wear sunglasses.
Dr. Leigh Weisz: 45:58
In a hood. I’ve seen I think kids, kids like that.
Dr. Karen Lynn Cassiday: 46:01
Yeah. To just.
Dr. Leigh Weisz: 46:03
Kind of block.
Dr. Karen Lynn Cassiday: 46:03
It out in that.
Dr. Karen Lynn Cassiday: 46:04
Overwhelm. And then through gradual exposure therapy, we can teach people on the spectrum to tolerate more and more stimulus. But it’s a slow process. And so we want them to miss as little as possible. And then the same thing.
I have kids on the spectrum where in the lunchroom, it’s not the social aspect, it’s the din and the noise. So is there an area where they could sit where it’s less so?
Dr. Leigh Weisz: 46:31
Right, right. We.
Dr. Karen Lynn Cassiday: 46:33
You know, is there a lunch bunch we could create in the resource area where they can, you know, eat and do that and not be so overwhelmed they can’t do afternoon classes? Absolutely. So those are just some.
Dr. Leigh Weisz: 46:47
These are great examples. I was going to say, can you share a success story of a kiddo that you have been working with? Of course, without their names, who were they were originally avoiding school and kind of like what what interventions were used both at the school and the home and kind of how it turned around to give some hope to struggling families.
Dr. Karen Lynn Cassiday: 47:08
Yeah. Yeah. So okay, here’s an example is we had a middle schooler who had been doing really well. We she had 1 or 2 episodes in early elementary where she avoided school, and the parents weren’t sure she was sick. And when she looked back on it, she just knew she felt scared.
She couldn’t articulate why. But we saw that happen. But it wasn’t something that coalesced. And then starting in seventh grade. Okay, so our second year of middle school, she started getting sick and missing school and after a week saying, I’m going to throw up.
I, I am sick, I can’t do it. And so they kept her home, you know, they gave her palliatives, you know, Tums. And then the mom got her to see the pediatrician. The pediatrician referred her the gastroenterologist. The school was sending out homework, and she she would say, I want to go to school.
She would try to go to school. And then she, the nurse would call and say, you got to pick her up. She says she’s going to throw up. The gastroenterologist scoped her beautiful GI tract. Nothing wrong, upper GI.
This is a couple months into school and the GI doctor concludes she’s fine. This must be something somatic, something to do with anxiety. And so then she got referred to us. And when we interviewed her, we realized she had had an episode in school where she started to feel really lightheaded and dizzy and mildly nauseous, and felt like she was going to die and thought that she’s going to have stomach flu. And so she called the nurse and went home.
And we think that actually was her first panic. Panic attack. Yeah. Yeah. And we ended up diagnosing her panic disorder with agoraphobia.
So agoraphobia is where you avoid something for fear of making yourself anxious. And so we started doing interoceptive exposure where we made her recreate the symptoms of anxiety. And we did this before we started getting her back in the school building. And so we would run in place with a stomach full of 7up to try and make that fizzy stuff, make her feel awful. And we had trash cans with plastic liners, said your goal.
Your goal is try and make you sick, So you might even throw up and we would run up and down stairs.
Dr. Leigh Weisz: 49:48
You’re basically hazing her? Yeah.
Dr. Karen Lynn Cassiday: 49:50
He had her eat a Big Mac and then run up and down stairs. And very interestingly, we could get her to gag, but she never vomited. And which was very powerful, her, because she realized, actually, it’s really hard to throw up when I’m anxious.
Dr. Leigh Weisz: 50:07
It’s not really likely to happen.
Dr. Karen Lynn Cassiday: 50:09
Not real. It’s just I feel like I might and I’m worrying that I might. And then once she realized that, we’re like, okay, we’re going to start going back to school. And what we’re going to have you do before we go back to school is we’re going to go through the building. We got permission to go after school, and we’re going to go into the rooms that you go into, and we’re going to do these inteiros exposure exercises to see if we combine school with this, if we can make you barf.
And of course, we didn’t. But that that was an moment because she was thinking it’s the situation that makes this happen, right? Full time. We’re talking here like this is. And reframing, saying this is good.
I’m glad you feel this way. You’re learning something important. What are you learning? I can handle it. Yeah.
And then we. And this took place over a week where every day we did this.
Dr. Leigh Weisz: 51:00
Really intensive work is what you’re describing. Yeah.
Dr. Karen Lynn Cassiday: 51:02
Where we we were like, we gotta get you back. But we want you to. And because she was over £100 and her mom was a very petite lady, and dad often traveled, we realized we don’t have we can’t drag this kid. Yeah. And then we got her in school, and we had the rule that unless a thermometer shows 100.1 or higher, or you have someone witnessing three diarrheas, and we got a picture off the internet to show what we made it look so tiny.
Little bit of brown or mucus does not count. Same thing with vomit. We need a bowl full of vomit.
Dr. Leigh Weisz: 51:38
I was going to say, and they have to show you because I’ve had, you know, we’ve had kids where they say that they have. And you don’t believe it.
Dr. Karen Lynn Cassiday: 51:44
Yeah, there’s the tiniest little spot and you’re like, no, that does not count. That’s not it. It’s it’s the real deal. Like. Right.
Any of us have had stomach flu. Right. And had the school have that. And the school needed my basically saying this is not a medical issue. So they had the authority to say, no, we can’t send you home.
Yeah. And then what we did is we gave them a big bottle of fruit flavored Tums and said, she’s allowed to have one of these if she wants, just to help, if it helps. It made her feel better, although it didn’t help the symptoms.
Dr. Leigh Weisz: 52:17
I was going to say whether it’s placebo or real, it’s it’s benign. Yeah.
Dr. Karen Lynn Cassiday: 52:22
Heard it to see I can cope.
Dr. Leigh Weisz: 52:25
Yeah. Absolutely.
Dr. Karen Lynn Cassiday: 52:26
But it’s, you know, no different than we might let a kindergartner take their their teddy bear, lovey.
Dr. Leigh Weisz: 52:33
Right. Absolutely.
Dr. Karen Lynn Cassiday: 52:34
Yeah. And we would think nothing of that.
Dr. Leigh Weisz: 52:36
Of course.
Dr. Karen Lynn Cassiday: 52:37
And so. And then we had rewards where there were things she wanted to guarantee and earn. And each day you got to school without talking about getting sick, because she would want to talk and talk and then mom would, oh, I’m so sorry. We’re like. And then mom got report cards.
And if she accidentally asked her daughter how she felt, she had to pay up a dollar to the daughter if she accidentally looked sad or concerned about the daughter crying or being teary, she had a dollar and that quickly stopped that.
Dr. Leigh Weisz: 53:10
As you’re retraining the mom to, you know, to not reinforce this. Yes.
Dr. Karen Lynn Cassiday: 53:14
Yeah. And the daughter was really clear. Yeah. When you get upset, it makes it worse for me.
Dr. Leigh Weisz: 53:19
Absolutely.
Dr. Karen Lynn Cassiday: 53:20
I don’t like it. Even though I like your sympathy. I don’t like it. Yeah. So.
And so we got her back in school and there were. Whenever somebody else was sick, she would want to make more calls. She’d show up in the nurse’s office and we got to where just we gradually had more and, you know, less time where. And we started with five minutes and got it down to, oh, it looks like your anxiety. Just bothering.
Here, let me walk you back to class.
Dr. Leigh Weisz: 53:47
Wonderful. Oh, what a success story. That’s incredible.
Dr. Karen Lynn Cassiday: 53:51
Really?
Dr. Leigh Weisz: 53:51
Well, yeah.
Dr. Karen Lynn Cassiday: 53:53
And it’s it’s not an issue now.
Dr. Leigh Weisz: 53:55
Yeah. That’s incredible. Very powerful to just hear. You know, kind of again what what steps were taken and where she is now. And of course we could imagine.
How that could have gone if the parent didn’t get any help and just kind of kept, you know, leaning into the anxiety and listening to the anxiety and letting the anxiety kind of roll the roof. Yeah.
Dr. Karen Lynn Cassiday: 54:16
And and one last thing to say is that when someone has an anxiety disorder, we know it’s chronic unless it’s properly treated. And that could also include medication.
Dr. Leigh Weisz: 54:27
Yeah, absolutely.
Dr. Karen Lynn Cassiday: 54:29
And so it is an emergency. Yeah. So parents I think the earlier and the more aggressively we can intervene, the better for my kid.
Dr. Leigh Weisz: 54:38
Yeah. No, I think that’s like a huge take home message that from this, from this, you know, this hour with you is just do not assume it’s going to get better without intervention. Take it really seriously. Treat it as an emergency to avoid what could turn into something much, much bigger in terms of, you know, future, future, almost feeling like they’re unable to function in society, you know, like that you could think of the worst case situation as a wake up call.
Dr. Karen Lynn Cassiday: 55:08
Yeah. Yeah.
Dr. Leigh Weisz: 55:11
I want to ask you just one more question before we end, which is for the parents who are listening, if they are interested in learning more on this topic, what are some of your favorite resources, whether they’re books or podcasts, anything that might help them learn more on this topic?
Dr. Karen Lynn Cassiday: 55:27
Yeah. Okay. So the first thing that I would recommend is my book called The No Worries Guide to Raising Your Anxious Child, and this book is geared towards helping both parents and kids. And so it’s got exercises in there for the parents as well as for your kid. It’s kind of a two for one.
So that’s one thing I’d recommend. Another thing that I would highly recommend is Lenore Skenazy podcast and her website and videos, which is let Let Them Grow, Let Them grow.org. And although it’s not specific to anxiety, everything in there is research relevant to kids with anxiety and families that have it in it. And you will be inspired and amazed. And one of the things they’ve shown is if you can do independence based parenting where you’re have strategic boredom, strategic frustration, strategic anxiety without parents intervening, you can create a whole new trajectory for your child.
And we try to get all our parents to do the independence training program that they have in there. Wow. So that is something that is and it’s so user friendly and fun. Wonderful. And then the other thing that I can say is, if you’re looking for therapy and you’re having difficulty, if you go to the Anxiety and Depression Association of America, that is the largest single listing of people who are trained and experienced with the kind of things that Lee and I do that we know help kids with anxiety.
And the biggest mistake parents make when their kids anxious is they think, if I can make them more confident or make their self-esteem better, then that would get help. Their anxiety. And what we see is actually action creates confidence. So we know for sure that exposure based parenting is the single best strategy to use if your kid tends to have anxiety, or if you yourself have had it. So those would be like the three big easy places to go to get the information that you need.
Dr. Leigh Weisz: 57:48
Absolutely wonderful. Thank you so much, Dr. Cassiday, for sharing your time and your expertise with us. It’s been a pleasure. Everyone check out more episodes of our podcast, go to copingpartners.com and click on podcast and articles. And thank you, as always for tuning in.
And thank you again, Dr. Cassiday.
Dr. Karen Lynn Cassiday: 58:10
Thank you, Leigh.
Outro: 58:11
Thank you for listening to The Coping Podcast. We’ll see you again next time and be sure to click subscribe to get future episodes and check out our podcast page at copingpartners.com.