Today, I saw seven patients - middle schoolers, high school students, and college students.  Although they were all there for different anxiety problems, one theme ran through my day: anxiety about Election Day.  Even my youngest patients have been voicing concerns for months about who is going to win the election and what the consequences of that outcome will be.  These worries seemed particularly palpable today, with only two weeks to go until Election Day.

The New York Times published an interesting article about last week called, Talking to Your Therapist about Election Anxiety.  It is a great read, but I felt it was important to write about some tips for kids and teens who might feel even more anxious than adults because they can't even vote!  

-Acknowledge what our kids are feeling.  Anxiety is all about the unknown and at this late date, the probable outcome of this election seems to depend on the source that one consults!  Not knowing makes people feel uncomfortable.  It is okay to say to kids, "Yup, it is hard to not know.  It makes me feel uncomfortable and worried too."

-And, to the extent that we can, boss back that anxiety!  Although we do not know who will win the election until Election Day, we can remind ourselves that our government is set up to prevent really bad things from happening.  Kids have been expressing their worries in my office for months and I find that we can boss back many of these worries by saying, "Not gonna to happen!".  The media has stirred up so many worries and kids need a reminder that there are checks and balances in place to prevent many bad outcomes.  

-For some kids, DOING something in service of the electoral process makes them feel more empowered.  One of the kids I met with today decided she would like to volunteer for her preferred candidate with her mom over the next few weeks.  Many kids value going into the voting booth with their parents.  Although they aren't casting a vote per se, they feel they have contributed by participating in the family vote.  

-For other kids, tuning out is a better strategy.  If reading the newspaper or watching the news is causing your child undue anxiety, it is okay to encourage him or her to stop for the next two weeks.  If Election Day is going to be excruciating (especially for kids who have the day off of school), make a plan to keep your kids' brains busy with something else.  Go to a museum.  See a movie.  Set up some playdates.  Logging on to the computer every few minutes to check the polls is likely not a good strategy for making it through the day (for adults or kids!).  

-Coach kids through the complex social aspects of this election season.  Many of the kids who I work with have told me about conflicts among friends due to the candidate that their families are supporting.  Some kids have told me that they have noticed an increase in disrespectful behavior toward girls and female teachers during this election season.  Kids need our help with these situations.  The best way to do this is to model appropriate discourse with our own friends, relatives, and work colleagues.  We need to model to our kids how to respect people who hold different opinions than us.  

Yesterday, I attended the Scholastic book fair at our school with my almost 9-year old son.  Although he is drawn to those huge, pricey Star Wars books that come with mini-figures, we had already agreed that these were off limits!  I find it interesting that he is drawn to totally different books than my 11-year old daughter.  Whereas she loves fiction, he wants to learn about history, wars, how things work, and so on.  This brings up a controversy in my house -- does reading fiction build better reading skills than reading non-fiction?  


This morning, I decided to turn to the literature to find out.  Here is what I learned:

• Independent reading of any kind is awesome!  Kids who read a lot have a better vocabulary, become more proficient readers, and enjoy reading more than kids who don't read much.  And this proficiency and enjoyment builds on itself - if kids like reading, they continue to read more and become better and better readers (see Stanovich, 1986).  
• The Common Core Curriculum places equal weight on fiction and non-fiction texts, but this is not without controversy.  Without getting into that controversy....here is the thinking....
  • "One reason reading nonfiction may be so important is that it helps students develop their background knowledge, which itself accounts for as much as 33 percent of the variance in student achievement (Marzano, 2000). Background knowledge becomes more crucial in the later elementary grades, as students begin to read more content-specific textbooks (Young, Moss, & Cornwell, 2007) that often include headings, graphs, charts, and other text elements not often found in the narrative fiction they encountered in the lower grades (Sanacore & Palumbo, 2009)."
  • Greatschools.org suggests: "In order to create a foundation for later learning, educators now agree that students should begin reading informational texts in all subjects from the earliest grades."
•  As I noted, each of my kids has a preference for either fiction or non-fiction.  It seems I should be encouraging each of them to read broadly from the genre that is less appealing to them.  The case for non-fiction is stated above.  As for fiction, check out this great article by fiction writer Jane Smiley.
• The bottom line is that kids need to read books that interest them!  My daughter who loves the Percy Jackson series could read some non-fiction on Greek Gods.  My son who loves reading non-fiction about history and wars can read some historical fiction.  Find a great Children's Bookstore in your area (like Children's Book World in my neighborhood!) -- the staff will be able to help you make these connections and find great reads for your kids!  

www.metro.us/boston/ocd-foundation-advocates-share-the-reality-of-the-disorder/zsJpjm---33AAM2qA7Ay3k/

• KRISTIN TOUSSAINT

The average time between an OCD diagnoses and proper treatment is 14 to 17 years, says the foundation's director.When Ethan Smith was 14 years old, he constantly worried about getting sick and knew only way to cope with that anxiety: He took his temperature 70 times a day.

Smith was diagnosed at that age with OCD—obsessive compulsive disorder. But he didn’t receive proper treatment for his mental disorder until he was 31 years old, when he came to McLean Hospital’s Obsessive Compulsive Disorder Institute.

“I lost 31 years of my life to some extent, so I really feel like I was reborn after [getting treatment] because living in the moment was completely foreign to me,” he said. “When I got better, I felt like an alien. It’s really strange, and it’s still amazing.”

Now 38, Smith returned Boston on Friday as a spokesperson for the International OCD Foundation, which has its headquarters here. The IOCDF is celebrating its 30 years as an organization and just commemorated the end of OCD awareness week.

The IOCDF has made great strides for people with OCD in the last 30 years, but it still has a long way to go, said Executive Director Jeff Szymanski.

The IOCD started in Connecticut where a group of people with OCD participated in one of the first studies about the disorder, Szymanski said. The foundation moved to Boston in 2008 to be closer to its vibrant medical community because the organization focuses on financing OCD research. (Although there is no cure for OCD, the compulsions can be managed).

Though the foundation has made great strides in terms of growing OCD awareness—more than 1,600 people attended IOCDF’s annual conference this year, four times as many as the first conference in 1993—Szymanski said the mental health community still struggles with the diagnosis and how to treat it.

Smith was lucky that he was correctly diagnosed so early. More than 3 million adults live with OCD in the United States, but physicians misdiagnose patients 50 percent of the time and mental health professionals a third of the time, Szymanski said. It took Smith 17 years to receive proper treatment, and that’s a common reality.

Szymanski said the average time between a diagnosis and proper care is between 14 to 17 years.
“If you had cancer, who is waiting 14 to 17 years? It’s not acceptable anywhere,” he said. “Yet, it’s the state of things with OCD.”

Both Smith and Szymanski highlighted how OCD has been warped in the public’s eye: It’s not about being “neat” or liking things a certain way. It’s a debilitating medical disability stemming from obsessive, anxious thoughts.

“When we’re in our rituals, we don’t want to be doing them,” Smith said. “No one wants to wash their hands 100 times. We know it’s irrational, but we believe we have to do it anyway.”

After his diagnoses, Smith met with multiple different therapists, but none of them had ever specialized in OCD treatment or were able to refer him to a specialist.  “What I mean by proper treatment is that a general psychologist is not equipped to treat OCD but roughly most of them think that they are,” Smith said. “And attempting to treat OCD by doing psychotherapy, called talk therapy—well, what happened was it ultimately made my OCD worse and harder to treat in the future.”

Szymanski worked as a clinical psychologist at McLean’s OCD Institute before joining the foundation. He explained that while most therapists are trained in psychotherapy—where you talk through your issues and try to uncover how they may have started in your childhood—that’s actually damaging for OCD patients.

Instead, professionals need to be trained in Cognitive Behavioral Therapy, and specifically a subset of that called “exposure and response prevention.” In that practice, those with OCD are forced to confront the very things giving them anxiety and prompt their obsessive thoughts. Instead of giving in to their compulsions to ease their anxiety, the patient is forced to sit with it.
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If someone’s OCD centers around germs, for example, the therapy would involve them touching the floor or something else they consider germ-infested without allowing them to wash their hands repeatedly.  “The best way to get over a phobia is to repeatedly expose yourself, and over time your brain stops putting out those anxiety signals,” Szymanski said.

Smith, who underwent the therapy while living in Boston, described it as “torture.” But it’s the reason he’s alive today, he said. He had told his mom that if he ever got better—and for a while, he never thought he would—he wanted to help others like him.

“Coming back to Boston and being able to speak in Boston, where I struggled so much, on a national stage, it’s full circle and emotional, but it’s also extremely gratifying,” said Smith, who now lives in Los Angeles where he works as an actor. “This is where I discovered the strength and power of the human condition. This is where I learned what I was made of as a person.”