What are some common signs and symptoms of anxiety in children, and how can parents recognize these signs? What are some steps parents should take if they recognize anxiety in their kids? Would the kid's age change any of the signs/symptoms/steps to take? How might anxiety show beyond typical kid worries?
​The most important thing when talking about mental health in children is to notice changes - whether it's anxiety, depression, or other issues there will be changes in how they interact. This could be physical changes like not sleeping well, changes in appetite, and not wanting to socialize in the same ways they would before. With children especially, we can see a shift in their independence - they may show a sudden separation anxiety and fear of doing things on their own they once did. Those are important changes to notice. School-age children might experience anxiety in terms of working about grades and tests in a manner that is excessive. Typical "kid worries" might be getting some butterflies in the tummy on the day of a standardized test and that resolves when the test is over, however the child with high anxiety might worry about that days or weeks in advance and not be able to let it go after the test ends. They might perseverate on what they got wrong and beat themselves up over a lack of perfection. Instead of some simple butterflies, highly anxious children might experience physical symptoms of headaches, knots in their stomach, tears and at times school refusal may be present. Because children are still developing emotionally and cognitively, they often are not fully aware or able to place in words what they are thinking or feeling. They might need help in being able to connect their worries about grades with the fact that they get a headache every morning as they are getting ready for school.
How can parents create an environment for their kid to feel open to discussing their anxiety? Are there any strategies you can offer for how to help a parent navigate that conversation? Especially if the parent initiates the conversation about anxiety or their concerns. Any specific dos and don'ts for either?
First, I would encourage parents to be kind to themselves too - just because your child is anxious does not mean you are a bad parent or that you did something wrong. The best of parents can have anxious children. It is far more important that you simply open a safe space for your child to express themselves. When talking to children, get on their level - sit down with them and maybe go into their space where they feel safe. Maybe have a talk in their room or sit outside in a place with little stimulation and few distractions- this ensures that the environment itself is set up for open discussion and safety. Using open-ended questions that encourage your child to open up can be very helpful. Often anxious children might be afraid to upset others, including their parents. So, we could say something like, "It seems like you're feeling a lot of things right now and I want you to know I am here. It's okay to 'feel all the feels.'" It can also be helpful to empathize with your child and let them know you are not perfect either. For example, "I might be a grown up, but I get scared sometimes too," by doing that you are modeling for them that feeling feelings is normal and healthy. Our feelings are not the problem but rather what we do with our feelings can lead to a problem if it's not healthy. When you are first starting to have conversations about these things, start slow and allow your child to slowly open up. Shift the goal from "fixing your child or their problem," to "listening to your child and creating an open space." That makes a world of difference in the reaction over time. One very important thing to certainly always do is to rule out if your child is developing anxiety or if they are experiencing a trauma reaction. Most often, it will be uncomplicated anxiety, but we want to rule those things out. So we can always ask a child directly in a gentle and caring tone, "has anything happened to you directly that is making your feel scared or unsafe right now?" If there is an unsafe situation happening than of course we manage those situations swiftly and with immediate professional guidance. Anxiety is also something that can gain power over time, so we want to help the child feel small wins "wow - you made it to school today without any headaches this morning - that's amazing!" Or "wow, I am so proud of how you used your deep breathing and positive self-talk to pull yourself out of the worry spiral!" Praise the wins so they begin to see how they are improving in time. In terms of "don'ts" - here we just want to stay away from trying to "fix" the child or make something go away overnight. Patience is key with shifting anxiety. I would also recommend never using a forceful or judgmental tone, or closed ended questions. That can increase the intensity of the anxious feelings. And, if you make a mistake in parenting and you could have handled something better, just own that. That can make a world of difference to your child.
If a parent is worried about their child's anxiety, who should they contact? Their family doctor? What about any school resources? Would this be different for older kids or pre-teens?
 There are many options these days and often the parent can decide what they feel is best in alignment with their family values. Schools have many options - sometimes kids and teens have anxiety that is so extreme that it can impact their schooling process. Schools are aware of this and there are methods of managing this that can vary from school accommodations, to placement in exceptional student education programs to ensure that the child is helped to make school the safest place possible for them. Some schools also have counseling available and/or group therapy. In addition, therapists can help greatly! Anxiety is very responsive to treatment and the earlier it's caught the better the outcome! Therapy can focus on shifting unhelpful thinking styles, developing coping techniques to regulate one's nervous system (eg., deep breathing, grounding exercises, positive self-talk, etc), and lots of other things. In addition, your family doctor or psychiatrist can assist to discuss potential medication options that can also help to regulate the brain so that the person less likely to be in 'fight or flight' and more capable of using the coping techniques they have learned. The major point is that options exist and anxiety can be helped! With regards to older children and teens, the process is really the same. The differences are mostly going to be in adapting the language we might use to help the child open up about their worries. Older children and teens might also be more aware of what the thoughts are that are fueling their anxiety which can sometimes make it easier to reframe.

​why it's still so unknown
In the mental health field I think it is pretty well known! The challenge in this space I think is understanding and deciphering the difference of whether the depressive episodes are specifically associated with one's menstrual cycle or if it is more generalized fitting a different type of depression. I am not sure about the other professions and whether it is unknown in that space!
how to spot the signs
PMDD is serious! This is not "PMS" or "just cramps." PMDD affects people's lives. It will impact functioning in areas of social, romantic and potentially occupational functioning. Often times, I see people with this condition that have no idea what is happening and they think that they just have normal 'PMS' issues. The keys here are that the person's personality really seems to change specially in relation to where they are in their cycle. They may have mood swings, physical symptoms and inability to regulate emotions effectively. They often feel shame and guilt over these experiences.

and how to get help/cope
First, let go of the shame! This is NOT your fault! You have a true condition that deserves help and assistance. As a psychologist, I understand that often the best treatment for such a condition is to work with a therapist for coping techniques, but also ensuring you have a OBGYN who has medically assessed the person and has ruled out anything else that could be happening. The treatment is typically therapy combined with medications like SSRIs prescribed by a licensed provider. With treatment, life can be so much better!

What Is ADHD
Many people do not understand that ADHD is essentially a neuropsychological issue in which a person's nervous system is under-stimulated and therefore they may need stimulant medications in order to regulate it (counter-intuitive I know!). There are four components - inattention, hyperactivity, impulsivity and poor timeliness.  ADHD can affect all or just a couple of areas. When it is not regulated, we may see inattention that impacts schooling and workplace outcomes. It can also impact one's relationships. If we cannot take in information correctly, then we cannot process that information in our lives. Attention is managed by our executive functioning processes which also control and regulate our emotions. That is why we sometimes see challenges with impulsivity, anger outbursts or overall mood swings in this population too. So learning to regulate these systems is incredibly important!

ADD vs ADHD
So this is confusing to many of us. In the pop culture world, we usually distinguish these two with ADHD being used for hyperactive people and ADD being used for inattentive subtype.  In the psychological world, it's all ADHD and then we specify which subtype, whether it's inattentive or hyperactive/impulsive. 

Is there an ADHD test?
Well, yes! Testing can absolutely be done to confirm an ADHD diagnosis.  You should not self-diagnose based on an online survey.  Those can be a nice start to confirm some of your concerns but they are not diagnostic.  A full psychological evaluation battery can be used to determine this. KML completes high level fully integrated diagnostic assessments to determine what exactly your issue is - memory? Executive functioning? selective attention? long-term memory? There are many factors that can be involved. They can be completed on both adults and kids.  If you go outside of KML, make sure they are using a CPT test as part of their diagnostics. Many people do not and the results of your testing will not be as comprehensive.

ADHD Treatment
Medications (usually stimulant based but there are others!) are the gold standard treatment for treating ADHD due to the nervous system dysregulation. In addition, non-pharmacological approaches can complement this to ensure the best outcome possible.  The nonpharamcological ADHD interventions that can be helpful are things like eliminating distractions in your environment while you are doing a task that requires mental effort. Think about when you are most productive and schedule your hardest tasks for those times. Testing in small groups or preferential seating in a classroom or an office space can be helpful to eliminate additional information competing for space in your attentional capacity. It is also important to ensure that you are taking care of the basics in life like balanced nutrition, physical activity, and getting plenty of sleep to ensure your neurological system is functioning at ideal capacity. In this population, we also encourage frequent breaks to refresh the computer of the brain and to "chunk" information together. Opportunities for additional movement, like walking desks, doing work in a standing position or being able to fidget with toys can also improve focus. For some having music on or sound in the background is also a strategy for success! There are programs such as "brain training" and nuerofeedback that have some promising results on impacting the outcomes of attentional capacity as well. Finally, I would say placing organizational skills in your life to help you organize the information of your daily needs is also a really effective strategy.

Can Apps help with ADHD?
Yes - absolutely! There are many apps out there. There are apps intended to help people with ADHD manage their poor organizational skills or to remind them to do certain things at certain times. There are also apps that can be used to improve overall executive functioning skills, which is a major deficit for these folks. Typically those types of apps are game-like and can feel like puzzles or fun!

When to See a Doctor
Often I see people struggle with thinking they are not smart and that is not true! People with ADHD are often very bright. If you have done some of the above and you are still struggling at work or school, then you likely need more. That is okay and nothing to be ashamed of. This is a neuropsychological disorder and requires lean in from a multidisciplinary team who can often help create a specialized plan for success! That includes a dietitian, psychiatrist, therapist and sometimes study skills coach, life coach and neurologist. There is help out there and life can be better!

Happy Halloween 2023!  First off - be safe. Read my articles on how to protect your while having fun this Halloween. Second - the big question - is halloween candy bad? Should I limit my child's Halloween candy consumption.  This is tricky - understandable you don't want your children to eat three million pieces of candy over the course of three days and get sick. I get it.  But you also need to be aware of how limiting children impacts their relationship with food.  Here are some quick tips on some things you can do to keep healthy boundaries while also allowing kiddos to enjoy the holiday! 

1. Have healthy boundaries around candy - do not try to eliminate the candy all together. This will really reinforce problematic relationships with foods.  Boundaries are OK!  Maybe saying okay let's have a few pieces a day (without be so specific or overly rigid).  It's also OK for them to eat too much candy a feel a little full.  They will survive and next time they probably will eat a little less.  That creates an intuitive relationship with food! Kids who are used to extreme rigid boundaries around candy are usually the ones who go overboard when they see it.  

2. Do NOT label foods as good or bad! Labeling foods as good or bad, healthy or unhealthy is a sure way to really mess with the natural food intuitive relationship.  Stay away from strong labels around food.  When 'all foods fit' it actually really allows us to regulate ourselves and we will find a natural balance of candy and vegetables!  

3. Do NOT use candy as a reward! Stay away from 'earning' the candy at the end of a certain tasks. Rewards are great for kids -but food rewards are tricky. You want to keep food about food; not about good or bad or earning something.  Trust me!  Find other rewards for positive daily behaviors other than food.

4. Enjoy the moment with your kiddos!  The cute costumes, excitement for life and running around the neighborhood can be so fun.  Remember to enjoy that moment as they go by too quickly. Don't worry so much about the candy.  

Happy Halloween folks! Be safe! Dr. Kelsey :)

How do clinicians define psychological projection?
Projection is defense mechanism, and defense mechanisms are ways a person protects themselves form things that they are possibly unready to hear or manage. That means that these defenses are out of the awareness of the individual. Projection is when we take feelings that we might not want to acknowledge in ourselves, such as jealously or anger and we "project" them onto someone else. Think about what a projector does - it takes an image in a movie theater and places it on the screen so you can see it. The image is not coming from the place we seen it (ie - the screen), it's actually coming from the lens of the projector onto the screen. This is the same thing here.


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What causes it?
The person sees parts of themselves in others that they cannot stand in themselves. They may be overly upset when they see someone who might be showing jealousy or anger, when in fact they too may feel those same things. For whatever reason, the person has sort of cut this part off, and potentially placed it in the "shadow self" (another trending term) but this part of them is not gone - it's now taking the wheel when they are unaware and creating reactions that might cause them issues in relationships.

Are there signs or symptoms?
I think signs to look further into are "triggers," meaning when your emotions escalate extremely quickly in response to someone you might not know well or haven't reacted to in that manner prior. This is an indication to take a step back and ask what might be deeper here.

How does it affect your mental/emotional health and physical health?
This defense mechanism is normal to an extent in all of us and therefore it might not affect you at all, other than random fights with friends or your partner. However, for others it is a totally different story. This might lead to cutting off relationships, dramatic fights and feeling out of control with emotions. This is when you really need help sorting things out.

How can you stop if you recognize the behavior in yourself?
As noted above, this is extremely hard to do on one's own because it is often out of one's awareness. You need help exploring this and that can be done in individual and group therapy.

What should you do if someone is projecting on you?
Apologize if you have something to apologize for - that's an important quality for anyone to have! However, be careful to over-apologize for things you know you have not done. Instead maybe express concern for the person and let them know you really have not intended to do what you are being accused of and that you are willing to hear them out, but you do not believe you have actually acted in such a manner so you want to be heard too. At the same time, it is important to have boundaries for yourself and not just accept projections of others as this can be dangerous.

I frequently work with the teens and young adults in the college age that deal with the outcomes of drinking too much. The stories are extremely upsetting and the costs can be more than a bad morning with a handover. I have seen drinking games and binge drinking episodes lead to experiences of sexual assault (never means the victim is to blame - you aren't!), alcohol poisoning and failing out of school or losing one's job. For some individuals, the partying turns excessive and becomes more about having to drinking than even wanting to. It changes the brain over time and can impact other mental health disorders, such as intensifying depression, anxiety and suicidal thinking. Often it can be paired with an eating disorder as well. My immediate tips as we move into the holiday times where everything is about excess is to do the following.

1. PLAN for your safety - If you are a young adult going out, do everything you can to increase the safety around drinking. This includes having a sober driver either in your group or a plan ahead of time of how you will get to/home from the party. Be extremely careful about shared ride experiences, as these are not always going to guarantee your safety. If you choose to take those rides, never ride alone. Have someone with you and remain awake and alert in those rides, know where the safety button is on your phone to alert the shared ride carrier if you are unsafe in the vehicle (these exist adn are extremely helpful!). Check the license plate and driver before you enter into the car. There have been numerous times in the past where the worst has happened because someone was not alert and went into the wrong car. It is safest to have a sober-sister or friend that will agree to ensure that the entire group is safe and accounted for both in ride and in number. This person will remain alert and aware of where everyone is and that no one is leaving the crowd.

2. Monitor your drinking - Make a plan before hand of how much you will drink. This may sound funny, but it's important for many people. The reason for this is that many of us when nervous may just sit and sip to decrease the social anxiety. This can lead to losing track of your consumption quickly. In addition, choose drinks that allow you to know how much alcohol is in it. That means staying away from the "unknown punch." Watch your drink being made and never, ever leave your drink unattended. I have come across many sad stories of people's drinks being spiked without their knowledge. It is also incredibly important to eat normally throughout the day and snack while drinking as well. College age people will frequently have the "drink your dinner" mentality and again, this can lead to bad things happening. You will be impacted by the same drink much more when you are not eating throughout the day.

3. Get help! If you notice you're doing these things and your friends can stop drinking or not think about it until the weekend and you can't - then you might have a problem. There's nothing to be ashamed about. There are many people who suffer from addiction. The earlier you get help the better. Addiction is a progressive disease and will take more and more over time.

I recently spoke to Yahoo News regarding the reality TV craze of Love Is Blind.  Here's the extended interview you didn't get to see.  





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Is love really blind? What were your thoughts on this season?
This season showed many issues and dynamics that can occur in relationships that we all experience and reality television can be used to either mindlessly "tune out" from one's life or to actually "tune in" and become aware of how we relate in our own lives. There are always I few things I strongly push in understanding these shows. In reality television shows, often the casting is geared toward trying to pull for those dynamics as the audience generally is more engaged with high intensity interactions. In addition, even if the taping of the shows are done in a fair way, the editing team may be completely separate and showing us only the parts of the recordings that support the storyline they are interested in portraying. It is always important to keep that in mind when watching these shows and to remember that any one of us could appear to be a 'certain type of person' if our lives were filled and boiled down into an hour show. I saw this because I saw many people online making snap judgements about these people's overall character, saying Lydia was a 'stalker' and JP is an 'abuser,' etc. We have to remember these are people not characters and in their lives, there is likely far more to them than the pieces of film we saw. I always try to remember that when watching these shows. Here's a few specifics I took away:

• 1. Healthy vs unhealthy communication - This season really highlighted some excellent examples of healthy communication using the factors of the empowerment triangle where each person has equality and the ability to express themselves fully and be heard by the other person. I saw this immediately in the relationship between Milton and Lydia, which was a stark contrast to the relationship dynamics of Uche and Lydia. In that relationship dynamic, there appeared to be a fight for power and control and it was highly intense (from the scenes that were aired at least). Anytime a relationship dynamic is based on intensity and power struggles, we have the ingredients for drama. Remember, casting and editing teams are wanting this for good television so we are not always seeing the entirety of a situation, we are seeing the edited version of what really happened. Having said this, we can take a look at the specifics of the filming we did see and really learn a lot about relationships. We can see that when dynamics are healthy in a relationship, it can bring out a totally different side to that same person. Look at how different Lydia appears in her relationship with Milton versus Uche. All of us could benefit from self-reflection in our own lives and looking at who are the people that fire us up and we seem to lose control of ourselves with, and who are the others who balance us in a healthy way and create a sense of vulnerability and safety.
• 2. Boundary setting - Milton is an excellent example of how a person can attempt to pull us into a power struggle in communication and we can choose to step right out of this by not engaging in the 'bait.' Throughout the season, he shows a strong level of maturity to see that 'one's perception is their realty' and therefore there is no one way to see things. He diffuses situations by acknowledging, "I hear you even though I might not agree with you." I think his reaction style is often not one seen on reality television, and he can teach many of us how to not engage in the drama triangle of dynamics we are able to fall into on a day to day. It seems that he is capable of taking this approach because he seems fairly confident in who he is. When a person has more internal stability of knowing who they are, they are less likely to be shaken by other dynamics that may make them question themselves and become defensive. What's also very cool, is that people loved seeing this on reality television, so hopefully casting crews will remember this!
• 3. Opening up about sexual assault - We also got to see a very interesting storyline with Chris who spoke about his first sexual experience being one of assault. I wish there had been more media attention to this story, particularly during October's domestic violence awareness month. It showed how his partner in the pods, Johnny, just listened and was there - she didn't need to say anything, but just being there provided a safety that allowed him to open up for the first time ever about the trauma he experienced. It also showed that men can experience assault too - this is incredibly important to break the stereotypes of what sexual assault is.
• 4. The impact of the real world on relationships - We also got to see how the stressors of the real world impact any relationship. In the pods, there are no distractions - just talking and trusting your own gut. When the couples go on the honeymoon, there's fantasy like the fairytale many romantics desire. When they move back into the real world and start living with each other, we can see how people may truly bond and have the start of love, but struggles of finances, different ways of living, and family doubts can place a strain on real world relationships. Sometimes those things are outweigh the passion and feelings of internal love a couple may have for one another.

Yes, people have gotten engaged and married through the show but do you think the experiment really works on a mass scale?
It's important to remember it is an experiment. They note this multiple times throughout the show and the cast members also state this. Can it work? Sure it can - but on a mass scale? My answer as a psychologist to that is likely no. We have to remember that the people who even apply to be on the show are likely 'romantics' in their personality style - they believe from the start this could work and that's powerful! I am not that way and would not ever consider applying to a show like this. So the pool of candidates here is biased since they have a "placebo effect" of believing it could work to begin with. Having said this, there are some wonderful aspects to the show. In the real world, we start often with the physical chemistry that pulls us together (passionate fatuous love), and then we move to developing a deeper bond on our values (romantic love) and eventually we commit to a long-term bond with this person (companionate love). On this show, the script is flipped to first focusing on teh deep bond and romance, then adding in and determining fi there is passion to back the values bond, and then finally whether the commitment is going to be made. It is a TON of pressure on these young people to make over a very short period of time. Most couples average over 2 years before they consider marriage and these folks are making lifelong decisions in 4 weeks. It's admirable they would even consider that possible and for many couples, they are still together! And, given that so many people watch the show, I think it speaks to the 'romantic' that lies in each of us that the fairytale is possible and we could be loved for who we are. In a true healthy relationship, that is what holds people together and true love is blind, but it is also okay for love to have physical chemistry and a passion on the outside too!

​OK parents, I feel for you on this one.  Your adorable little child that used to want to know what you thought the best costume was, used to have you help them getting ready to go out and collect giant heaps of candy.  They were adorable little ghosts, superheroes or cartoon characters.  Suddenly, they are teens and everything has changed.  If you haven't already had to have this convo, it might be one you will someday.  I was recently asked to contribute Parents Magazine about teens wanting sexy halloween costumes and how to manage these conversations.  The article is fantastic and I highly recommend you read it fully.  Below is my expanded thoughts on the topic.  

What if I totally disagree with a sexy halloween costume???
I think in today's times this is an awesome opportunity to have a loving and open conversation with your teens that provides a sense of you aligning with them and supporting them for the remainder of their teen years into adulthood. If you see them wanting to get one of those costumes and you disagree as a parent, first i would probably validate their feelings. Remember the old movie Mean Girls and the halloween party scene? This has been a thing for a long time and there's nothing to be ashamed of. I would encourage your teen to talk about why they want to wear a certain costume and what they are hoping to get from it. You might find them opening up deep concerns of not feeling good enough, or needing validation of worth from others, or just a sense of fitting in. Those are all very important things and normal things teens want to feel. Hopefully, you have laid the foundation of other times you have talked about self-esteem and validation.

So what does a parent actually do?!
You can then validate their feelings and say "of course those things are normal, and I totally wanted the same thing when I was your age." You can ask them what else they might communicating to others by wearing a particular outfit - I don't mean to send a message that a flirtatious costume means a person is asking for something bad to happen because that is not correct. What I do mean is that we might be sending a message that we are looking for external attention in a negative place and is that the message your teen wants to be sending. The key here is creating curiosity and openness, not shame for wanting attention or for showing one's body. WHat are other messages do they want to send into the world about themselves and their personalities - is it that they are fun? Creative? Exciting? What about using the Halloween holiday as a time to express those things and to enjoy being a teen. I think the main things here are to really lean in with understanding and to connect with your teen during these challenging times of wanting to fit in. Tell them you really do support them and that's why you want them to be able to enjoy this time in their lives of fun and freedom, as there is time to make more grown up decisions about how they feel about these same things in the future. If they want to still dress in a particular costume when they are no longer a child, then that is their ability to do so and you will support their adult choices at that time because they will be equipped emotionally to see the whole picture. Ensure that any choices you make as a parent are to provide them with safety and ability to have a live a life of freedom, not emprisonment, since that is what teens may think the motivation is. Let them know it is your job as a parent to help them reinforce healthy boundaries until they are ready to take the reins when they are adults. Your teen might hate you until they are 25 (kidding, not kidding!), but eventually they'll probably understand you were trying to protect them until they are adults who can make healthy decisions for themselves.