Dr. David Anderson on supporting children's mental health during a crisis | Homeroom with Sal

From Khan Academy:

Welcome to the Daily Homeroom live stream! For those of y'all that this is your first time, this is really just a way for us to stay connected during school closures. Obviously, Khan Academy has many resources for students, teachers, and parents to be able to work, whether the school is in session physically or whether it's happening at home, as I think most of y'all are now having to cope with. We realize, above and beyond those resources in math, English, language arts, science, and humanities that go from pre-K through college, that we need to provide more supports.

It's our duty as a not-for-profit with a mission to provide a free, world-class education for anyone, anywhere to step up right now in this time of crisis. That's why we're doing teacher webinars, parent webinars, this Daily Homeroom live stream for everyone, as well as things like the daily schedules that many of y'all are now leveraging to think about how to structure your days for students of different age groups.

I will remind everyone, as I always do, that we are a not-for-profit organization and we are supported. The only reason we can exist is because of philanthropic donations from folks like yourself. Even before this crisis, we were operating at a deficit, and now, during this crisis, our server traffic is up two and a half, approaching three times. Our registrations for students and parents, actually students and teachers, are six-fold, and parent registrations are 20-fold. So if you're in a position to do so, please think about donating to Khan Academy.

I do want to give a special shout out to several corporations who stepped up in record time when they realized that we needed help, not just generally, but especially in this COVID response period. Bank of America stepped up in that first weekend, followed by AT&T, Google.org, and now Novartis. This has been incredible help! Any of you who are corporate leaders or work for corporations, we need more help. I would love to add logos to this, and for all of you individuals out there, we still are running at a significant deficit, so every donation matters.

Whether it's as small as the three dollar donation, five dollar, ten dollar, we know that that is hard earned money, and we really appreciate it, but we really do need it if we want to support kids around the world and parents and teachers. So today we have a fairly exciting live stream. We have a clinical psychologist, David Anderson. I encourage everyone, I say this every time, to start putting questions on Facebook and YouTube that you might have for either our guest Dave or myself about anything.

We're going to talk about something that is very front of mind for a lot of folks right now. We are all socially distanced. Many of us have kids at home. Kids are trying to stay learning, but there are many other things going on in all of our minds. Anxiety is up, stress is up for everyone, and I'm hoping Dave can help us navigate. I'm speaking not just as a representative of the Khan Academy community, I'm also speaking as a parent who has seen some of the difficulties of what we're going through.

So thanks for joining us, Dave. Maybe the first question is: any general advice you have for parents and students who are just trying to cope with everything going on right now?

David Anderson:

Well look, thanks for having me. It’s wonderful to be able to be here and have a forum to talk about some of these things. You know, we have a practice on both coasts; about 60 clinicians in the Child Mind Institute. We're hearing a lot from parents and students. I would say that the first things that are top of mind, especially for parents, are to manage expectations.

I mean, the biggest thing is that none of us have encountered challenges like this before, and I count myself within that with two children. It’s something where trying to manage the work lives that we were attempting to manage before this crisis hit, with child care and without many of the major supports that we have in a time of online schooling, is tough and it’s going to be tough for anybody.

Some of the first things we talk to parents about are taking the to-do lists and the kind of level of perfectionism they would normally expect of themselves and really trying to edit those things down as much as possible to ensure that there’s something manageable each day. You have a moment to mindfully pause and perhaps enjoy some of the silver linings of this in terms of time spent with family and an opportunity to connect a little bit more.

What should we keep a lookout for in our children, or even for ourselves? I know you focus on children especially, but as a clinical psychologist generally, I think sometimes things can happen in bits and pieces, and you know you've gone too far before it's too late. What should we look out for, signs of difficulty in our kids or even ourselves?

I mean, the reality to your point is that we always say this: child therapy is so much about it being mediated by the parents. Parents aren’t necessarily the cause of the child's particular difficulties, but they’re often the solution. We spend probably about half the time talking to parents even when the child might be the particular focus of our intervention.

In terms of how parents can support kids at the moment, especially with online schooling, it’s that everybody's adapting to this new normal. Schools are trying to outline assignments in certain ways and make it manageable for the kids, and they may not necessarily be getting data in real time from parents related to what the kids can handle and what kind of scaffolding they need.

I think the kids we're especially concerned about at the moment for our clinical population are those of mental health and learning disorders that normally are supported in allowing them access to a school curriculum in school, but we may see a lack of those kinds of support services. Parents are being asked to be therapist, speech language pathologist, and teacher all in one. That's something that’s exceedingly difficult for everybody right now.

How are you all supporting those parents or supporting those students?

A lot of it is retooling our clinical services to be digital at this time. In many ways, we're starting from a population-focused prevention level. The Child Mind Institute now has two Facebook Lives per day. There’s a section on the website which you can see here on coronavirus support and resources, just for supporting families. It includes links to our daily tips and Facebook Lives, a link to phone consultations we can provide right now for families who are having difficulty, and then also articles that are really focused on coping with the coronavirus crisis.

We've tried to make those articles targeted to age groups, to parent stress management, the incorporation of mindfulness, and then specific diagnostic clusters where parents may be experiencing certain kinds of unique difficulties, say for kids on the autism spectrum or kids who might have difficulty with behavior. So I thank you for scrolling through that section of our website right there.

You can also catch me again a little bit later. I’ll be doing these Facebook Lives twice next week, so if folks have questions that go unanswered between you and me, Sal, they can catch me again.

This is super useful, and we're getting a lot of interesting questions here for you, Dave.

This first one is from YouTube; Molly Franklin asks, "As an extrovert, how can I keep from losing my mind during quarantine?"

David Anderson:

That’s a really good question! I mean, you know, I think that in many ways we’ve seen an explosion of these kinds of self-categorizing terms on Twitter and on the internet right now, where folks realize, in terms of the definition of extrovert, we see it operationalized as somebody who really gets their energy and feels like their mood gets a boost in any given day from the close contact they have with other people. That’s where they get their energy.

So, look, what we try to do at first is help extroverts cope in a sort of accepting way. We know that it’s not going to be the best in terms of how to support their mental health right now. We know that a lot of the ways they would normally draw energy or get a mood boost are not available to them. It's about thinking as creatively as possible.

We try to assess with people what the level of relationship is with anyone they might currently be socially distancing with, how they can make the most of those safe in-person connections, and then similarly how they can connect with others to do daily activities kind of together.

The sense of can you watch a TV show together? Are there online games you can connect with and play with other people? I’ll give one last quite creative suggestion I’ve seen from some of the teenagers I treat, which is social distancing walks, in the sense that they'll meet up across a block from each other, never be on the same side of the street, but at least feel like they're walking together and can look at each other in person.

That's fascinating because I think the rational part of our brain says why does it matter for watching that Netflix show at the same time? But to your point, there is something deep inside of us that's saying, "Oh, other people are experiencing it at the same time."

David Anderson:

Exactly! That's a neat idea! Cook the same food and then share a meal. You get to compare, you know, who did it best and kind of tinker with each other's recipes. There's a lot that can happen with that, especially if your friend is a better chef than you are!

Oh, although you could pretend that your own dish was more delicious; no one will ever know!

This is somewhat the lobby; you can always do this. Obviously, we could do video versions of this live stream, and then it might even help with our little technical glitches that sometimes we have with our broadband.

No one should feel broadband guilt at this point!

But this is the value that we're all globally right now having this shared experience. We’re getting a ton of more questions from Facebook.

Taylor Kobayan asks: "How do you cope with school workload without getting distracted? Personally, as a high school student, I'm struggling with staying focused since I have ADHD; advice?"

David Anderson:

My first job at the Child Mind Institute was running our clinical center for kids with ADHD and behavioral issues. So this is right in my clinical wheelhouse! Thank you for the softball! I mean, look, with a lot of the patients that we're working with ADHD right now, we know certain things: we know that if they get sleep, focus can be better. If they take medicine, it’s important to think about the timing and when they’re going to get the most benefit from that.

Beyond that, it’s important to think about organizational skills and the structuring of the day. With a lot of my patients right now, we think about especially with adolescents, even though they may be waking up slightly earlier than they would during the school day, we’re structuring their workspace to make sure it’s as free of distractions as we can.

Maybe putting any distracting devices where friends might be trying to contact us outside the door elsewhere in the house. We’re trying to get good work blocks in the day, making sure we’ve got at least one work block before lunch and perhaps starting with some of the more ambitious tasks that will have less energy to really tackle later in the day. Structuring in good meals and breaks, and really trying not to save a lot of the challenging work for later.

You can kind of knock off the easy stuff for the late-night time when medicine or motivation has really worn off. It’s about managing yourself like that! If you can't talk back to yourself to combat procrastination effectively, sometimes we've seen teens and college students try to get accountability buddies who can keep them on task and say, "Alright, let me meet with you for five minutes at the beginning of the day. What's your list? And then how can we check in in a non-judgmental way to keep you on track?"

That's super powerful! A lot of what you described, once again the rational parts of our brains say, "Oh, why should I have to text message a friend when I’ve checked something off my to-do list?" Or, "Why should I have to eat or watch a movie with someone else?" But there's something very powerful about having that community accountability to what you're doing.

We've talked about it at previous live streams. Just getting started, having those early wins, and do some of the high cognitive load things early with breaks. That's super good advice.

It’s also that friends can help us be accountable in a more non-judgmental way. Not to mention, friends are often the ones who are most gentle with us in helping us to be self-compassionate.

You have better friends than I do; mine are quite... kidding me!

Carefully! Yes, you should see some of the text accountability that I have with my friends. When we have one group where we text each other whenever we eat something we should not, and they are quite harsh. We are all harsh with each other!

Well, I've seen folks do things where their friend will control a certain portion of their money; it’ll be donated to a cause they don’t support if they don’t accomplish their goals, but to a cause they do support if they do! You can set up lots of different schemes for yourself with your friends.

This next question is from YouTube, and actually, this is something we could probably both take a stab at answering. YouTube's Ashutosh Tewari says, "Hi Sal, I want to know how you people are coping with COVID-19. I want to know how you all are keeping your offices running."

I'll take a stab at it, and I’d love to hear Dave's thoughts as well. Ashutosh, you know, Khan Academy, it's a hard time for everyone. Obviously, some good things that Khan Academy had going for it is we already had about 35% of our workforce as remote or distributed. We had a lot of the infrastructure in place where we could do meetings over Google Hangouts or Zoom. We would use things like Google Docs to collaborate. So that aspect has been relatively okay for Khan Academy, although it’s still been difficult.

The part that's been much harder is that now, many of our team members are at home. Their children, many of them, have very young children at home. You can imagine getting work done while you’re also doing child care, especially if your children are very young is very difficult. I know many of the parents and teachers out there listening are coping with the same thing.

I consider myself very fortunate. I have three young children; my wife, my mother-in-law lives with us, and that helps us kind of be able to tag team a little bit. Since the COVID crisis has been going on, Khan Academy’s load and, in fact, my workload has gotten even higher than it typically would have been pre-crisis. I really have to thank my wife and my mother-in-law for stepping up and filling in the gap. My wife is a physician, a rheumatologist, so you can imagine there’s a lot of complexity in her world as well.

She’s been kind of the hero of the household lately, but it’s tough on everyone. I think we all just have to take one step at a time, and to quote Frozen 2, "Do the next right thing."

Dave, I’d love to hear personally, how are you coping, your family, and your work?

David Anderson:

I just thought my son’s favorite character is Elsa, so if I can mix flexibility, gratitude, and Frozen references into my speech here, I think that was pretty perfect. No, you know, at Child Mind, we have 300 employees across a couple coasts, and similar to you, there were aspects of our work that were, as a non-profit, already online and fruitful for collaboration, even working at a distance.

I think others, like clinical care, have both suffered and then also been adapted in new and inventive ways to serve our patients. We all knew that the models of treatment that we use for children, adolescents, and families are most tested in person, but in an environment like this, in many ways, we've seen organizations like ourselves kind of figure out how we can become borderless.

We can serve with consultations or clinical care in really creative ways using video camera coaching with parents at home or all kinds of different formats online just to get in touch with our patients and make sure we provide support as best we can.

Like you, I have a three-year-old and a seven-month-old at home. The only way I’ve been able to function or keep work up is because of my wonderful wife and in-laws who also live with us. But even with that said, my son is used to a bounded lifestyle. My son, by three years old, knows that daddy goes to work each day in an office, and he goes to his preschool. The fact that I’m working upstairs has been a real adjustment period for him in the sense that he doesn’t understand why he can't be involved in everything.

So I've tried to work out a rhythm where I take a long lunch break with him each day outside in the yard. We have at least a meeting with a team member of mine— not a patient, that he joins each day. I then try to drop everything the second the workday is over and spend a good bit of time with him.

I think everybody's trying to find their balance that way. Whenever I start to feel sorry for ourselves, because my youngest is five years old and he’s a little bit difficult sometimes, I remind myself of those of you who have a three-year-old or seven-month-old at home.

The funniest thing is that in the midst of this, I think my wife and I had so many goals for where we’d like him to be right now. We have gotten through potty training the last year; he’s sleeping in his own bed. Just the last few nights, in the last week or so, he’s found it unable to sleep through the night without one of us in his bed.

We’re just adapting to that. In the normal rhythm of life, we’d say to ourselves, "No, we’ve got to set some boundaries here," but the reality is our kids, we’re trying to stay healthy, we’re trying to keep everybody safe, and keep their mood up.

So what’s a little bit of relaxing the boundaries right now if it makes everybody feel safe and loved?

That’s actually a good segue to this next question that I have here. This is from several folks who are talking about feeling stressed either when they're trying to learn a specific thing like math or reading or feeling stressed because they actually have a fairly large to-do list from school and they’re feeling like they’re not able to do it.

What tips do you have for those students who are feeling stressed?

David Anderson:

I mean, part of it is that I think everybody's managing this crisis together, so more so than ever it both feels alone, but you're not alone. The reality is we're hearing from so many students who will tell us, "I can’t manage the workload," or, "I feel so ashamed because the other students seem to be taking this online learning like a fish out of water, but not me."

We don’t really meet people who are finding it easy during this time, so I think it’s more that we want to encourage people to reach out to their fellow students for how they're coping with this and to reach out to their teachers, because we're all, I think, functioning on more limited time and kind of headspace than we normally have.

At the same time, we want to help. We know that the switch from in-person to online schooling will not come without bumps. For that reason, we’ve seen teachers more so than ever interested in connecting very quickly individually to try to help a student through something or figure out how they can get support, and I think that a lot of teenagers we see and college students are really surprised by that.

I'll just add to that, because we've been seeing that type of stress not just amongst students using Khan Academy, but we’ve been seeing it even in our own employee base, where folks have their headspace is shrunk, there’s a baseline of anxiety or dread going on, and then they’re taking care of kids.

They might have a family member who’s having financial difficulty because they lost— I mean, there’s just all sorts of stresses that are going on, and then they’re also trying to do their work, and they’re feeling almost guilt or stress. They’re like, "Oh my god, the goals that I thought I was going to be able to do are not realistic anymore."

What we're telling our team members and what we tell everyone is: no one is judging anyone right now. I only judge the people who are judging others. We keep telling folks you take bite-sized chunks and then you do it as high quality as you can but don't think about quantity or the same productivity right now.

No one's capable of it, and no one is judging it. And you just have to release yourself.

For example, a lot of schools, even my own children’s schools, they’ve given a very robust list of things for the students to do. But I think I can speak on their behalf; they completely get that if kids or their parents are not in a position to do everything on that checklist, it’s completely okay.

We're all trying to cope with this situation in whatever way we can.

So, Dave, thanks so much for joining. We’re at time. Every day this half-hour goes by fast, and today was even faster than normal; a sign of how much fun we’re having!

I think you’re going to be able to join us hopefully in future live streams, and I just want to tell everyone, as what Dave and I just said, you might feel physically separated from others, but Dave gave some good ideas for how you might become feel a little bit mentally closer or emotionally closer to others in this type of crisis.

The whole point of this live stream is for all of us to realize that we’re in this together. The whole world is going through this. So as best as you can, you know, keep safe, stay healthy, and don’t beat yourself up too much.

Take some time to breathe, relax, meditate, whatever it takes to kind of give yourself that mental reset. We’ll see you tomorrow!

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