Caring for Trauma and Anxiety in Families

Today on At the Forefront Live, UChicago Medicine Comer Children's experts will talk about how parents can best care for their kids anxiety and trauma, as well as their own, during this stressful time. What are the primary causes of anxiety and trauma? How can families gain confidence or peace of mind? Dr. Seepa Anam, Dr. Sonya Dinizulu, and Dr. Bradley Stolbach will answer these and other questions from you during this live Q&A. That's coming up right now on At the Forefront Live.

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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Let's have each of you start by introducing yourselves and telling us a little bit about what you do here at UChicago Medicine. And Dr. Stolbach, you were kind enough to join us in the studio, so we will start with you.

Good afternoon. It's good to be here with you. My name is Brad Stolbach. I am a trauma psychologist in the Department of Pediatrics here. And I've been working with children of families on the south side of Chicago for the last 25 years, focused entirely on providing services and programs for trauma. Here, our programs specifically support families who've been affected by community violence and also young people who've been injured by that violence-- shot, stabbed, or assaulted. And we also have programs that you might hear more about from our other guests that support people dealing with other types of trauma.

Perfect.

And Dr. Anam, we'll go with you next.

Sure. I'm Seepa Anam. I'm a child adolescent and adult psychiatrist here in the Department of Psychiatry and Behavioral Neuroscience. I work with Brad Stolbach and Sonya Dinizulu in the Recovery and Empowerment After Community Trauma program providing psychiatric and psychopharmacological services. I also co-direct the Mood and Anxiety Clinic here at the University of Chicago. And part of my specialization is providing culturally informed care, especially for children who've been affected by trauma and anxiety.

And Dr. Dinizulu.

Hi good afternoon, everyone. My name is Sonya Dinizulu, and I am also in the Department of Psychiatry-- child and adolescent psychiatry. I'm a clinical child psychologist. And I work with youth with all different clinical presentations but my background is specializing working with youth exposed to trauma and violence. I also co-direct the REACT clinic with Dr. Anam, and I'm also the director of the trauma programming in my department in psychiatry. It's the University of Chicago Stress, Trauma, and Resilience program.

You all do some wonderful work with the community here and, again, I'm sure it's a tough job but it's also going to be a gratifying thing that you do working with these children and their families. Let's jump right into the questions because we're at a very interesting time in history and a very trying time, I think, for a lot of families. And Dr. Stolbach, I want to start with you just to kind of get your thoughts on what you've seen so far as people have dealt with this and dealt with the variety of issues that will come up with families and the challenges that come up with families. If you can kind of just tell us what you see?

Well, this is a very challenging time for all of us. And so we see the long-standing stressors and traumas and difficulties that people have been dealing with for many years here related to violence as well as the structural inequities in our communities. And on top of that, in recent months, we've had the very public killings of black men by police that have led to a lot of protests. And then we've had the pandemic. And so all of those things combined, I think a lot of us are feeling anxious, uncertain about the future, and don't necessarily always have the best ways to communicate about that, even with each other but also with our children.

Dr. Anam, it's interesting because I think UChicago Medicine is somewhat unique, just in the way that we're an academic medical center, we're in the south side of Chicago in that general vicinity in Hyde Park, obviously, and so we're kind of a unique place, and the work we do, or you do, specifically with the kids and the families here is unique. And Dr. Stolbach brought up health care inequities and some of the work that's happening there. What do you see from your standpoint with the children and families you deal with? And what are some of the challenges that we face?

There are a number of challenges. Just as Dr. Stolbach said, there's a long history of structural inequity that has proved a challenge for our children and families to access health care, specifically related to mental health. Among some of the specific challenges that affect communities and communities of color include stigma that can prevent people from wanting to seek help to offset some of the effects of the traumatic stressors and anxieties that are affecting all of us.

One of the main challenges we have is that children don't often show up for appointments to help to offset some of those mental health concerns. What's also interesting is that children may not express their anxiety or trauma in ways that are very easily distinguishable for adults. Sometimes they may not be able to voice their concerns with words.

The expression can look very much like physical manifestations, like stomach aches, headaches, freezing, crying. It may also show up in behavioral ways. A lot of kids will suddenly seem more irritable. They may seem like they're having tantrums. And this is not necessarily identified as an expression of trauma or stress, and that may preclude their ability to go and seek treatment for the concerns that you're actually having.

And Dr. Dinizulu, from your standpoint, we are in trying times, I guess you could say, or unprecedented times with the pandemic and some of the other incidents that have been mentioned. What are your thoughts, and what's your take on the situation and what you've seen as a provider here?

Yeah. So I echo everything that Dr. Anam and Dr. Stolbach had already mentioned. We're facing two pandemics. We're facing a pandemic that is involving social unrest, particularly as it relates to racial trauma, and we're dealing with COVID-19. And certain populations, particularly African-American and Latinx population are really exposed the most because we know there are higher rates in those populations as it relates to deaths associated with COVID-19.

So as of late, within the past several months, we have received a lot of calls related to racial trauma. We have received a received a lot of calls related to those who have lost loved ones to COVID-19 or kids and families being really anxious about their loved ones going to work, such as those who are essential workers, whether their health care or in other areas.

So I think it's really important that when we think about what's happening that we have to remember that trauma and anxiety-- let me start with trauma. Trauma is more than just COVID-19 right now. We have to look at trauma as being experienced by those who are most vulnerable. So again, it's the COVID-19, losing a loved one to that, plus the racial trauma that's going on. Those combined isn't a cumulative stress-- what we would say is a cumulative stressor-- and that in itself will have a different outcome from those who are just experiencing COVID-19 stressors.

The anxiety, too, I want to highlight that anxiety-- it's healthy to have anxiety. And so it's OK for us to have this feeling of worry or nervousness or unease because we are in uncharted territories. We have to expect the unexpected. But part of the thing about anxiety is you have to expect the unexpected during turbulent times like this. We'll talk more about it, I'm sure, about different ideas of how to cope with that, but I want to highlight very much so the idea of us experiencing two pandemics and that everyone needs to be mindful of that and be responsive.

I think that's certainly well put, and the fact that you have those things combined just makes it tough. It's tough being a kid.

Absolutely.

Yes. Actually, our programs have been almost 100% telemedicine for the last several months.

I love what we're showing now in the screen because here we go with some online video visits. And this shows, I think, the value of it. And don't know, Dr. Dinizulu or Dr. Anam, if you want to jump in on this and talk about your experiences with doing these video visits, but it's like a house call.

Absolutely. I am actually-- I was hoping that one of our team would mention that it is critical to start the process early to start to seek treatment, talk to a professional, when you have experiences of anxiety or depression or trauma because they can limit the impact and severity of that incident or that situation on long-term development. We have an expanded capacity, fortunately, to provide these services now at University of Chicago.

And just like Dr. Stolbach said, and I'm sure Dr. Dinizulu will echo, almost all of our services currently are done remotely, which is wonderful, because it allows us to have access to more patients who have had a hard time managing several kids and babysitting and jobs. So we have a lot more capacity, which also, in some ways, allows us to see patients who we would not have been able to see otherwise. So it's really a good time, I think, to start to link in because we have more capacity in terms of workforce and also more capacity in terms of platforms in which we can see patients.

Dr. Dinizulu, one of the things that another provider had told me before, it is like a house call and you're right there in the patient's home so you can see the interaction and that sort of thing. So that's got to be kind of helpful, I would imagine.

Yeah, it's very helpful. We get to see a different perspective of our patients, and they get to see us too, actually. So it goes both ways. It allows for more-- I think it's even stronger rapport-building because now we're introducing a different part of our lives. So it's been really cool to see some of the kids that I see and their families. And to me, it feels like we have even a better connection sometimes. So it's a nice feature, and it's not going away. It's here to stay.

I agree. I think it's wonderful. And I'm so glad that we're doing this as an institution and embracing it because I think it's really great. Is anxiety in children more common at a certain age? Another viewer question there.

I would not say that it's more common at a certain age but that the way that it manifests is different at different ages. Separation anxiety is really normal at an early age but it can be an issue, really, at all ages, especially with trauma. But in general, the way that it manifests may look different. And Dr. Anam talked a lot about some of the different things that you might see. So with younger children you might be more likely to see physical complaints, stomach aches or headaches, versus them saying that they feel anxious.

So Dr. Anam, here's another question from a viewer. My daughter has lupus. My son has-- I believe-- it's apraxia of speech. We take quarantine very seriously but I want to try to keep a good balance between staying safe and not causing too much anxiety. Can you give advice related to maintaining that healthy balance? And that is the million dollar question, I think, for all parents right there, that healthy balance.

That is the million dollar question. I wish I could answer it with-- because I'd get that million dollars. I think it's really critical to take stock of, what are your children's needs? What are the things that help them feel secure, supported, and safe in this situation? I think it's very hard to do a one-size-fits-all. I think you have to consider, just like you said, you have some medical concerns that are specific to your kid. You're very concerned as a parent for doing optimally what is going to get your child through this period with the safe and healthy way and not compromise their development.

I think it's tricky. I think the most important thing to you-- you are the expert in your child. You know what their needs are. And I think what can be helpful is if you're noticing that your child is not developing, they're having impairment in terms of their ability to engage with things that give them life, that give them happiness, that give them joy, if they're avoiding situations that have been helpful to them, that's when you start to think, maybe I could use some more support because they're avoiding social relationships, they're avoiding school or academic functioning. They're not spending as much time with family. Can we use some more support in helping us get our child through this difficult period? But I think it's really important to partner with your health care provider and use your combined expertise in helping care for your child.

We are about out of time but I have another question from a viewer that I really want to ask. And Dr. Dinizulu, I think I'm going to throw this one to you. It's basically about attending school as we get back into the fall. There's two questions here, so I'll just give you both and let you take a shot at it.

So what about anxiety with either not attending school in person during the fall or with attending school but with modified social engagement and that sort of thing? And then another one is, what can educators recommend to parents to support children that may experience challenge in transitioning back to school or not transitioning back to school? This is a tough one because, as you mentioned earlier, the social aspect for children is so important, and school plays a critical role in that, obviously.

Yeah.

Yeah. That's a billion dollar question as well. I know I need more time than a minute to answer this but just real quickly, again, we have to make decisions based on the information that's before us. So today they may say, we're opening school. It might be a hybrid. But come September here in Chicago or late August for those areas in the suburbs, you may not be going back to school fully. It all depends.

You have to be able to follow the guidelines, read the guidelines, make sure the school is also implementing the guidelines by the CDC. And it's really going to have to be a family decision. And again, expecting the unexpected is just knowing what information is before you and let that be your guiding-- talking to your primary care physician, talking to any other family members that may need to help you decide this. But you don't have to be alone in making these decisions.

And whatever you decide, you're not going to be the only parent and family that's going to make this decision that's different from everybody else. There's going to be other people in the same boat with you. We're all in it together. Some people may go back to school, some people may not opt to go back to school, and that's OK. You just have to make whatever decision that's best for your family given the information that is before you in that moment. We have information. You just have to be able to use it to help you make that decision.

We're out of time. We'll have another At the Forefront Live next week, and please remember to check out our Facebook page for our schedule of programs coming up in the future. Also, if you want more information about UChicago Medicine, take a look at our website at uchicagomedicine.org. If you need an appointment, you can give us a call at 888-824-0200. And also remember you can schedule your video visit by going to the website. They're very, very good and very, very critical. Thanks again for being with us today, and I hope you have a great week.

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