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Welcome to the Nimble Youth podcast, where we provide expert insights and valuable resources for parents navigating the complexities of their children's mental health. We empower parents to nurture healthy minds in children, teens, and young adults through real conversations.
Our team of seasoned professionals, including physicians, therapists and educators, delve into pressing topics, share research-based strategies, and offer practical advice for fostering mental and emotional well-being within your family.
Welcome back to the Nimble Youth Podcast. I'm your host, Matt Butterman. Today, we're talking about a parenting approach that might sound a little counterintuitive at first. Helping kids with anxiety and OCD by changing not their behavior, but the parents. Joining me is pediatrician doctor Gretchen Hoyle, who brings twenty five years of experience in pediatric mental health or special interest in pediatric mental health.
And, today's episode is inspired by the work of doctor Eli Leibovitz and his book, Breaking Free of Child Anxiety and OCD. We'll have a link to that title in our show notes for this episode. Before we start into our conversation, a reminder that this podcast is for informational purposes only and should not be construed as medical advice. Always seek the counsel of your pediatrician or other mental health therapist with any mental health issues your child is experiencing. So let's start with what we mean by accommodation.
Doctor. Leibovitz talks about how parents, out of love and concern, often change their behavior to help a child avoid anxiety triggers, caused by OCD. And what are some common examples that you see in your practice? Right. So I would say if you think about, like, when we talked about OCD that, you know, that there's this it's driven by these intrusive thoughts, and then that causes them to have compulsive behaviors.
And so, one of the more common ones I see is that the child has an intrusive thought about, like, the house being broken into. Mhmm. And so then they will try to mitigate that intrusive thought or that anxiety caused by that thought by checking the lock on the door, like, repeatedly. Okay. And so and then sometimes they will engage the parents in this ritual as well.
So the idea here is that the child will, you know, say will ask the parent, have you have you locked the door? And the parent's like, yes. And then they're like, oh, will you check it? Yes. We'll check it.
And then they'll make the parent check it. Sometimes they'll make the parent check it a certain number of times. And then the child will go check it for a certain number of times. And then they'll ask again. And they'll come into this ritual where they have to do things a certain number of times, ask a certain number of times, do it again in order to feel like they're addressing the intrusive thought that somebody's gonna break into the house.
Right? Okay. So the intrusive thought is the thought that somebody's gonna break in. The compulsive behavior on the child's part is the constant asking for reassurance and checking. And then the accommodation is the parent engaging in this by reassuring the child and checking the lot themselves to reassure the child.
That's the accommodation. And what he's saying in the book is that that accommodation is actually counterproductive because it gives the child the message that the parent is also concerned that the child cannot cope with the anxiety that they're having over their intrusive thoughts. Right. So that's yeah. So the book flips the script.
Right? It does. Yes. Instead of the child, focusing on the child's behavior training them Right. Where, it coaches the parents to, gradually stop all these accommodations Correct.
They may be unwittingly making. Right. And so, doctor Levovitz talks about something he calls the space model. Right? Mhmm.
Which stands for supportive parenting for anxious childhood emotions. Talk a little bit about that. Right. So there's a difference between being supportive and providing an accommodation, and that's what he's really trying to get to. So what he means in this context of supportive parenting, the supportive communication and being supportive has two ingredients.
One is acceptance. And so the idea here is that the parent needs to explicitly convey to the child that they accept that the child is anxious about some situation. Right? And that they're doing that in a way that's nonjudgmental. So I think a lot of times parents tend to say things like, oh, you know, your sister could do this at the age that you are now, or the kid down the street doesn't have this problem.
And that's not super helpful because it's kinda judgy and they kids don't typically respond to all that all that well. So the first thing you need to do is be able to accept that the child is indeed anxious, that this makes them anxious, and do that in a non-judgmental mental way. So that is the first, you know, message that you need to send to the child. But the second message is that you have confidence that the child can cope with that. Right?
So you're I believe you can handle it. So acceptance is, I know this is hard for you. Confidence is, I believe you can handle it. And that tends to help bring down the need for these compulsive behaviors and ultimately help with the intrusive thoughts as well. Because, if you're sending the message to the child that you also think that they can't cope with it, then that is feeding into this cycle.
Conceptualize the child's anxiety and OCD as separate from them, as separate from the child. Right? Right. Like, this is a condition that we are both allied with each other to combat their condition, not the kid. Right?
And so we don't want to feed the OCD and anxiety. And so when you are articulating to the child, like, what your plan is gonna be, which we'll get to, you need to have them understand that this is the plan to help reduce the OCD and the anxiety, not as a punishment for the child's behavior. Right. Right. Right.
So it's a big shift. Yeah. Child's behavior. Right. Right.
Right. So it's a big shift Yeah. For many parents. Yep. So let's talk a little bit about how it would play out.
And we mentioned, earlier on the behavior, of excessive worrying about doors being True. Yeah. Right? Mhmm. How would that, how would parents sort of deal with that behaviorally?
Right. So the book has a lot of really good resources about how to put together, like to identify what the accommodations are that the parents are making and then choose an accommodation to start reducing and then come up coming up with a plan to to to start reducing that accommodation and then also, like, being able to communicate that effectively to the child. And so he'd, like, in the book has, like, way like, fill in the blank plans as to what you're going to like, what is the what is the behavior? What is the accommodation? How are we going to then express this to the child?
What are we gonna do when the child, like, pushes back? And that is a really important part of this process. So we're gonna sort of summarize that in the podcast, but I really encourage people to go and get the book and be able to use the resources there because it's something that you really have to think through and have a plan in order for it to work well. Because if you try to sort of do it off the cuff, it's you know, kids are very good, especially kids who are driven by anxiety and OCD to try to maintain that accommodation are very, like, they are they're very motivated to keep you from reducing the behavior that they want you to do. Right.
Okay. So kind of manipulative. They can be. Yeah. And it's really the OCD that's doing the manipulation.
Right? I mean, or the anxiety that's doing the manipulation. But and so we want to, you know, like, if you were to say so I guess one of the simple ones, simpler ones, although people who are having this happen, it doesn't feel simple, but is that the block checking thing. Okay. So the idea here is that you're going to make a plan.
The parents are going to make a plan to reduce the parents behavior of the accommodation. So in this setting, you can't do anything about the child's compulsive behavior. You can't do anything about the child's intrusive thoughts. You can't just try to keep them from engaging in this compulsive behavior. You can't change what's going on in their head.
Over time, we're gonna get there. But in the moment, the only thing that you can control is your own behavior as the parent. And so what you can control is you're gonna say, okay, I'm not gonna accommodate this behavior anymore. So the plan here is that, you know, that we're gonna have a conversation about how the house is safe. If you ask me if the door is locked, I will answer you one time and tell you that it is locked and that we are safe.
And then if you ask me again, I'm not gonna respond. Okay? And the reason that we are doing this is to be able to combat your anxiety and OCD, not as a punishment. Right? And so if and I am not going to engage in checking this lock with you or for you or in between you or whatever ritual you've come up with as to how we need to check this lock every night.
Like, I'm no longer gonna engage in that. And so, definitely, kids will really get upset by that. They're like, you know, I can't, you know, I can't deal with that. He recommends that you actually give them a written plan because a lot of times when they are first hearing this, they are so distraught that they can't really process it. Right.
And so then you need to be able to refer to a written plan, and you have, you know, a couple of copies. So they may take the first one and tear it up and throw it in the trash can. Yeah. So I think that sometimes the plan is about doing these things, you know, incrementally. Like, I will reassure you two or three times, and then we're gonna stop.
And then, you know, you can the next night. And but whatever the plan is, you have to sort of, like, be able to recognize that it can really only be that you're changing the parent's behavior and that you are consistently giving the child the message that is supportive, which I accept. I know that this is hard for you. I accept your anxiety about the situation. I know that this is hard for you, but I have confidence that you can cope.
Mhmm. And that is what supportive parenting for these conditions is, ultimately. Right. So a very clear plan. And as, doctor Levitt says, you know, often printing it out and and, putting it in written form is very helpful.
And using those supportive statements, consistently, but the child, I'm sure, in many cases will push back. Right. But the parents must hold the line. Right? Correct.
And that's a really hard thing to do. And so and so while the lock one is common, probably the most common accommodation that I talk to parents in clinic about and may or may not really be in the context of, like, oh, you were here for an anxiety visit or something. It's just, like, you know, can be just in a checkup. And it's the, it's co sleeping. Right.
Right? And so we could do a whole episode. We could do a whole episode. We could do a whole episode. Episodes on it.
Yeah. Volumes on this. But if I think that, you know, he does talk about that in the book. So I am like, if you've got a co sleeper and you don't wanna be doing that anymore, this is a good book to try to figure that out because really the way to frame it, I think, is that it's an accommodation that the parents are making for a child who has separation anxiety, who's having difficulty separating from them at night. And while that totally makes sense, you know, like, as far as, like, children are often having those feelings at night.
But, especially if as children get older, if they spend a significant, you know, part of their growing up, like, feeling like they need to sleep with their parents, then that that sort of continuously that accommodation kinda continuously gives them the message that their parent also thinks that that is a reasonable thing to do. Like Right. And so we have got to, you know, and this is, like, obviously, parent specific as to when and if they wanna start making these changes. But by far, the most common thing that I hear from parents is having the child having difficulty separating from them at night. And we have this huge sort of ritual behavior around bedtime, getting them to fall asleep, and then staying in their bed throughout the night.
And so, you know, and I will say, like, I guess that this can sometimes happen where you have a kid who has a big ritual to go to sleep and then they sleep all night in their bed. But the more common scenario is that you can get them you can get them to sleep with some, you know, series of things that is part of their bedtime ritual. But if it's pretty elaborate and the child is driving a lot of it and there's a lot of angst involved, then usually they they will they will sleep through one cycle of sleep, and then they'll wake up in the middle of the night and come get in bed with the parent because they have not learned the skill of falling asleep on their own. Right. Right?
And so if we continue to make these accommodations, then that will become an ingrained part of, you know, how they view sleep. And, and so, you know, obviously, eventually, most kids just stop. But I think a lot of it is that parents are at a place a lot sooner than kids are when they're ready for this to, you know, for us to sleep separately. And so, and so that is probably the most common scenario that I see that gets directly addressed in the book. Right.
Yeah. And as doctor Leibovitz points out in the book, the big goal is to sort of overcome this inertia that the child feels. And with the parent leading that change, once the change starts to occur it'll be, you know, frustrating, I'm sure, for both at first. And you may not see a lot of progress for a while. But once you overcome this inertia to change Mhmm.
Then the changes kind of build upon each other. Right? Right. It's like it's a series of successes. Correct.
Yeah. And, like, you're getting more and more confident with your abilities. Like, we talked about agency in a previous podcast. Like, you want to be able to give that child confidence and agency that they can cope with their embodied world. And so this is just a, you know, part of that experience in raising children is getting them to be able to to regulate, you know, their own emotions in different circumstances.
And so, and so while there have been volumes and volumes and stuff written on bedtime, I think, like, this approach is often a good one, especially for kids where, where they're really at an age where it's really much more appropriate for them to sleep independently. We just need to get that. We need to get that into their brain that the parent is, you know, is willing to accept that this is a challenge for them, that they're not judging them. But they are confident that they can cope with that because they believe in their child. And that is a message that he will talk about in the book about even, like, sort of laying the groundwork for that, like, several weeks before you're gonna pull the trigger on changing the accommodation.
Just like, I'm confident that you can do this. I'm confident that you can do that. And those kinds of statements to the child can be very beneficial at helping reduce their anxiety. Right. So it's about it's a very clear plan and then just repeating the supportive statements and then also celebrating the successes you have along the way.
Absolutely. Yeah. And sometimes it's really an incremental success. So there's a part in the book where he's talking about a mom who had, like, a significantly older child by maybe 14 or so. And, like, the, like, the child, you know, could not be alone in the home for any amount of time.
And, you know, and that the mother decided where we're gonna start trying to figure this out, and came up with a plan and presented it to the child. And the child really pushed back, but the plan was, at least at the beginning, was, like, each night at, you know, a certain time, I'm going to, leave, and you're gonna be by yourself, and then I will come back. And so the first few nights, it was for just, like, ten minutes. And the mom literally just went outside and closed the door of their house and stood on the porch. And the child initially had significant, you know, dysregulation, crying, upset.
By the time the mom came back ten minutes later, though, the child had been able to reregulate. And then it's sort of the celebration of, you know, you were able to cope with this. I'm confident that you can cope. You were able to cope with this. And you did that for ten minutes tonight, and we're gonna continue to work on that.
And a lot of times, once kids get over the hump of realizing that they are capable of coping with that, like, that discomfort that they have with being anxious, that they can apply that to other situations. Right? So the idea here is that you're gonna try to make all of their anxieties, not obviously all of them, but, like, you're gonna help a lot of their anxieties by giving them confidence in being able to cope with one of the specific ones that you're most that you're most either troubled by or that is causing the most, you know, dysfunction in the family. Right. Giving them agency.
And, another thing that this can be very helpful for is, that that we've discussed in past podcast episodes is, you know, refusing to go to school or having problems with, yep. He talks about that quite a bit. Yeah. Yep. Because that's a common one too.
And the other thing he touches on that I think is really helpful too is that there are definitely families out there where siblings are involved in accommodation. And it's the kind of thing, like, there's a story in the book about how, you know, it was a, like, a boy who was maybe 10 or 11, and he really had, like, significant anxiety and OCD. Their his theme was germs, which is a really common theme. Yeah. And, and so he had this requirement of everybody to wash their hands a certain number of times and a certain, you know, length of time and, before dinner.
And that if people didn't do that, he would get, you know, really worked up. And so one night when they were at the dinner table, his sister yawned and he kinda went into orbit about that because he felt like that was exposing everybody to germs because her mouth was open. And the child was like, well, I'm, you know, I'm yawning because I'm tired. I'm tired of having to do this. Right?
At having to accommodate you, the child didn't say that. But, like, that is what they're really they're they're tired of. And so what the book says about siblings is that for parents is to just, you know, let if they don't wanna accommodate that, then they don't have to. You're not necessarily gonna try to tell the sibling we're all gonna stop doing this. Right?
I mean, that is typically, like, more than you can do. But sometimes, you know, siblings will sort of align themselves where, like, one of them is accommodating the child and thinks it's, you know, mean that the parents aren't doing that anymore. But, like, this is a situation in which parents need to be parents and they're gonna change their behavior. And then they're gonna allow the other child. So a lot of times what's happening is that the other child has been sort of making these accommodations as well, and the parents have been encouraging them to make the accommodation because that's just what's making things harmonious in the family.
Like, you know, just go ahead and wash your hands because he may get upset. If you don't, let's just do it so we can eat. Right? And so and so, yes, you do want your child to wash your hands, but not for, like, fifteen minutes. And so the idea here being that you, you know, your parents can give the child the green sibling, the green light that you do not have to accommodate this anymore.
We will back you up if you're not going to accommodate it. And if you're, you know, you're also not gonna get in trouble for accommodating it either way. Right? So really, air back to the idea being that the only person's behavior that the parents have to be, you know, changing or in charge of is themselves as opposed to, like, the kid who is the patient. So if the patient oftentimes, like, they don't wanna go to therapy or they don't wanna engage in different strategies that might help them.
But this isn't dependent on that. Right. Right? And it's not dependent on, you know, it's not telling a sibling that they, you know, that you have to change their siblings behavior because they're used to doing the accommodation. Like, you can let them do what they want to do and know that they have your support if you don't want to accommodate it anymore.
Whereas in the past, they probably have been encouraging the child to accommodate the sibling. And so this is a really, really, I think, important concept for parents to get. And it really took sort of, digging into this book, which is just, I think, life changing for parents. We've recommended it for lots of parents, and they've read it and used the tools. And it's just made a huge difference.
So I really recommend it. Yeah. And, in the book, doctor Lee Woods has worksheets Yep. For the parents to do, which is very helpful. And, again, it's part of that structuring a very, clear and concise plan of action.
That's right. That's very critical. Once again, the book is called Breaking Free of Child Anxiety and OCD by doctor Eli Leibovitz. We will have the link to the title in our show notes for this episode. Thanks again, doctor Hoyle, for giving us your insight onto this topic.
And, please visit our website, www.nimbleyouthpodcast.com for the share notes for this episode and all episodes and links to the various books and other studies that we've discussed. Until next time, please take care of yourselves and each other.