Limitations of Children’s Mental Healthcare
with Jason Kahn, Ph.D.
We are in a crisis when it comes to children’s mental health and the healthcare needed to address it. We’re seeing a spike in anxiety and depression in kids and almost zero availability of mental health professionals. In this episode, I’m talking with Dr. Jason Kahn of Boston Children’s Medical Center about what parents can do when counseling or therapy isn’t yet available for your child. Tune in to learn about community and at-home supports.
Resources in this Episode
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Jason Kahn, Ph.D.
Dr. Jason Kahn serves as the Chief Science Officer and co-founder of Mightier. He combines his expertise in developmental psychology and mental health to create video games that help children build emotional strength and the ability to harness their emotions to overcome behavioral challenges. While obtaining his Ph.D. in Education at Tufts University, Dr. Kahn began his appointment at Boston Children’s Hospital with the Department of Psychiatry and later joined Harvard Medical School as an Instructor. He continues to partner with both universities where he creates and researches new technology to address acute problems in pediatric mental health. Dr. Khan also serves on the Executive Committee for the Brookline School Staff Children’s Center, a program designed to provide child care services for public school teachers.
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Jason Kahn 0:03
One of the things we have to understand is that our kids are on a journey. They're not little adults and getting things wrong as part of that journey. And so understanding that mistakes are okay, that if they get themselves in trouble when they make a mistake, even if it's in the realm of emotions, it's fine. It's part of growing up, and they'll be okay.
Penny Williams 0:22
Welcome to the beautifully complex podcast, where I share insights and strategies on parenting neurodivergent kids straight from the trenches. I'm your host, Penny Williams. I'm a parenting coach, author and mindset mama, honored to guide you on the journey of raising your a typical kid. Let's get started. Welcome back to the beautifully complex podcast, I am really excited today to be joined by Dr. Jason Khan, who is co founder of mightier, and we're going to talk about that too. Oh, my dear, and also about the state of children's mental health, the current wait times and limitations and what parents can do to kind of bridge that gap if that's even possible. So thanks so much for being here. Dr. Kahn, I really appreciate you sharing some of your time and wisdom with everyone. Can you start by telling all of our listeners who you are and what you do?
Jason Kahn 1:22
Absolutely. So as you said, my name is Jason Khan. I am the chief science officer of a company called by deer, which I also co founded, my dear works on building tools that help kids build emotional strength, which I'm sure we'll get to talk about a little bit. I am also a part time instructor in psychiatry at Boston Children's Hospital and Harvard Medical School. And perhaps most importantly, I am the father of two children, a nine year old and a six year old.
Penny Williams 1:44
So let's start I think by talking about kind of where we are with children's mental health right now, there's definitely seems to be a crisis of availability. And I will think a lot of parents are really struggling with that and struggling with the impacts of the pandemic and other things that are going on. So do you want to touch on that first?
Jason Kahn 2:06
Yeah, absolutely. I think. I mean, you said it, and I curious what you're seeing and hearing too. But over the course of pandemic, we've had so much change in children's lives, we've by necessity to protect physical safety, we've closed down schools, we've had less social contact about less contact with friends family in the lake, and I think as to be expected, that change and uncertainty has impacted children of all ages. And I think now we're starting to see it in the numbers, right. So we hear nonstop about children waiting for care for months, at a time we hear nonstop about in Massachusetts, we hear nonstop about if children need care, they're actually waiting in the emergency room to try to find care. The rates of anxiety and depression among adolescents have never been seen before a just stat after stat after stat, just reinforcing that things have gotten really out of hand. I don't know another way to say it.
Penny Williams 3:04
Yeah, yeah. And it's really impacting so many people and families. And I think it's really tough when you have a child who clearly needs some expertise in mental health. And you can't find it. You can't find anyone who's accepting new patients, or you tried to take them to the emergency room, and there are no beds in the psychiatric area. I mean, I've been hearing those stories for years. So I can't imagine how bad it is at this point. And so then, that leads us to the question, What can parents do? What do they do when they really need a counselor or a therapist for their child, and they can't find someone who has availability.
Jason Kahn 3:49
There are options for parents. And I think it's important for parents to understand the resources and community that are around them. And speaking as a parent. And then also in this field, I think the starting point is, enlist the resources in your community that you can enlist. And so be transparent with your child's school about what you need. Be transparent with your child's pediatrician about what you need. They think different parts of the country are going to have different attitudes and resources towards this. But making sure the community is aware of the need is, is step one, pediatricians are taxed. School counselors are taxed like you're not we're not going to find people who are are not overwhelmed. But if they don't know they can't help. So that's trying to start that process there. Just so everybody is on the same page and utilizing the community that wants to support your child that wants to support you, is really I mean, step number one for any parent.
You know, beyond that there are services. What we do at my dear is I mean, we do something for six to 12 year olds, we build in home intervention for a skill called emotional regulation. And not everyone is familiar with the idea of emotional regulation. emotional regulation is a foundational skill. So it's a strength. It's something that kids build up and when When kids have this skill, they tend to thrive. So you see kids with emotional regulation they do better in school that are pure relationships that are family relationships. It even like projects out later on to their health and well being. And one of the things that has been noticed, especially like at the beginning of my career at Boston Children's is that kids with mental health diagnoses, they often could benefit from some extra supports around building emotional regulation skills. And absolutely, we'd like parents to know that it can be built. So wherever your child is, it's not destiny, like your child can get better no matter where they are. So we work on putting this skill through video games, through biofeedback, video games, we work on building the skill and building it in people's homes. So it's something that families can do in their home and get started even while they're waiting for other services. Yeah, and there are things out there like my dear, so it's not just by deer, but there are things that families can bring into their homes.
Penny Williams 5:52
Yeah, so I've noticed that, that availability is really growing, that we're looking more and more toward technology and how we can use that to help kids grow and learn and build skills, executive functioning, emotional regulation, even attention, and mindfulness practice. So it's really amazing the opportunities that we do now have for our kids within our homes. And I think that it's just so valuable, especially given the climate of mental health care, and what isn't, isn't available. I love that you brought up speaking to the school counselors, as a resource to because I'm seeing so much more school avoidance and school refusal. There's a lot more anxiety around school now that kids are going back. And I think it's very, very important that the school knows what's going on and what the need is, and they can provide whatever help that they're available to provide as well, school counselors, I think we don't tap them enough as parents, we don't have enough conversations with them. But that's what they're there for.
Jason Kahn 7:00
Yeah. And I would even as a parent, I would go further to I mean, I would absolutely involve the school counselor, but I would look and what are the other places in where are the other adults in your child's life where there is an opportunity to enlist even just the tiniest amount. So is your child on a soccer team is your child on a church band, whatever it is, I think there's space where those adults, they're not going to be experts. And so it does add some extra work for you as a parent to say, How can I help this other adults support my child, these are people who all care about your child and all the children in their lives, and they want to help. And so if you are willing to be transparent with this group, there's a lot of space where we can really utilize the supports that are and we're lucky, like I mean, these supports are coming back. And so parent, you really can utilize these supports, if you're willing to be open and share. And I know the stigma makes it hard. But if you're willing to be open and share, I think there are a lot of people who are willing and would be thrilled to help.
Penny Williams 8:00
Yeah, absolutely. And I think we have turned a little bit back toward community, maybe because of the pandemic. And I think that that's so so valuable for families in general, not just families who are neurodiverse. But for families in general, like, the more people that care about our kids, the better they feel about themselves, right, they, just having another caring adult in their life is positive for their mental health. I'm not trying to minimize mental health issues, depression and anxiety. But I think that always when we care about kids, it helps to boost their self esteem and how they feel about themselves.
Jason Kahn 8:43
Yeah, I mean, I think it's important for parents to realize that the stress they feel is real, and because that stress is real, and that's going to impact their body, that's going to impact their emotions. And then that's going to be part of how they interact with their child and finding these extra supports, finding these places where they can, where you can lessen the stress on yourself and not feel like you need to hold up the entire burden. It's going to help you as a parent is gonna help you as a human, and it's also gonna help your child and to your point, exactly, that's not going to minimize, it's not to minimize anxiety or depression, or many of the other very real challenges that both kids and adults face. But having that extra support is always going to help.
Penny Williams 9:23
Yeah, absolutely. And I'm just thinking about now, how do we get our kids to open up to us because especially teens, right? They try to hide what they're going through, they don't want to talk about it. There's a lot of stigma stow. And I see often parents who are kind of blindsided by some intense mental health stuff that their kids have kept bottled up and they finally sort of, explode or the pressure cooker blows and they feel sort of blindsided and I think it's, we still don't have this culture of talking about out what we're struggling with with others. So how do we get our kids to open up to us, so that we know that there's something that we need to be helping with?
Jason Kahn 10:08
Absolutely. And I will, I'll add the disclaimer that my expertise is more with younger children than with teens. But I think with teens, and with adolescents, we have to understand they're still in some ways, they're still growing, their brains are still growing. And so the ways they want to talk and listen might not look completely familiar. But that doesn't mean they're not talking and listening in their own way. And so I think for parents, there's this real awkwardness that comes with like being willing and making sure that a child knows there's a space to have these conversations. And that feels like a diverse set of feelings are okay. And as they're in their brains are getting a lot bigger as they go through adolescence, which means new feelings are coming into play. Yeah, and that it's okay to explore these feelings. And it's okay for them to go find some safety of where they want to explore these feelings. I think, the what listening looks like for an adolescent is probably not going to feel terribly satisfying to a grown up, yeah, all the time. But they are listening. And they are I mean, the parent relationship is still a really important one in their lives. And beyond that, how they show and how they act like I think if you are giving them that space, like what they show you and what they give, you might not be direct, and it might not be immediate, but I think, you want to have that space. And then part of growing up are these really large episodes. And I think for a parent, that's when the real challenges come, because it's hard in the moment to give your child space and try to like, understand, like, the best thing you can do is be supportive in the moment of a crisis. And yeah, that's really hard.
Penny Williams 11:42
As a parent, we're wired to fix it. Yeah. Right. So it is really hard to kind of sit with and say, I'm not sure what to do, but I'm listening,
Jason Kahn 11:51
I'm not sure what to do. And I'm listening. And I like the way you put it. And I think, again, being open, I mean, to the point you've already made, like understanding that, as a parent, depression, anxiety are real, they might even be beyond your expertise to help or your ability to help as a parent. So being supportive, but also understanding like, as we talked about before, this is where you want to bring in the community, absolutely bring in the pediatrician as a starting point, and then look for services that can continue to build on that.
Penny Williams 12:21
Yeah, and I think it brings us back to the conversation about feelings and emotions, and regulation. We have a culture where we don't talk about our feelings very much. Or we only talk about the feelings that we feel like are positive, and we want to shut down the feelings that we feel like are negative and, and the reality is that all feelings are natural, and okay. And it's really what you do with them, how you regulate, right, how you get back to regulate it, and when you're dysregulated, and how you manage the emotions, when I think that there's so much as parents that we can maybe should be doing with our kids, even early on and really young to build their emotional intelligence. Right.
Jason Kahn 13:00
Yeah, I mean, when we're talking about really young kids from birth, really, children are depending on grownups around them to help them build and foster the skill of emotional regulation, to the point where I mean, you can almost draw a map. So babies are completely dependent on their caretakers, if something happens, then the response and the regulation is completely externalized. And so it's called co regulation. And then that skill builds over time, really, as the brain grows and builds the capacity to take on more and more regulation itself. For grownups, I think one of the things we have to understand is that our kids are on a journey, or they're not little adults, they're not going to have all the answers and getting things wrong as part of that journey. And so I think that's another piece especially when it comes to emotions and regulation, it's child understanding that you as a grown up, like face challenges and that you face difficulties and that you have to moderate your response and choose your response based on the situation and that understanding that mistakes are okay, if they get themselves in trouble, and they make a mistake. Even if it's in the realm of emotions, it's fine. It's part of growing up, and they'll be okay.
Penny Williams 14:05
Yeah, I love that you brought that up, we talked about that so much on this podcast, is that as parents, we have to be real with our kids. We have to let them see us make mistakes fail, see what we do with that, right? See us upset and how we manage it. Because, I feel like we've kind of had this parenting culture where we want our kids to think that we're perfect. And if they think that we're perfect, they are going to automatically feel like they never measure up because nobody's perfect. Right. And I think it's so so important that we show our kids real life and that we're human beings too. And that also brings in modeling, right? It brings in showing our kids an example that they can attune to and regulate to but also knowing the skills right and of how to keep going, when you do make mistakes, keep going when you do feel really bad, what are those skills look like to regulate?
Jason Kahn 15:09
Yeah, I mean, I think it just comes down to the fact that just embracing your child's mistakes is, it's really, really hard. I mean, I can't think of any, like I said at the beginning, I have two children, I can think of so many examples where like, you want to drop into fix it mode, or you want to drop it like you want like something around the line. It's like, No, what, we've got to put the mistake in perspective and move on. And just, it's okay to learn. It's, it really is. And, this gets discussed a lot in academics as either grit or resilience or growth mindset, or many of these things. And I think, even with that, we try to like, put kids on a static, like, here's your measurement, and we don't reflect on how does change happen? How do kids grow? How do kids get better? If we as grown ups embrace the idea that kids are changing, kids are growing, and our job is not necessarily to reflect some sort of like perfect destination, but some sort of process under which they get better? Kids are naturally going to find a way to thrive if we set up that environment where that's what we encourage.
Penny Williams 16:07
Yeah, I love that. It's very helpful.
Okay, so I want to take a minute to talk about Mightier. Mightier is a clinically proven mobile gaming app, which was developed at Boston Children's Hospital, it's already helped more than 100,000 kids. One of the things that's so great about Mightier, it empowers both parents and kids. And it's all done through play. So how does it work, kids play on a tablet or a phone while wearing a heartrate, monitor, and Mightier incorporates breathing exercises and other calming techniques. As part of the game, kids get to see when it's time to cool down and learn how to do it themselves. And parents get to track their progress, boom, empowerment. With time those calming skills become muscle memory, all it takes is 15 minutes a day, three days a week, and 87% of parents see improvement in 90 days. So checkout mightier.com/penny to learn more about the science and how Mightier works, that's mightier.com/penny.
You mentioned how important that parent child relationship is. It's so crucial to our kids mental health and our own, I think as well, right and as parents, but also, it's really crucial to have our kids open up with us to be able to talk to us. And to feel like they can do that until medicine so that we can understand what's going on and can offer help where needed.
Jason Kahn 17:49
Yeah, I mean, I so wholeheartedly agree, my advice is for a parent, like don't hold on to one image of what that relationship could look like. Because as your child changes and grows, that relationship is going to change and grow. And it might have different needs at different times. And that's okay, knowing that your child is always listening and is there and I don't know, I mean, again, as I interweave my professional and personal lives, like the part that I take away is that I know like, there are going to be days when my child is going to talk to me, there are gonna be days where my child is not going to talk to me. But no matter what it looks like, I know in some form or another, I'm supportive, that relationship is there.
Penny Williams 18:26
Yeah. And it brings up another good point, too, which is that everybody struggles, right. So sometimes our kids are gonna have a bad day, sometimes something awful is gonna happen, they might get teased at school, or whatever it might be. And knowing that that's part of life, that was a journey for me, as a parent, I couldn't stand the thought of my kids struggling or hurting, right. And I think so many parents have that same sort of intuition. And it was a journey for me to be able to say, wait a minute, that's part of growth, that's part of being a child. It's part of learning. It's part of life. It's how they build resilience and grit, these things that we were talking about. It's important for them to be able to do hard things and push through. And I think that part of that is that emotional regulation piece that we've been talking about. That's how they can get through some hard stuff, right?
Jason Kahn 19:28
I mean, in some ways, this is where the neuroscience like ties so nicely into the conversation because then you think about a kid's brain and at our core, when we face challenges, our brains are wired to respond chemically straight up, like there's a biological piece that happens when we face a challenge. And I mean, it truly is rooted in when people and precursors were running away from Tigers like we had to get our bodies ready for that fight or flight reflex. Yeah, part of childhood is just discovery, discovery of that process discovery of your body I need discovery of how you are going to respond to these and how to productively respond to these, especially because we are social. And so understanding like that, when you're getting taunted or teased, or you can't do something or something's too hard, those chemicals are still going to come flooding out into your brain. They absolutely are. And you're going to have a reaction. And that reaction is not always going to be positive, especially if you're a little kid. And again, but part of childhood is, is are having those feelings and understanding those feelings and understanding the reaction of your body. And, again, not all kids are at the same place, and some kids need extra support. But if we hide those feelings from our kids, and we hide those sensations from our kids, then they're not going to grow and be able to manage them well as they get older.
Penny Williams 20:45
Yeah, I think you know, those conversations start early, and not really conversations, but just really helping our kids be okay with discomfort being okay with feeling different emotions, and working through them. You know, teaching them how to work through.
Jason Kahn 21:00
One of the things you talked about here a lot is, my dear is like how emotional regulation is honestly a lot like bike riding, right? So you ask any adult like, have you read a bike, no one can tell you how to ride a bike,
Penny Williams 21:10
Right? You have to experience it.
Jason Kahn 21:13
Try to write down directions that will work. And if we call them kids to classroom or an office and said like, we're gonna give you bike riding lessons, we want to teach kids how to ride a bike. And these emotions are part of your body, they're part of who you are. And you have to give kids that experience just like riding a bike. There are tools that can help them be better tools, like deep breathing, or progressive muscle relaxation, or the many, many other skills that you'll get out of therapy. But until you've experienced them working, it's hard to know, you have to know how it feels to go up, up, up, up up. And you have to know how it feels to come back down and how it feels when you have control over bringing yourself back down.
Penny Williams 21:48
Yeah, and so many of our neurodivergent kids are avoiders of discomfort. I have one myself, I call him a serial avoider, because that wall goes up instantaneously, always just in like, if he doesn't know if there could possibly be something that wasn't super comfortable, right? He'll try to avoid first and we've had to do a lot of work on, you can do hard things. And and that's kind of the hurdle is until they've experienced that they can do hard things, they really resist because they don't necessarily trust that that's true, because they don't have any history or basis for that yet, right. So it can be a really tough challenge for kids like ours to put themselves out there and trust that I can do this and I will be okay. And yeah, maybe it will feel not great or kind of crappy, but I can do it. And I have found that when we certainly weren't doing that early enough or consistently enough. And it became a bigger issue as he got older. And so we're still you know, in the young adult age, working on some of that, and I always in the parents that I work with, I'm like, okay, you've got to work on that. If they're avoiding discomfort, we've got to, we've got to jump on that. Because it's so valuable, because, they're not really regulating, right? They're just sort of putting on the brakes. Yeah. And they're not learning to regulate either.
Jason Kahn 23:18
It's funny, right? Like, they're, they're choosing a strategy where they don't have to be in a place where they regulate. And I mean, that is that absolutely. The strategy is kids get older, they do get more cognitive control. And so you can start to like build some more of a, more appraisal, more of the traditional therapy skills with older children to sort of move through challenges, but listening to you talk like it's, it's just such a good reminder that we are interacting with kids bodies when we interact with their emotions. Yeah. And so there are a couple of words like either mind body awareness, or interoception, which is knowledge of how emotions make your body feel. But just interact with that and play with like, I mean, that's the other piece like I mean, and this is what we try to do it, my dear, but try to make it playful, because otherwise it just gets hard. And it definitely it definitely can built. But even even when it's built like I mean, I think if we embrace the fact that it's a journey, and we embrace the fact that these are really skills that can be built up. So these these kids have everyone has a strength. We can build it up and everyone can make progress.
Penny Williams 24:25
Yeah, I think it's so important to that we're looking at progress, not perfection, and we're looking at really tiny baby steps. Like any movement forward, any positive change is great. You know, our kids aren't going to learn these skills overnight. As you said, it's a journey. It's a process and we need all the reminders we can get as parents I think of that, especially when things are tough and things are more challenging. I want to circle back and talk a little bit more about my dear, and I thought maybe he would want to share how it works. works like how does it help kids build emotional regulation skills as they play those games?
Jason Kahn 25:06
Yeah, absolutely. It's fun. And it's a little counterintuitive. So with my dear, my dear is biofeedback based. And so what that means is when you play my ear, if you're a kid, you come into this environment. And the first thing you do is you put a heartrate monitor on your arm. And that heart rate monitor serves to give mightier and yourself a window into your emotions. And so you've got this heart rate monitor on your arm, and you come into my ear, and you're going to be greeted by this library of video games. So you choose one that is right, for you are many that are right for you. And you play these games. And just like life, what happens when you play these games as you get to this point of frustration, like all games have this but we've all played video games, we've all seen this point where we just the game gets hard. There's this moment in the game. And within my dear, we see that. And so what we do then, which is the part that lets it feels a little like standing on your head, too, especially to grownups is we make the game harder. So we watch the child's emotions, we make react, and we make the game harder. And the reason we do that is because that's how life works. So when your emotions start welling up, and you're you start having this reaction to the challenges and frustrations in your life, things don't get easier for you, they get harder, yes.
And in that moment, we help children lower the temperature, we call it going back to the blue, they can do it with a skill will scaffold the skill if they want. So they can do deep breathing, they can do progressive muscle relaxation, they can do visualization, or they can do it by themselves. Most kids do actually transition to do it more independently over time. And what's so powerful about mightier is the visualizes this whole process, it turns it into a game on top of the game. And so kids play and they do it hundreds, if not 1000s of times. And in the course of these, we call them cooldowns. But in the course of this practice, and there's hundreds of moments of practice, or 1000s of moments of practice, it becomes automatic for children. And we see this I mean, we see this, we've done it, like I said, my background is in academic medicine. We've seen this Pharaoh and scientific trials, which is why we started by Dr. Because we had scientific data, this was incredibly powerful. But we've also seen it we've been in over 50,000 homes, we've seen it in people's homes, we've been working in medical settings, we've been working with insurance carriers, we've been working with families with children with autism, like we've just countless settings, we've been able to see this process of playing games, finding moments of challenge, and then cooling down in moments of challenge is fantastic. But it we've seen it change lives, which is why we feel really good about what we do.
Penny Williams 27:34
Yeah, it's amazing. And you're really leaning into kids interest as well. You know, I think that's a really valuable thing that we don't often do enough, because we're scared of technology, we're scared of screen time. And we tend to fight it. And sometimes it can be a really valuable tool to really help kids with differences to build skills where they're sort of lagging behind. And I've been excited about my car for years, I think that it's super powerful, because it's a way to connect the sort of learning and growing in a way that our kids are really open to and responsive to, there's so many things that we try, where we're basically just lecturing or asking them to do things a certain way, or trying to talk them into somehow being different, right somehow, being more organized or being less emotionally reactive. And that doesn't work. And our kids tend to just sort of tune out, right. And so with mighty era, you're really grabbing their attention in a way that they really relate to, and that they'll buy into, right, because we always need their buy in, or we're not going to be able to really make change or improve things if our kids are fighting against it.
Jason Kahn 28:54
This is a place where technology really has so much to offer. Because we need a environment where their emotions can come to life and where they can play with their emotions and interact with their emotions, in some ways, like we're told, be wary of screen time. But this is an environment where kids can learn and they can grow and they can get more powerful. And, that's something that we can lean into as parents and it's something that makes me excited.
Penny Williams 29:17
Yeah, absolutely. What a great conversation we've had. I think it's really impactful for our parents who are listening and maybe also professionals and educators and just understanding that we're on a journey, and that we make mistakes and we grow and it's okay and that there are tools out there that can help at home when maybe the resources that you're looking for are not yet available. Tools like mighty are so really thank you so much for sharing some of your time and your wisdom and, and your passion around. You know what you're doing and the science behind it and seeing awesome results for kids. I mean, it's amazing work. And for everyone listening, you can get a link to my idea which is mightier.com, as well as their social media and other ways to learn more about that tool and that program, and also the science behind it. I know it's available at mightier.com. But you can get all those links in our show notes for this episode, which are found at parentingADHDandAutism.com/176 for episode 176. And I hope that you'll take the time to do that and dive deeper and check out my dear. With that. I guess we will wrap up anything else you wanted to add? Dr. Kahn before we close
Jason Kahn 30:36
Thank you Penny for having me. It's been wonderful to have this conversation with you.
Penny Williams 30:39
Yes, thank you so much. With that we will wrap up and I will see everyone on the next show. Thanks for joining me on the beautifully complex podcast. If you enjoyed this episode, please subscribe and share. And don't forget to check out my online courses and parent coaching at parentingADHDandAutism.com and the behaviorrevolution.com
Transcribed by https://otter.ai
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