"It's really no wonder that young people are anxious"
I talk childhood anxiety with clinical psychologist Dr Jocelyn Fleming
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I’ve known Jocelyn online for years now, and we’ve had many emails back and forth over that time about sharing her valuable insights into childhood anxiety with my readers. I’m delighted we’ve finally made it happen! Since we first started talking, she has created a wonderful resource to support children with anxiety before, during, and after travelling: My Adventure Journal.
I’m so grateful to Jocelyn for taking the time to share so much useful information with us today.
“I constantly see examples of anxiety cycles being perpetuated by an adultist society”: an interview with Dr Jocelyn Fleming
Will you tell us a bit about yourself?
I'm Jocelyn. I'm a Clinical Psychologist, world schooling mum to three little adventurers, and part-time photographer, author and trier of all things! I grew up in London, where my husband and I became friends as teenagers, and where I did my clinical training.
I was very privileged to have the opportunity to travel regularly throughout my childhood and was exposed to adventures both big and small (it's important to remember that adventure and excitement isn't just about far-flung adventures, but also backyard exploration and making the most of free community resources, low-cost local events and of course enjoying our natural environment and its other inhabitants).
Growing up in the city was a lot of fun but as adults we were drawn more to nature than the big cities so we moved to the Lake District, where my eldest was born, and then to New Zealand where we've been based for 6 years and added two more to our family. In February 2023, we sold much of our stuff and packed up the remainder in to storage to take off for a life on the road with 7, 4 and 1 year olds. We've been in South East Asia since and have been loving our life of family learning - but please don't be fooled; there's still laundry, sibling arguments, sickness and chill days of nothing!
Pre-covid, all my work was face-to-face. I specialise in neurodivergence and trauma. Of course the pandemic meant that psychology, like many other professions, shifted online, and now, I have been able to continue my practice online only and I'm dual registered to work with both U.K. and NZ clients (I just have to remember which time zone I'm working in)! I do a bit of a mix of autism and ADHD assessments, some therapeutic work and a fair bit of parent support for neurodivergent families.
You’re the author of My Adventure Journal, which is a great resource for children who feel anxious about travelling - whether it's a weekend away or a longer trip. What made you want to write it?
The idea for My Adventure Journal started taking shape when we moved from the U.K. to NZ. We travelled via North America and spent several months exploring the USA and Canada. I knew that I was intuitively using my clinical skills and knowledge of attachment to ensure that my toddler felt safe and enjoyed the experience of moving around and having new experiences. He's never been one for routine (despises it in fact!) but even the most fluid and rhythm-adverse of us still have moments of uncertainty and need to feel contained within the boundaries of flexibility and non-adherence to any sort of routine.
I had previously had a number of successes with families I was working with in writing and illustrating 'social stories' to prepare neurodivergent young people for upcoming changes in their lives and support them with the accompanying anxiety. I wanted to develop a resource that would similarly support young people to adventure away from home and I wanted to make sure it was accessible and relevant for all families, both neurotypical and neurodivergent, for local adventures and those further afield. And so I started sketching out the text and ideas for illustrations that you now see in the finished book.
I would have loved to do the illustrations myself but sadly there are not enough hours in the day (I miss having time for art - a hobby I have sadly not had much time for since school, when I did Art A-Level, and has dwindled further since becoming a parent). I put that vision to one side and sought just the right person to bring my ideas to life.
It was important to me to give a home educated young person with aspirations of becoming an illustrator a chance at their first publication so I took to home ed facebook groups in search of an artist with a style that was easy to decode but still charming and magical. I found Samara, a teenager from Christchurch, NZ, and her work was all that I had hoped; just the right balance of realistic but quirky and whimsical, a palette that was inviting but not overwhelming, and a commitment to representing all people in her work.
How might a parent recognise if their child is anxious, as opposed to, say, just tired, or in a bad mood, or upset? What is the difference between developmentally 'normal' anxiety - such as separation anxiety - and something which parents might want to give more consideration to?
Anxiety is a very normal and important emotion - it keeps us safe - and our children will all feel anxiety at some point in their young lives. In most of these situations, parents and caregivers will feel able to guide their children through it (using the types of strategies you talked about in your newsletter along with plenty of time for connection and communication) and, like all emotions, it will peak and then pass.
For some young people though, anxiety can feel very overwhelming, and tolerating its peak before it does pass can seem like an insurmountable task. Caregivers are often left feeling lost, disempowered and helpless while trying their best to support their young people. It's really important to remember that anxiety can frequently present as behaviours that look more like anger, meltdown, withdrawing, shutdown, fawning and masking.
Just because school say 'they're fine', doesn't mean they are. Just because they display threat-related 'fight' behaviours (think fight/flight/freeze anxiety response), doesn't mean they have 'anger issues'. Just because they've suddenly had a reduction in what might be referred to as 'independence' (think taking a backstep in self-care, needing more rest, seeking more support and scaffolding in tasks that they were previously doing alone) doesn't mean they're being 'lazy' or that they're necessarily 'depressed' - although please do seek support for mental health concerns. These things can all signal anxiety.
It can be really hard to figure out whether what you're seeing is something to be concerned about vs, for example, hormone changes, tiredness, normal grumpy days (we all have them!) and unfortunately there is no easy cheat sheet to refer to! First and foremost, you know your child best; trust your instincts.
So many parents I speak to are supporting children with anxiety, ranging anywhere from mild to severe. Here in the UK children's mental health services are almost non-existent in some areas, especially if you can't afford to go private, and many are at their wits end. What can parents do if their child is anxious but they are struggling to access support?
If you know your young person is struggling, don't be afraid to advocate for them at school/in health services/in extra curricular clubs/with family etc. No one is born with the skills to regulate their emotions - these have to be learned and when we are little we look to our primary caregivers for clues.
Check in with your own strategies, get yourself some support if it would be beneficial, and practice being a calm presence even when your child's world is in turmoil - but forgive yourself when you cannot be as calm as you aim for! This is incredibly hard and no one will succeed 100% of the time, even if their social media suggests otherwise.
When it comes to teaching your young person how to implement helpful strategies for anxiety management, it's important to remember that no one can communicate effectively or take on new strategies while in a distressed state; leave all heart-to-hearts and learning new tools for when your young person is calm and comfortable. Think of their sensory comfort as well as hunger, thirst, safe environment, temperature, and illness.
Anxiety management is not one size fits all; a key part of my job is to offer people an evidence-based starting point and then support them to test out strategies, evaluate them and then adapt them to best suit them. This variation of suitability is particularly pronounced when we consider the neurodivergent community.
The specific strategies that I would recommend as a starting point to manage anxiety in autistic people differ wildly from the approaches I would recommend as a starting point for those with ADHD, and completely different again from those that might benefit people with a PDA profile of autism.
A good pointer for all parents though is 'body doubling'; the act of doing something alongside in an effort to support. Do it with them; do your own deep breathing, talk about/play with/investigate their special interests nearby, practice mindfulness techniques alongside them, move your body to get your own worries out.
Remember, if you're being recommended a particular strategy that everyone else seems to swear by, all the parenting books mention and the social media gurus seem to have nailed, but you don't think it will work for your child, it's ok to ignore it!
I regularly teach mindfulness strategies, for example, but I would never expect an ADHD'er to get on board with this approach when feeling anxious; visual planners can be a fantastic way to manage anxiety around uncertainty but are sure to send a PDA'er into a spin of panic; a weighted blanket may work wonders as a regulation tool for one person but ignite feelings of fear and being trapped in another.
Sadly the story of children sitting on waiting lists for years to access child mental health services and neurodevelopmental services (for autism, ADHD and cognitive assessments) is not uncommon and certainly not limited to the U.K. (it's the same in NZ). Covid delivered a double whammy here - more people needed access to services, but those same services were hit with reduced capacity, so waiting lists quickly grew. Throw in an unbearably long stint of a conservative government which has squashed funding far beyond what is sustainable and sent many practitioners running for the hills, and, well, you get a bit of a mess.
But there are still wonderful clinicians out there doing the best they can!
How much of the rise in childhood anxiety do you think can be attributed to the fact children are living in an adultist society, with education systems which don't have their best interests in mind, politicians who don't take action to curb the climate crisis, and so on?
Ooo, this question is an excellent and interesting one! I work a lot with neurodivergent young people who have to navigate a world that is not only not set up for children, but also not set up for neurodivergent people. Of course this can take a huge toll.
Let's take mainstream education; clearly this is an adult-led model with adult-derived goals and measures of outcome. Traditionally, school refusal was considered a behavioural symptom of separation anxiety and treated as such - with the problem located in the child. There has thankfully been a slight shift in both research and public perception to considering that the problem may actually be located in the school. This is still in its infancy despite many psychologists like myself screaming for accommodations, change and advocating for child agency.
I constantly see other examples of anxiety cycles being perpetuated by an adultist society, but the specifics that feel relevant for your readers will undoubtedly vary depending on factors like cultural background. For example, I find that in most Asian cultures, my children are treated as far less capable of physical tasks than I would expect in the U.K. or NZ. People try to grab them to lift them out of cars, for instance, and they have to verbally and physically tell them that no, they can do this themselves.
Touching children generally is considered far more acceptable in Asian cultures than in western cultures and I have at times had to very firmly advocate for their body autonomy. I have too often seen my sons ignored when trying to place an order in a cafe or ask for something in a restaurant, and adults seem to not notice them in queues like they would another adult.
These are all examples relevant to young children, but perhaps for older children and teenagers we can notice the adult that talks over the young person when discussing politics, the control the government has over GCSE choices (young people can choose only one subject from each category, which assumes that they don't understand their own strengths, limitations, and hopes for their future), use of language by adults that labels teens as lazy, stroppy, grumpy etc. It's really no wonder that young people are anxious when they're given a constant message that their ideas, thoughts, and dreams are not good enough.
Which books and resources do you find yourself recommending to parents of anxious kids? Are there any solid resources for young people themselves?
Here are some resources that I would recommend to parents wanting to learn more about supporting their children to manage anxiety. I've tried to include a mix of parent reading and child-led self-help, and have included helpful resources for ND families as well.
The Very Hungry Worry Monsters Activity Book Illustrated by Lara Ede (consultation by Ruth Birnbaum Ed.Psych). This is a really fun activity book grounded in evidence-based CBT and narrative ideas. It's marketed at little ones - I'd say 3-8 - but of course it'll depend a lot on the child.
Avoiding Anxiety in Autistic Children: A Guide for Autistic Wellbeing by Luke Beardon. Luke Beardon is a leading name in anxiety management for autistic adults and children, and is very well respected. His work is optimistic and neuroaffirming.
Happy Families: How to Protect and Support your Child's Mental Health by Beth Mosley. The how and the why of child mental health strategies with comprehensive sections on anxiety and low mood.
Overcoming Your Child’s Fears and Worries by Cathy Creswell and Lucy Willetts. A CBT self-help guide that's more formal in nature, and therefore more suited to older children.
Alphabreaths: The ABCs of Mindful Breathing by Christopher Willard and Daniel Rechtschaffen. A lovely picture book that introduces young children to mindfulness exercises and diaphragmatic breathing.
Declarative Language Handbook: Using a Thoughtful Language Style to Help Kids with Social Learning Challenges Feel Competent, Connected, and Understood by Linda Murphy. A must have read for parents of autistic young people with a PDA profile and those with an overactive threat system.
Thank you so much Joss!
You can purchase My Adventure Journal here: https://olympiapublishers.com/book/my-adventure-journal
Is someone in your family affected by anxiety?
In our family, I’m the anxious one. It comes and goes in waves, and it can hit seemingly out of the blue, though I’m slowly getting better at recognising triggers and when I might be more at risk (like many others, I also feel intensely anxious just before each new menstrual cycle starts).
If you’d like to share your experiences - or any useful tips or suggestions for reading which have helped you - feel free to leave them in the comments section.
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I suffer from anxiety, though mine is certainly far from the worst case out there. Here's some tips I've worked out that many people might overlook:
1. Take your shoes off. I don't know why it works. Some people say it's about grounding, others say it's about your feet feeling trapped... I really don't know. I just know feeling the floor/ground helps. (Obviously this tip doesn't work in every situation.)
2. Keep fidget toys around. I don't care how old you are. Having something to fidget with distracts your brain and helps cool down the parts that are on overdrive.
3. If possible, physically remove yourself from whatever is causing anxiety. If you have a panic attack while paying the bills, physically walk away and do something else for a few minutes. When you get back to it, your brain will have had more time to accept thw transition. If you're a parent having a panic attack while dealing with your kids, say something like "We're all going to sit down and breathe." Your kid picks up on your emotions and probably needs it as much as you do.
It's great to read an article about children's mental health that takes into account the child's point of view! So many writers focus on adults restricting screens, when we should be helping children learn to cope with strong emotions. We can certainly discuss with them whether they think their screen use is causing them distress and guide them in making the best decision for themselves.
My adult sons and I are all neurodivergent and struggle with anxiety at times. My older son - a PDAer - responds well to distractions like doing something together or getting out of the house. My younger son learned some basic techniques for calming from a therapist. I have found that stopping to think what my anxiety is really about is a good starting point for me. If it's just worrying too much, I ask myself if there is anything I can actually do about the problem. If there isn't, I can either try to let it go or perhaps journal about it to get my feelings out.
At one point, I had extreme anxiety and found it hard to leave the house. I did "exposure therapy" on myself where I tried to do one small errand and gradually added more. It worked, and I think it was because I needed to prove to my brain that nothing bad was going to happen. Dr. Fleming's point that it is different for everyone is certainly true!