 Hello and welcome to today's live chat which is about Q&A, it's a Q&A about children and young people and anxiety and how we can support them. I am Dr Pookey Nightsmith and you also have my cat Mork here and I'm here to answer your questions this afternoon. So I have had some questions sent through a head for those of you who wanted to log those ahead of the chat but I'll also be very happy to take questions as you comment them throughout the session this afternoon and I will prioritise the questions that come in live so if you're here I will make every effort to answer your question. So the first question that I have is from Catherine who says that her six-year-old son struggles with anxiety and is finding the situation very difficult as he can't understand why the rules keep changing and she wants to know how can she help him and this is something I'm getting asked about a lot at the moment children young people let's be honest people of all ages who are feeling quite anxious right now it's a very anxiety provoking situation and I think the first thing I need to point out here really is that we are in the midst of a pandemic it's an objectively stressful situation and anxiety levels and levels of low mood and depression are inevitably higher than we might normally expect to see that doesn't mean to say that there's nothing that we can do about it and when we're working with younger children so the the person in question here is a six-year-old boy and then we can be thinking about how can we support with that anxiety the first thing I think that we need to do is think about how can we talk to children in an age and stage appropriate way about what is happening and what is changing and why that can be difficult because sometimes as the supporting adults we don't feel like we've got enough of an understanding about what is going on and why the various rules are in place and sometimes we find it difficult because we're not sure what's going to come next and what we can do here is to be as I was talking to the head of well-being at catering school earlier they talk about being cheerfully imperfect and I think that's a really good way for us to be right now to be humans rather than heroes in our interactions with our children and say I don't know and it worries me a little bit too but here are some ways that we can try to understand what's going on so try to explain as best you can to a child in an age and stage appropriate way but help them realise that we're learning too and we're doing our best to try and manage this we can think about how to be role models to our children and we can talk to them about the different ways that we manage with this uncertainty and these changing rules and it's also really important that as the rules do change and we have different expectations on our children that we look to communicate those really really clearly one of the kind of key things that will provoke anxiety particularly in younger children is a fear that they're going to get things wrong and so they need to know what the boundaries are what's expected of them and how they can appropriately act in the given situation so let's talk to them in an age and stage appropriate way a final thing that I find very helpful here is to think about when we're talking to a child help them think about what are the things that they can control and what are the things that are beyond their control so there are some things that they can't control they can't control the pandemic they can't control whether or not other people adhere to the rules but they can control how they behave how they act whether they're washing their hands and so on and so forth and taking control of the things that we can control and realizing that there are some things within our sphere of control can be really helpful you might want to look beyond the pandemic when thinking about the things that we can control and some children will take a lot of comfort in controlling other things so they might control things like their collection of various toys or you know how they are in other situations so think about things that they can control help them to feel that sense of mastery and control of some things and then try to sit with them with that uncomfortable feeling of there being some things that we can't control but realizing that they're not alone that we're together and we'll face this together okay next question has come in live and as I said I will prioritize the live questions so do feel free to ask them and Sinead is asking how do you help an anxious child aged 12 with regard to doing homework and with written work in school has multiple diagnosis so this is a 12 year old who is struggling perhaps with some degree of academic anxiety and that might be linked in various ways to various diagnoses here so how can we help and when it comes to kind of academic anxiety then I think it can be really helpful to break this down and try to get a bit of an understanding from the child if we can and communicating in whatever way feels comfortable to them at a time of calm to try and understand what's going on for them it can also really help if the adults around them begin to understand a little bit about what's going on for them my daughter Lyra who some of you watched in our facebook live last week has struggled with academic anxiety and a key thing for me and the other adults around her has been to really understand that this is a really serious thing for her and that if she sits down and it looks like she's refusing to write for example actually this is because her brain is going into that fight flight freeze type response and for her this is you know as difficult as for some people standing on a stage and giving a speech might feel and you might worry that you would freeze and and not be able to get your words out there or facing another kind of fearful situation for you so understanding that and empathizing with that a little bit the other thing that can be really helpful here is as well as kind of understanding and empathizing somewhat is learning about some simple kind of calming and relaxation strategies and teaching those to the child so that when in these situations that provoke this anxiety they can actually try to proactively calm ahead so that they go in with their brain hopefully not in that complete fight flight freeze type situation but feeling a little bit calmer which means that their brain is in a situation where it can access its kind of higher-level thinking and language capabilities it can help to build some routines around this so you might work with the adult school and home might work together essentially to create some routines for creating that calm and then a really helpful thing can be for the child to have a signal of some kind that doesn't put too much stress on them that enables the adults around them to know i'm struggling right now and i need your help and that might be i will often teach children the sign for nervous the british sign language sign which is like this so we show our kind of rapidly beating heart and the nice thing about that is you can do that and someone will notice it across the classroom and know that at this moment you need their help you can do other things so for example sometimes children can be taught to do things like put a red card on their desk or to leave a pen on their desk to signify to an adult i need your help but not having to put my hand up and say please can you help me i'm struggling with this that's usually a bridge too far so trying to create some sort of signal and encouraging a child to recognize those early warning signs that they're beginning to panic that the anxiety is rising so helping them recognize what that feels like for them in their body so that they can ask for this help earlier because what we're trying to do if we can is to get to a point where the the child is able to pick up early so we can then use our calming strategies to then try to get to a point where they can engage and the final thing i'd say here when it comes to academic anxiety is just to really break down what our expectations are of that child so instead of expecting them to be able to perform on a par with their peers right away actually just being able to be in the lesson might be a starting point or just to kind of be you know somewhat involved with their homework to kind of be in the room with it can be a big step sometimes then we might look at what do we think they can do and breaking this down into small achievable steps so just being present is a start next we might perhaps look for their engagement sort of listening to to what's going on perhaps somewhat interacting with others then we might move on to actually participating in the written work regular breaks can be really helpful here but just really breaking it down and understanding that this is not this is not a child trying to be difficult which is what it can come across as this is a child who is panicking who is distressed and what they need is calm supportive adults around them and the ability to use some calming and soothing strategies to try and get their brain to that point where there's some possibility of engaging with the learning if we push and we push and we push and we try to make it work when the child has got that fight flight freeze type response we're likely actually just to you know reinforce that cycle of fear and anxiety and we'll often find that things will worsen so taking a step back and really looking at how can we break this down into small achievable things and then really celebrating those little successes where we have them okay next questions from Steph that's come in live and again I will continue to prioritize questions that come in live how can I help my daughter she's eight and just diagnosed autistic but she's extremely anxious about being different she isn't taking any of the brain breaks that school are offering as she's so anxious about being different first of all Steph I would want to just start off by saying how fabulous it is that your daughter has this diagnosis now it might have felt a long time coming for you but eight is relatively young when it comes to autistic girls many of them us I am an autistic woman don't find out until much much later on and finding out relatively early like this is a great thing and whilst it probably feels quite hard right now it's quite a lot to come to terms with it does stand her in really good stead and it sounds like the school are trying to be supportive and do the right things but perhaps your daughter is a little bit more resistant to that and it feels to me like maybe that the key thing here is about helping her to be accepting of this label which is a new thing for her and perhaps to look for some autistic role models the book I was about to recommend to you I don't have to hand because my daughter has stolen it because it's really brilliant and it's now completely escaping my head but there are some great books out there so one is this always escapes my head I'm going to google it so I don't tell you wrong but there's one which is basically written by a 17 year old autistic girl whose name has completely escaped my mind and she talks about how to manage life the universe and everything as an autistic girl and that's very very good I'm just looking it up now so that I can recommend it to you I put it on the Facebook page recently actually so you'll be able to see it there there is also another one by Libby Dillon called Can You See Me I think which is very very good and then finally the books by the children at Lymphsfield Grange is which called M is for autism and then M in the middle when she gets a little bit older and these are written by autistic girls and they are absolutely fantastic because they explore things from the point of view of the child who is autistic so I'm just looking this up no so Can You See Me by Libby Scott I would really recommend that that is a story told from the point of view of a child who's a similar age as your daughter is now and it's also got lots of bits in there written by Libby herself who is I think about 11-12 at the moment or at the time when she wrote this and she talks about how things that help her and that might help your daughter to feel a little bit less alone in that and I'm completely losing what the other one is but I'm gonna look it back up now so bear with me and M in the middle and M is for autism is also very helpful right I'm going to come back to that I'm not sure if my colleague Sophie is watching in at the moment and might be able to help us but yeah so look for autistic role models there are lots of really good ones out there and I think talking to your daughter about actually picking apart and exploring what is it that you're worried about in terms of being different and might we be able to think about how we can educate peers at a time and in a way that feels acceptable to your daughter what we often find is that children are really supportive once they are aware of the issue and once we do some teaching for them and the other thing is that we will often find that the things that help an autistic child will also be really helpful to their peers so it might be that we explore with the school whether these kind of brain breaks even if they're very brief might actually be helpful to everyone so it might be introduced as a universal thing rather than just for your daughter that's another way that we might think of approaching it right the book which was escaping my head is called the Spectrum Girl Survival Guide How to Grow Up Awesome and Autistic by Sienna Castellone and she is 17 I believe and she wrote this book because she didn't think there was anything out there that really met her needs as an autistic girl growing up and so she created this book to kind of try and fill that gap and it covers all the different things that you might be interested in as autistic preteen and then adolescent and includes also some tricky things like puberty, bullying and first relationships and things like that which might be important as your daughter gets a little bit older and someone here saying I've read Can You See Me and I recommend it too yeah that's a really really brilliant book I would highly recommend it and I believe that there's a follow-up in the pipeline which I am very much looking forward to reading. I'm just looking for what other questions I'd had sent in prior so for anyone who's just joining in now we are talking today about anxiety in children and young people I'm Dr Pukie Night Smith one of the directors at Creative Education and many of you know me through other things too and so I'm answering questions live do you feel free to put them as a comment if you've got questions I'm prioritising them and I'm also answering some questions we had in ahead as well so the next question I've got here is my son aged 13 has high anxiety and has not attended school for a year where do we start to help him understand and bring his anxiety down so he can engage in life again now this is something that we will often find with children and young people who are experiencing more severe anxiety that their world can get smaller and smaller and smaller because we become fearful and anxious about different places things situations and so on and so forth and that we avoid those things and what happens when we avoid things is that our brain assumes that had we done those things that something awful would have happened and it kind of builds on that anxiety cycle so what we need to do is to try and have positive or neutral experiences of some of those things that feel fearful to us and we need to do that in a really carefully supported and scaffolded way and we need to do that with real confidence that we will succeed so it works best if we break it down into really really tiny steps a lot with anxiety comes to breaking it down into tiny steps and thinking how can we support and scaffold in order to ensure success so what I would be looking for with this young man this 13 year old boy who's not been to school for so long and we really want to help him to perhaps return if that feels appropriate I would be thinking not about what he can't do and he will have a head full of things that he can't do he will be very aware I'm sure of the things that he might perceive as failings right now and so instead we want to think not of the things that he thinks that he'll fail at but what does he think he can do and I would explore um directly with him about whether there are things that he thinks do feel possible and I would go tiny here I'd go really really really tiny so if the idea of going to school is hugely hugely fear and daunting I might think about what about walking past the school at the weekend when it's shut just walking past and seeing how we feel about that or maybe if he feels up to it wearing a piece of school uniform in the safety of his bedroom just for a few minutes and seeing how that feels so you take it to tiny tiny tiny tiny things and we celebrate those successes and we look to build what I refer to as an I can cycle so we're looking for tiny things that we can do and with each success we then try to build incrementally the next success and anytime when it becomes begins to feel a bit difficult we quite happily step back to where we feel confident and comfortable and then we try again and we think about how to scaffold this I would think really carefully about what that transition is looking like and how we're able to ensure that that success happens that we don't go too fast and that we very very gradually look to reintroduce him to school if that feels like an appropriate thing that I can see that my colleague Sophie is here thank you and helping to link through to the things that I'm suggesting I think she might also have just messaged her dad who is our premises manager to tell him to turn off his leaf blow which you might have heard in the background it's a real family affair here so I'm not quite sure from the question that Helen put in whether she's specifically looking to engage him with school but she also talks about engaging him with life again and what we do sometimes find with young people or people who are experiencing severe anxiety that their world shrinks and shrinks and shrinks and shrinks and actually we will get young people who end up in a state where perhaps they're just in their room they're not really going and interacting with the world at all so again I'd be thinking about what small steps might we be able to take to start to help him to do the things that matter to him and here I would stop and I talk to him always talk to him what does he like to be doing what does he wish he could be doing but that feels too hard right now and that will help us to create kind of goals that we're working towards that matter to him and again you know with that return to school why does he want to go back what's in it for him and he might not be able to find anything but maybe there's a tiny thing often we find with our autistic young people there have been some activities that they were doing that they really enjoyed so for younger and many autistic boys in particular we find that lego club will be a real kind of motivator for them for example there might be a particular friend that they miss or a particular lesson that they used to really enjoy it doesn't have to be a big thing it doesn't have to make sense to you but it has to be what motivates them to re-engage with school or whatever the the the thing that you're trying to get them to do might be and then with that in mind we think okay what would be a tiny tiny step we could take towards it so again we might look to engage with friends briefly online to start with then maybe spending a little bit of time together and with a friend in a way that feels appropriate and outside of school before then perhaps having that friend buddy the child as they return okay i'm just looking back through we've got more questions coming in now um so we've done Steph um Sophie thank you so much for your help on here um what advice this is Alison Palmer now has asked a question on the chat what advice would you give a mum whose daughter aged nine is very fearful of being separated from her especially going to school so this is a question around separation anxiety um i'm not sure if it's in the current context or more generally um but just putting it in the the frame of the current context momentarily we're hearing a lot around separation anxiety right now and this is often an anxious moment for both adults and child at the moment because we're quite fearful of the situation both adult and child may be worried about whether the child will be safe in school for example what we need here is really good communication between school and home we need to make sure that everybody feels confident that the child will be safe in every sense of the word their emotional needs their physical safety will be assured when they arrive at school very specifically about that kind of that that drop-off moment which is often the very difficult bit i would be looking to create routines and put them in place for this child talk them through very thoroughly between home and school think about who might be able to meet that child when they arrive it needs to be an adult that they trust an adult that they feel safe with what activities might they be able to engage with first thing in the morning that feel acceptable to them that help them have that soft landing so that arriving at school feels more possible where possible what we want is for that very first experience when they arrive to feel one where they feel warmly welcomed where they're going to do something that they enjoy they feel comfortable doing so that they then can ready themselves for the rest of the day and we can often really motivate children to come in and to be separated from their trusted adult at home if they're going to start off the day with something they really want to be doing or with a person they really like spending time with another great one if you have it available in your school is time with the school dog that can be a great way to spend that first part of the day and very motivating for many children but thinking about what's the carrot we can use to entice them in and really keeping open communication between school and home and making sure that we celebrate those successes when they do happen and that also we communicate back home and to let home know that the child is safe that they have settled well and that things are going okay but really thinking carefully about what would that routine look like understanding a little bit and really exploring with a child what are the things that are of concern to them what are they worried about when they wake up in the morning and they're fearful about going to school and being separated from home what is it that's on their mind and also having really open and honest conversations in an age and stage appropriate way with the adult and the child all the various adults around the child together exploring if there are any other potential issues here so sometimes we find that separation anxiety in a child can be that they're worried and that their parent isn't going to be safe for example and that might be in some instances that will be because things are objectively difficult at home and they worry and that their parent isn't safe so we see this sometimes in cases of things like domestic abuse but at the moment also we find that there's lots of fear from children that their parent won't be safe because of the current pandemic and there can be lots of fears there so we need to provide a safe space in which a child can explore this and we can explore the adults as well and have those really open and honest discussions and see which are the bits that we can respond to here and control and then how can we look to manage and cope with that distress and have some tolerance for it where we're not able to do that but routines and rituals having a key adult that that child is able to be kind of met by and greeted by when they arrive in some activities they're really keen to engage with as they arrive can make a really big difference okay looking for the next question that was Alison Sarah I like the idea of an I can cycle but how do we get on the school on board with that so one things that I find is that there can often be this slight us and them thing I work with parents and carers and I work with schools as well as all sorts of other people and what we really need to do where we can is to try and bridge that divide and the thing that we've all got in common is that we really want the best for our children and that's usually a really really good starting point so what we want to do where possible is to try and come together as a team around the child and so we're all working with the child's best interest in heart and we want to look to create some goals some aims and some ideas that we can work forwards on which are really where possible directed by and led by the child in which they're really motivated to try and do and our questions should be about how can we all help the child and specifically if you're coming up against barriers with the school and you feel that they you know that you're on different pages here then the advice that I always give whether it's you know within school within home or between school and home if we're not on the same page actually just try and understand what are their aims and how can we try to help the school to meet their aims so perhaps you're getting some kickback because your child isn't attending as much as they want perhaps you feel that this is an issue they want that attendance up and you feel that you know this is something that you're kind of being almost told off for here i'd be thinking right well the aim here is to have my child in school you want their attendance up actually we want that we want the same thing and let's discuss together about how we can make that happen here are the things that i think that you can do to support me and here are the things that i'm going to do to support you we don't have different aims we don't you know it's all about the child bring it back to them would be my my my key suggestion there the other thing we'll be thinking about if you've not got on well with a particular adult in the school it might be that there are other adults other people within the school who you might be able to have these conversations with who you've not spoken with previously so very often you can have very good conversations with people like family support workers members of learning support staff school nurse if you have them and other members of pastoral staff there are lots and lots of adults working within school so it might be that you've specifically had to work with for example a class teacher who perhaps you've not found that you've got on so well with so look elsewhere and see if there are other adults perhaps but i would start with the starting point of we all want what's best for the child and to try to have a meeting if you can with the child where possible where you look together and create some goals which are for the child by the child with the child and try to take things forwards there um ah do you know me was also published in April this year so i think that's the follow-up which i was talking about uh Libby Dillon um what advice this is Claire Cooper now which has come in live what advice would you give to a 14 year old girl with um autistic spectrum disorder who is worried about gangs kidnapping terrorists hurricanes etc she is school refusing and rarely leaving the house she just ordered uh she just opened up about these fears for herself and family yesterday okay well first of all Claire it's really great news that your daughter has opened up to you about this that's a really important start because that means that you have created that kind of emotional safe space where your daughter feels able to talk about her fears um it's really important that she feels seen and heard about this and that you listen to what she's saying and we try not to kind of trivialize and dismiss it but a really helpful thing to do here can be sometimes to actually really explore this you know she's a 14 year old girl who's clearly got a lot on her mind um quite possibly um very bright if she's worrying about these kinds of things so maybe let's um do a bit of research and actually understand a little bit about the statistics around this some some families that i've worked with have said they found this to be quite helpful and actually understanding you know when was the last time that hurricane hit our part of the world um and what the chances were happening and you know what are the things that we can do to try and uh kind of keep ourselves safe if that were to happen so i'm not sure where in the world you are but maybe you're somewhere where there are hurricanes and then you might learn about hurricane safety and watching the weather and making sure that we do the things we can do to keep ourselves safe the the thing here is to have really open honest and explorative discussions with your daughter and to really understand what those fears are and perhaps try to understand a bit about where they're coming from um and then yeah thinking what are the likelihood and then what are the things and i come back to this so often what are the things that they can control and then what are the things that are beyond their control so there will be some things that they can do in order to keep themselves uh more safe and there will be some things that will be beyond their control and then we're thinking about how do i sit with this distress and a really helpful thing you could look up is distress tolerance which is um part of dialectical behavior therapy or dbt and distress tolerance is one of the skills that we learn as part of that therapy which is all about actually recognizing that sometimes things feel really hard and sometimes the situation is difficult and there's nothing that we can do to change it and we're feeling distressed and it's about how we accept that distress and we sit with it and we kind of manage that feeling and that can be um quite helpful but i think actually listening to her enabling her to feel heard understanding a little bit about where these fears came from making sure we do not trivial trivialize them and say well you don't need to worry about that it won't happen but rather say okay well let's explore this together and actually find out what the likelihood is and see what are the things that we can do to keep ourselves safe would be the route i think i would go down but this is obviously very very um early on at the moment um the the other kind of element here was the the kind of school um school avoidance and um not leaving the house which are kind of other symptoms really of a child who is very anxious and i don't know what support you have in place for her at the moment but she sounds like a child who could really benefit from um things like cognitive behavioral therapy so she can understand some of the very difficult thoughts that she's got and some of those cycles that she's got herself into and begin to try and break some of those cycles and if she's not accessing that kind of support already um i would really recommend uh looking down that route um and there are lots of things you can also do yourself so if you look up kind of cognitive behavioral therapy and negative automatic thoughts which is probably you know she's probably got lots of these what we call thought traps uh which are happening for her and these can make our well get smaller and smaller and smaller and again it's about thinking what little steps can we take to make her well just get a little bit bigger again so are there things that she's not doing anymore that she misses are there friends that she's not seeing places that she's not going that she wishes that she could access right now to try to find what motivates her and then we take tiny tiny steps really scaffold and support her to take those steps so that she can succeed and really celebrate when she has even minor minor wins there so we can try and make her well a little bit bigger again um really important to to do that if we can just otherwise her world might get smaller and smaller and smaller over time we see that happen quite a lot um next question from Emma how to help my seven-year-old little boy he worries and stresses and gets upset and won't be in another room alone as he worries that something bad may happen and wants to make sure um doors and windows are locked and he gets really upset um that's I need he gets really upset that much I need lie with him he goes to sleep um nothing has happened to make him like this he seems to have happened since um the first lockdown and I spoke to him and told him I understand um he's um okay going to school though okay so okay so that's that's that must be really challenging Emma and quite hard that you've seen quite a significant change um in your son um in quite a short period of time um again it sounds like you know there's a really good and positive relationship there and there are some really good and positive things going on in his life if he's going to school okay that's a really really great sign um and the fact that he's so worried and it sounds like he's very worried about the people that he really loves right now um and and that he's fearful that something will happen to you um and I'm sure that you've done all of the standard things that we would do around um sort of reassuring um and and that kind of thing um and so it yeah this is quite a tricky one um I think really actually stopping and hearing what he has to say which again I think it does sound like you're doing but exploring this at a time of calm so one of the things that can happen is that we only explore this when the child is exhibiting these kind of signs these anxious signs and and this process is happening those are the moments we tend to look to explore it because right now my child has just asked that all the doors and windows are locked so let's explore why that's happening and actually um I would look to really try to begin to unpick this a little bit and try to problem solve with him at a time of relative calm so if we can be doing an activity together that your son really enjoys then when he seems quite calm and happy then maybe get just a little bit curious and just say you know I've been um really curious about um the worries that you've been having about the doors and the windows and actually trying to reassure him at those times um as well um and you maybe will want to think about where you're trying to get to and what the tiny steps might be there so you talk about um sleep and bedtime for example and being quite a tricky moment and you might think about what do you want that to look like and what might be the tiny steps that we can take um but he's obviously got lots on his mind and the fact that he's able to to kind of talk about that and verbalize it and explore it I think is really crucial and having that that that good relationship with him really matters it would also be worth thinking about um whether there is an adult and perhaps at school um that he might be able to have some of these conversations with because it's quite common for children who are worried about an adult at home because they've got a really really good strong relationship with you he's obviously you know really worried something will happen to you because he really loves you um that can make it quite hard for him to kind of open up to you about it and to explore it because he might not want to really worry you um even though obviously you're very worried but thinking about whether there are other adults in his life other trusted adults who might be able to help to begin to unpick this a little bit might be really helpful and also if we're finding that he feels relatively safe and school is an okay place again he might just be in a better place at those times to begin to explore this what happens is that when we are fearful when we've got that kind of fear response then um our brain kind of shuts down it just goes to working in a really basic capacity in order to keep us safe so you know if you've got a lion running towards you you don't need to access kind of higher level language and thinking skills so when we've got that kind of fear response similar to having a lion running at us we're not in a great space to to talk about things and to problem solve them so we try to do it at a time of calm and in a place of relative safety so school i would think about talking to school um and seeing if there's someone there who might also be able to support um one of the the really positive things is thinking that this has happened relatively swiftly and you picked it up quite early which will mean that it's really you know probably much more possible to unpick it those habits won't be really really really well formed at this stage um uh sarah asking about how you build a tolerance for distress that's uh a big question um and um it's a very specific kind of set of exercises and skills that come as part of dialectical behavior therapy but part of it is often just sitting with that feeling and one of the things i often find very helpful with children and young people is actually talking them through what distress actually physically feels like in their body and helping them to recognize that and actually sitting with that feeling and recognizing and talking through the fact that actually as we stay and we sit with that distress it begins to dissipate over time and this is because our body you know has that kind of fear response and we're all fired up to respond to a stressful situation we're ready to fight flight um and actually our body can't keep that response up in it indefinitely so those kind of panic and fearful type responses will begin to pass over time um but we could do a whole whole another session really on on uh distress tolerance it's um it's a really big topic and there are several sort of different ways of looking at it but there's there's really good information out there and i think um looking at the um yeah the distress tolerance exercises might be a really a really helpful thing to do but yeah for me that's a really key one just actually physically sitting through the distress actually watching our physiology acknowledging it and seeing it pass and we can do that with things like scales or colors and saying you know where where are we on a scale of one to ten right now and then as time passes um actually recognizing that i was at a nine and now i'm at an eight and then a few minutes later realizing that maybe i'm in a seven or a six and just noticing that change um over time um here again also things like our distraction or calming activities can be very very helpful too but this is about recognizing there are some things that we can't change sometimes we feel horrible and there's nothing we can do about the thing that's causing that feeling and so we sit without distress and we notice it and we kind of allow it to pass um Jennifer says enjoying the discussion so far thank you Jennifer so we're talking about anxiety in children and young people and how we can support um my 12 year old gets anxious about going to sleep by herself at night and wakes during the night normally at 4 a.m this started after her transfer to secondary school last year i'd really appreciate any advice many thanks Jen so sleep is um sleep is the most important thing and i come back to it all the time when thinking about the physical and emotional well-being of children and adults as well good sleep um is is absolutely crucial and when we're struggling actually being able to take steps to improve the quantity or quality of our sleep is one of the things that can have the biggest impact on our ability to to cope and thrive and and so we find that when our sleep is impacted negatively um that can obviously then mean that we're less able to cope each day you know what it's like trying to manage any kind of problem-solving or emotional issue when you've had really bad sleep it's just difficult we're more likely to get angry tearful so on and so forth so sleep really matters is the the kind of start point here and when we find that we get into a negative pattern of sleep um then that can feel very difficult to kind of find our way out of but the really good thing is that we can fix sleep relatively easily so um not always but often we can we can make quite rapid changes quite well so the first thing to ask yourself here is how much change do we actually want to happen so um you start off by saying your 12 year old gets anxious about going to sleep by herself i would start by wondering does she need to right now if this is a really difficult thing um perhaps you will find that she is able to go to sleep quite well with someone else in the room and that that might happen quite quickly and it might not impact massively on your life and her life and then she's gone to sleep safely and she feels okay um if that's the case then i would question whether that's an issue um quite often when it comes to things around sleep right from very small children we think we need to do things in a certain way because there's all sorts of societal expectations and we think well she's 12 year old she should be able to go to sleep on her own but if it's not having a big impact on your life and it means that she gets to sleep better and happier i would just sit with her while she goes to sleep um that might not be possible and it might be this is taking a very long time and you're really motivated to change that or she's really motivated to change it in which case then i would start thinking about what that routine running up to bedtime looks like and how we can make sure that the point at which she's going to go to sleep she's as ready for sleep as possible so i would take a look at her room making sure that it's nice and cool and calm and dark i would make sure that if possible that her room is not a place where she does things that stress her out but rather it's a place of relaxation so i would perhaps not have her doing things like homework in her room for example and i would be not encouraging use of screens and things like that so trying to have a relaxing space in her room so her room is her kind of calm zone and then i would think very specifically about what happens particularly in that hour leading up to bedtime what's happening then how could she maybe create a routine of really nice calming relaxing activities that she really enjoys and make her feel happy and safe so then when she does go to start the process of actually going to sleep that she is in a really good place to go to sleep and some people will find that things like having relaxing calming music might really help and you can hear you can build up an association with a certain piece of music for example or one of my daughters always listens to the same audiobook and hearing that same thing each night it reminds your body ah yes this is sleep time i'm ready for this there's a particular song by Mogwai that i used to play to my daughters when they were tiny as they were going to sleep and i used to put it on a loop because i'd kind of conditioned them that when they heard this song they would go to sleep and now right to this day years later if that song comes on in one of our playlists we all just start yawning because it was so conditioned to it so you might think about what that routine kind of looks like so really thinking about that run up to bedtime and then there's this other issue that she wakes during the night and again i would think about what's the routine for what happens during that waking so what you haven't said is whether she's distressed during that time or if it's just that she's kind of a awaken alert and struggling to get back to sleep one of the biggest mistakes that we make when we're struggling in the night with sleep is just repeatedly trying and trying and trying and trying to sleep and failing and that can mean then we begin to associate our bed with wakefulness rather than sleepfulness sleepiness yeah sleeping and so if we are trying to get to sleep for more than 10 or 15 minutes and not succeeding then i would suggest that she actually gets up and moves away from the bed for a few minutes and does a relaxing or calming activity so it's something like coloring or if there's you know like knitting or reading something that's calming that she could do preferably not too much with a screen and some people will find things like kind of mindfulness type activities helpful there but have a plan for it if you if you're awake at this time and you're not able to get back to sleep again right away what will you do and again if she is finding that this is happening kind of repeatedly it's about just being accepting of that and acknowledging it saying oh that sounds really tricky but let's have a think about what that looks like and depending on you know if there is distress at that time and she needs the input of an adult and then again trying if we can actually just to be responsive to that need and trying to cut down the time that it takes to respond to that need each time but actually just just being you know welcoming supportive and kind and caring if we can but have a plan for what happens during those moments of wakefulness and in order to try and get her back to a calm place and then go back into that routine that she does at night time with with sleep routine is a really key thing so having routines and rituals around sleep same times every day and I would keep them the same at the weekend as well certainly in terms of bedtime where possible just because then our bodies get really used to going to sleep at those times and we can also do things like you know having a nice warm cup of milk or cocoa and some of these things that just help us to feel kind of sleepy and snuggly and ready for bed and they sound like really simple things but actually getting into these routines and these rituals around sleep can make a really big difference but yeah I think Jennifer my kind of number one takeaway from from what you're saying is just to really question whether you're looking to make changes particularly around bedtime because you think they need to happen and she and you are motivated for that to change or because you feel you know society says oh a 12 year old shouldn't need a parent there if she needs you there and it helps and you don't mind doing it I would sit with her for a few minutes next what advice can you give to help children who get anxious frustrated and throw tantrums when there are to do activities such as speak in front of the class or playing a game with peers or participating in competitions etc we've tried calming down strategies meditation mental relaxation imagery talking about feelings using positive language and mindfulness that they have not created much of an impact wow it sounds like you have tried a lot of things all of which I possibly would have suggested but you've tried them I would kind of step back here and get curious about what is happening with this child and see if we can understand a little bit more about what might be underpinning the the response that you're seeing this child who's getting frustrated and throwing tantrums just trying to understand why is that why is this happening and there's all sorts of different reasons that might be underpinning it but I would keep a journal for a little while a bit of a mood journal and recognize for this child in any given week when are the good moments so actually are there times when this child is succeeding in engaging with these activities positively and if so where are they who are they with what's kind of happening and what's preceded it and so on and so forth and but then also noticing when things are going less well and you will begin and work with the various different adults around the child you'll begin to see some patterns and it's possible that you will find that this happens more for example towards the end of the day and if you find that this is happening repeatedly towards the end of the day that might suggest that this is a child who's working really hard to manage and that as the day wears on that actually they're getting very very tired and fatigued and that might be a child for example where lots of the things that you're suggesting might work really well but we might do those really proactively throughout the day to give them the chance to reset rather than specifically in response to these activities. Another pattern you might see is that these behaviors always happen when with certain children or in a certain environment or with certain people and then we begin to explore what about that situation is it that the child is finding challenging and are we able to manage that situation a little bit differently or again to use these suggestions that you've already tried but using them proactively ahead of this happening rather than afterwards but I think getting really curious really trying to understand about when this is happening and why but also getting curious about when are things going well for this child when are the times when they are actually engaging in a more positive way and seem to be more thriving in these environments and what can we learn from those times so we can try to replicate it so look for patterns and look for what's working as well as what's not. Jenny my daughter is 11 has ASD SPD diagnosis also has school anxiety and separation anxiety how do you get them to open up and talk about why they won't go to school good question Jenny there's not a one-size-fits-all answer here when it comes to encouraging children to talk about what's going on for them and your daughter wouldn't necessarily even know the answer it may be very very like complicated and there might be lots of different things going on and there's no right way and wrong way here it's about really just exploring what works for her and I would encourage having these conversations at times of calm and also just considering that sometimes these conversations won't be conversations you might do this through emojis or through play or through art or through music or through any other means that your daughter finds as a good way of communicating I would also think about whether there are other adults in her life who might be able to be involved in these conversations too again we sometimes find that children find it particularly difficult to talk to parents and carers and people with whom they have a really strong and positive bond because they're worried about worrying you so sometimes it can be really helpful to identify other adults in their life that they might speak to and the the final thing I'd say here is that if you're able to build a routine of listening so that your daughter knows that there are certain times in the day or the week when she's got your undivided attention and when she might be able to kind of talk to you or otherwise engage with you then that can be really helpful so it might be that you know during the during the evening in the run-up to bed for example there might be a quiet time there and when you always sit together and you're open to listening if she wants to just look for moments in your day or in your week when you might be able to just just be there and hear what she has to say. The final bit there is that sometimes we'll find that children depending on you know what her kind of strengths and challenges are but some children will find it easier to write down what's going on for them rather than to say it and just giving lots of space and time for that to happen and just being open and non-judgmental in our response when our children do begin to open up and really encourage that it might be hard to hear some of the things that she has to say but yeah just just it can take time just be there be consistently there and really hear her create moments for listening and yeah try to hear what she has to say with an open mind. Sophie says can you talk about cards against anxiety please thank you Sophie good good yeah prompt there so cards against anxiety I've got various I've got them up here behind me somewhere cards against anxiety is a resource that I put together about a year or so ago now and it's a set of prompt cards and there's a booklet that goes alongside them and they're basically just really really practical ideas to help you manage anxiety day to day and they include really simple things like breathing strategies relaxation strategies ideas around addressing negative thoughts and so on and they're basically designed so that you can carry you can take you know three or four of the cards that particularly make sense to you and you can carry them around with you as a prompt lots of schools and also kind of various kind of therapists and people like that that are in my network have found them to be really useful and whilst they were designed for use really with adults lots of people are using them with children and they're very bright and colorful and I'll see I'll just grab a set here we go so these these are they you can buy them on on amazon and actually there's a new set coming out soon called I thought it was going to be cards against negativity but they seem to have renamed them cards for positivity and they will be about trying to encourage a positive mindset which is challenging in the current moment so we thought that was relevant so yeah so they've got a book that has more ideas and more in depth and then we have this series of little cards so each of them has on it a prompt and then kind of step by step guide and then it tells you where in the book to find out more but you'd basically kind of carry around a few with you and yeah I've been really pleased with how popular they've been and yeah they've gone down really well and I get kind of tagged in on instagram posts all over the world because they've been translated into all sorts of different languages now which is lovely. Jade my daughter is almost 16 suspected ASD can't explain how she's feeling I fear she's reaching shutdown she doesn't want to attend school although she's still going but begs not to go she feels not good enough despite trying her hardest sleep issues anxiety presents as poor and controlling behavior at home but masks at school how do I offer support she brushes off relaxation techniques and she struggles to see the way she feels is due to anxiety oh wow this sounds really hard Jade and the first thing I'd say is that she's really lucky to have you make sure you look after yourself because this is very difficult and can really take a massive kind of it's quite a large emotional load to carry so make sure that you're doing what you can to look after yourself and remembering that when we take time to exercise good self-care as a parent or carer we are also being a really good role model to our children so if you feel that it's selfish to exercise self-care remember it's not you're actually you know role modeling to your child as well I think this this is this is quite challenging and when we've got children who aren't really engaging in this way and aren't necessarily really motivated to change one of the really helpful things that we can do here is to use techniques which are based around what's called motivational interviewing which is about getting people to a point where they are ready to accept that there is a need for change or that change is possible so it's a technique that's used a lot with people who are struggling with drug abuse or eating disorders for example but can be helpful in a whole variety of different situations and and the most important thing here is about flipping our thinking and looking at things from the point of view of the child and trying to understand how the world feels for them and how they might want it to feel even just ever so slightly different so are the things that she's not able to do right now and that she'd like to be able to be doing or are there ways that she's feeling that she doesn't like feeling that she wishes were different and trying to understand that and then to break it down into really tiny steps that we can take and one of the things you talk about here is her emotional literacy so not really being able to explain how she's feeling and i would suggest working with school there will be support staff in school who are brilliant at this every school has got support staff who are amazingly good at this kind of thing and they will have all sorts of different strategies for this and i find very helpful the use of emojis i mentioned them a lot there are um there's a really nice resource called chatty's cards which i don't know how many i've got little ones so you can get so chatty's cards you can get big ones or little ones these are the little ones that you can carry around but you can get big like dry wipe ones and it's basically just a whole bunch of emojis um and these can be really useful for having conversations about different feelings with children and young people because they get emojis they will often speak in emojis when they don't have the words they mean something to them these were developed in conjunction with young people by a youth worker and i love them i use them all the time both in my work and also in my home and one of my daughter struggles quite a bit with her emotional regulation and her emotional literacy and just every now and then i'll find that she's having a bad day and she'll just line a few of these cards up and often there's a whole range of different feelings going on for her and then we can begin to pick that apart a little bit um finally here talking about not being very accepting of various kind of relaxation strategies and that kind of thing i would just stop and think what does work for her when are the times when you reflect on the last week month year when are the times when things felt a little bit better for her um are there moments when she does feel calm or happy and what was she doing then and what can we learn from that and how can we use that perhaps as an activity or place or stimulus for helping her to feel a little bit calmer or happier and at other times so just reflecting always on what's worked well in the past can really help us to think about what might work well in the future um okay mandy my daughter's anxiety is developed into a complex vocal and motor tick disorder we've also noticed more ASD traits how can we support her in her frustrations that arise from this we've established its school related anxiety and pressure OCD which is heightened due to returning after lockdown we have multi agencies involved in trying to get things in place to help um to be honest this sounds really complex and it sounds like you've got lots of really good uh you know you've got lots of people trying to help right now so i'm not really sure that i know enough to offer really good advice um if i'm perfectly honest the thing i would just always come back to though is um always starting with looking at things from the point of view of your daughter and trying to understand things how they feel for her um what are the issues that she feels that she's facing what's her perception of this because sometimes we um we think that we know what's going on when we're not always um we're not always so good at actually hearing um the child so making sure that she feels really heard as part of this process and sometimes when we get lots of different people involved it's great you know for all that expertise around you just making sure that her voice doesn't get lost in this so a key thing for you um as as mum here is to to really be an advocate for her i think the other thing is that if you've got lots of different people involved and people are trying to make things better actually the other really brilliant thing you can do as mum is just be mum sometimes just have fun with her and try and do things that are outside of all of this remind her what it is just to have uh you know have a good time and and do things together because we can sometimes get so focused on the issues and the problems that we forget to just have that kind of really golden fun time outside of this when we lose all our worries for a little while and whatever that takes um whatever activities you know that you are able to do and that you're both able to enjoy together um i would yeah just really encourage that taking time out from all these issues because that sounds really hard for both of you and again i echo what i said to another parent earlier make sure also that you are uh looking after yourself too that's really good role modelling for your daughter and you can't just continually be there for her all the time you must also take time for yourself or your burnout um okay just looking at any more questions how do i approach my son's anxiety ticks they change constantly from one to another um okay so when it comes to this um if it's changing all the time then it sounds like what we need to do is not to address so much the ticks as the cause of the ticks and try to understand what are the ticks responding to rather than worrying so much about the ticks so when teaching about any kind of challenging distressing or harmful behavior in children um then the first thing i usually advise is just look beyond the behavior um and try and understand what is underlying it so again i find things like journaling here can be really helpful and trying to understand well when are they happening who is he with what's going on what was going on just before that um and then also looking at one of the times when the ticks are not happening and what are the positives that can be drawn from that so try and look for the patterns to try and understand what's going on once we understand um what the you know the potential issues are there and we've got a bit curious about that then we can begin to unpick this a little bit and think about what we might be able to do um to support uh the child to overcome those issues but the problem here isn't the ticks they might be the thing that are causing distress or challenge or disruption and but actually the the problem is whatever's causing the ticks and until we know what that is it's very very difficult to help um okay my daughter is a school refusal but the bad experience from the lockdown makes her think she is not able to learn anymore how do i encourage her to start studying again even just a tiny bit um the you've almost answered during question really it's just a tiny bit um i think thinking with her about what her motivations are in life you know life the universe and everything i'm not sure how old your daughter is but thinking with her about what she would like things to look like in a year's time in five years time when she's grown up what are the things that she'd like to be doing and then working that back and thinking well okay what would i need to do in order to make that happen and actually kind of hanging on to those motivations um as a reason for perhaps engaging um a little bit and i think the other thing is that school isn't all about study there are other really good bits about it but the study is good you know i love study but but if you know that's a bit she doesn't like what are the bits that she does like um and what might be other motivations for engaging it might be that there's a particular friend or an activity that might motivate her that we can kind of tap into so looking for those things but yeah starting really really really tiny so i talked earlier on in this session about i can cycles and i've done a youtube video on that recently and this is about for children who are very much used to thinking that they are failing they're used to what they can't do they've got a very negative self-narrative which often happens where we've got this kind of school based anxiety going on they're getting told off for not attending they feel like they're failing actually we want to look for building up a list of things they can do so no matter how tiny it is maybe you know we start with literally sitting holding a pencil in our hand for 10 minutes and seeing if we can manage that does that provoke so too much anxiety could i write for pleasure rather than um as part of a lesson might i engage in an activity which um is something i might do at school but that i can do at home and enjoy perhaps she enjoys art for example okay so carmel says she's 16 so so at that age you know 16 is a really difficult age to be right now there's so much uncertainty about the future and exams and all sorts of different things so tapping into yeah really tapping into her motivations and thinking she's 16 now what does she want the next step in her academic uh life to look like i don't know where in the world you are but if you're um here in the uk then she'll be in school till she's 18 um and so just actually thinking with her about you know maybe she's not able to focus in on the right now and today this all feels a bit futile and pointless but she might have dreams and aspirations for what you know those final couple of years might look like she might be wanting to go into a certain profession or off to university and actually just really helping to understand how what she's doing now can help to act as stepping stones towards that can be um incredibly kind of helpful and motivating otherwise this can all just feel a little bit theoretical and pointless you know when you're you're doing your studying and you can't link it to actual things that you're going to use in life that can be really hard but yeah break it break it right down um into into steps that she feels that she can engage with would be would be my kind of key point there and just you know try to make sure that we do take time out from this worry as well i think i said that before about taking time out from the worry and having some time that we enjoy and we have fun as well sometimes we need to take time out from a situation and to kind of build ourselves back up like invest in that emotional piggy bank and then we try again if we constantly trying and trying and trying to overcome this it can be really really challenging so it might be that we take a step back build ourselves up get ourselves feeling really strong and then we begin to try and break those cycles and build things back up okay it's gone five o'clock uh my my cat who you'll have noticed coming around a lot here it's it's time for her dinner so unless there are any more questions coming in here now then i will wrap up and i hope it's been helpful for you and that if you've asked a question i've answered it adequately and if you found this hope hope if you found this helpful then we'll happily do other sessions again in the future and we've got lots of courses on our website that you can access on demand lots of them will tackle many of the issues that we're talking about today so we do have courses on anxiety we've got self-harm eating disorders we've got one around school-based anxiety and avoidance as well so lots of lots of things that you can access there and yeah and we're adding to it all the time so that might be worth checking out but yes have a good evening i hope it was helpful and yeah see you again soon thanks ever so much bye