Understanding Teen Anxiety and Neurodiversity

Hello and welcome back to another episode of the Drug Prevention Power Hour. I’m your host, Jake White from Vive 18, and today we are hanging out with Jamie Roberts. Now, Jamie is a licensed marriage and family therapist, as well as the author of the book, Mindfulness for Teen Anxiety, a practical guide to manage stress, ease, worry, and find calm.

She’s the founder of Equilibrium Counseling Services, a teen and young adult mental health center in Southern California. And that’s a place where all identities and brains are celebrated with the goal of building confidence in oneself and reducing symptoms of depression and anxiety. She is the neurodivergent therapist throughout social media and is an active speaker on neurodivergent and teen topics. So Jamie, thank you for saying yes to being on the Drug Prevention Power Hour.

Absolutely, I’m so excited to be here. Thank you for inviting me. Talking about teens and mental health is my favorite thing to do. So I’m excited to be here and have this conversation.

Yes, and for those of you watching on YouTube, you can see Jamie’s amazing background with all the colors, all the art. It’s super, super fun. Jamie, tell us a little bit about you.

Yes, well, I mean, I love color. I love art. These are one of the things that make me the happiest. They call this dopamine decor. When you put the things that you love and make you happy up on your wall so you get dopamine from being around your decorated environment. Yes, so thank you. So as you said in the introduction, I’m a therapist in California and I have been working with teens in mental health for over 15 years done this before, I love this.

I started really focused in on just the teen experience and I just found myself working with more and more neurodivergent clients, meeting autistic clients, meeting ADHD clients, learning about bipolar, really starting to see some patterns and trends. And about six years ago, I was like, you know, this is ringing true a little bit too close to home for me. At first I was like, I just really get these clients. Like I’m really good at what I do. And then I was like, oh wait, because this was me too.

I initially started because I really struggled in my teen years with my anxiety and mental health. And so I wanted to become who I needed when I was younger. So I was studying psychology and mental health. And then I figured out, I was undiagnosed, both ADHD and autistic. And so that really changed the lens at which I viewed the work I was doing, the clients I was working with, and just how people connect with each other when we have different brains and that our mental health supports, our coping skills, our anxiety stuff is different for neurodivergent people than it is for neurotypical people.

The Importance of Accurate Diagnosis

Wow, that is so interesting. What a cool story too that you had that revelation later into your professional career. Like, wait, am I part of this community? Like I can relate on a whole other level.

Yes. Yes. I was like, I really relate to this.

I really get this. And I was like, there must be a reason why I get it so well. And so then I was assessed and I was diagnosed and like, that’s something we’re seeing a lot right now, especially for women. And that’s something I wanted to talk about today because we’re talking about like harm prevention is only 80 % of autistic women are diagnosed before the age of 18. No, sorry. 80 % are undiagnosed by the age of 18.

So we see a lot of the mental health struggle that teen girls go through who are undiagnosed or misdiagnosed really still struggling. Even if they have an anxiety diagnosis, even if they have a depression diagnosis and they’re getting treatment, something still feels off, something still isn’t connecting. And often that’s because there’s something neurological also present and women just aren’t diagnosed.

What? do you think that is? How is this happening? How’s this gap?

I think two major points think one, the research over the years, especially about autism, has been very focused on white male boys, and that’s who all of the study groups are on. And so that’s very exclusive of women and when you’re not a child anymore, right? Because we grow up and it looks different as you get older. And so I think because it’s not included in the research, then it’s not included in the diagnostic material, that it’s not taught to clinicians. And so if we’re only looking at it, at a, does the three year old line up their blocks or their trains? That looked very different when I was lining up my Barbie clothes and dressing them in a row, right? That wasn’t caught in the same way it was caught for boys. And so I think that there are ways just in that piece with the research. And then I think we present different just based on how we’re raised or socially how socially how girls are raised compared to how boys are raised with just some of those societal expectations of socializing or caretaking or interests. And so it does present quite differently, even though it’s very much the same.

Wow. And I imagine that diagnosis or misdiagnosis, you had mentioned sometimes it’s just called something different. Like they will misdiagnose it as depression or they just won’t catch it. There’s a lot of, I mean, that can be very frustrating for a kid. I could have lifelong consequences when you’re developing at such a rapid pace as a student and your brain is developing.

Actionable Steps for Supporting Teens

Absolutely. The pattern that I see is that about like third, fourth grade anxiety starts, fifth, sixth grade depression kicks in, sixth, seventh, eighth grade is when girls might start self-harming and then suicidality pops in. And then by ninth grade, they might be experimenting with drugs. Because so much of it is a chemical imbalance also that we’re trying to self-medicate in some way. And that’s how I see self-harm as well is self-medicating just trying to get some release, trying to feel better in some way because something’s not making sense. And so a number of the girls that have been referred to my office are on multiple antidepressants, have been in therapy for years, have done higher levels of care, and they’re still depressed, but they’ve never been assessed for a neurodevelopmental disorder. They’ve got the depression diagnosis, they’ve got a bipolar diagnosis, they’re talking about borderline personality.

But technically you’re not allowed to diagnose that until after 18. And so all of these labels are getting thrown at somebody, feeling more and more like something’s wrong with me when you haven’t even had a full, like, thorough, like, looking at the core of what might be your lived experience.

Wow, okay. And I want to move into this to some actionable steps because this is, this is the best way to start a podcast. We’re like getting into a problem and we’re going to explore some solutions.

Welcome to a conversation with an autistic person. We like to go straight to the point, skip the small talk, let’s get to the meat of it.

I enjoy that. This is the main thing. This is why I want 30 minute episodes, right? I’m like, this is great. Let us learn what we can and take action. what is, what are some things that every person or people who are listening to this podcast, they care for young people. Maybe they have families as well, but they’re, they really want to help reduce the stress and anxiety and misdiagnosis. They’re in the healthcare field, adjacently looking after young people so that we can reduce self-harm and substance use and things like that. So you told me and you’re like Jake, I’m really passionate about this. This is going to come up. So what’s the takeaway for this? Like how can we be partnered to help young girls not get misdiagnosed or to avoid the like seeing the signs? Do you have a tool that we can go see or is there a resource or something?

Tools and Resources for Mental Health

Three specific things pop to my head, but if we’re talking about a specific tool, I mean, my first book is Mindfulness for Teen Anxiety. And in this book, there are 45 activities for regulation skills, whether you’re using your body, whether you’re using your mind, whether it’s through communication. And so I think that is a direct toolkit. It’s written for the teenager with teen examples. It’s good for everybody if you want to interpret the examples.

45 activities in here that can be used you with neurodivergent people. We want it to be used now. We want it to be applied now. And a lot of like sensory and somatic stuff is really helpful for regulation. And so everything in the book can be applied immediately, can be very subtle to where you can do it in the classroom and nobody will even know that’s what you’re doing. Like one of the things that we talk about fidget toys, but like even just the seam on your jeans or the string on your hoodie can be like a fidget toy or a self-regulation tool if you’re using it like very intentionally. So there’s ways to do it very like inconspicuous. So that would be my number one tool. I’m writing a book right now specifically on neurodiversity for teen girls and that will be out next year. So those are the big tool kits have three specific actionable items for adults who are working with teens. One, believe lived experience. Believe what they’re saying to you. Believe that when they tell you something is hard that it actually is hard for them. Even if as an adult we can look at that and be like, well, why is that math homework hard? Like, it shouldn’t be hard.

You’ve been in this class for how many months? If they’re saying it is hard, believe them that it is hard. Because being believed is such a huge validation and it opens the door for more conversation. And just because we think it might be easy or it shouldn’t be hard, it doesn’t mean that it’s not. So believe in lived experience or even if the person’s telling you this medication’s not working or I need something else, believe that. The second thing, oh, I lost it for a second. I was like, wait, where’d that thought go? Okay, it’s back. I call them secondary questions.

But I think we tend to ask like very certain, like introduction, like how are you today? Right? Is very open. But a secondary question goes a level deeper about, tell me about how you are today. Right? So there’s a little bit more directive to it. And like when we come to like helping diagnose or figure out, I think a lot of times when we think of ADHD, we’re like, are you forgetful? And if I say, no, I’m not forgetful. I always have all of my things with me. Somebody may go, well, then you’re not ADHD. So the secondary question is, how do you remember all of your things? Because then I will tell you, because I have a hook next to my door that says keys and my keys have to go on there. And if they don’t go on there, they are lost. But I’ve gotten such a routine that they have to go there because otherwise things disappear. So I have a system that makes me be able to do it. And we forget that we often have those systems. And so asking those secondary questions get to the like, well, how are you able to, what is it like when you gets us to know like what are the efforts that are going into some of those actions or behaviors.

Okay, how was it like? Ask secondary questions.

Yeah, because it kind of opens it up. goes like, explain to me how you’re able to do that. How does your brain figure that out? How do you remember to put the things there? What is it like for you when you’re cleaning your room? Where do you start? Right? Like leading with curiosity about explain like teens. Everybody likes not just teens, everybody likes to feel like they know something. They have an authority that they’re going to teach you something. So to open it up like, explain to how you figure out how to do that. I’m so curious because I do it a different way. What’s your way?

Yeah, you’re right. People love talking about that. They love sharing their expertise. And what’s cool as the listener is you’re like, do I get my teenager to talk to me? Like that’s probably a real frustration in a certain age group because you’re like, they do seem closed off. They only want to talk to their friends. But if you practice this curiosity, it becomes a normal part of your relationship. That’s a really cool tool. So you have believe lived experience, ask secondary questions.

Understanding Sensory Experiences in Anxiety

And then the third thing, think we really need to pay more attention to people’s sensory experiences. And what I mean by that is how the sensory environment impacts how our nervous system regulates. And so don’t think we give that, I don’t think the majority of society gives that enough credit about how we can become sensory flooded very easily. Like imagine being an anxious teen in the school cafeteria where it’s loud where it’s echoing, where people are bumping into you, where you’re having to make a choice about what food you’re gonna put on your tray, where somebody’s gotta decide where to sit, where maybe you’re thinking about the test you have next period, you just get inundated with sound and noise and smells of the food and people bumping in and touching you, that can be so dysregulating. And so when we focus on sensory needs, we start to figure out the ways that we can soothe our nervous system through our environment.

And I think that’s super important because it can then, okay, do I need to wear headphones? Do I need to wait until the end of the period? Do I need to ask if I can go early because of my anxiety? Do I need to know that like, hey, there are certain classrooms that it’s easier for me to be in because it’s not as loud or rambunctious? Or I like being in the library because it’s so quiet and figuring out what those needs are that help us like soothe the nervous system through our sensory needs.

Okay, that’s super helpful. So paying attention to those sensory experiences. And when you said that, I’m glad you painted that picture for me because I was thinking, what’s a sensory experience? So, right, what you’re feeling, what you’re hearing, what you’re thinking, like looking around. Mm-hmm. Yeah. Sight, sound, smell, taste, and touch.

Yes. Okay, so I have a question and then I actually want to get back to your book because I want to learn all about it. I think teen anxiety is such a relevant and important topic that a lot of teens can relate to right now. And the people listening might say, yeah, that’s right, because that’s one of the top reasons they give us on why they’re choosing to try a substance instead of looking into a healthy coping strategy is there turning to this and like you said, it could be mental, like self harm or things like that, but I, this came to my mind and I don’t want to ignore it. Is there an appropriate way to ask someone if they have, something going on like that is diagnosed. And I ask this because I don’t think I’m trained on it. Whatever it is, do you know the answer to that?.

Navigating Conversations About Mental Health

I think the answer depends on the situation, on the environment, and what your relationship is to that person. I think if you just walk up to somebody and say, what’s your diagnosis? Would not be appropriate. But I would say if you’re in a mentorship role, or if you’re in some sort of connection with teens where you are providing support or resources, there are, so two thoughts at the same time. One is, I think as adults, If we aren’t saying the words, if we’re not talking about it, teens don’t know we’re safe to talk to about it. So if they’ve never heard me say autism or name it, if they’ve never heard me talk about anxiety, if I don’t straight up say to somebody self-harm, they may not know it’s okay for them to talk to me about it. So I think as adults, we need to be very clear with our language so that they know we’re safe people to talk to.

Now, if you’re asking somebody specifically what’s going on for them, like, I believe in self-disclosure. So I would often say to people like, you know, when I’m feeling anxious, I tend to think this, this, and this. Have you ever felt that way? Right? And so I’ve named it for me. I’ve described my experience. Have you ever felt similar? And depending on how well you know someone, could be like, you know, labels don’t really matter, but sometimes it’s helpful to like know what something falls under.

Like it doesn’t matter what anybody’s diagnosis is, I’m still gonna relate to them, I’m still gonna provide care and we’re gonna figure it out. Sometimes when we have a cluster of feelings or symptoms, it’s helpful to know what like a label or a grouping of it is called, because it helps us find resources faster. So if you happen to have one or you’re okay with sharing it or you ever end up getting one, that would be helpful for me, because it helps me connect resources to you faster.

Okay, that’s cool. That’s really helpful because I’m thinking of our listeners and they’re running youth prevention clubs and maybe they have a conference coming up or they bring in this experience or a speaker like us and they’re wanting to take care of their students really well and know that but sometimes if it’s a conference, let’s say, and we’re bringing in 100 to 300 students at a time and you know, maybe the first thing is we’re used to asking the question, on our survey, what are your dietary needs because we’re feeding them lunch. But maybe there’s another question to add because we want to be sensitive to those other things. And you’re getting excited. Tell me what you’re thinking right now.

Creating Inclusive Environments for Youth

Oh my God, I love that question. Going along with what are your dietary needs, I would ask what are your sensory needs? Do you need, like if you’re running a conference, do you need to have a sensory breakout room or a quiet room that if somebody’s overwhelmed, if you’re in a 300 person lecture hall and you’re giving this big thing and everybody’s getting excited, what if I need to set out? Because I’m having a panic attack or I’m overwhelmed or I’m sensory overstimulated. Having a separate room that somebody could step out.

Because with that questionnaire too, you can ask about like disability needs. Does somebody need access with a wheelchair or with like another walking device? Does somebody need to wear headphones and need to know that it’s okay that they can wear that? So if you’re asking the questions on your conference like questionnaire, that also gives permission, right? Even if it just says, will you be wearing headphones? Like, do you need to wear headphones? Do you need a sensory breakout room? Do you need a quiet room? Do we need space in the back that maybe the chairs are spaced further apart and they’re not right next to each other that also tells the person who’s filling out the form, if something does come up while I’m there, I know I can ask them because they know what it is.

Yeah. that’s, so this is super helpful. I think that there’s been people in my life that have started talking about this. And if you aren’t, if you aren’t familiar on why it’s important or what could happen otherwise is it can seem like, why would I go through all that trouble to add the extra room, add this? And I’ll just tell you.

It’s the difference between having an ambulance show up to your event because someone is having a panic attack, or at the very least, they don’t feel cared for at your event. right? Yeah. That could be or they just don’t go.

Any of those things would be, to me, that’s a good enough reason to ask your venue if you can set aside some space or adding an extra row of chairs set apart, like you had said, or offering earplugs or headphones or whatever that might be. And I’m thinking of camp experiences, right? Where we’ve taken youth to camps and had a clear policy because we want to get them off their phones and out of their headphones and stuff.

But I wasn’t really trained to check if they have any sensory needs though. It was just like, no, no headphones allowed. But now that we’re aware of it, if they’re like, I need my headphones, they’re putting up a fight, like I need them to fall asleep or I need them, you know, in these times is to being able to ask those questions. Like, Hey, is this something that you truly need because it’s how you operate at your best with sensory or it’s, it’s medical or whatever it would be. Give them a chance to advocate for themselves.

Yeah, and if you’re setting it up ahead of time, then it’s not the kid having to fight for their needs, but it’s that we’re meeting their needs before they have to fight, right? Because if it is a need that they use on a regular basis on their signup form or when they’re getting ready for camp, it’s gonna be added to that. I need my noise canceling headphones in the launch room. I need them. And you can set that up with the teams you’re serving. it’s like, we wanna be equitable more than equal.

Because if we’re equal, somebody gets left out. But if we’re equitable, and we want everybody to show up and be able to receive the service you’re providing, some people need headphones to block out the extra sound. Some people need to bring their fidget toys, and or need to be sketching and drawing in the conversation in order to attend and hear the information you’re sharing. That’s how we make it accessible for everybody.

That’s good. Not equal, excessive, equitable. Okay. I’m like, I need to write that down. That’s so good.

Yeah, yeah, yeah. Because equitable means that like in order for us all to meet the goal, we need different supports to get there, right? It’s very similar to like making sure you have a wheelchair ramp in order to get into a building. That is equitable for everyone to access that building. And so that is the same way for youth camp, for any presentations you’re doing, for a classroom to be able to, if we have a blanket rule that’s like, absolutely no fidget toys in class, no fidget spinners, like, but can I have my cube? Can I have something else to play with because I need something to keep my hands busy or I start tearing at my skin, right? Like what are our options? Let’s do the harm reduction route of giving them something to play with instead of picking at their nails to where they’re now they’re ripping their skin off, right? Like there’s better options.

That’s right. And that’s so caring. That’s so thoughtful. And it needs to become the norm. So I heard this loud and clear, like my takeaway as someone who puts on events that are Vive 18 events, we work at a lot of other people’s events too. But for ours is like, I’m adding that question to our survey right now. Like that is such a simple thing to do. I’m so happy to hear that. That makes me so excited.

Awesome. So Jamie, talk to me a little bit about your book. Let’s do this because we’re doing great on time. Let’s say we have five minutes to chat about your book and some takeaways, like some practical strategies maybe or ideas to help in anxiety from your book. Can you take us through a couple?

Mindfulness and Anxiety Management Strategies

Absolutely. So the book is broken into four, five chapters, four sections. One is on just like, yeah, like, let me look back. When did I write this? So it’s really focusing on like the mind body connection. So it teaches what is mindfulness. Let’s just start there. What is mindfulness? Mindfulness is being in the present moment. It’s being in the pre, it’s being in the here and now. So like being mindless is when you’re just doing things on autopilot and like you’re driving home and you’re like spaced out and you’re like, wow, I didn’t, how did I get home? I’m just on my, that’s mindless. You’re on autopilot. Mindful is being very present, taking in the colors, taking your surrounding, being able to be sensory present too. so we, mindfulness works really, really well with anxiety. And I often think that anxiety is a symptom as opposed to the primary issue. And so anxiety usually comes from something else either it’s coming from trauma. It’s coming from sensory overload. It’s coming from being dismissed or overlooked. It does authentically just originate in and of itself as well. But I think more often it is a symptom of other conditions.

So how do we understand what anxiety is? Where’s it coming from? What is it telling you? What are the stories that anxiety is creating? And so the mind body experience is bringing in that sensory piece that we’ve just been spending so much time talking about and has very specific sensory grounding tools and regulation tools how to connect back to your body, or if your body’s not feeling safe, how to then externalize what you’re feeling into it in a safe way. Then it goes into like shifting your thoughts. So if your brain is telling you a story, how can we know if this story is true or if this story is missing information and how to gain accurate information so we can redirect and switch our thinking? So one of the examples in here that I love the activities is using puppy language and so usually in our minds, we have a really harsh inner critic that like is really like beats down on us. Like you’re so lazy. Why can’t you do this? What’s wrong with you? But if your puppy is laying there, how would you talk to your puppy? If they’re being a little lazy butt, you’d be like, hey, lazy butt time to get up. Let’s go do the thing. Right. We will use a very different language talking to our puppy. So why aren’t we talking to ourselves the same way? So I think a lot of the time we’re given the example, well, would you say that to a friend?

And like, no, probably not. And sometimes that translates, sometimes it doesn’t, but like we’re talking to ourselves. And so it’s like, think teens might call this cringe and that’s okay. I’m gonna be cringe. Sometimes it’s okay to go to the other extreme. Like if we’re trying to be really cool and it’s like, well that’s cringe. I don’t wanna go that far. Like we’ll do an experiment. Like try it, see what happens. Like, so there’s a whole activity in there of translating some thoughts into puppy language so that people can start changing some of that like inner language that they might be having that influences some of their anxious thoughts.

I love that. And I love it. I love the illustration because what you just did is said, I’m going to do something that might be cringy. But here’s what I had this revelation this week is part of the reasons why our speaking program and our conferences are so fun is because we give people permission to fail and to do the cringe and to do the goofy and to let them be who they are. We need that mission. So if you start with yourself. You’re giving yourself this room to grow and it’s also permissing, like being permissive to other people to do that as well. So I love that you just did that.

Empowering Teens Through Playfulness and Self-Expression

Mm-hmm, absolutely. I think the sweet spot, especially for working with teens is finding a way to talk to them like adults and giving them space to play. You can be playful and silly and fun and have a really serious conversation at the same time. They are absolutely capable of both and they crave both. Yes, thank you. And then we talk about managing emotions. how to like, if you have a lot of emotions, how to let them out, whether that’s journaling or talking to somebody, or if you want to get them out through art, if you want to use music. So there’s an activity on creating playlists based on your emotional mood. Like maybe you want to really sit in your anger until you have an angry playlist, or maybe you have a separate playlist that’s like, I don’t want to be angry anymore. How do I get out of it? And so I work with teens of like creating different playlists for different moods or different vibes.

Yeah, everybody’s got their music everywhere. They’ve already got playlists going. It’s something they can share. It’s a really, actually, it’s a really fun activity with teenagers to say, that’s one of my favorite groups is, okay, we’re gonna talk about, we’re gonna talk about anger. I want everybody to send me in their favorite angry song. And they send it to me. And then I share it with the group anonymously. And we all listen to it together. And I might print out the lyrics even. And we all listen to this angry song of somebody in our group.

That’s so cool and so practical. I love it and then you just see everybody relating to it. And they’re like, I almost sent that song in. my God, I’m adding this one to my playlist. I really like this part. And then you receive validation that somebody else is relating to the song that connects to you. And you’re creating connection and cohesiveness in the group, creating belonging.

That’s good. And that’s such an important feeling that we all need.

Yeah, absolutely. And then it wraps up with challenging your behaviors. There are some behaviors that serve us. There are some behaviors we all want to change. And how do we identify what those are? Because there are some coping tools that they served us at one point and they no longer do. Right. And I think like that’s when I talk about like self-harm or that might be with substance use that at one time it served you. It served a purpose and it met a need that you had.

But that may not be the case anymore. That if we’re changing and shifting some things, we can find other coping skills or we can shift that because it worked before, does it mean it still works now? And how do we shift and find something different.

Challenging Behaviors and Finding New Coping Strategies

Yeah, that’s such an empowering message and, the realm of like recovery to not, not shame someone for a mistake they made. Like, Hey, I did this because I wanted to feel this way for a certain, I didn’t think about the future and how it could have fixed my problem, but I’ve made the mistake. And now you’re teaching them how to course correct and make a new decision and keep learning and growing instead of making them feel shame for a mistake that they had made. that’s very cool.

Exactly. Especially if there’s moments of relapse or if they like just step back into old life. Like, okay, let’s talk about why, what happened, what led you there, what purpose was that serving, what draw was it having? Okay, where do we want to go next? Of exactly how you said, not shaming, not judging, it is what it is, we’re here now. What are we going to do with that information?

Yeah. that’s so cool, Jamie. Well, we have reached the end of our time with you. I’ve had a ton of fun. yeah, I feel like I’ve got a new friend. So, your other friends listening to this podcast want to know more about your book or what you’re doing, where can they go?

Yeah, you can find mindfulness for teen anxiety anywhere books are sold. It is online everywhere. You can find me on all social media platforms at NeuroDivergent Therapist. And my practice is equilibrium counseling services in California. And yeah, I have training. If you’re a clinician and you’re listening, I have another company called NeuroPebble where I have trainings that teach clinicians about neurodiversity and how to set up your practice to be neurodiversity affirming.

That’s incredible. Awesome. Well, for everyone listening, this has been an episode with Jamie Roberts, and we hope that you feel empowered. We hope you got some good takeaways. I know I did. And even just learning what we can do, but then also some fun activities we can do with our students to help bring in this sense of belonging and acceptance and this sensory experience and mindfulness. So this has been super fun. We will see you all next Monday for another episode of the Drug Prevention Power Hour.