How to assess your child’s social ability part 2

eyesThis is part of the infant 360 degree appraisal series on social ability. This and the next few posts will give you information about how to assess social ability (from minimal to maximal) in children around the age of 3-5 years old (for short, I will refer to 4 year olds). Later on I will post on how you can help young children to develop their social skills.

Problems with social ability are currently rarely diagnosed in the pre-school period unless problems are severe. This is not because they do not exist but because adults, particularly parents are extremely obliging in making up for their child’s weaknesses, and aren’t aware of their difficulties. Even if a child is gibbering in Alien, you can bet, the parents know exactly what is being communicated and get quite grumpy when you infer that you have not a clue what they are trying to say. Play dates at home supervised by adults will involve parental supervision and intervention to assure that children “play fair”, “don’t leave people out”, “wait their turn”, “be nice”, and critically don’t beat each other into a pulp. If another child is “not nice” to your child, they are not invited back. Not so the school playground where your child will have to communicate with other children who are impatient, do not necessarily care to hear what your child has to say, have little incentive to include your child in games and may beat your child into a pulp if they find them annoying. I don’t care what any school says in their prospectus, teachers cannot be there at all times, and it is much wiser to ensure that your child has the social skills to survive! By educating parents to be more aware of their child’s social skills, weaknesses can be identified earlier, leading to interventions, better support and prevention of more difficult problems developing later on.

When people think about social ability, they tend to first think of the confident thespian, the extrovert lead in the school play. Often these people do have good social skills, but social skills are more than confidence, acting and oration. It is about ability to make lasting friendships, seek help, read emotions, understand social situations, adapt to new social environments and avoid trouble. All the skills required to “get on” with other people, the essence of social ability. If your child was assessed for a private school “assessment” at age 4 years, without a doubt one of the key components that they would have been making a selection on was social ability. A sociable child will get on with other children in the class, be easier to teach, cause less trouble and ultimately, make the school’s life a lot easier! These skills continue to be highly valued throughout life, and there is a reason that even into adulthood, we are asked to demonstrate our “people skills”, “ability to be a team player”, and “communication skills” in any career.

Before talking about how you can improve your child’s social skill, it is a good idea to think about assessing you child’s social skill. It may be that your child is extremely socially able and you have no need to do anything. Lucky you. But how do you judge this? Over the next few posts, I will detail here observations that can be made of social skills from the most basic to the fairly sophisticated levels of social skill.

Basic Social Skills

The most basic social skills are required in an interaction with a familiar adult. Most children aged 4 years should be able to interact easily and readily with a familiar adult. Many children with mild autism (de facto impaired social ability) can pass this level of interaction, as the familiar adult will be primed to be patient, can guess from experience what a child wants, is accepting and willing to invest in understanding the child, and letting them have their own way.

Spending time playing with your child and conversing with them can reveal if there are fundamental difficulties in social interaction. Some readily testable tasks are whether your child turns to face you if you call their name from behind them. Can your child ask you to pass something to them that they need? Can your child look you directly in the face when talking to you/ you are talking to them? Can your child smile at you? Can your child smile at you if you smile at them? Can your child spontaneously wave goodbye to you when you leave, shake their head to mean “no” and nod their head to mean “yes”? Can your child use gestures to show you how to do something (e.g. brush their teeth) without using an actual toothbrush? Can your child recognise facial expressions in picture books and tell you what they mean? Can your child point to show you something and check that you are looking at the right thing? Can your child make up a story? Can your child feed their teddy bears or make their dolls talk to each other? Can your child realise/ understand that other children may have different thoughts and preferences to them? Can your child copy what you do?

Most typically developing children can definitely do all of these things by the age of 4 years. Clinicians are looking for the presence or absence of ability in all the above (and many other things) in a typical autism assessment in 4 year olds with typical development.  They may sound like an arbitrary list of things to look out for, but they are amongst the basic building blocks necessary in developing sophisticated social ability.

If you do not have a preference for looking at people’s faces, particularly their eyes, which are usually the most expressive, you will fail to pick up all the social nuances in expression that a person is communicating (see part 1). “You idiot” said with angry eyes will mean something different to “You idiot” accompanied by a glint in the eye. If you are not looking at a person’s face/ eyes, you cannot infer intention and you are liable to misunderstanding. If your child does not naturally pick up common social conventions (smiling at people, nodding and shaking the head, waving) they will have more difficulty understanding what is going on as social conventions are so frequently used in communicating with others instead of speech. Think how awkward you feel when travelling to a foreign country where all the social conventions are different (bowing in the Far East, not using your left hand in India). Your actions may be misinterpreted by others and it will affect how you get on socially. If your child has difficulty understanding that others may have different thoughts, they may not act in consideration of other people. If they cannot understand facial expression, they cannot infer how someone else is feeling and act accordingly. If they cannot ask for something to be passed to them, they may have difficulty communicating their other needs in an appropriate way. If they do not naturally copy you and what you are doing, they are missing out on the most frequent method children naturally have to acquire social skill, by emulating their parents and other adults around them.

If your 4 year old child is struggling with all/ most of the above, it would be worth considering the 4 main possible reasons that a child psychiatrist would consider: hearing impairment, speech and language problems, learning difficulty and autistic spectrum disorder.

Intermediate social skill

Interacting with an unfamiliar adult takes more social skill than interacting with a familiar adult as an unfamiliar/ less familiar adult will not know or understand the idiosyncrasies of a child’s communication. For instance, when Big Sis was two, she loved to watch a music DVD called “Fun song factory” (which incidentally starred a pre-fame member of JLS). She was at the time unable to enunciate “Fun song factory”, but called it “Bun song Bactery”, or just “Bactery”. One time, when my mother was looking after her, she repeatedly stated that she wanted “Bactery”. My mother was at a loss at what she was talking about and it led to a lot of frustration on both sides. Indeed, my mother strangely concluded that she was talking about the “lavatory” (rather advanced vocabulary for this age group) and whisked her nappy off and plonked her on the lav. Needless to say, Big Sis was not amused. Eventually, my mother called me and I immediately knew what she wanted. Thus interaction with an unfamiliar/ less familiar adult pushes the need for better communication skills to avoid frustration.

In clinical practice, we often see parents that are so good at compensating for their children’s weaknesses that they cannot see that their children have pretty severe impairment. They get very upset when teachers report difficulties at school and blame the teachers, but the reality is that the level of ability required to interact with an unfamiliar adult is more challenging than interacting with a familiar one. If your child has consistent difficulties interacting with a kind and supportive teacher, the chances are, they will have difficulties interacting with many other people and are likely to have weaknesses in social ability.

Interaction with unfamiliar adults can be observed easily. Leave your children with a trustworthy friend whom they do not know well and see how they behave. How well your child is able to communicate what they want can be observed (child psychiatrists and psychologists would do this crammed behind the one-way mirror in our clinics, but you can do this by poking your head quietly into the room or hiding behind a door left slightly ajar) and you can extrapolate their behaviour in this situation to their likely interaction with their new teacher (an unfamiliar adult). If you want to challenge your child’s social skill a bit more, you can ask the adult to occasionally disagree with the child, or to deliberately thwart them (e.g. accidentally knock down the tower they were building), or try to contribute a different idea to the game they are playing and see how your child responds.  If this is all a bit too Cold War, just ask your new babysitter how they got on and garner as much intel from this as you can.

In addition to communicating needs and wants, in this scenario, a socially able child would understand that they will need to behave better than they do with a parent or a familiar adult, this is called “social inhibition”. Even if your children are naturally boisterous and cheeky to you or their grandparents, they should be inhibited by someone they know less well. This natural recognition of social context, the awareness that something is different about this social environment and the appropriate way to respond is part of a child’s natural social ability (whether they are able to sustain behaviour is a different matter). Most children are able to behave well and interact with an unfamiliar adult even at age 4 years for a short time at least, which is why even hyperactive children can behave well when they visit the doctor’s clinic much to the chagrin of their parents who have spent the entire time talking about the child’s inability to sit still. More worrying is the child that is over-familiar with strangers, and goes straight up to cuddle and sit on the lap of a stranger, not only as this has implications for vulnerability to abuse, but as here it is clear that they are unable to pick up the difference in social environment and expectation naturally.

The types of difficulties in social interaction which we professionals would be looking out for fall broadly into the following categories:

1) Aloof – a child with no interest in social interaction. They neither initiate social interaction nor engage in interaction when it is initiated by others.

2) Passive – a child who will engage in some social interaction, but will not initiate it.

3) Active but odd – a child who both initiates and engages in social interaction but does it in an odd or inappropriate way (such as the disinhibited, over-familiar manner described above).

A caveat to this interaction as a means of assessing social skill is the confounding factor of anxiety and security. I will discuss these issues at greater length in another post, but needless to say that if your child has difficulty separating from you or is anxious in new situations and with new people, you will not be able to get a clear picture of their social ability using this type of observation.

Brownie points if your children are well behaved, appropriate, polite and obliging with an unfamiliar adult. Extra, extra brownie points if they are also engaging, interactive and interested. They will have no problems with interacting and communicating with their teachers and in the structured environment of the classroom. However, it is easier for children to interact with adults. Many children with autism are able to interact with adults. This is as adults are generally nice to children and will make allowances for children, will have the ability to guess what a child wants, give in to what a child wants and are generally predictable and sensible. Higher levels of social ability are required in interacting with other children; the basis of next week’s post.

Organisational hell – what to pack in a travel handbag

bag6

I heard about Cath Kidston’s #totesbig/totessmall campaign and laughed, surely for all parents it’s #totesbig? Mine’s this fetching strong and waterproof Longchamp number.

Carrying large quantities of “vital” stuff around with you all day has never been quite so important as when you have kids in tow. The ante on organisation is raised on having children, purely because logistically, there is so much more that is required to be remembered and carried with you at all times in preparation for all eventualities. We all have a “very organised friend”. Someone who is always on time, never forgets anything and prepares for everything. For me it’s my big sister. When baby Lil Bro yakked up lunch all over himself, and I had not brought a spare baby-gro, who should pull one out of her handbag? Apparently a spare, even though her child no longer wore baby-gros. When we went on a weekend break with the extended family and I forgot to pack towels, who produced a whole spare extra set which she had packed “In case”? Yup, my darling sister. Indeed, whenever I go anywhere with her, I can rest on my laurels as I know that if I have forgotten anything, she will be sure to have “spares”. Thank goodness!

Although I have moments of organisational inspiration (packing a volcano making kit in my suitcase on a holiday to Sicily so I could teach the kids about volcanoes in-situ), at other times I  am pitiful. For instance,  when Lil bro was a baby I remember joyfully pushing the buggy to my mother-and-baby yoga class in Primrose Hill thinking that I was on time for once, but actually having forgotten the entire meticulously packed Cath Kidston baby changing bag on the table at home. Thankfully, what I lack in organisation, I make up for in practical, can-do attitude. I didn’t miss my yoga class, I just popped into a newsagent. I got some funny looks from the skinny and beautiful Gwyneth types that frequent Triyoga Primrose Hill with their yummy-mummy nappy changing bags, matching cashmere blankets, Sophie giraffes and  wooden rattles when I rocked up with nothing for my baby save a 34-for the price of 30 jumbo pack of nappies and a pack of Johnsons’ wet wipes. Well, what more do you need – eh?

At the start of this summer though, I thought that given that I am now a blogger and passing on my worldly (ahem) views on all things parenting, I would write an illuminating blog about all the things “one” should carry in their totes when travelling with young children on holiday. Here is my list:

Sustenance:

Bottled water (I know it’s heavy, but always comes in handy)

Snack (usually of the pre-packaged biscuit/ chocolate variety – but on a good organisational skill day, a pair of satsumas)

Sun protection:

Bag Sun

Like all good doctors, I espouse the sin of sun worshipping, although a little dose here and there to relieve vitamin D deficiency doesn’t do any harm. Still always best to carry sun hats, sun glasses and sun screen with you at all times over the summer hols. A warm waterproof top is meticulously tied around the waist of each child should the weather take a turn (Brits will understand this!).

Activities:

Bag lo-tech

My kids (like most) are terribly impatient in restaurants, and will not stop asking “When’s the food coming?” as if I have personal telepathy with the kitchens. For distraction purposes, I have found it well worth my while to carry sticker books around with me at all times. In addition, fully equipped pencil cases as pencils and coloured pens can be transformed into any activity: drawing, colouring, noughts and crosses, the shape game (where one person draws a random shape and the other turns it into a picture of something) , pass the portrait (where one person draws a head on a picture, folds it over and passes it to the next person to draw the upper body, then passes it on etc.) and an endless possibility of other games. If we visit a landmark (like a cathedral) or an art gallery, the children will always be asked to draw what they see as  this really makes children look carefully, observe and remember what they have seen.  I carry 2 of everything because do you think it is possible that they could share? It’s not worth the grey hair.

Kid-proof Tech:

Bag tech

I know that most people just let their kids use their iphones or ipads, but I am of the old school who fuss and worry about tech getting broken. It comes from my dad’s indoctrination of us in childhood over the perils of biscuit crumbs and spilled milk on the Commodore 64 such that anyone holding food or drink was not allowed within a 3 metre radius of “the expensive computer”. I carry cheap his-and-hers cameras with me to give to the kids to take photos as part of a game or just to see what they find interesting. Looking over pictures they have taken at the end of a day trip is always fun, particularly when you find that the beautiful city of Rouen you visited had nothing more worthy of photographing than a mannequin in a shop front…

IMAG0010

The children got “kiddigos” (hand held TV/ games console for little ones) for Christmas last year. As exposure is strictly rationed, the effect of producing the kiddigo is dramatic. The kids are only allowed to use them for the last hour of a long (3+ hours) car journey if they “have been good” during the earlier parts of the journey, and it’s really amazing how well the constant threat of losing the screen time can keep the kids at bay.

So, with all this “well prepared vital stuff” being carted with me everywhere on holiday, you can imagine what a peaceful time we had. It was all going wonderfully smoothly, with hardly a hiccup of “Are we there yet?” or wails of boredom and running up and down in restaurants, until a day trip to the Citadel at Carcassone. We exited the Castle to go home. “I need the toilet” one of them said. “No problem, I’ll take you” I said. Only to find, it was a number 2 of diarrhea proportions. Only to find there was no loo paper in the ladies or the gents. I looked in both.

Despite having a variety of splendid craft and technological activities in my bag and enough sun protection to keep a Scotsman from burning in a dessert, there was no tissue or wet-wipe to be found.

Having unsuccessfully attempted  to use pages of the sticker book as toilet paper, it was  – OH CRAP – literally.

Well, as I said, what I lack in organisational skill, I make up for in can-do attitude.

Maternal hand it was….

Where was my big sister when I needed her?!

How anxiety in pregnancy can lead to anxious children

Fire engine

This is the last of the How to improve your child’s success before they are even born series. See Part 1, Part 2 and Part 3. OK, its pretty heavy going on the science, but if you really want to understand anxiety then its worth a read.

Most people are aware that stress and anxiety are not good for pregnant mothers. Even in 400 B.C., Hippocrates espoused the influence of emotions on pregnancy outcomes, leading to a plethora of literary dramas old and new where stress has caused the leading lady to miscarry or go into premature labour. More recently though, following Barker’s theories of foetal adaptation to the mother’s womb environment (see my post How to improve your child’s success before they are even born: Part 3), scientists have found that a mother’s anxiety in pregnancy can influence psychological and behavioural outcomes of her developing foetus over and above those caused by premature delivery.  There is now a well-established literature base linking mother’s anxiety in pregnancy to several psychological and psychiatric outcomes in children, including: anxiety, attention deficit hyperactivity disorder (ADHD), cognitive problems, changes in temperament, aggression, conduct problems and even schizophrenia (Beydoun & Saftlas, 2008; Talge et al. 2007; Van den Bergh et al., 2005).

 

Animals stressed in pregnancy give birth to anxious baby animals

The first evidence for this came from animal studies. Researchers found that rats and monkeys exposed to stress in pregnancy produced offspring that had long-term difficulties with attention, motor behaviour, aggression, memory and showed “hyper-vigilant behaviour” (Van den Bergh et al., 2005). Hyper-vigilant behaviour in animals is a proxy for human anxiety. It incorporates being alert to potential threat with corresponding changes in body systems to prepare to respond to threat. Think about how you would have felt travelling to work on the underground the day after the 7/7 London bombings of 2005, and this is probably a good picture of human “hyper-vigilant” state. Darting eyes on the look-out for suspicious bags with no owner, or people with over-sized back packs, slight tension in muscles, slightly increased heart rate and breathing rate, a little bit more perspiration than usual and if someone were to pop a balloon behind you, you’d probably have been ready to run. Hyper-vigilance is a good thing if you are in a stressful situation. It has served me well on many a walk home from the night-bus stop. If you are continually hyper-vigilant or hyper-vigilant in non-threatening situations like social situations or on aeroplanes; it can be very problematic and is called “anxiety”.

In animals it is easy to experiment and find out what is happening, you can wire animals up to measure muscle tension, heart rates and perspiration fairly unobtrusively. Even better, you can take blood samples and measure the levels of “stress hormone” cortisol. By doing these experiments, scientists have been studying the various effects of maternal stress on animal offspring and among several suspected effects, they have found pretty conclusively that in animals stress in pregnancy causes changes in the development of the foetal stress regulation system, the Hypothalamic-Pituitary-Axis (HPA) re-setting it to be on heightened alert.

 

How does the body deal with stress? What goes wrong to cause anxiety? – an analogy

What is the HPA-axis? The HPA axis is a collection of parts of the body that communicate by hormones to regulate certain bodily responses, including the stress response. In its function to regulate stress-response, it works pretty much like the emergency fire service. When you see a fire, you pick up the phone and dial 999. This puts you through to a national call centre, where you are asked which emergency service you would like. Once they realise that it is the fire service you need, they contact the regional fire control centre which contacts your local fire brigade which sends out an engine to where you are. The firemen hopefully put out the fire and call back the fire brigade centre to report that the job is done, which then feeds this information back regionally so that the case can be closed. Alternatively, if the fire has gotten out of hand, they can report regionally or nationally depending on the extent of the fire to request more engines to help.

The hypothalamus (a region in the brain) is the national call centre. When the eyes see threat, they alert the hypothalamus. This lets the brain’s pituitary gland, (regional fire control centre) know that there is a threat and a stress response is required. The pituitary communicates with the kidneys (local fire brigade), which then provides the stress response: the steroid hormone cortisol (fire engine). The fire engine goes out to sort the problem. Cortisol does this by going to the heart and making it pump harder, it goes to the lungs and makes it breathe quicker, it goes to the sweat glands and makes them produce sweat, it goes to the muscles and makes them tense and ready for action. All so that you can either fight or flee the threat.

If a city undergoes a heat wave and there is an increased propensity to fires starting and burning out of control. The fire service would probably request more resources on standby and be on heightened alert to send out more engines. More engines than needed might be sent out to small fires to ensure that they did not catch and turn into large fires. This is precautionary and helpful in the short term, but is an over-reaction if continued long term, beyond the time of realistic threat. The same thing happens to our body’s emergency response system. If there is a history of heightened stress, the body responds by increasing the base level of cortisol in the blood stream and increasing the amount of cortisol released in response to stress. This is not a problem if there is continued threat, but if the situation calms down and the body does not down regulate its stress-response system, the result is persistent anxiety.

In animals at least, it has been shown that the animals themselves do not need to have been exposed to stress for their bodies to be placed on heightened alert, they merely have to be exposed to their mother’s heightened alert system in the womb. Thus in animal experiments, giving pregnant mothers injections of cortisol equivalent substances can cause their children to have higher base levels of cortisol and heightened cortisol response when they are born and with continued effect into adult life (Van den Bergh et al., 2005). These animals went on to display a range of long-term behavioural and cognitive impairments. This can be thought of as part of Barker’s hypothesized foetal programming whereby the foetus exposed to high levels of maternal stress hormone predicts a hostile environment and prepares itself by adapting its HPA-axis to best cope with impending fight for survival. Where the resulting environment is actually not that stressful; the HPA-axis is now not working properly and leads to a range of problems.

 

Who cares about animals? What about humans?

Stressing humans to study anxiety is rather unethical. Shockingly, it used to be allowed and “Little Albert” is a classic case in psychology literature. Little Albert was a 9 month old boy who was not afraid of rats and was given a rat to play with. A dastardly psychologist John B. Watson wanted to see if it was possible to cause a phobia of rats. Every time little Albert touched the rat, a man stood behind him and banged a piece of metal with a hammer making a loud noise scaring little Albert. Needless to say, after a while of this, Albert became afraid of rats and stopped going near them, proving it is possible to induce a phobia[1]. No wonder experimental psychology has a bad name!

These days, we are thankfully not allowed to do such things, but it does mean that extrapolating work from animal studies into humans is harder. We have to rely on stress that occurs naturally in the lives of pregnant women rather than purposefully causing stress in order to study its effects on offspring. Natural and man-made disasters have been used to study the effects of anxiety in pregnancy.

Studies of children who were in the womb of mothers affected by 9/11 showed that these children were born with lower birth weights even though they were born at term, compared to children conceived following 9/11 (Berkowitz et al., 2003). Infants whose mothers were pregnant during the 1998 Canadian ice storm that led to electricity and water shortages for up to 5 weeks scored lower on mental development indices and tests of language development compared to other children, even after taking into account birth complications, birth weight, prematurity and post-natal depression (La Plante et al., 2004).

It is not just extreme stress such as a national disaster that can cause effects. Studies have also used questionnaires asking pregnant mothers about their levels of stress at varying times in their pregnancy and then studied their children at varying ages from newborn to adolescence. In general the link between maternal stress and impaired offspring outcome is borne out, sometimes even with a direct dose-response effect[2] (Beydoun & Saftlas, 2008; Talge et al. 2007; Van den Bergh et al., 2005). Results from different studies vary as each study is different in terms of the stress they are measuring (some studies ask for work stress, bereavement, marital stress, criticism from partners, or just how anxious you feel), the time in pregnancy the stress occurs (studies vary in studying stress in the first, second or third trimester), and the outcome and age of children they are studying (some studies look at language and development in the first year, others look at ADHD symptoms in childhood and yet others look for anxiety and conduct problems in adolescence). Despite this, the majority consensus of all the studies is that there is a significant negative effect of maternal pre-natal anxiety which can have lasting effect. In this way, it is not just your DNA that is biologically influencing your child’s outcome, but environment, via biological mechanisms.This is epigenetics, the new buzz in child psychiatry research.

 

Interesting finer details

The theory regarding differences in timing effects is that this relates to timing of brain development. Throughout pregnancy the developing foetal brain goes from a neural tube to a baby’s brain which is a complicated journey. Different parts of the brain are forming throughout the 40 weeks, and the effects of insult to the brain at a particular period in pregnancy will depend on the part of the brain that is forming at that time. So for instance, a brain insult (such as anxiety) occurring at the time that the language centres in the brain are forming may lead to language deficits down the line.  It is known that the links between pre-natal anxiety and schizophrenia are related only to stress that occurs in the first trimester (Khashan et al., 2008), whilst maternal anxiety experienced in the third trimester is more likely to cause offspring anxiety (O’Connor et al., 2002). Even more interestingly, there appear to be differential effects depending on the gender of the developing foetus, females more likely to develop anxiety, males more likely to be affected by attention, cognitive problems and aggressive tendencies! There is strong evidence for this in animal models and supportive evidence for this from human studies (Glover 2011; Glover & Hill, 2012)

The reason for these different gender outcomes has been thought about from an evolutionary perspective. Historically the female role in species survival in animals and humans has been to bear children and look after them, the male role has been to protect and provide resources. Different skills are required for these different roles. Thus, in a hostile environment, it pays for the mother to be fertile to ensure succession and hyper-vigilant to prey and threat. It pays for the father to go and explore new territory for food and shelter, to take risks to achieve this and to be aggressive enough to fight others for territory and food. In this context, the effect of stress in generating anxiety in females and cognitive impairment and aggression in males can be understood. Hey, in an Armageddon situation I think we would all want rough and tough Bruce Willis at our side not intellectual Stephen Fry.

In animal models it has also been found that stressed out female rats reach sexual maturity earlier, are sexually active earlier, have more offspring but invest less time in the care of each (Meaney, 2007). We have to remember we are talking about rats here, but in humans there is evidence that a harsh early environment (poverty, neglect, abuse) can lead to precocious puberty. You can draw any other rat-human parallels yourself.

The astute amongst you, might be complaining that this is all hogwash and that so many things might be confounding the picture. A confounder is something that can be related to both the purported cause and the outcome. The main ones affecting our current scenario are things like poverty, post-natal depression and maternal educational level. One could argue that a deprived, uneducated mother prone to depression is more likely to experience stress during pregnancy and more likely to have difficulty raising children, thereby causing the psychological deficits seen in their offspring in childhood and adolescence. In animal studies, this is easy to exclude, the new born pups or monkeys are cross fostered so that the mother stressed in pregnancy is replaced once the baby is born by an unstressed mother. Results remain. It is not possible to do this with humans.

In the majority of human studies, known and suspected confounders (social class, post-natal depression, maternal education to name a few) were measured and significant results remained even when these confounders were taken into account. What about the effect of genetics? It is possible to argue that a mother genetically predisposed to anxiety is likely to be anxious in pregnancy and to pass on anxiety genes thereby causing offspring to be anxious. You can see how hard it is to prove anything in science, yet clever research designs continue to come up to try and get to the answers. In a master-stroke of research design now possible due to the frequency of in-vitro fertilisation, Rice (2010) compared, in a cohort of IVF children, the association between prenatal stress and child outcome in those who were genetically related to the mother with those who were not (i.e. receiving egg donation). They found there was an association between mother’s stress in pregnancy and child’s symptoms of anxiety and conduct disorder even in the unrelated mothers.

 

How does this relate to you and me?

So, how to prevent anxiety in pregnancy? For me, I was smug reaching pregnancy having achieved a stable, loving relationship, stable financial and employment situation and having lived child-free life to the full. I felt I was ready to face pregnancy and motherhood in the best position that I could be in to avoid anxiety. There would have been nothing to stop a loved one being run over by a bus or being faced with infertility problems or illness but, at least the readily controllable variables were answered for.

Things can’t always go as planned though! Typical of most pregnant ladies, the thought of a new bald addition to the family somehow provokes the mental image of bald addition being placed into a beautiful, white cot with pressed linen sheets in a light and bright nursery attached to a south-facing home with wooden floors, modern furniture and period features. Hence in the first trimester of pregnancy Banker and I embarked on a 10 month process of flat hunting, flat offers, flat rejections, flat offer accepted, flat exchange of contracts, flat completion delay, eviction from rental and 2 weeks of homelessness, worldly goods in storage and 2 week enforced holiday in France to avoid sleeping on the street, flat completion, moving in, moving out, flat total remodelling and renovation, all of which no doubt sent the cortisol flying through my placenta!

Here biology and scientific literature come to the rescue again. Thankfully, like all natural miracles, the pregnant body seems to do all it can to protect itself and its prize. It is well known that in the third trimester of pregnancy and for a period post-natally the body dumbs itself right down (Henry & Rendell, 2007). Having for many years prized myself on my amazing memory and lauded it over my husband who seems to have been born with the happy disposition of the forgetful, I became just the same. Misplacing things left, right and centre, but instead of fretting and panicking, just sitting back and saying “Ah, sod it”. During my last week at work, I merrily typed away at a patient’s report only to re-read it to find that it was gobbledegook! Evolutionarily this dumbing down particularly affecting memory impairment is likely to protect against the harmful effects of third trimester anxiety, as well as to help block out the trauma of childbirth so that we become willing victims for another round!

Further, there was a caveat in the maternal anxiety literature! In a review of the literature, Vivette Glover (2011), a fellow North West London resident, describes studies selecting only well-off middle to upper class women in stable circumstances. They found that in this group mild stress in pregnancy had a beneficial influence on child outcome with better mental and physical development of the children and a similar trend for IQ. The suggestion is that in this group of women, a small amount of pre-natal stress may actually enhance foetal brain development. This inverted-U shaped dose-response effect is typical of anxiety and you will be familiar with the idea that a small amount of anxiety helps you sharpen your attention to perform on stage or in an exam, but too much anxiety can cripple your efforts. If Big Sis wins the Nobel Prize, I’ll be remembering to send a bottle of bubbly to my builders for the aptly timed “mild” stress!

References and Influences:

Beydoun H, Saftlas AF. Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence (2008). Paediatric and Perinatal Epidemiology, 22, 438–466.

Talge, N.M., Neal, C., Glover, V. and the Early Stress, Translational Research and Prevention Science Network: Fetal and Neonatal Experience on Child and Adolescent Mental Health (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal of Child Psychology and Psychiatry, 48, 245–261.

Van den Bergh, B.R.H., Mulder, E.J.H., Mennesa, M. & Glover, V. (2005). Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neuroscience and Biobehavioral Reviews, 29, 237–258.

Berkowitz, G.S., Wolff, M.S., Janevic, T.M., Holzman,I.R., Yehuda, R., & Landrigan, P.J. (2003). The World Trade Center disaster and intrauterine growth restriction. Journal of the American Medical Association, 290, 595–596.

LaPlante, D. P., Barr, R.G., Brunet, A., Du Fort, G.G., Meaney, M.J., Saucier, J.F., Zelazo, P.R., & King, S. (2004). Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatric Research, 56, 400–410.

Khashan, A.S., Abel, K.M., McNamee, R., Pedersen, M.G.,Webb, R.T., Baker, P.N., et al. (2008). Higher risk of offspring schizophrenia following antenatal maternal exposure to severe adverse life events. Archives of General Psychiatry, 65, 146–152.

O’Connor, T.G., Heron, J., Golding, J., Beveridge, M., & Glover, V. (2002b). Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. British Journal of Psychiatry, 180, 502–508.

Glover, V. (2011). Annual Research Review: Prenatal stress and the origins of psychopathology: an evolutionary perspective. Journal of Child Psychology and Psychiatry 52, p 356–367.

Glover, V. & Hill, J. (2012). Sex differences in the programming effects of prenatal stress on psychopathology and stress responses: An evolutionary perspective. Physiology & Behavior 106 (2012) 736–740.

Meaney, M.J. (2007). Environmental programming of phenotypic diversity in female reproductive strategies. Advances in Genetics, 59, 173–215.

Rice, F., Harold, G.T., Boivin, J., van den Bree, M., Hay, D.F., & Thapar, A. (2010). The links between prenatal stress and offspring development and psychopathology: Disentangling environmental and inherited influences. Psychological Medicine, 40, 335–345.

Henry, J.D. & Rendell, P.G. (2007). A review of the impact of pregnancy on memory function. Journal of clinical and experimental neuropsychology, 29 (8), 793–803.

[1] Interestingly, there appears to be an evolutionarily hard-wired biological predisposition to phobia development to things which are traditionally harmful. Thus, it is easy to induce a phobia for things like rodents, snakes and spiders but very difficult to induce a phobia to cars, guns and knives which are more likely to be a threat in the modern age.

[2] A dose-response effect is an effect whereby the greater dose of something purported to cause a particular effect, will cause a greater effect. For example, if sun exposure is linked to tanned skin, a dose response effect would mean that more sun exposure leads to a deeper tan. Finding a dose-response effect is good (but not necessarily definitive) evidence that a causal link exists.

Goodbye Babies

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I can’t believe that Lil Bro is starting school next week.

The sleepless nights, the wiping up of bodily solids and fluids, the sleepless nights, the heaving up and down, the sleepless nights, the pushing here and there, the sleepless nights, the feeding and bathing, the sleepless nights, the changing into clothes and out of clothes, days are over. He can do all that by himself now, which has all led to this point: his departure in to the big wide world. Ok, so its only reception, but if what happened with Big Sis repeats itself, I am sure that as he turns to wave goodbye to go into his class I will get a glimpse of his future teenage self, waving a goodbye to leave home forever. That split second transformed into a movie slow-motion. That’s why I’ll be packing the hankies.

Parents up and down the country are laying out crisp, clean uniforms and ironing or stitching on names, and wondering where did that strange, squashy, floppy, bundle get to? How did ‘it’ possibly become someone that was going to inhabit these long trousers and enormous shoes? And the cheekiness of time to cheat you into thinking at times “Oh my God, my life is over, this is never going to end”; when in fact, it’s gone in a blink of an eye. You have become that annoying “well-meaning friend” whose eyes you wanted to scratch out as they told you “They grow so quickly, you must enjoy this time”, as you jiggled, bounced and paced around in your puke-stained pyjamas –turned-acceptable-day-wear, willing your baby to sleep. You look back with rose tinted glasses at those times. You remember those tiny, fat, irresistibly kissable feet that smelt of talc (rather than the smelly, sweaty, verruca prone ballet/ football feet they have become), and the little hands that reached upwards to be enfolded in yours and the clear eyes that looked at yours with nothing but innocence and love. It wasn’t so bad, the crying wasn’t so loud, the poo wasn’t that disgusting; you are now accustomed to a messy house and sleep deprivation anyway.

This, my friend is about the time that you absolutely need to reach for your contraception….!

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biscuits

What’s Cooking?

biscuits

Big Sis, Lil Bro and I have been doing a lot of cooking over the summer.

Both Banker and I love cooking and food. So, it is no surprise that we would want to share this with the kids. Banker likes his meat and fire, and has recently developed a craziness about bread. I like my cakes and puds. This division of labour is not a matter of happy circumstance, but a compromise between two bossy cooks who have now become highly territorial over their area of expertise. Lest Banker ever attempt another foray into the tarte tatin area, there will be full out war (his was way under-caramelised anyway).

My own love of food came straight from my mother, a talented cook of Chinese cuisine; she would taste something at a restaurant and then set about trying to replicate it at home from the memory of the flavours. Sadly this meant that we had no cook books whatsoever at home; my mother cooked fabulously on intuition. The smells of Taiwanese beef noodle soups, sesame broiled chicken and New Year cakes deep fried in batter always filled our home. I watched her cooking from a young age, and dumpling making was a family affair. Sadly though, I lack her flair and am woe-fully recipe bound in my own practice. In contrast to my mother’s still total vacuum of recipe books, my household has over-flowing shelves of them and they are always attempting to colonise tables and floors. I can remember from early childhood pouring over cook books from the local library. Although I was brought up on my mother’s excellent Chinese cuisine, it was Western puds that I craved: warm sticky-toffee pudding with ice-cream, brandy-laced chocolate mousse, apple-pie with vanilla flecked custard. The Chinese lack the key ingredients of cream and chocolate for desserts. Although I will be the first to stand up for red bean as a chocolate alternative, I cannot quite find a cream substitute and perhaps my love of dessert making arose from my cream-deprived childhood salivating over pictures of chocolate éclairs.

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It is from this background that cooking with the kids has become a staple weekend/ holiday activity. It is great fun to cook with kids given the hands on mess-making that can be had; wonders of science and alchemy involved, satisfaction of making something from nothing and best of all the gobbling up at the end. If you are still sceptical, cooking involves mathematics (measuring and weighing, calculation if doubling or halving recipe ingredients to make more or less), chemistry (melting, dissolving, colloids, acids, boiling points and much more, especially if you attempt to make honeycomb), biology (nutrition, health), history (spices and the spice trade, origins of recipes), geography (where ingredients come from, food miles, farming practices), art (decorating cakes and plating up) and P.E. (try whipping a meringue by hand, and have you seen the size of a baker’s arms?). I cannot think of a more  enjoyable and educational activity for children. What other activity can awaken all 5 senses as well as stir the imagination?

Whats cooking

Yet why aren’t all parents doing this with their kids? It was a sorry state of affairs to see on Jamie Oliver’s TV program that British primary school children could not identify common vegetables such as a courgette and an aubergine. More depressing when you see excellent home cooks whipping up gorgeous food, but not having time to cook with their children, or for fear of the mess. Why don’t they pass on their passion? I know that in my generation of women, there are some that deliberately avoided learning to cook. “Home Economics” as it was then called at school, was a subject reserved for the non-academic; a “wood-work” equivalent for the girls on track to early motherhood and a life of domesticity. High-flying women feared that their ability to cook would mean enslavement to the kitchen; but personally, I think they were cutting off their noses to spite their face. Not only is cooking a highly enjoyable creative outlet, but an essential life skill, and given the rise in obesity levels, knowledge about food, healthy eating and cooking may save your and your children’s lives, and everyone should be taught to cook. A friend of mine has a lovely little business teaching little ones about food if you need inspiration.

Of course nowadays, food has had a reinvention and young men and women have become passionate about food and there has been a renaissance of fine eating in London. The depressing thing though is that I don’t think that it has filtered down to children. Although Jamie Oliver has done a sterling job in highlighting the atrocities of school dinners, what about the stuff we are serving to kids at home? I have found that many parents, even foodies (myself included at times), cook separate meals for their children (invariably pasta or chicken based); then sit down for their own dinner of something much more interesting. Children’s menus at restaurants dare not stray from spag bol and chicken nuggets; and yet how are children to learn of new flavours and textures? Worse still, the London restaurants serving the most interesting food discourage children, either by snooty staff/ clientele with intolerance for children, or sky high prices. Not so in other countries. In the Far East, eating is a family affair and for Dim Sum in Hong Kong, you’d be hard pressed to find a table for two. Dining is without exception en famille, with everyone sharing the same interesting food on a massive table laid to the brim served by a lazy Susan. Closer to home, on a recent trip to France, Big Sis and Lil Bro tried veal’s head truffle, cuttle fish balls and petit pois ice cream for dinner from a 12 Euro Menu d’enfant at a 1 star Michelin Restaurant. That’s roughly the price of a Pizza Express pizza and ice cream. Why can’t we get this in London? Contrary to popular belief, children can develop an interesting palate with exposure and encouragement, Lil Bro totally enjoyed guzzling down snails in France, and although Big Sis is less adventurous, she has developed a taste for a variety of interesting cheeses.

I hope that the new found British enthusiasm for all things foodie can find its way to our children. Now that schools have done their part; isn’t it time parents and restaurants did the same?

***

For those wanting a quick and easy starter recipe that’s great for kids, here’s Big Sis’s step by step guide to our version of Nigella’s Rocky Road. So easy Big Sis can make it herself (almost), pretty much mess free and devilishly scrumptious.

1. Break up 300g of chocolate. We use dark chocolate (>70% cocoa solids) as it is less sweet, better quality and also as Lil Bro had a dairy allergy and now prefers dark chocolate.
RR1

2. Put into a bowl with 125g of butter.

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3. Melt the chocolate and butter together in the bowl over a pot of boiling water. (I’ve tried this part before in the microwave and it doesn’t work very well). If your butter was at room temperature, then you can actually get it to all melt together over a pot of boiling water from the kettle if you use a metal bowl, thus avoiding any requirement for an open flame for younger kids.

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4. Add 3 tablespoons of golden syrup to the chocolate and butter, or, we have also used honey and that also works well.

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5. Put 200g of biscuits in a plastic bag and bash it with a rolling pin. Kids love this. A mixture of crumbs and big bits is perfect. Nigella uses Rich Tea biscuits in her recipe, but we prefer digestives. You can also do ginger nuts or amaretti biscuits for a posher version.

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6. Pour half the chocolate mixture into another bowl and put to one side. Pour the biscuit bits into the remaining chocolate mixture and add 100g of marshmallows. Or, what we do is to add 70g of marshmallows then throw in 30g or so of other stuff, e.g. raisins, cranberries, brazil nuts, pistachios, almonds, orange zest, Turkish delight, smarties, fudge bits, salted cashews, white chocolate chips, desiccated coconut, coffee essence, vanilla essence – whatever takes you and your kids’ fancy.

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7. Mix up the goodies with the chocolate.

RR

8. Spread the mixture into a container. A foil container that you can easily bend open is best, but we never have them in the house when we need them. We have plenty of plastic boxes from takeaways and they work just as well. They also have lids so you can stack your boxes up in the fridge to save space as well as carry the rocky roads with you for picnics easily.

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9. Squash the mixture down with a spoon as much as possible, then pour over the remaining chocolate. Put it in the fridge to set.

10. Once set, cut into squares and sprinkle with icing sugar, or just gobble it up as is!

 

Eating rocky road

Why I hate raising boys

gender“Raising Boys”, and its sequel “Raising Girls” have been worldwide bestsellers for parenting author and psychologist Steve Biddulph. These books are about “differences” in girls and boys and how parents must adapt their parenting by their child’s gender. As I come from a family of girls, I keenly bought “Raising Boys” when Lil Bro came along. Yet, reading it made me wince and I didn’t even bother to get “Raising Girls”.

Why?

The indispensable mother

The notion of the indispensable mother is an example of the typical “Male authority figure tells largely female audience what they should be doing” parenting fodder of the past. Male anthropologists, male paediatricians, male psychologists, male psychiatrists all rushing to get their two-pennies bit in on how women should improve their maternal performance. Once women started to move towards professional work roles, the same male experts sought to keep women tied to their babies by citing pseudoscience to support the need of babies for their “mothers” as opposed to gender-neutral “parent”. Steve Biddulph (although he is by no means the worst culprit, as he at least tries to create a role for dads), is guilty of this by citing the specific requisite of maternal (over parental) presence in the early years of parenting in his book “Raising Boys”. A typical example of a phrase that gets my goat is this (page 11 of 3rd Edition):

“What all babies and toddlers need most is to form a special bond with at least one person. Usually this person is their mother. Partly because she is the one who is most willing and motivated, partly because she provides the milk, and partly because she tends to be cuddly, restful and soothing in her approach, a mother is usually the best equipped to provide what a baby needs. Her own hormones (especially prolactin, which is released into her bloodstream as she breastfeeds) prime her to want to be with her child and give it her full attention.”

Although I was motivated to be a good mother, I expect my husband was as motivated to be a good father and to form an equally strong “special bond” with our children. Much of the “willingness” and “motivation” to be a good mother (compared to father) is driven by guilt and social pressure, rather than being inherent or biologically mediated. Much of this guilt comes from the expectation to be “cuddly, restful with a soothing approach” perpetuated by books such as this. I’m not sure that Steve has encountered many modern mothers but “frazzled, shell-shocked and muddling through” are the more appropriate words that I would chose. He then tries to give scientific credence to his position by bringing in hormones. Even if prolactin were some magic love potion (which it isn’t), he probably doesn’t know that fathers and expectant fathers have increased prolactin concentrations compared to un-mated males (Nelson 2011) and clearly hasn’t seen the figures on the number of mothers that actually continue to breastfeed (<30% at 6 months).

There is no robust scientific evidence that maternal care is better than paternal care. Ben Goldacre aficionados will know that in order to robustly prove this, the scientific gold standard would be a blinded and controlled study with a very large sample size over time. i.e. following a large cohort of babies raised mainly by men and another raised mainly by women (matched for economic, educational and social factors) and then assessing the children blind to whether they were raised by mothers or fathers. Guess what? This has never been done, largely because there have never been a sufficient number of male primary childcarers. Even amongst widowers or male divorcees lucky enough to have full custody of their children, I am guessing that the majority remarry with stepmothers taking over the role of childcare, or some female relative swoops in like a fairy godmother to relieve “incompetent” men of their primary parental responsibilities. Naturalistic studies are only now becoming possible because of the advent of increasing numbers of same-sex parents. We should soon be able to scientifically compare two dads with two mums and be able to answer the question of the necessity of maternal care; but until the evidence is out, I don’t think that “experts” should inject so much gender bias and judgement in their advice. From my experience with working with same-sex families, men have made damn good primary childcarers. In my mind, there is nothing inherent in the Y-chromosome that incapacitates good parenting by men; it is society, perpetuated by the experts, media, and let’s face it, even you and I.

The myth of extreme difference

The concept of the “Raising Boys” and “Raising Girls” franchise is that boys and girls are inherently, “biologically” different, and therefore require to be “nurtured” in different ways. More likely, it is a marketing ploy to allow largely the same information to be repackaged and re-marketed. For instance, in his “Raising Boys” book Steve provides a handy list of questions that you should ask a school to evaluate if it will be any good for your son. This list includes: “What statistic does the school publish about boys’ progress?” and “Do teachers shout at children at this school?”. These are useful questions to ask, but like these examples, the whole list of questions is equally appropriate for girls – so why differentiate?

Yes, yes, I am medically trained (which can not be said of Biddulph) and am therefore well aware of the anatomical and hormonal differences between the male and female of our species. However, unlike Biddulph I do not believe that the biological differences are so great (asides for urination and reproduction, which are obviously different). Even for overt biological differences between men and women, such as musculature, although the mean strength/ speed of the average man will be faster than the average woman, the overlap will be great. Christine Ohuruogu can still run faster than most men. This will also be the case for any neural or psychological correlate that you wish to cite. Typical “male” qualities: aggression, high sexual drive, lesser verbal/social skill; are also found in many women. A sizable proportion of most normally distributed “male”/ “female” traits will be overlapping. Further, many of these supposed “biological” gender traits are exaggerated by society. The relative liberation of women in the last century has seen women freed to express their sexuality, aggression and turn to vices previously the preserve of men: smoking, drinking, ASBOs, fisticuffs and the like. At this point in time, we are unable to comment on pure “biological” gender traits as we have never lived in a gender-neutral society.

Even if you buy into strong biological gender differences, the fundamentals of human security, the stuff that makes a child flourish: warmth, love, praise, affection, guidance are universal not gender specific. Why would you need 2 different books to tell you this?

Perpetuation of gender stereotypes

Biddulph cites gender differences in child psychiatric disorders as a basis for his differentiation of the sexes. Higher levels of conduct disorders in boys being a reason for why boys are in crisis and in desperate need for particular parenting; followed by higher rates of eating disorders and self-harm in girls meaning that we must now fear for our daughters and treat them differently. However, any psychiatrist will tell you that all psychiatric diagnoses have biological and environmental aetiologies. This is why I love my subject area, it’s not simplistic; it is about the subtle interplay of biology with environment at all levels. Do boys have a genetic predisposition to fighting, stealing and getting into trouble with the police (components of conduct disorder), or do we as a society encourage this? Boys are encouraged in rough and tumble play; boys are encouraged to stand up for themselves, physically if necessary. Boys will be boys after all? Do girls have a biological predisposition to eating disorders? Or do we as a society encourage this? Girls are encouraged to care about their looks, from the day they are born and the first relative that describes her as “Beautiful”. Does drawing up specific parenting plans led by gender-based social pressures lessen or perpetuate old gender stereotypes? There is even a whole chapter in “Raising Boys” on “Boys and Sport”…need I say more?

Over the last decade, we child psychiatrists have been seeing increased numbers of male anorexics on our wards and females in youth offending units so times, and gender-roles, are-a-changing. Yet although changing social factors influence the symptoms, signs and behaviours that may vary between girls and boys, and with time; the loneliness, disconnectedness, anger, helplessness, frustration, despair and self-loathing that drives them is universal and unchanging. Promoting differential parenting strategies based on outdated stereotypes of what it means to be a girl or a boy seems backwards facing. Society is moving towards equality, why should parenting be any different? Drawing up parenting strategies by gender to me seems outdated and secondary to helping individual children build resilience and thrive.

If Steve is promoting the “male” and “female” off the peg M&S suits over the unisex overalls; I think we need to be moving on from this to bespoke Saville Row tailoring.

 

Reference:

Nelson, Randy F. (2011). An Introduction to Behavioral Endocrinology (Fourth ed.). Sunderland, Mass: Sinauer Associates Inc. p. 438. ISBN 0-87893-620-3. (Apologies, this reference came from Wikipedia and has not been personally checked).

The Y and Z factor

yandz
Everyone knows about the X factor, that “Je ne sais quoi” that leads to desirability, fame and fortune. But what of the other attributes that lead to success (in those of us that are not blessed with the looks of Zac Efron or the appeal of Kylie)?

I can’t claim to know the answer, but I think I have spotted 2 new factors: “Y” possessed by Big Sis and “Z” possessed by Lil Bro. They are both of course bound for success, so I might as well spill their secrets now.

 “Y”

Big Sis is the oldest in her school year. This meant that in her reception class, she was often given a prominent role in class assemblies due to her relative maturity (in one class assembly she played Little Red Riding Hood, Mummy Bear and led the closing prayer). By Year 1, the other children in the class had gained in maturity and confidence and so the lines became more evenly distributed, as I would have expected. Big Sis came home from school upset. Here is our conversation:

Big Sis: I have only been given one line in the class assembly.

Me: [With a knowing smile and having perused the script] Everyone has only one line. It’s got to be fair. Everyone needs a chance to perform.

Big Sis: But I want more lines.

Me: Well, maybe in the rehearsals if you say your line really, really well, the teacher will give you some more lines.

Big Sis nodded.  I felt smug that I had handled the situation well, given sensible advice which had been taken in. That’s why I was surprised the next day when we had this conversation:

Big Sis: I didn’t get given any more lines.

Me: Oh dear, what a shame. Sometimes that happens even if you do a really good job. What happened?

Big Sis: The teacher asked if there was anyone that didn’t want to say their lines, but everyone wanted to say their lines so I didn’t get given any more lines.

Me: Hang on, why did the teacher ask the whole class if there was anyone that didn’t want to say their lines?

Big Sis: Because I asked the teacher if I could have some more lines.

Me: [incredulous at the gall] What? What happened to our plan to do your line nicely then see if the teacher will give you some more lines?

Big Sis: No. I just asked the teacher for more lines instead.

That my friends, is what I call the “Y” factor. Not least appropriate because for the most part this type of self-assurance and audacity is currently found mainly in men (Y chromosome). I bowed to Big Sis’s superior nature after this conversation and vowed never to give her any more of my rubbish advice. I realised that although the advice that I had given her was genuinely how I would have dealt with things, and was probably inherited from my parents – “Work hard, do a good job and you will be rewarded”, it was actually total BS. It reminded me of the reasons given for the gender pay-gap: women never ask for a pay rise or a bigger bonus, women don’t put themselves up for promotion, women beaver away at their work thinking that good work will eventually pay dividends, meanwhile being stepped over by male colleagues that push themselves forward, that step up to the plate. I wondered if these women had been told by their mothers to “keep quiet, say their lines nicely and maybe the teacher would give them some more lines” when they were six years old. I’m so glad that Big Sis took no notice of me, and in fact has taught me a great lesson in what my genuine and well-meant advice might do to my children. Inflict them with my own weaknesses and foibles.

Here’s to Big Sis becoming that woman that will ask for that pay-rise.

 “Z”

Self-assurance, confidence, self-worth, balls, gall, the “Y”- factor; whatever you want to call it. It’s great, but for those that are not in possession of it, there is another way.

Lil Bro had his nursery sports day recently. He came home from practice despondent. Here is our conversation:

Lil Bro: We had practice for our sports day today.

Me: That’s good. How did it go?

Lil Bro: [in hushed tone as if it were top secret] Mummy, I am not the fastest runner in my class.

Me: That doesn’t matter!

Lil Bro: But I want to win!

Later that week, I was reminiscing with Big Sis about her nursery sports day.

Me: Big Sis, remember that boy Adam that won all the races at the sports day?

Big Sis: Yes, he was really fast.

Lil Bro: [Quietly contemplative, then in serious tone] Mummy, how did he do it?

Me: Huh?

Lil Bro: How did Adam win all the races? Can you call his mummy? I want to ask him.

We never got to ask Adam the secret to his success, but his mother told me this: once on holiday, he ran twice around a 400m track. On the second lap around, he was extremely tired (being only 6 years old!), but kept going to the finish saying to himself “If Mo Farah can do it; Adam can do it”.

So it turned out that Adam, like Lil Bro, had a desire to win and a determination to work to this endeavour. I was totally impressed that 4 year old Lil Bro could not only articulate a desire to win, but was also self-aware of his own capabilities and had devised a strategy to help himself improve. He was not afraid to ask for help and saw opportunities to gain mentorship. This self-awareness linked to drive for self-improvement, perseverance, determination and a desire to succeed is what I call the “Z” factor. This silent but steely, and oft-over-looked factor is the one that lets the slow and steady tortoise win the race against the brash and overtly talented hare.

I have no doubt that Lil Bro will succeed in bounds, not least because he wants to. Sadly, I wasn’t articulate enough to be able to convey these thoughts to Lil Bro. The best I could muster was:

“Just move your legs really, really fast…”

Happy 6 month Birthday!

6 month birthday

Shrinkgrowskids has reached it’s half year anniversary and 6000 hits! So a great big:

“THANK YOU!”

To all the readers and subscribers as I wouldn’t have the confidence to carry on without you!

If you read my site regularly, please follow by email – I am aiming for 100 followers at 1 year ( I am at 80 at present so your subscription can get me there soon!).

If you like my site, please “like” me on my new Facebook Page.

Please tell your friends about my site!

Here is what people have been saying about Shrinkgrowskids:

“I must say I am an avid reader of your blog. I read it religiously each week, it’s a highlight of my Fridays. So thanks very much and congratulations on its success”

“This article so accurately reflects my life now and it’s such a comfort that other women actually admit to feeling this way.”

“This is such a wonderful piece of writing…. It may be the hormones but it really moved me”

“This is the most articulate, intelligent summary of the issues presenting to parents in the UK today that I have read in two and half years of being a parent (and reading more than my fair share of such pieces).”

“Well this started some interesting playground conversations today!!”

“Hilarious”

I love your blog….so much sense!!”

“This helped me understand ADHD better than I have in the last ten years of working with kids!”

Shrinkgrowskids has been read in over 75 countries from Russia to Guatemala, Jamaica to New Zealand. It’s being read in Israel and Syria, by parents in countries of NATO and the BRICS. Parenting endeavour unites us all!

I will be with Big Sis and Lil Bro over the holidays so may not be regular with posts over the Summer, but will still be posting so please do check in to find out what my rascals and I have been up to. Alternatively subscribe and you won’t miss a thing!

HERE’S WISHING YOU HAPPY SUMMER HOLIDAYS !

Here are some highlights from the last 6 months in case you missed them:

 porridge

http://shrinkgrowskids.com/2014/02/21/why-do-gender-stereotypes-still-persist/

glass ceiling

http://shrinkgrowskids.com/2014/03/07/inspiring-women/

Planes ADHD

http://shrinkgrowskids.com/2014/02/27/what-is-adhd/

swimming

http://shrinkgrowskids.com/2014/05/02/pass-on-a-passion/

tigger

http://shrinkgrowskids.com/2014/04/25/the-battle-hum-of-the-tigger-mum/

mum

http://shrinkgrowskids.com/2014/03/28/mothers-and-motherhood/

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http://shrinkgrowskids.com/2014/06/13/the-changing-roles-of-fathers/

Image from my favourite MAP London T-shirt

Image from my favourite MAP London T-shirt

http://shrinkgrowskids.com/2014/07/11/did-you-get-mad/

denim

http://shrinkgrowskids.com/2014/05/16/how-to-get-into-the-best-grammar-school/

 

Yes He Can

Lego menCan a man change nappies?

Yes He Can. (Astronauts use Velcro to strap things down. They are mainly men. Sewage workers deal with excrement. They are mainly men.) 

 

Can a man puree vegetables?

Yes He Can. (I have seen many men do this on Masterchef)

 

Can a man bottle feed expressed milk/ formula?

Yes He Can. (Vets and farmers bottle feed lambs all the time. They are mainly men.)

 

Can a man sterilise bottles?

Yes He Can. (Chemists and pharmaceutical scientists sterilise their equipment all the time. They are mainly men.)

 

Can a man do the laundry?

Yes He Can. (Commercial launderers (think army, hotels) are mainly men)

 

Can a man cook the dinner?

Yes He Can. (Most professional chefs are male – particularly the highly paid ones)

 

Can a man sing nursery rhymes?

Yes He Can. (Justin, Andy and all those other men on CBeebies)

 

Can a man take a child to the doctors?

Yes He Can. (Unskilled task, any numpty can do this)

 

Can a man drop-off and pick-up at a nursery?

Yes He Can. (Unskilled task, any numpty can do this)

 

Can a man wipe a child’s bottom?

Yes He Can. (I hope so at least, as it is easier to wipe some one else’s bottom than your own)

 

Can a man read the letters that come back from school?

Yes He Can. (Any literate person can do this)

 

Can a man buy a fancy-dress costume?

Yes He Can. (Many shop buyers and traders are men)

 

Can a man book a ballet class?

Yes He Can. (Many events organisers are men)

 

Can a man check a child’s homework?

Yes He Can. (If he has the intellect to be able to do the homework, he is qualified to check it)

 

Can a man book a dentist appointment?

Yes He Can. (If he can book his own appointments for work/ leisure, he can do this)

 

Can a man pick up an unwell child from school?

Yes He Can. (Unskilled task, any numpty can do this)

 

Can a man iron on name labels on to clothes?

Yes He Can. (Unskilled task, any numpty can do this)

 

Can a man sign a permission slip?

Yes He Can. (I presume he can write his own name)

 

Can a man test a child’s ability to spell?

Yes He Can. (I presume he can spell)

 

Can a man make an Easter hat?

Yes He Can. (Mister Maker is a man)

 

Can a man read with a child?

Yes He Can. (Any literate person can do this)

 

Can a man arrange a playdate?

Yes He Can. (If he can arrange his own leisure activities, no reason he cannot arrange someone else’s)

 

Can a man interview a nanny/ au pair/ babysitter?

Yes He Can. (Many men interview staff for jobs)

 

Can a man go to parent’s evening?

Yes He Can. (Unskilled task, any numpty can do this)

 

Can a man watch a school play?

Yes He Can. (Unskilled task, any numpty can do this)

 

Can a man give a cuddle?

Yes He Can.

 

There you have it. Confirmation, with observational evidence from a medically qualified doctor, trained in medicine, genetics, psychiatry and psychology. There is no medical, genetic, psychiatric or psychological reason why men cannot do any of the above.

Where men are not doing these things, there are only 2 reasons:

  1. Men don’t want to.
  2. Women don’t want them to (they don’t want to nag or fight with their partner/ they want control over parenting and the household).

Men are a highly skilled and under-utilised resource within the home. Their involvement should be encouraged.

It strikes me that if all men and women worked together to enact equality in their own homes, equality in society would follow.

 

Nurturing nature

glassesEveryone (I hope) recognises the existence of genes and their effects. Most people are happy to “believe” in genetic effect in hair colour, blood group and genetic medical disorders, but where “personality”, “intelligence” and “mental health”, come into it, most people prefer to see environmental causation. Part of the problem in selling genetic explanations is in the fear of “determinism”: the thought that your lot in life could be determined at birth and that human will and struggle are for nought. The funny thing is that “nurture” the proxy term for “environment” can also have its own form of determinism, with many people struggling to escape from the prison of their family and birth environments. Funnily enough, it is when things go wrong, when a child becomes “out of control”, that people flock to a genetic explanation, absolving themselves of responsibility. “They were born that way. It had nothing to do with our parenting.”

Outcome is clearly about both nature and nurture. What interests me is the interaction between genes and environments. It’s a wonder how the nature vs nurture debate has lasted so long, as the two are so intertwined. At the most basic level the success of a gene is purely based on its suitability for the environment. At a more complex level, a parent will give to their children both genes and environment, genes will seek out their own environments (e.g. a child with “intelligent genes” will ask to go to chess club), and evoke their own responses from the environment (a child with genes for physical attractiveness will generally evoke more favourable responses from others).

It is a misconception that you can have “good genes” and “bad genes”. Genes are like nature’s version of trial and error. A new combination is attempted at every conception, and the genes that are successful within an environment survive, the ones that don’t fall away. Thus the success of a particular gene is purely judged on environmental adaptation. A “good gene” in one environment may be a “bad gene” in another. Take genes that cause sickle cell. This is generally thought of as a “bad gene”, causing anaemia. However, in some parts of Africa, where Malaria is endemic, the sickle cell gene is a “good gene” as it is protective against malaria. This is palatable when talking about a medical condition, but the same applies for genetically determined personality traits.

Take aggression. Elements of aggression are genetically determined. It easier to think about dogs when talking about this: certain breeds of dog make for better security and attack dogs. No one would ever have a pug dog or poodle as a security dog. Yes, you can rear a poodle or pug dog to be aggressive certainly, but not as readily or to the same extent as an Alsatian or Pit Bull. There’s something in the genes. However, aggressive genes are not in themselves “bad genes”. In certain environments (the end of the world/ lost in a dark forest with wild animals surrounding you, a competitive job market), they may be the best genes ever.

Another reason for fear of genetic explanations is in the fear of genetic modification, gene selection and “tampering with nature”. You either feel it will end in a slippery slope to eugenics or you feel there is nothing that can be done with genetic predispositions and you just have to live with them. The thing is; it’s much simpler than that. In this day and age; we are able to cheat nature. My genetic predisposition to short sightedness has been environmentally sorted by living in a country with access to an optician. By all rights, had this not been the case, I would be dead by now, probably having gone to hug a grizzly bear that I mistook for my mother. The most common genetic predisposition in the world; that for having dark hair; is environmentally corrected around the world on a daily basis by bleach from a bottle.

WHAT HAS THIS GOT TO DO WITH PARENTING?

Well, it strikes me that as parents, we are able to drastically manipulate our child’s environment, especially the early environment, which is thought to be one of the most important periods of environmental influence. This is not only by providing safety, books and toys, but exposure to language, music, models for good social interaction, peer group, selection of nursery,  primary and secondary school, and critically, love, warmth and understanding . By learning via observation about our children’s “genetically determined” personality traits, we are able to best shape their environments to suit their needs. All parents are doing this already off course, when you select your child’s nursery, primary school and secondary school, you are thinking not only about the values of the school you wish to impart on your child, but the attributes of your child and how they will fit into the school. It would be an oversight to send a small, intelligent boy with a love of learning and loathing for the outdoors to a school specialising in outdoor sport with a relaxed attitude to bullying, for instance. If your child has particular needs, for instance a learning difficulty, for all the medications and new age therapies; thinking hard about school and environmental placement is the most effective treatment.

A child with average genetic susceptibility to aggression can become very aggressive if brought up in an aggressive community. Equally, a child naturally predisposed to aggression can succeed perfectly well if the environment (parents, schools and society) show understanding and help shape the aggression so it is controlled and pro-social outlets found: competitive physical sport (though not biting other players), some occupations where controlled aggression is valued e.g. some businesses. A child naturally predisposed to aggression can only become a menace to society if parents, schools and societies allow it to be so.