Look for silver linings

These are strange times indeed. Perhaps you, like me are stuck at home, working on your computer. I’m home because I’m on annual leave that I’d booked months ago to crack on with writing my next book. My husband is in the next room working from home indefinitely as London shuts down. Next week, I’ll be back in my NHS job. Being a child psychiatrist, I’m not on the front line, but doing my part ‘Keeping calm, washing hands and carrying on’. For now, we are continuing our usual service save that all our appointments will be conducted via phone or video conferencing. If there is one thing about the NHS it is that the staff are dedicated and we will do all we can to support our patients, either on the front line with corona-virus or trying to maintain as many normal services as we are able.

Children handle uncertainty and change differently. Big Sis has been dancing about with glee that school is cancelled, not at all downcast about a cancelled school trip to France, and outrightly refusing returning to school even if a place becomes available due to her mother being an NHS employee. Lil Bro has been subdued and downcast at the prospect of change, the cancellation of a class assembly and not being able to see his friends in person. All this, meanwhile grandma is self-isolating with a temperature >38 degrees C for the past 5 days.

Is it possible to stay sane? Here are a few tips:

Stay sociable. Social distancing doesn’t mean cutting all contact with friends and family. The telephone, texting, FaceTime and all manner of ways to remain connected still exist. Perhaps Big Sis’s nonchalant reaction to self-isolation is because she has her own smartphone and is part of generation digital who see no difference between personal and digital contact. We older generation can perhaps learn from our kids that we are lucky that we have tech and I’ve had more contact with my university gal pals this week than any other via WhatsApp. To be honest, we all lead such busy lives that we only saw each other once every 6 months anyway even before enforced isolation. It is also perhaps our social duty to stay connected digitally with our friends and family so that others know that we are doing OK, and we are not contributing to other people’s anxiety. You may find that they need a virtual shoulder to cry on or that their jokes still make you laugh however geographically far apart you are.

Stay active. Whether it be yoga, weights or a run in the park (keeping 2m away from others), staying active is as good for the mind as it is for the body. Plenty of home exercise videos and internet workouts are available.

Practice managing uncertainty. These are uncertain times, and for many of us that are used to being in control, managing uncertainty can be difficult and a source of anxiety. Start with a deep breath. We will all require to manage uncertainty at times in our lives and practising to manage it is a good thing. Most people that struggle to manage uncertainty do so because they fear that they are responsible for outcomes and will not be able to cope. They constantly worry whether they have enough loo roll, whether they should or shouldn’t use ibuprofen, whether their elderly parents have strayed outside. Rather than to go around in circles of panic worry, it may help to think through the worries and problem solve each scenario. Would it be the end of the world if you ran out of loo roll? In many countries loo roll doesn’t even exist and the good old hand suffices (I should know). Since we are all trapped in our homes and hopefully have access to running water, the world won’t cave in if we run out of loo roll. Take each day at a time and try to evaluate the facts rationally. The risk of serious ill health to most people, even in the older age group are still low. In the worst case scenario, if we or our relatives are severely affected (it will of course inevitably happen to some of us), there is nothing that we could reasonably have done to alter the course of events and worrying excessively adds to not relieves problems. If worries are financial and imminent, research government and business websites and see what support there is available for you.

Re-set your priorities. It’s not often that we get a break from our hectic lives. Being stuck at home for a while can be seen as a positive enforced break from the tread-mill. Use this time productively to think about your life’s journey and where you are going. In times of crisis, what really matters to you (health, family and friends) become sharpened – remember this feeling and perhaps take this opportunity to re-set priorities.

Spend quality time with your family. OK, we are all going to be forced to spend more time with our families. Social media is rife with despair about having to spend time with spouses and families, and indeed divorce rates have increased in some areas with enforced working from home policies. But taking time to reconnect with family members is positive. Although I was initially annoyed that the other half had eaten all my working from home snacks on day one, it is nice to have a coffee and lunch break with my husband rather than colleagues, and next week when the kids will join us, I have promised breaks for board games, indoor picnics and for Lil Bro and I to finish building the hydraulic robot arm project that we started at Christmas.

Help out those around you. We were posted a leaflet through the door from the local volunteer corps. It’s heartwarming that in any crisis, there are amazing people in the world that step forward to help others. People are rallying around to support those in the community around them, whether by donating time, resources or money there is so much do-gooding that can be observed. Lil Bro and I packed a care package that his school was collecting for the local Age Concern care home. Taking part in helping the community and those more vulnerable has benefits for mental health and can take your mind off the uncertainty that we all face. Not all of us are able to offer everything, but we can all offer something, even if it is just to make sure that you order take-out from a local restaurant business that may go under without your support.

Look for silver linings. When all this is over, for this too shall pass, there will be some silver linings. Pollution levels will have dropped and the air will be cleaner. We as a population will see that it is possible to change our life-styles and priorities: reduce air-travel, work from home for better work-life balance, and invest in the NHS to name a few changes, which may have long term benefits.

Self-Help. Prof Roz Shafran a lovely colleague at UCL is currently doing research on the quality of mental health advice on social media platforms such as Mumsnet. The initial data is pretty good, so good self-help is out there, both for a virtual hug and for decent information.

An excellent book for helping children with anxiety is this one:

Overcoming Your Child’s Fears and Worries, by Cathy Cresswell.

Other internet resources include:

https://www.nhs.uk/conditions/stress-anxiety-depression/anxiety-in-children/

https://www.minded.org.uk

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Podcast to help explain Coronavirus to children with Autism by my excellent colleague Marianna Murin

Hello Thailand!

I’m so sorry that I’ve neglected this blog for most of this year. Finding time to write has been really tricky which is a real shame as it’s what I really enjoy. I have so many more stories to tell about Molly and D over the last few years but as every working mum or dad knows carving out time for oneself in amongst children transitioning to secondary school, contemplating mobile phones, Year 4 friendship crises, packed lunches, class assemblies, forgotten violins, bake sales, endless clubs and classes, permission slips, nits, verrucas, molluscum, stitches and so on, there is hardly any time for anything. Just as you think one problem is sorted, another crops up.

It’s therefore such a joy that my lovely agents at Watson Little occasionally send me an email to tell me that the rights of my parenting book ‘Inside Out Parenting’ have been sold abroad. And yesterday, hiding in the secret cupboard where the postie leaves things that cannot get through my letterbox was a parcel containing 3 copies of a lovely little book.

I’m so chuffed to report that my book ‘Inside Out Parenting’ is now available in Thailand. I can’t read a word of it but the pictures are super cute! I particularly like that the cartoon me is missing a few tyres around the waist and bags under the eyes. If you know anyone in Thailand in search of a parenting book, please let them know!

How to Get into the Best Independent Schools

So, if you have been following my blogs then you will perhaps have followed my daughter’s 11+ journey. Unfortunately she didn’t manage to get into the local grammar school which is the one that I myself attended (see posts about overcoming failure and how 11+ was in the 80s), but luckily for us, we were financially able to consider independent school options. We have sent our children to state schools so far and have never employed a tutor and so this would be our first departure into ‘paid privilege’. An unequal education system is not something that I am altogether comfortable with, but having the knowledge that within the state primary system my children have been relatively unchallenged and indeed have been teaching other children in their classes, I did feel that it would be important for them to go to a secondary school that would be more academically challenging in order for them to fulfil their potential. Whilst I was happy to teach my children the content of the 11+ exam papers, I really am not up to teaching GCSE French or Geography and quite frankly am looking forward to resigning from the teaching role altogether!

Choose the right range of schools

Many London independent schools are among the best independent schools in the country and we made the decision to sit Molly for 5 schools within reasonable commute. As our main reason for choosing the independent sector was for the teaching and academic environment, we only looked at schools which were well-known for good academic record and/ or pastoral care. For me the grounds, the school uniform and the politics trips to Washington and netball trips to Barbados were actually a turn-off (promoting privilege) although I recognise that there is nothing wrong with being interested in these aspects of schools. We ended up choosing 5 schools including one which is usually consistently in the league table top 5 schools in the country and one which was slightly less academic which we knew Molly would have a very good chance of getting in to bar disaster. I think that if you are putting children through 11+ exams, you should absolutely set them up to succeed by choosing at least one school that is a definite shoe in. Even if this school is not your first choice, make no differentiation between it and the other more challenging schools. In my mind, 5 schools is a sufficient number of schools to choose. I know children that sat 8,9,10 different schools and really? What is the point – you are aiming to narrow down to 1 school at the end of the day, so increasing a child’s exam burden is really a big price to pay for your own indecision. Try and get a realistic idea of your child’s ability as if your child has very little chance of success (say less than 50:50), remember that your ‘let’s have a punt’ is potentially at the expense of your child’s self-esteem.

Avoid setting your heart on a school

Unless a school is an absolute shoe in for your child, it is worth not setting your heart on a competitive school. The reason being that however hard you try to hide it, your child will be able to tell that you have a preference for a school and if they do not get in, they will feel that they have let you down and suffer disappointment in themselves. For children at this age never underestimate how much that they want to make you proud – it’s probably their top priority. If you can protect them from feeling like they have disappointed you, I would recommend it. My mantra throughout the whole 11+ process was ‘We don’t choose a school, a school chooses us’ and when pushed to choose a favourite ‘My favourite school is the school that chooses us.’ This was not a disingenuous act, but the truth. I’ll tell you why.

League tables are not all that they seem

If you look carefully at independent school league tables, you’ll see that the majority of schools in the top 50 have children who achieve remarkably good grades and regularly send children into Oxbridge and other really good Unis. Their position in the league tables is largely determined by the proportion of children who for one reason or another do not do as well. Rather than fixating on the number of A* children, we should consider why some children are not doing so well. It is easy for a school which sets a gruelling entrance exam to select intelligent children; and when you put intelligent children in, you’ll likely get intelligent children out. Simples. It does not necessarily mean that the quality of teaching at these schools is better. More impressive are schools with an easy entrance procedure that achieves good results – like many in the state sector. What the league tables hide is that in the majority of highly competitive schools a tranche of children are ‘managed out’ between acceptance and GCSEs. I know this because as a child psychiatrist, we often see children whose parents have been at best ‘asked to look at other schools’ and at worst ‘told/ threatened’ that their child will have to leave their school, because their child is not cutting the academic mustard at the prestigious school and their results will affect the school’s league table position. Are the top schools in the league tables then, just the schools that are best at smuggling ‘unsuccessful’ children out? It would be useful for league tables also to publish the number of children that left each school before GCSEs. One would imagine that people needing to move out of area would be fairly evenly distributed and so schools with higher than average student turnover would be interesting. Worse still are schools that kick children out between GCSE and A-levels or dictate which A-levels a child is and is not allowed to pursue for the sake of league table standing. This is not acceptable in the state sector and should not be acceptable in the independent sector either. In my mind, a school as a safe supportive environment for the formative years of children’s lives should commit to trying to fulfil the potential of its students and not be actively contributing to their potentially life-long neurosis that they ‘are not good enough’. To this end, much to the chagrin of my own Tiger mother (now tiger grandmother), I was happy to give Molly the choice of which school she went to amongst the 5 that I had chosen that she sit, irrespective of league table standing.

Good mental health promotes academic success

My strategy in getting Molly through the 11+ exams incorporated thinking about mental health, because as I frequently want to say to my patients ‘If your child commits suicide, it won’t really matter whether or not he/she got a place at Oxbridge will it?’. Extra-curricular activities continued throughout Year 5 and 6, as did play dates and holidays. Work hard, play hard was the mantra. We had started working towards 11+ early, so there was no panic and the increase in work was gradual. I was fortunate in that after Molly did not get into the grammar school, the majority of the motivation to work harder came from herself, and it was amazing to see how determined that she could be when she wanted to do something herself. From the start, the 11+ process was something that we did together and I was clear that whether we succeeded or failed, we would shoulder the joy or defeat together. In this way, if she failed, she could have someone else to blame as well as herself. After the exams and interviews, but before the results came out, I asked Molly to rate on a scale of 0-10 how stressful the experience had been. She said 4.5. I’ll take that! (Although it did cross my mind that damn – I could have got her to work harder!).

Interviews

I really can’t give you much advice about interviews as Molly did all the hard work. Luckily, social ability is actually Molly’s strength and I knew that as long as I could help deliver her to the interview stage she’d more likely than not shine. Unfortunately, little did I know that at some schools the parents are also interviewed. Having been on-call and therefore unable to take annual leave to take Molly to the exams, I was responsible for taking her to interviews so could not back out now and make my husband take leave again. After a morning fretting about getting ready for the interview, words of wisdom from someone much wiser than me saved the day: ‘Don’t worry mum. Just be yourself.’ How lovely.

The Final Say

We were lucky enough in the end for Molly to be offered places at all 5 schools that she sat. We gave the final school decision to Molly and she is looking forward to starting in September. As mentioned, my mother was horrified at the lack of regard to league table standing in the decision making, but all my friends and colleagues in child psychology and psychiatry were in agreement. I liked what one of them said: there was a survey about how much people liked their furniture and IKEA flat-pack came out really well as people appreciate things more when they feel that they have contributed to making it. I hope this means that Molly will really enjoy the school that she has chosen. I am also grateful that if it all goes tits up – she can’t blame me!

And finally – it’s not just in Hollywood

Just as a sordid aside, I want to mention that I really wasn’t shocked about the stories from Hollywood about the rich buying their children’s places at elite universities. It is really a sad state of affairs if people think that only a few schools or universities can ‘make’ our children’s futures, and sadder too that the rich and influential feel that they can take these opportunities from other people. But just so it is out there, it happens here in England too, and it already starts at 11+. I know several children who have managed to get a place at academically selective schools for which they had not been on the waiting list for after interview, or had never been invited to interview or had never even sat the entrance exam for! These are not the super rich and famous but everyday upper middle class folk enacting their (white in the cases I know) privilege. Unfortunately, I’m not party to how these amazing feats were accomplished by parents so cannot share the tips with you here – that would probably have been a more interesting blog post! Sorry!

The Uncomfortable Truth About Screen Time

Last year I had a lively debate with my literary agent about children’s screen time. She had mentioned that there was a gap in the market for a book about the toxic effects of screen time for children and did I want to write a book about this? Many parents worry about the negative effects of screen time and really want to know about safe levels of screen time.

Being an evidence-based science nerd, I mentioned to her that I had not seen any good evidence for there being any negative impact on children of screen-time (based on length of time, not content). I admit, that I am not doing research in this area and so have not been ploughing journals and databases for evidence on this area, but in general, I go to conferences and child psychiatry meetings and get to hear about important research that is brewing (if there is any) before results are released to the press and general public and I had seen nothing on screen-time ‘being toxic’ that was definitive or evidenced based and that would warrant a book. I myself love the telly and happily watch anything from Newsnight to Love Island. On my days off, I’m quite happy to watch Flog it! and Cash in the Attic too. I’m good at putting boundaries on my phone, but admit to watching videos of pug dogs and dancing cats first thing in the morning or late at night. I am not ashamed to say I love screen time, it’s how I relax and I certainly don’t feel that my life is being ruined by screens.

There are many confusions in the screen-time debate that deserve clarification:

  1. Different people mean different things when they talk about ‘screen time’. Screen time could mean any TV, smart phones, internet, gaming, social media or any time doing anything on a computer. Most adults who spend their day working on a computer are in effect spending most of the day on ‘screen-time’. Is this detrimental? Excel can certainly drive me crazy at times, but I’m not sure this is what is meant when most people say that ‘screen time is bad for your health’. What about cooking with a YouTube video – is this screen time? What about my children’s favourite (not)…playing piano to ABRSM practice partner? Does this count? As screens are used for a myriad of activities which are getting more and more interactive, these days defining ‘screen time’ is rather more tricky than it sounds and we should be specific when we (particularly ‘experts’) talk about ‘the ills of screen-time’ and what it is exactly that we mean.
  2. Most of the weariness about screen time seems to be a judgement call on content rather than the fact that entertainment is brought by a screen itself. I think that we can all agree on children staying away from pornography and having age-appropriate certificates for internet content because beyond a doubt exposure to inappropriate content is harmful to children (violence, sex, aggression, extremist content, websites on how to build bombs and slit wrists etc.) – I don’t think anyone finds this contentious. But beyond this judgements on screen time being detrimental seem to be related to our own personal sense of ‘good’ and ‘bad’ content. I’m sure most parents would not complain about their children watching the news or Blue Planet. What about YouTube? Does it make a difference if your children are using YouTube videos to make loom bands or bake cakes or if they are watching YouTube videos of YouTubers watching other YouTubers play video games? Does it make a difference if your children are playing chess on the computer as opposed to MarioKart? If so, what we are really saying here is not that screen time is bad, but we should raise the standard of programming or that there should be parental control over access to content. How children use social media is a separate debate to absolute screen time usage and relates again to content rather than screen time-limit discussions. The best way to be aware of and happy about the content of what your children are accessing is to have an open, respectful and trusting relationship with your children. This takes time and energy to build but will make everything in your life easier, not just reduce screen time arguments.
  3. Association does not mean causation. Type in negative effects of screen time into Google and I am sure you will get a whole list of science-sounding information about the ills of screen time. But the same can be said if you type in vaccination and autism, deodorant and cancer and any number of absurdities. There are association studies between screen-time and health factors for sure e.g. obese children watch more TV and depressed children use more social media, but these do not mean that the screen-time is CAUSING negative effects on health. Is it because children that don’t like exercise like to watch TV, or did the TV ‘make’ children stop exercising? Does social media ‘make’ children depressed or do depressed children get drawn to social media due to their existing insecurity? Does TV make children behave badly or do parents of badly behaved children struggle more to get children off TV? Does gaming stop children doing their homework or do children that don’t want to do their homework play computer games? It is difficult to untangle and at present, the jury is still out, but my wager would be that simply removing screens from households of obese children would not miraculously lead to the child suddenly taking up sports, nor would removing the screen from the gamer lead to more homework being done.
  4. It’s not what children are doing, it’s what they’re not doing. The only evidence for the ills of the screen is that it takes up time that children could be doing something more worthwhile. But in this regard, the screen is no different for instance than an intense sedentary hobby like stamp-collecting or knitting. Both of these hobbies have some merits (as does watching TV), but done for hours at a time can lead to inactivity and lack of social interaction. The solution is not to ban screens but to encourage other interests.

The reality is that it is difficult to do any proper ‘gold standard’ research in this area, as this would require an ‘experiment’ where large cohorts are required to reduce or stop screen time altogether and measures of before and after are taken and confounders are taken into account (e.g. socio-economic status, parental educational level, child’s innate personality). These experiments are generally expensive and unpopular (most people will not react well to being randomly told to stop screen-time and if they volunteer to do this, they are de-facto a biased sample) and very hard to enforce (it’s difficult to check study participants are not having sneaky peeks at their TVs and phones), but I am sure that some researchers may try and do this kind of study in the future.

In the meantime I was very pleased to see that earlier this month the Royal College of Paediatrics and Child Health Guidelines on screen-time took heed of available research (or lack of it) and stated that there is no evidence for a ‘safe’ screen time limit because screen-time has not been proven to be ‘unsafe’. Please read the report, but in summary the guidance was:

  • Children should not use screens before bedtime ( this is as blue light can affect sleep)
  • Children should not snack while using screens (to prevent obesity)
  • Children should have other opportunities for exercise (to prevent obesity)

and

  • Screen time should be under the control of parents, at a level that they feel appropriate

And so, this is the uncomfortable truth about screen-time. Instead of asking: ‘is screen-time toxic?’, we should spend more time asking ‘How can I support my child’s social skills?’, ‘How can I improve my child’s diet and exercise?’, ‘How can I support my child to read/ write/ draw?’, ‘How can I improve my relationship with my child so that they want to spend time with me?’, ‘How can I improve respect in my relationship with my child so that they will comply with my instructions?’.

It may be convenient to blame ‘screens’ for all the ills of our children, but ultimately, it is parental responsibility to control screen-time in younger children and ensure that they are accessing appropriate content and doing other activities that are enhancing their development (physical activity, creative activity, social activity) instead of/ or as well as screens. It is also parental responsibility to teach children to control their own screen-time so that as adolescents they can make their own appropriate life choices. All the above is really tough and not necessarily what we thought we were signing up for when we had kids, but the reality is that if we don’t do it, who will?

If you are having trouble starting on rules around screen-time in your primary aged children, here are my family’s house rules on screen-time (but of course you should develop your own that work for you):

  1. Encourage other activities (play dates, reading, street dance, baking, swimming etc) from a young age BEFORE allowing access to lots of screen-time. This way, your child has formed good friendships and outside interests which they will want to continue and are willing to give up screen time for. Starting friendships and new activities can be daunting for some children and screen-time is a good excuse not to do things that are daunting, therefore: establish other strong interests first.
  2. Be good with boundaries. Parents that are good at setting boundaries in general (e.g. for bed time, eating greens, homework) generally don’t have problems establishing boundaries for screen time. The issue for parents is usually about being able to set and stick to boundaries in general not anything specific to screen time. If you have difficulties with boundary setting, get help to improve this. The Incredible Years is a very good behavioural management book for parents.
  3. Demonstrate your own ability to control screen-time. If you are always on your screen, then most children will do as you do rather than as you say.
  4. No TV between 9am-5pm (enforced about 90% of the time in term time, less so in the holidays). Within this (as there are plenty of hours before 9am if your children are early risers like mine and after 5pm), my children regularly have access to between 2-4 hours screen-time a day (aged 9 and 11) and I do not feel it has made them morally corrupt/ aggressive/ obese/ brain dead/ socially inept children. I have however had to endure a rather tiresome programme called Nicky, Ricky, Dicky and Dawn – episodes of which could lead me to stick pins in my eyes. Unsanctioned TV use leads to no TV for any children for a week – once you’ve enforced this once or twice, they tend to learn not to break the rule .
  5. No screen time until homework/ music practice/ chores are completed (enforced with 70% success). This rule both limits screen use and also ensures that there are no arguments hauling children off devices to do homework, the homework has to be done first.
  6. iPad which can be used between 9am-5pm is locked by password under parental control so that I am largely in charge of when and where this is accessed and for what purpose.
  7. No screens at the dinner table for any one including adults (enforced with 90% success rate by me and 50% by father), although as a family we do like a regular TV dinner all together watching Bake-Off or something similar. I work part time and generally have already gassed enough to the kids about their day and my day, but if this hasn’t happened and dinner is the only time to engage your children in chat, then I would recommend dinner table chat over a TV dinner.
  8. Try and avoid giving a child a phone until secondary school. Believe me, if your children are losing friends solely because they don’t have a phone, these are not the best friends for your child to keep anyway. If they are struggling with friendships, the solution is to support this, not to buy them a phone/ trainers/ designer clothes to keep these so-called friends.
  9. Keep going. Like with any family, there are occasional rows in my household about getting children off the TV/ iPad , but these are once in a while and part of life and no reason to abandon all control or feel like a failure. Remember, tomorrow is a new day to try again.

I’m told that the whole screens issue becomes worse as children become teenagers so I’m sure that the house rules will need revising, but for the time being this has worked so far. And as an avid viewer of reality shows like ‘Faking it’ and ‘The Real World’ as a teen, I’m now a psychiatrist: the ultimate real-world people watcher. My agent’s husband is also an advocate of avid film and telly watching as a child and he is now a film director – so go figure.

It’s not all bad…

Keep Calm and Carry On: How to Prepare Children for Exam Failure

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So, Molly is in Year 6 now and I’m sure that I am not the only parent in the anxiety provoking situation of considering secondary transition. I am in the fortunate position (minus a few holidays and luxuries) of being able to consider a private education for my children. This rubs against my preference for all children, from any background, to be able to receive the best possible education, particularly as my siblings and I were all state educated. But where we live in London, in the vicinity of dozens of the top private schools in the country, the difference in available quality of education is all too stark. The draw of these selective schools to the local population, means that many academically able children are removed from the state education system with some demographic consequences for some of the local state schools. While we never considered a private primary education, a private secondary education was always on the cards. Of course, we also applied for the local grammar school for Molly, one that I myself attended in the 80s (see my blog on this), but unfortunately, Molly didn’t make it through the selection process (although I have managed to remain tutor-free). Not altogether surprising since we were told that there were 3500 candidates for 100 places – worse odds (35:1) than Oxbridge (10:1) but still far easier than getting on Love Island (2500:1)! The remaining selective school exam onslaught is in January with weeks required to be cleared from my diary for exams and subsequent interviews and my wallet some-what lighter for the registration fees.

I’m Chinese. I take education seriously. But equally, I am a child psychiatrist and I take mental health even more seriously. Optimal performance in any domain is impaired by poor mental health (as is happiness) and this consideration needs to come first and foremost. When Molly was told that she had not made it through the grammar school exams, she was understandably temporarily disappointed and subdued, but she was readily reassured, and within the hour was back to her usual happy self and has been looking onward and upward. There has been no dent in her self-esteem that I can discern, rather, there has been a smidgeon of increased effort in her work ethic. Given that we have come through and managed the first hurdle of school “rejection” relatively unscathed; I feel somewhat able to advise on some ways that I found useful in combatting rejection dejection.

  • Start early and go slow:Adapting to big changes and making a big lifestyle change is always more stressful than making small, incremental changes over time. If you have the long term goal of children sitting selective school exams, I would always advise starting early with a small amount of work (30 minutes a day) up to Year 5 and building incrementally to a reasonable amount of work (1 hour a day) in Year 5 and Year 6. As our state primary school does not give much homework, this is very manageable. Children, who are not used to doing work regularly at home, will be more stressed if they are suddenly loaded up with tutors and work towards exam time, and this also emphasizes the fact that these exams are ‘super important’ which drives anxiety. If little and often has been part of life from the start, then exam preparation remains part of normal life and the attention and importance of exams (and therefore their outcomes) can be normalised.

 

  • Let Life Go On:It is really important that children get selected into schools that are academically suited to them. If your child has extra-curricular activities that they enjoy as down-time, or that they would wish to continue in secondary school, then it is really important that these continue throughout the period approaching exams. If a child requires to stop everything else in their life in order to work towards exams, the likelihood is that they may be selected into a school where they cannot keep up with the class unless they continue to work at this heightened level. This leaves children in the stressful and vulnerable position of potentially giving up enjoyable extra-curricular activities forever. Extra-curricular activities are usually enjoyable and act as a source of stress release and social interaction. Some parents think that it is advantageous to ‘sneak’ spoon fed children into highly academic schools, but believe me, this is never advantageous. If children are unable to keep up they will be ‘managed out’ of these schools which can sometimes be ruthless about maintaining their league table status, and if a child has to work all-out to keep up, then this has consequences on their mental health.

 

  • Realistic expectations and realistic explanations: I have a notion that self-awareness is the key to happiness. That if we understand ourselves and perform to our expectations then we are happy. Unhappiness arises when we do not know who we are or fail to live up to our own expectations of ourselves. This is of course more likely to happen if our expectations of ourselves are unrealistic. For many of us, myself included, I only truly felt that I started knowing who I was in my late twenties, and now in my forties, I am perfectly content with my own flawed self. Imperfect but comfortable in my imperfection – like an old pair of shoes. For the typical 11-year old child where identity is yet to be fully formed, ‘expectations’ are defined by parents. To prevent children feeling like they have fallen short, try to ensure that expectations are set at ‘realistic’. Asking school teachers, reviewing children’s independent work and having an idea of the academic level required for particular selective schools is important when choosing schools for your children. It is OK to be ambitious and choose some schools which may be a stretch, but if you are doing this, then explain it clearly to your child that there is no expectation to get into these schools, but that they are worth a punt. I take the school selection decision as a spread betting exercise and have opted for a selection of schools with varying academic vigour and will let fate decide. State school options are included in this spread bet and are talked up as being as appropriate as the private school options.

 

  • Preparing for Failure:Children will always take things harder if they are not prepared. Many children, particularly the high-achieving and confident children that tend to apply for selective schools, have never experienced failure before. Make sure that failure is discussed openly well before exam time. Put your own failures on the table and demonstrate that failure is not something to be embarrassed about, but a normal part of life. Inculcate the mantras: “Strength is not in the never falling, but in the getting up after a fall.’ And “If you are not constantly failing, you are not really stretching yourself.” I will explain this latter statement. Children who participate in competitive sports will have a wealth of analogies that can be used to demonstrate this. Thankfully Molly does a spot of competitive swimming and is used to constant failure as the thing with swimming is that once you get to the top of a group, you get moved to the next group and start at the bottom again: succeed at school swimming, attend club swimming, succeed at club swimming, attend county swimming, succeed at county swimming, attend regional swimming and so on and so on. Unless you are Rebecca Adlington, somewhere along the line you will fail, fail, fail! What excellent life experience! I highly recommend this as an extra-curricular activity for acclimatising to failure! The truth is this: if you are succeeding easily constantly, your pond is too small. Of course, discussing failure openly can also bring up hiccups. During an explanation of why it was no problem not to get into the grammar school (before it actually happened), Molly pipes up: ‘You don’t think I’m going to get in do you?” – it’s always a good idea to answer these questions honestly: “You know what Molly? I think you have a good chance, but I really don’t know because there are a lot of other clever girls out there who all have a good chance. But it doesn’t matter if you don’t get in because it just means that the school is not suited to YOU, and there are other good schools that will be.”

 

  • Contain your judgement.Children around this period are hawks to information and opinions about various schools. Much of it is hogwash because ‘one man’s beef is another man’s poison’. Literally. A highly-academic school can propel some girls to glittering careers, but the same school can contribute to a different girl to commit suicide. It’s all about ‘fit’. Therefore, it is no good listening to the judgements of other parents to make decisions about your own children, and its no good transferring judgements about schools to your children. They will take these comments from you as gospel and it will affect their mindset and they will tell their friends, spreading irrelevant judgements. Although I have chosen a variety of schools, I never talk of a preferred school and merely state that all of them are good. Other parents find this extremely frustration and keep pushing me with “But REALLY, which one is your preferred school?” and my honest-truth is REALLY– my preferred school is the one that offers a place to my daughter! It helps not to pay too much attention to the school propaganda machine and prospectuses which imply that they will be the only ones to hone and sculpt your child’s mind in the right way. In my opinion, there is no such thing as ‘one partner who was destined to be my lifelong love’ (sorry hubby) – there are many people in this world who we could each have fallen in love with; and equally there are many, many schools which will do a good job at educating my children. Unless you are an Oscar winning actor, if you have a ‘preferred school’ that you have singled out as being ‘the ONE’, it will be very difficult to hide disappointment from your children if they don’t get in. Anyone who has gone through the house buying process in the UK will have experience of the disappointment of being ‘gazumped out of our dream home’ and quickly realises that the scatter gun offering on many perfectly acceptable houses and THEN loving the one that you exchange on is a much better strategy.

 

Also – I am a control freak and if anyone is going to be ‘shaping my child’s mind and attitudes’ – it’s going to be ME! Mu ha ha ha ha. (For as long as possible anyway!)

 

  • Contain your own anxiety. OK, I have to fess up that every 8-10 weeks I do have an anxiety wobbly where I worry that no selective school will take my money and accept my daughter to their school and that by some freak influx of 11 year olds to my local area, we will now live too far away to get into the good local state school. At least though, I recognise this anxiety wobbly for what it is and am able to mostly keep it to myself, give myself a good slap around the chops and saying: ‘stop catastrophising’. I doubt any parent can really get through this period without a stitch of worry and anxiety, but the best advice is to ‘Keep Calm and Carry On’ and preferably try not to show your anxiety to your children as your anxiety is fuel for their anxiety.

 

  • Pride and unconditional love. If you are a bit shy about expressing your emotions to your children, now is a really good time to release yourself from your shackles. Go all out on expressing pride and unconditional love. This does not mean that you let children off the hard work that they are likely required to do, but that the effort that they put in is noted, praised and whole-heartedly appreciated, as well as their non-academic attributes that make them the lovable person they are.

 

  • Silver Linings.When failure happens, make sure that you accept it. Highlight the silver linings to yourself and your child. It’s better that you actually BELIEVE these silver linings, other-wise your child will know that you are just trying to make them feel better and see it as fake. If you can, convince and accept it yourself first then you’ll be able to deliver the silver linings genuinely. You might feel some innate need to contest the failure and imagine some mistake has been made and feel a need to make an appeal. Alternatively, you might feel that it is necessary to make up an excuse as to why your child didn’t get in to a particular school or feel embarrassed to divulge failure to family and friends. All of these common parental behaviours meant to make your child feel better often have the paradoxical effect of making the failure hurt more for your child as they highlight your disappointment and disbelief in the legitimate outcome. As I said, unless you are an Oscar winning actor, try to be genuinely happy with the outcome as if you feel disappointed, your children will know about it however much you try to keep it from them. Many 10 year old children’s main wish is to make their parents proud. Conversely, feeling that you have made your parents ashamed or disappointed can feel like agony.

To all parents embarking on the same journey as me in the next 2 months:

Stay Sane!

To all girls and boys out there who are embarking on the same journey as Molly in the next 2 months.

Good Luck!

You will be Brilliant wherever you go to school!

Helping children to identify their own emotions

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Many parents are happy to spend time and effort daily to teach our children to read and write, but very few of us sit down with our children daily to talk about emotions. Yet difficulties in managing emotions have a direct impact on learning and is the major reason that children get excluded from school. Getting in the habit of talking about emotions should happen early on. In my book “Inside Out Parenting”, I talk about teaching managing emotions with the same effort and at the same time as teaching our children to manage their motions (toilet training). We should spend as much time and effort encouraging our children to tell us that they ‘need a cuddle’ as we would teaching them to tell us that they ‘need a pee’. If talking about our common experiences of emotion is habitual from toddlerdom, it will become part of our natural repertoire and free us for a life time.

Remember when our children were babies and they cried if they were wet/ hungry/ thirsty or tired? Children who have difficulty identifying their emotions are in the same boat. They convey distress in one way (usually anger) which does not help others identify what is actually wrong. In clinic, it is often evident that many families (parents and children alike) can only identify and express one negative emotion: ANGER – and all manner of other nuanced emotions: frustration/ boredom/ jealousy/ sadness/ pain/ irritation/ annoyance/ unfairness/ grief/ hunger just become subsumed under ‘anger’. This inability to identify and define emotions and their cause is impairing as the solutions for relieving distress in each case is very different. The more that we as parents can actively support and teach our children to identify emotions and physical states, the easier our children will find it to manage their emotions.

Emotions can be tricky things to identify, particularly so for children who have learning disability or autism spectrum disorder who may not understand where the discomfort is coming from. Negative emotions like frustration, anger, jealousy and sadness feel intensely uncomfortable and unless we have an understanding of the cause and temporary nature of the feeling and ways to deal with it, then it can cause immense distress to children, adults and all around them. I will give a funny first-world problem example:

When Molly was around 6 years old, she had quite a temper and one dinner time she complained incessantly about the dinner that I had cooked. Having had rather a long day and spent time trying to prepare a nice dinner, I didn’t feel like listening to her complaints any longer and as she is usually well-fed and watered, I sent her to bed without her dinner. Around 11pm, down comes Molly in immense distress and sorrowful tears.

Molly:  Mummy! I’m dying. I’ve got a pain in my tummy and it really hurts.

Me:      You’re hungry, that’s all.

Molly: No, it’s not that. It’s the most pain I’ve ever felt in my life. I really think it’s serious. I waited ages and it’s not going away, it’s getting worse and worse. I’m frightened.

Me:      OK. But eat this first and then we can call the doctor if it still hurts.

Molly [buttered toast later]: Mummy. The pain has gone.

From then on, Molly was able to identify what ‘hunger’ felt like and the solution. If we are on hand to explain to children their emotions as and when they experience them, then they will learn what these emotions are and how to handle them. Of course, sometimes in the heat of the emotion children may not accept your explanation: try telling an over-tired child that they are tired and you’ll get the most vehement denials – but reinforcing your explanations the following day when they are calm can help, as can witnessing the same symptoms in their siblings and having these pointed out. Molly became quite the pro at tutting “He’s over-tired” when D was raging due to tiredness. 

Sometimes, we need to do a bit of investigative work to find out the cause of negative emotions: for instance the source of jealousy or frustration, but if we find it, normalise it and explain it, it generally helps for the next time around. If we are there to catch emotion forming and can head it off, all the better:

Me: I can see Molly that you are upset that your brother got a massive Lego set from Grandma for his Christmas present and you got a book. But this doesn’t mean that they love you any less, it just means that they happened to know what he wanted and weren’t quite sure what to get you. Tell you what, why don’t the two of us go and buy you something else as an extra present tomorrow?

 

50 shades of grey: Parenting is not all black & white

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One of my bug-bears regarding mainstream advice for parents is the extreme focus on “Dos and Don’ts”. Having been asked to write a few articles for mainstream media, I often sigh when I am asked to produce a list of my top ‘dos and don’ts of parenting’.

Incidentally, it would be the following:

DO:

  • Use sunscreen on your children
  • Vaccinate your children

DON’T:

  • Sexually abuse your children
  • Physically abuse your children
  • Emotionally abuse your children
  • Physically or emotionally neglect your children

But this isn’t usually what people are after.

I know what people are after: Don’t allow your children on social media/ Don’t allow your children to watch TV/ Don’t tell your daughters that they are beautiful/ Don’t praise your children for being intelligent/ Do praise your children for effort/ Do encourage exercise/ Do read with your children/ Don’t push your children to achieve/ Do push your children to achieve.

The advice may be catchy and ‘sound’ sensible and I could even throw in a few science sounding sound bites to support my case, but really – it is meaningless and often based on fluff and anecdote rather than hard science. The reality is that in the words of Ben Goldacre: “I think you’ll find it’s a bit more complicated than that” and like most things, parenting does not exist in the black and white, but 50 shades of grey.

“Black and white thinking” is often an undesirable symptom of conditions such as depression, personality disorder and autism spectrum disorder. In depression for example people can feel that making a small mistake is a disaster because in the binary world of ‘black and white’ or ‘perfection and imperfection’, small mistakes necessitate categorisation in the ‘imperfect’ pile. People with personality disorder may tend to classify people as “good or bad”, those who are good are put on a pedestal, but if they cause even minor offence, they then become enemy number 1 – because there are no in-between options. In autism spectrum disorder, there is much frustration, anger and a sense of injustice with queue-jumpers and rule infringers, because often there is only “right and wrong”. In all cases, black and white thinking is a negative: it does not reflect reality, discourages adaptability and perceptions of nuance and as such causes unnecessary distress.

So why does the media wish to encourage its audience to think in such maladaptive ways? And how can we protect ourselves from binary thinking?

In cognitive behavioural therapy for children with black and white thinking, one of the purposes of therapy is to challenge black and white thinking: to map out every shade of grey and to consider every caveat.

I think we parents could also do with some of this in our lives to stop our own binary thinking regarding how we parent:

Mapping out Shades of Grey:

(If black is no and white is yes)

Does looking like a hot mess mean I am a bad parent? Black

Does having a messy house mean I am a bad parent? Slate

Does doing the school run in my PJs mean I’m a bad parent? Ash

Does shouting at my child in anger mean I am a bad parent? Pigeon

Does physically abusing my child mean I am a bad parent? Snow

Caveats:

If I give my children ready meals am I a bad parent?

  • What if it is not every night?
  • What if I am a time poor working parent?
  • What if I am a time poor single parent?
  • What if it allows me to spend more quality time with my child?
  • What if it allows me to help my child with their homework?
  • What if I have 4 children?
  • What if I have a new baby?
  • What if it is a hipster vegan and gluten free ready-meal?

I know that binary parenting advice is an easy-to-understand way of delivering information, but I think that it is about time that we trusted the intelligence and judgement of parents a little more. The focus should be on providing good quality information and education and not on sound bites to be dogmatically followed. I hope that my blogs and book reflect this ethos. I don’t want people to ‘do as I do’ or ‘do as I say’ but to reflect on their own parenting and find their own path with a clear understanding of the implications of compromises that we must all make. And to embrace grey in their lives like they would Jamie Dornan if they got the chance…!

 

 

Smart Women Week

Red SWW_Instagram Organic Feed_Holan Liang

Jo Malone CBE

Kelly Hoppen

Melissa Hemsley

Trinny Woodall

Ella Mills

Clemmie Hooper

(lots more amazing and smart women)

& Me!

I can’t believe that I am going to be part of this amazing line-up at Red Magazine’s ‘Smart Women Week’ September 18th-22nd. I have been a great fan of Red Magazine the last 10 years and so I was absolutely chuffed to be asked to speak at their London event about all thing’s child mental health. If you would like to come along, please see the link below for tickets!

smartwomenweek.co.uk

It’s all in the Mind: Psychosomatic and Somatopsychosis

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Watching Molly do cartwheels the other day, I discovered a new psychiatric syndrome: somatopsychosis. It’s a very rare condition and she may be the only sufferer largely due to her terrible parent: me.

Most of us are aware of the miraculous power of our minds over our bodies and the inextricable links between psychological problems and physical problems. At the most basic, feeling physically unwell can make us feel sad about not being able to do things we wanted to do, or anxious that we may have a serious or life-threatening illness. Being a medical student was the worst. Reading lists of symptoms of rare neurological diseases was bound to bring on symptoms of blurred vision, pins and needles and lethargy such that a self-diagnosed brain tumour became a convincing reality. Conversely, when we experience bereavement, adversity or tragedy, we often feel it physically as “heartache” or “headache” or “tiredness” and “sleeplessness”. The term “psychosomatic” is basically a fancy way of saying bodily (somatic) symptoms for which there is a psychological (psycho) basis.

Children are no different and due to their immature abilities to identify and express emotions, their propensity to cite psychological problems as physical ones are more frequent. For children, who may have less understanding that psychological problems stem from the head, the gut is the most frequent organ assigned to physical problems. Children who are worried at school may experience genuine stomach aches or constipation which miraculously remit at the weekends and on holidays. For teenagers and adults, the neurological often (but not always) begins to preside with headaches and migraines becoming more prevalent presentations of psychosomatic symptoms.

Psychosomatic symptoms more commonly arise in children who are less able to understand, identify and report their feelings and emotions. Therefore younger children, and children with learning difficulties and or autistic spectrum disorders are more vulnerable. It may also occur in children where reporting feelings and emotions is not possible, discouraged or seen as a sign of weakness or failure. Often children may have experienced past or current physical problems and therefore have a good understanding of how to solicit help or get their needs met for physical problems. Often parents can contribute to symptoms by their own fears and anxieties about their child’s physical health. This is particularly so if the child has a long standing medical condition or has been unwell in the past. Doctors and health professionals can add their own anxieties “of missing a rare disorder” into the mix with repeated investigations and suggested treatments to help uncover and treat an underlying biological basis to problems, and neglect to consider that the underlying problems may be psychological.

If that is the long established thinking on psychosomatic symptoms, what then is my new disorder of “somatopsychosis”? Well, exactly the reverse: psychological symptoms caused by physical ones. This sounds highly unusual, and indeed, Molly is the only recognised case report of this pathological condition that I have just made up. Here is how it works:

Some doctors, like myself (I hope this is the case and I am not an unusually hard-hearted anomaly), have a skewed sense of pain severity due to our dealings with pain at the very severe end. At times it can border on the down-right unsympathetic: when my husband complains of woozy head and sniffles, it’s most definitely man-flu of no significance and he should take Lemsip, go to bed and quit complaining. When an adult patient complains of pain from a blood test, I sometimes mentally think “Come on – it’s a skin prick – I’ve just sewn someone’s entire arm back on!” and don’t let me get started on people that wince in extreme agony from having a blood pressure taken. I am of course professional, kind and sympathetic to my patients, but I am also human, so I hope you will forgive the occasional internal eye-roll at such “wimpish” behaviour.

Unfortunately for my children, professionalism doesn’t wholly apply at home and although broken legs, cuts that are likely to leave scars and high temperatures are met with the usual heightened maternal anxiety (including vivid nightmares of misaligned bones or fractures that disturb the bone growth plates that only people of medical training contemplate) I admit to a general propensity to a lack of sympathy to minor physical pain. As such poor Molly and D have learnt that a grazed knee will earn a dusting off, a quick wound wash, a hug and a wipe of the tears, but then an expectation that the episode is now over and they are to carry on playing. A bumped knee will unlikely earn more than an “Oh dear, you’ll get a nasty bruise” or sometimes, I admit to even worse: “Well, that’s what you get for charging around without looking where you are going.”

As a child psychiatrist on the other hand, identifying and expressing feelings and emotions are a different kettle of fish. From a young age, both children have been encouraged to talk to me about their internal lives, what has worried them at school and all angles are thoroughly investigated and talked through with utmost attention.

It appears that this table-turning of the usual scenario where parents pay immense attention to physical pain and tend to access less of their children’s internal worlds can have its own unhealthy consequences. Here’s what happened:

Molly: Whee! look at me! I can do really good cartwheels now!

Me: You’d better watch out, doing cartwheels on a slippy rug is not the best idea…

[BUMP]

Molly: Ouch! [Blubber, blubber]

Me: I told you so.

Molly: You don’t know what a terrible day I had. Girls were being mean to me at school.

Me: [???? What the hell? Where did that come from?]

I had to suppress a smile as I realised what was happening. Molly subconsciously knew that I wasn’t going to give her sympathy for a bumped bottom, but a potential peer interaction problem would give her the comfort and attention she needed at that time of physical pain.

AAARGHH! I have generated somatopsychosis! At least my early recognition of this oddity has reminded me to be more sympathetic to my children and change my ways. I absolutely don’t want her to subconsciously fabricate mental health problems to gain attention. It does go to show though, the frightening power of our day to day words and actions on our children, and the critical importance of what we DO and DON’T give attention and kindness for.

 

 

 

Exercise Your Mind

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Just a quick blog to shout out about an exciting new “Gym” that’s launching in London this weekend. No, it’s not one for planks and TRX, but one for exercising the little grey cells!
It does seem a shame that after school or university, we become cosseted in a life where IF we continue to learn, it is usually “on-the-job” such that we become super-specialist in our own pigeon-boxed specialties without gaining breadth of learning. No more getting to try “lino-printing” or “debating” as we did in the classroom, to the extent that I am rather jealous of my kids who are shipped off to exciting school clubs such as “Lego Workshop”, “Chess” and “Tech club”. Jealous no more, as this weekend (May 13th 2018), Cerebral Gym will launch at the lovely and charitable House of St Barnabas in SoHo. Here, you will get to learn about all manner of things from bridge, to opera via architecture, with a bit of rap and book club thrown in for good measure. If it all get’s a bit too much for the little grey cells, there’s massage and meditation on site.
And to top it all off, a spot of parenting chat with me! Yippee.
If you are free, do come down. See the sites below for info and tickets.

Cerebral Gym Website

BOOK TICKETS