Back to School

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For many parents it’s back to school this week, a time of mixed emotions. I’m sure that I am not alone in feeling a sense of relief (thank God I’m no longer responsible for them 24/7 or for organising who will be responsible for them 24/7), sadness (how the heck did they get this big? A minute ago I was wiping their bottom) and anxiety (how will they get on with their new teacher?).

The “Back to School” prep has all been done. This year, thanks to a last minute job application form that was due, the majority was delegated to Banker. For the first time, he braved John Lewis alone with the kids to battle over the last Size 3 Geox, AND he ironed on all the name labels on the new uniforms. This latter he did correctly this time as last year when he was assigned this task he spent an hour ironing on sticker name labels (used for books and pencil cases etc) rather than the iron-on name labels (used for clothing). They obviously didn’t stick and I had an absolute barney as I had to repeat the task. This year all was done to standard, which goes to show that these parenting tasks need not be the preserve of mums (if we are happy to tolerate a hiccup or two)! All I did was get Lil Bro his back-to-school haircut and then they were set.

As soon as my kids saw their friends they were off without a backward glance.

I toddled off to the shops. It was with sadness that on my return from the shops, a good hour after the school bell had tolled that I saw a mum and her son outside the school gates. I heard a snapshot of their conversation “Just go in and talk to the others. It’ll be fine.” It occurred to me that for some families, “back-to-school” is not just a logistic nightmare of name labels, new shoes and haircuts, but a return to a battle-ground and heartache.

As an autism specialist, it is not uncommon for my clients to loathe school and in extremis to refuse to go to school. Anxiety is the most common co-morbidity in children with autism, and it is also the most common mental health problem in primary school aged children. So here are a few pointers on school refusal:

Try to find the cause for anxiety

  • Encourage your child to feel safe to talk to you about their problems. This requires a non-judgemental attitude and a guarantee of confidence and that they will not get into trouble. They will also need to know that they will be taken seriously, and that you will have the resources and strength to help them. Many children I see in clinic do not disclose bullying to parents as “it will worry them”, “they won’t believe me”, “they will only confront the situation and make it worse” or “they won’t be able to do anything”.
  • Often it is not sufficient to ask your child why they will not/ do not want to go to school. Persistent badgering on this question may cause more harm than good if it is not forthcoming given encouragement. Sometimes your child may not fully understand their own emotions or the cause of their emotions and therefore cannot tell you even if they wanted to. In this instance, it is up to you to speak to teachers and friends and come up with your best guesses. Discuss these hunches with your child in a non-judgemental way: “If I were in your shoes, I’d be a little scared of your new teacher…” and see whether any of them chime with your child. This is a favourite child psychiatrist strategy of mine as usually one of your guesses will be correct and when you see a child’s face respond to you verbalising their darkest emotions, you can tell that you’ve got to the heart of it and work can begin.

If you find a cause then dealing with the cause will be your next step. Some common causes for school refusal in primary aged children are:

  • bullying/ social ostracisation by peers
  • bullying/ fear of a teacher/ fear of being told off
  • anxiety about a particular subject: fear of failure in an academic subject, fear of being ridiculed in P.E.
  • anxiety about leaving the parent (separation anxiety) for fear something may happen to the parent.

Sometimes, there is no one-single cause and anxiety may be generalised or the sum of minor anxieties that can overwhelm. Working through each one, however minor, can be important.

Dealing with the cause should always involve:

  • Working together with the school. The natural parental instinct is to do your utmost to protect your child which can mean confronting the school staff or the parents of other children. Try to stay calm and keep an even head – whatever happens, getting other parents and teachers on side will lead to better outcomes for your child than making adversaries.
  • Supporting your child. As well as in relation to the identified cause, increasing your child’s self-esteem, resilience and social skills will always help.

Avoid pitfalls:

  • Sometimes, parents will allow children to stay off school due to school refusal. It is important to remember that this can inadvertently encourage problems as you are in effect teaching your child that crying and fussing will lead to a day off school. Sometimes it is impossible to get a child into school, but if this is the case, then schoolwork should be done at home rather than a pleasurable day at home watching TV and playing computer games. An incredibly boring or taxing day of chores at home may lead some children to the conclusion that school is preferable!
  • If at all possible, get children back into school as quickly as possible because the longer that they are off school, the harder it will be to get them back.

 

Make Time For Your Dreams

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In September 2013, after a prolonged period of doubting, mental deliberation and build-up, I ventured on-line and bought myself a domain name: Shrinkgrowskids.com. It was meant to keep me busy while the children were in school because finding employment in school hours only is impossible. I psyched myself up. I was about to start writing when the following happened:

  • my daughter broke her leg (she was 6 years old and too little to use crutches. We have a typical Victorian townhouse on 3 floors. She needed hoisting everywhere. I put my back out)
  • my dad got diagnosed with cancer (thankfully now in remission)
  • my son had terrible allergies to a list of over 20 food items

There were a lot of hospital appointments. The blog got put on the back-burner. Life’s never easy and there is always an excuse NOT to do something.

I’m glad that I persisted.

In January 2014, I finally got the chance to sit down and blog and this led on some 3 years later to the publication of my book last month. So I wanted to share the following with you:

Remember your dreams and make time to make them happen!

 

***

Here’s a little taster from the intro of my book:

Oh, for pity’s sake!’ I silently cursed.
I had timed the nursery run to a tee and for once we were actually on schedule – until my three-year-old daughter, Molly, realized that her new shoes did not have her name label in them. Disaster! I tried to persuade her that this would be fine for one day and promised to stick the labels in that night; I explained that I couldn’t do it there and then because we would be late for her nursery (and, more importantly, I would be late for a meeting I was due to chair). But Molly out and out refused to see reason.

So I tried cajoling, then bribing, then threatening her. All to no avail. Ultimately I gave in, impatiently got the name labels and grumpily stuck them in her shoes. But by then it was too late. Molly was digging her heels in and her anger wasn’t just about the shoes anymore, but had become an incoherent fury with the world in general. And she was still refusing to put on her shoes. There followed more shouting, this time from me, along the lines of, ‘Now I’m going to be late!’ Reciprocal shouting and foot stamping from Molly ensued, until I realized that physically picking her up, bundling her under my arm and forcibly depositing her in the car was the only way I was going to get anywhere that day.

This was no mean feat. Picture me shuffling sheepishly down the road to the car, praying not to encounter any of my neighbours, Molly tucked under my arm like a log, kicking and screaming, with no shoes on. Simultaneously, my eighteen-month- old son D (Chinese for little brother, which is what we’ve always called him), was clinging on to me like an oversized pendant, his arms wrapped tightly around my neck. Assorted nursery-required paraphernalia was haphazardly piled into two bags, which weighed down so heavily on my elbows that they were cutting off the circulation to my fingers, from which dangled the contentious shoes. I must have resembled a demented rag and bone woman with my assorted wares hanging all over me. Meanwhile, Molly’s ongoing high-pitched wails of, ‘You’re hurting me!’ advertised our approach to everyone in the neighbourhood.

It was on that day of model motherhood that I decided I should write a book about parenting. If this seems perverse, I haven’t even confessed the funniest part of the story yet. About an hour after that little episode, I finally took my seat at the meeting. There I sat, solemnly discussing the effects that ‘compromised parenting’ has on the mental health of children. Believe me, the irony was not lost on me.

You see, I am a child psychiatrist. Handling Molly’s meltdown should have been second nature to me, but it wasn’t. After this humiliating escapade, I started to write down the more ridiculous of my parenting moments, because on one level they intrigued me: ‘Surely a child psychiatrist should know better?’ I kept asking myself.

Before having children I probably considered myself some-thing of a ‘parenting expert’. I doled out parenting advice to parents like hot dinners and wore my, ‘I know about parenting; I’m a child psychiatrist y’know’ badge with pride. It was only when I actually became a parent that I woke up to the humbling reality that there is no such thing as a ‘parenting expert’. Parenting is, in essence, often a process of mainly well-intentioned trial and error. The well-intentioned part is important because in recent times parents have been taking their role in their children’s development much more seriously. We’ve come a long way from the days when children were seen and not heard; when it was fairly common for them to be farmed out to wet nurses, governesses or boarding school at one end of the social spectrum, or sent up a chimney at the other. We now know that leaving the administration of parenting to others means potentially leaving the outcomes

of our children, and the adults that they will become, in the hands of others.

Indeed, sometimes it seems we have gone to the other extreme; there has been such a seismic shift in our attitudes towards parenting. Rather than abdicating responsibility for our children, or being ambivalent, we now have an almost obsessive preoccupation with them. I like to think that this is because my profession has done such a great job at promoting the importance of loving and understanding our children, though cynics might argue that it has more to do with the fact that most of us can no longer afford nannies, governesses or boarding schools. Whatever the reasons, there is no doubt that there is now a genuine interest in giving our children the best possible start in life.

***

Asian Woman: Nanny or Hooker?

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So it’s finally general election day (again!) and in the build up you’d think that local canvassers would be hungry to win over voters on the doorstep wouldn’t you?

Sadly not if you are Asian. This week, I experienced yet again the “Mistaken for the Cleaner” scenario. Here’s what happened:

Door bell rings.

I answer it.

The canvasser looks at me and gives me a flyer (for the party that I support) and asks me to give it to the resident voter.

I am taken aback, because I would like to have a chat about the candidate that I am going to vote for, but the canvasser has already turned his back and is already exiting the gate.

I finally find my tongue.

“I live here. I’m a voter too you know? Aren’t you going to talk to me?”

Cue awkward back-tracking by canvasser on the hot foot.

“Oh, sorry”

*sigh* “Did you think I was the cleaner?”

“No, no, of course not, we get doors answered by all sorts of people, you know friends and so on.”

I’m not really buying this. REALLY? Someone opens the front door and the first thing you think is: this person is a ‘friend’ of the resident…??!!

“Do you want to know about our policies.”

“Don’t worry. I’m good.”

Door shut.

This is not a unique scenario. Not too long ago I laughed out loud along with the rest of the world when the images of Professor Kelly’s report on South Korea was unexpectedly hijacked by his kids. Yet the initial hilarity and empathy with Professor Kelly’s clip soon became soured by the comments that flowed beneath the video. If there ever was a hero of the piece, it was his Korean wife that sped in to save the day and heroically crawled back in on all fours to close the door to allow peace to descend. I immediately warmed to her as her casual wear and practical pony tail looked just like my own. My own response to such an eventuality with my own children would have been instinctively identical.

Why then was she presumed by many to be the Nanny/ Maid, and worse still, why were her actions defined as being “submissive” and “fearful”? What would the “proper”/ “non-submissive” response from a wife and mother have been? To walk in and wave at the camera? To leave her husband to battle it out with the children on-screen?

Whatever people may say to try to justify their gut reactions, I am without a doubt that the “nanny-assumption”, just as the canvasser’s “cleaner assumption” was based on our ethnicity. How can I be so sure? Because it happens to me (and I’m sure other Asian/ Latino women) all the time. Here are a few of my highlights:

• When I first started dating my husband (a 6 foot 2 white South African), many people expressed surprise, questioning “You are a strange couple. What do you have in common?” I soon realised this was a bit of code for “He’s tall, white and handsome and should be going out with a leggy blonde not a short bespectacled Chinese woman”. This line of thought was later confirmed by a sozzled old bufty we had the misfortune to sit next to at a wedding once who stated the quandry more precisely due to inebriated state: “How did you two ever get together? He has round eyes and you have slitty eyes.”

• My husband had invited some of his new, white, male colleagues over for dinner. At 5 minutes to specified guest arrival time, I’m still in my tracksuit pants doing the last minute hoover and cushion plumping because in London with the ineffectiveness of the transport links and the relaxed attitude to time-keeping, I’m figuring I’ve still got 20 minutes to get changed and slap on some lippy. But what-ho? There’s the door-bell! The damn husband had failed to mention that his new colleagues had meticulous talent for punctuality. Never mind, I do my hostess duties diligently: offering to take coats and taking orders for drinks. The guests are genial and I show them into the dining room, where I start to serve the food that my husband has prepared. Here I figure that since they have caught me in my casual garb that it would be affected to disappear upstairs and re-emerge tarted up, so I don’t bother with that pretence. It is only when I plonk myself down at the table amongst the gathering that I notice the strange looks from my fellow diners. There is a definite note of initial surprise that “the brazen cleaner/ house-help is joining us for dinner”, followed by a tinge of embarrassment when they finally clock that I am the wife.

• When I was on maternity leave and started being in my house in the day time, I couldn’t help but notice that each morning a troupe of Asian ladies would come up the road, disappear into various houses and then leave in the evenings. I could see them through windows dusting and polishing in various houses. I realised that I looked more like them than my actual neighbours. It was no surprise then that when unexpected callers came to the door (the gas man, electricity man, charity door-stoppers, election campaigners, the police) they would ask to speak to the owner of the property when they were faced with me. After a few times of indignant proclamations of “I am the owner of this property”; I realised that it was much more fun and expedient to actually pretend to be the Cleaner and this works fantastically well to get rid of a lot of people that I don’t have the time for. I don’t even need to speak. I just put on a puzzled look, shake my head and shrug my shoulders like I can’t understand English.

• One time on maternity leave I went to the Royal Academy of Art with my baby and a friend with her twin babies. I had access to the Friends’ room so we ventured in there to have a snack, but the tables were all full, so we were kindly invited to join a table that was already occupied by a sweet elderly couple. This was a blessing as we had 3 babies between us. As my daughter was asleep, I helped out my friend with one of her twins by rocking her in my arms, and my friend chatted amiably to the elderly couple. When along comes a posh old dame who comes over babbling with delight about how wonderful it is to see families enjoying a day out at the RA. She talked at length about her own daughter who “also had triplets”. At this point I clocked things from her perspective. Here was a family of white grandparents, white daughter and triplets. That left me, the Nanny.

• Add to this the countless times I have had to have my passport doubly scrutinised at airports (apparently because there are Chinese gangs providing all manner of people with fake British passports) or if I am with my children, all our passports doubly scrutinised (because of Chinese gangs child trafficking). Strangely enough, if I travel with my husband, or if he travels alone with the children, this never happens. The addition of a “jolly fine white chap” somehow legitimises the rest of us.

Like for Jung-a Kim, Professor Kelly’s lovely wife, none of the above particularly bothers me. The reason being that for most non-white females, we have acclimatised and adapted to these day to day occurrences. I believe that these days we are to refer to them as “micro-aggressions”, but in my day, they were just things we ignored/ laughed at or put up with. Annoying, petty stereotyping is not the preserve of non-white females. Although I have witnessed a myriad of advantages that my husband gets purely by being a “tall, white, male”: aeroplane upgrades, hotel upgrades, many, many people-that-ignored-me smiling and offering to help him, people hanging on to his every word (when he is actually spouting my rhetoric which would have been ignored if it were coming out of my mouth); I have also witnessed my tall, white-male husband frequently mistaken for a Bullingdon club posh toff/ arrogant Apartheid supporting South African/ Countryside Alliance fox-hunter/ Trust Fund elite just because of the way he looks – which I imagine can also be tiresome.

“What are you doing going out with him?” my Socialist Worker reading friend asked.

But scratch beneath the colour of our skins and you will see that we:

• Are both the youngest of 3 children
• Are both from close knit families
• Are both immigrants to the U.K.
• Are both originally from pariah nations (South Africa due to Apartheid; Taiwan due to Chinese diplomacy)
• Both have direct experience of the effects of racism and inequality
• Both have an interest in opening our minds and hearts to new people, new places and new experiences
• Are both happy with who we are

So where it matters, we are immensely similar.

And so, in conclusion I think that we should all do a bit more of looking beyond stereotypes. I have no problem with being mistaken for a Nanny/ Maid/ Cleaner, because consider the alternative: I absolutely hated travelling with my husband to Thailand/ Indonesia and other developing Asian countries in my youth, because if we ever got in a cab, went for a nice meal or checked into a fancy hotel; I was clearly always “The Hooker”.

Talking to My Children About Terrorist Attacks

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I, like the rest of the country have been left dumbfounded by the cruelty of a terror attack targeting children and their parents. Of course, this is no more tragic than the bombs being dropped on hospitals and schools in Syria or elderly window cleaners being mown down on Westminster bridge, but it is a natural and human tendency to feel more empathy when the people involved are “just like you and your family”. The eight-year old girl that died, could have been Big Sis, the mum’s chatting outside waiting to pick up their children could have been me and my friends. Maybe it’s this that makes me feel it more this time around.

I asked Big Sis and Lil Bro if their teachers had mentioned the recent news at school. They had not. I wondered for a while if I should talk to the children about it. They were blissfully unaware that anything out of the ordinary had happened and I could have left it that way. Why let the world intrude on a “safe and idyllic” childhood living in a fortunate part of London?

Yet I decided not to stay quiet and here’s why:

  • Children do not live in a bubble and sooner or later the outside world beyond a loving home and sheltered school will impinge on them. As much as we parents want to shelter our children from hurt; hurt is an inevitable part of life. Children who are shielded from hurt never learn to manage their negative emotions so that when inevitably, they get hurt, they are less well equipped to cope. Better to gently expose children to reality and teach children to manage their emotions.

 

  • Children will become adults sooner than we think and need to have socio-political views of their own. There is talk of extending voting age to include 16 year olds: de facto: children. Whilst the children are young and I have an influence on my children’s opinions, I would like to pass on my ideals of openness, fairness and love so that they are entrenched before the likes of unknown peers and uncensored media get a hold of them. I felt that this terrorist attack was a marker event, so significant that they needed to know about and understand it, to shape their opinions for later life.

 

But what could I say? No medical degree or child psychiatry training teaches you this.  In this, like so many other aspects of parenting, I am like any other parent: a novice. Here’s how  I tried my best:

I told them that something terrible had happened in Manchester and we found the BBC Newsround clip together on iPlayer. We watched it together. A good quality children’s news program can convey facts in a way that children will understand and also be counted upon not to shock or overly upset the average child, so this is a good place to start.

I asked the children what they thought about it and I answered their questions.

Big Sis: What is a terrorist?

Me: It’s a person that does things to frighten other people so that the frightened people will do what they tell them to do.

Big Sis: Is it like a bully?

Me: Yes, I suppose so. They frighten people to get their own way or to make other people angry to start a war.

Big Sis: Why would anyone want to start a war?

Me: Well there are already lots of wars going on around the world. We are just lucky that we live in a country that’s safe right now.

Big Sis: Why can’t people just stop fighting?

Me: It’s easier said than done! Why can’t you and your brother stop fighting?

Big Sis [Hmm – recognising this is a tricky]: Well, we should just kill all the terrorists.

Me: It’s more complicated than that. Killing people just upsets more people and often leads to more death. I don’t have all the right answers, but it usually doesn’t involve more death.

Big Sis: What should we do then?

Me: I think we must just help the people that got hurt, remember the people that died and carry on with our lives. We can’t let bullies scare us into giving in or feeling anger and hate, because this is what they would want. Maybe it can help us all feel grateful to be alive and for what we have.

 

Lil Bro: Will a terrorist come and bomb us?

Me: I hope not, but we live in London so I can’t say for sure. What I can say is that I have lived for over 40 years and haven’t been hurt by a terrorist yet, so the chances are really low. It’s natural to feel a little bit upset and worried, everyone does – even me, but if we let it stop us doing what we enjoy doing then the terrorists have won. So we need to be strong and ignore them.

 

This was getting rather depressing and I was running out of things to say, so I was really surprised but pleased that out of the mouths of babes can come heart-warming positivity:

 

Lil Bro: At least they died happy.

Me: Huh?

Lil Bro: They went to see an Arianna Grande concert and had a good time. The last thing that the people that died felt: was happy.

 

TOP TIPS:

  • Don’t be afraid to tell the truth to children
  • Use language children will understand
  • Avoid unnecessary graphic and frightening details
  • Acknowledge that fear is normal
  • Encourage talking about fear rather than suppressing it
  • Model a good sense of the risks: don’t get overly worried yourself
  • Offer realistic reassurance
  • Model a “carry on” attitude
  • Continue to spread love not hate

 

And, if you can, find a glimmer of hope.

 

If you are lucky like me, your children may find the positive for you.

It’s here! Inside Out Parenting

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Sorry for the radio silence, but life has been pretty hectic the last few months to say the least. I have been interviewed by The Times, Country Walking and writing articles for The Telegraph and Daily Mail on-line sites. Crazy. Today a long-held dream has become reality and my little book, which came about from this blog, has hit the bookshops. When I paid my £60 to register this blog domain, little did I imagine that all this would be possible.

This morning after dropping off the children at school, I made a solitary trip to the local bookstore and headed to the parenting section where I have hung out quite a lot in the last few years. My only previous publication was a Chapter in a textbook so specialised that you had to order it on-line, so it was a very strange idea that I could go into a bookshop and see my book on the shelf. I didn’t really believe that I would find it, but there it was….

 

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Thank you so much to all the lovely people that have followed or read my blog. I do hope that now the hard work is done on the book that I will be back on the blog site again! I have missed Big Sis, Lil Bro and Banker, not least because they are transformed into Molly, D and Andrew in the book. Since writing the book, so much has happened and the children are no longer little anymore! I’m really looking forward to sharing the next adventures in parenting with you : Lil Bro is sitting his KS1 SATS and I am forming an excel spreadsheet of secondary schools for Big Sis – where did the time go?

If you have liked my site, please look out for my book: it may be tucked away somewhere next to books on potty training! – (I confess to having spent half an hour rearranging the shelves at my local Waterstones to get that photo above – at least I was decent enough not to sneak it widthways over Giovanna Fletcher).

Thank you again for supporting my blog. I could have not done this without you!

 

 

Children’s Sleep

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Lil Bro: Mummy – I can’t sleep

Me: Please, its past nine o’clock, what are you doing still up? You have to go to sleep now or you’ll be exhausted at school tomorrow! [Plus I just got started on this week’s episode of “This is US” and a tub of ice cream and I really fancy a rest!]

Lil Bro: But I can’t sleep.

Me: Just close your eyes and lie still! [Grrr]

I’m sure many of you are nodding in sympathy at this experience. Lil Bro who usually has no difficulty getting to sleep is having a spate of “I can’t get to sleep”. We have tried cuddling, cajoling, comforting, reassuring and now we are at the frankly fed up stage.

Children with poor sleep can have difficulties with poor concentration, over-activity, behavioural problems, day-time sleepiness, bed-wetting, obesity, increased clumsiness, depression and worse academic performance. Equally bad, the lives of their parents and entire family are also grossly affected. As parents of infants, we have all been there, but somehow I’ve taken immense umbrage at this recent spell of poor sleep because Lil Bro is now 7 years old and well able to put himself to sleep.

When Big Sis was a wee mite, I was the rabid sleep-deprived mother heckling the sleep experts flown in from abroad to teach us doctors about sleep EEG’s: “Can you tell me why, WHY, how, HOW can a baby go from stage 4 deep sleep to AWAKE and CRYING just by a 10 degree tilt to lay them in the cot????!!!! Give me the EEG on how that happens…!!!! What’s the possible mechanism???!!!”….zzzzzzzz – bonk.

So, I must now be the envy of most mums, as for the last few years I have had the pleasure of working with Paul Gringras a.k.a. the Professor in charge of the national Sleep Medicine centre at The Evelina Children’s Hospital. I have been working with him on an international multi-centre drug trial for sleep medication in children with neurodisability (mainly autism), which he is leading. His centre is hi-tech with observational sleep bays where children can sleep-over and be observed on video to capture what is going on, often plugged into electronic equipment that monitors breathing, brain and movement activity and I was fortunate enough to be able to sit in on consultations with Consultant Paediatrician Dr Mike Farquhar. It all sounds very medical. What then has a shrink got to do with sleep?

Well, it turns out that the majority of sleep problems in children are “behavioural”. Yes, there are known medical causes of disturbed sleep, e.g. restless leg syndrome, obstructive sleep apnoea, sleep walking and so on, but for the majority of cases in children who are otherwise fit and well, it is what children and their parents are in the “habit” of doing that is keeping them all awake.

What constitutes a sleep problem?

The definition of a “good night’s sleep” is variable from person to person. As a student, a full 10 hours was a requisite for me often causing tardiness to morning lectures. At weekends waking before 10am was unheard of. As a junior doctor, 4 hours sleep constituted immense good fortune and developed in me the very useful skill of being able to sleep anywhere, anytime – zzzzzz-bonk. These skills came in handy with babies that hadn’t read Gina Ford. The early years of parenthood are a sleep-deprived blur, but once the youngest had reached the milestone of 3 years, a more acceptable routine of 10 hours of continuously sleeping children was established –albeit the 6am wakenings were still somewhat painful.

In reality sleep requirements differ between children of different ages, but also between different children. Average daily sleep duration ranges between 10-17 hours at 6 months to 8-11 hours at age 11 years. This variability colours people’s ideas of what constitutes a sleep problem, and I am often bemused by some parents who come in desperation seeking medication for 10 year old children that sleep from 7:30pm to 6am: thinking with a mix of incredulity “What planet are you on? That’s almost a full 11 hours!” and admiration “Please tell me how on earth you get a 10 year old to go to bed at 7:30pm!” With these children who are getting hours of sleep within the acceptable range, the sleep is only classified as problematic if it represents a dramatic change to sleep pattern and/ or if there is any evidence of daytime sleepiness. If the answer to both is “No”, then one should feel reassured. However, for a psychiatrist, we know that often a parental cry for help of “My children don’t sleep!” is actually a cry of “I’m struggling to cope with my children when they are awake!” This differentiation is critical as the treatment strategies for the two problems are entirely different.

Aside from these perceptual sleep problems, the three main problems involving sleep are: struggling to fall off to sleep, waking in the middle of the night and co-sleeping.

Struggling to fall off to sleep

Problems falling off to sleep are often cited as a struggle. Sleep latency (to give it its fancy name) averages 19 minutes in 0-2 year olds and 17 minutes for 3-12 year olds. Anything over 30 minutes is classed as problematic. However, these average latency numbers involves the child actually wanting to fall asleep and lying in their bed in the dark, and any of the children’s wonderfully inventive delaying tactics “One more story”, “I need the toilet”, “I need a drink”, “Mummy sing to me” are clearly “behavioural” and not really to do with a “medical” sleep problem.

Night waking

As part of our natural sleep cycle, we all wake at some stage in the night. Most of us are able to close our eyes and will quickly fall back to sleep again such that we don’t realise that we were ever awake or close to waking. Where night waking is problematic is where children are unable to settle themselves back to sleep and start playing the drums and waking the entire neighbourhood in the middle of the night. Typically these children then decide to fall asleep at around 7am, just when they need to go to school, and then they either miss school as their parents are unable to drag them there, or they doze off in the classroom and can’t learn effectively. You can imagine the impact of this on their parents.

Co-sleeping

OK I am as seduced by the lovely mental images of canoodling up with my young children for a snooze as the next parent. Many parents are seduced into this as children love it and it often helps them to fall asleep more quickly, but each time you get the inkling that this might not be such a bad idea, I would like you to imagine you sleeping with your 15 year old son or daughter. If you don’t do something to nip it in the bud while your children are young, they might not “grow out of it” and it will be a battle to get them out of your bed and are not used to falling asleep alone. I would suggest that you turf them out of sleeping in your bed by age 7 years otherwise it may get horribly entrenched. Of course, the early morning “I’m awake” cuddles in bed are still fine!

So what can we do to help our children to sleep?

My paediatric colleague Dr Jess Turnbull who is starting up the community Evelina Sleep Centre off-shoot in my work-place has the following advice for encouraging good sleep habits:

  • Physical exertion in the afternoon – encourage daily exercise in children in the day-time. This will wear them out and make them physically ready to sleep.
  • Consistent daily bedtime – as with all things behavioural, if there is an established routine and children know what is going to happen and that they cannot get out of it, then compliance is more forthcoming.
  • Last drink 1-1.5 hours before bed – this reduces the likelihood of children needing to get up to go to the toilet in the night, which may make it harder for them to fall back to sleep.
  • Avoid sugar/ caffeine – fairly obvious really.
  • Try and have a routine wind-down regime in the hour before bed time (calming activities such as reading, bath, calming music). The idea is to try and calm your child down so that they are in the right physical and mental frame of mind to sleep.
  • NO SCREENS (TV, phones, tablets) for at least an hour before bed. TV programmes, phones and tablets are all designed to capture interest, attention and brain activity. Ideally, you want to be winding down your child’s brain activity in the hour before bed so turning off screens is desirable. I know that many parents are tempted by having a TV in a child’s bedroom to keep them quiet and contained in the day, but it then requires discipline for children to stop watching it late into the night. Only be happy to provide a child with a TV in their room if they possess such discipline or you are happy for them not to sleep.
  • Having a transitional object (eg. a soft toy) to develop sleep confidence and a healthy sleep association. This can be particularly helpful for younger children.
  • Working towards your child falling asleep by themselves in their own bed. If a child is used to sleeping with you, then you should gradually withdraw yourself. For instance, first get the child accustomed to sleeping with you sitting next to them, then in a chair in the room, then outside the room in sight, then outside the room out of sight. It takes time, patience and grit to do this as some children will really dig their heels in, but if you view this as ultimately for their own good (which it is) then it is more possible to undertake.
  • Limit setting on ‘fussing’ after ‘lights out’. If you draw out the bedtime process with attending to the child’s fussing, then it defeats the purpose as it will get later and later and only teaches children that you will give them attention for their fussing which encourages them to continue to do it.
  • Reducing attention given after ‘lights out’ to prevent reinforcing messages of attention (e.g. avoid eye contact and conversation): good old pursed lips and silent treatment. There is a rule in my house that after the official bedtime, “Nice mummy” goes to bed and “Horrible mummy” her doppelganger comes in her stead. Nice mummy cannot be accountable for the actions of horrible mummy and so it is much better for children to just go to sleep.

But I had done all this and still, Lil Bro could not get to sleep. This was even more annoying and I was starting to put it down to “naughtiness”.

The next day, I was lucky enough to be chairing a talk on Smith Magenis Syndrome (a genetic disorder which was frequently associated inverted sleep cycle – i.e. day time sleepiness and night time waking) and my colleague Paul Gringras was the invited expert. Half-way through his talk, he spoke about the solution to keeping these children awake in the day was by using blue light to cut off melatonin secretion in the day. Melatonin is the natural hormone our pineal glands secrete to tell us it is night time and aids sleep. It’s pharmaceutical form can be bought over the counter in the USA as a treatment for jet-lag and is a commonly prescribed sleeping tablet.

Hang on a minute, Lil Bro had recently been given a fantastic blue Star Wars light sabre light that he had been insisting on turning on as a night light when he went to bed….this type of blue light is used to KEEP CHILDREN AWAKE….aargh. We had been inadvertently switching off our son’s natural melatonin secretion via Luke Skywalker’s weaponry.

I double checked Jess Turnbull’s list of advice and saw that I had overlooked: “Use a red coloured light if night light is needed (does not interfere with natural melatonin production)”. That evening, I told Lil Bro that an important sleep expert had told me that his special blue light was keeping him awake. Lil Bro likes science and reason and he felt good that there was a reason for his insomnia and that it was not just “bad behaviour”. It’s silly mummy’s fault for letting you have that light on (he likes not being to blame). Releasing him of anxiety about insomnia and allowing the release of melatonin by switching off the offending blue light sabre led to zzzzzz-bonk!

Resources:

 

References:

The info from this post came from: Turnbull & Farquhar 2016. Fifteen-minute consultation on problems in the healthy child: sleep. Arch Dis Child Educ Pract Ed 101: 175-180.

 

 

Public Library to Publishing

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Around this time 2 years ago I ventured into the public library. The library has always seemed to me a calm and comforting place where natural introverts like me can hide without need for social interaction. I have fond memories of public libraries from my childhood.

  • My parents did not have much money for books when I was young and so it became a Saturday ritual to take us to the local library. My sisters and I delighted in the weekly routine of 4 books in and 4 books out. The sitting with a pile of books on the library floor to make the book selection was as much fun as the devouring at bed time. Decisions were critical of course as it could never be guaranteed that a book cast away could ever be found again in the bowels of the public library system. I conjured up images of the child that never returned the book that I had set aside for next week. I remember tittering as my precocious sister stole into the forbidden adult library to feed on the minds of Austen, Bronte and yes, Mills & Boon.
  • As I grew older, the library routine became an independent journey. There was a Mobile Library that parked on the next road from my house. Come rain or shine, the humble little van would open it’s doors to a wonderful and shifting collection of books rammed onto wooden shelves that seemed to be hewn from the very carcass of the van. It’s purpose? To open my mind. Here I discovered childhood favourites from Roald Dahl and Enid Blyton to Paula Danziger, Judy Blume (who can forget Ralph?), Robert Cormier and S.E. Hinton. From books I spent a childhood learning and yearning to be British and the teenage years aspiring to be American. 2016 has made both youthful aspirations rather less enticing, but I think the core of what I mean still stands: books shape opinions, identities and lives.
  • As an adult, sadly the enjoyable public library routines of old fell away to being buried in book stacks of University Libraries. The “downstairs” of the Institute of Psychiatry (IOP) library was in my day a pleasure. Hidden away, accessed by spiral staircase is a room with more books than space where one had to churn a handle to move whole bookcases in order to squeeze between the shelves to retrieve the required tome. It’s fortunate that it was almost always devoid of people, because the one occasion where the bookcase started to move while I was trapped in between stacks brought back Star Wars style nightmares of being crushed by advancing walls. It always impressed me that amongst those books were the first clumsy descriptions of Down’s Syndrome, Schizophrenia and Autism. The pleasantly eerie bolt-hole had an atmosphere that’s hard to recreate. Sadly, it’s all gone now, and the IOP library – like most things – has “gone digital” and now resembles an Apple Store.

A return to the public library was heralded by having children of my own. Although not quite up to the organisation of weekly visits, the public library is a space that my children know and enjoy. Helped by lack of overdue fees on children’s books and Drop-Back boxes for books, sporadic and opportunistic visits to the library are possible. My children, like me before them enjoy the rummage and many of their favourite picture books were bent and battered copies of random and obscure books (for instance one about a girl called Tina and an alligator that trips on soap while doing the Tango and falls down the toilet) bought for 20p from the Library rejects sell-off bins. While the children explored and tried to hack into the library computers, I would wander to the parenting section.

During this particular library visit 2 years ago though, I wasn’t exploring the parenting shelves, I was asking the man behind the desk for the little red book – “The Writers and Artist’s Yearbook 2014“. The Writers and Artist’s Yearbook is an agency listing for budding writers and artists.

I had decided to take the plunge. I scoured the book for agencies interested in non-fiction and parenting. I took down the emails. I went home and I sent out my story.

I had been here 2 years earlier for the same reason. I had written the beginnings of a manuscript about my childhood and it’s influence on my parenting. I had pored through the agency listings and sent off my manuscript to 5 agencies. I was rejected by all of them, although one had nice things to say. It wasn’t easy to think about going through this process of rejection again, but since the first round of submission, I had started the blog and was warmed by the people that had responded to my writing. Friends and acquaintances would stop me and say “I liked your last blog” or “my wife reads your blog” which was a real encouragement. Also, as I had nothing better to do at the time (as high flying work-places dislike women with young children), there was nothing to lose. Sometimes it takes having no easy option available to force us to take a risk.

And so it came that a lovely young mother connected with my story and agreed to become my agent, followed a year later by another lovely mother offering to be my publisher.

And that’s how I got to meet proper writers: Russell Brand, Joe Wicks, Jack Monroe, Leah Garwood-Gowers, Daisy Kristiansen, Laura James and Eleanor Morgan and pitch with them to media and retailers our books that will be released by Bluebird Books (Pan Macmillan) in 2017.

For those that harbour manuscripts (I know at least one-friend) – please send them out – it really does happen! And if you can, pop in to your local library. Without us they have been closing up and down the country and with their closure the door and mind-opening opportunities for many children.

VaNITy Case

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Now that the children are a little older, I am finding that I finally have time to look in the mirror. This is a very depressing past-time as over the last 9 years, I appear to have aged 90 years. Bags under the eyes, lines traversing the face, spare tyre around the tummy and plenty of black hair turned grey! Some of these aspects I find acceptable (crows feet while not exactly welcome, are a sign of a life spent smiling) or readily remedied (thanks L’Oreal) – and I may finally get to claw back some benefit from that under-utilised gym membership. What I found very frightening was to see the piles of dyed black hair clogging up the plug hole of my bath every time I washed my hair. Hair-loss – extremely frightening. There was definitely a bit at my hairline which looked thinner than previously and I started to find the jokes that I had made about my husband’s retreating hairline less amusing. (When he had denied any hair loss, I had told him that he should tattoo his hairline and then we would have physical evidence of whether or not he was receding – funny I thought at the time, not so funny now that I am suffering the same fate!).

So when I next trotted off to the hair salon to get a hair cut; I wow-ed at the massive poster in the window which promised “Thicker, fuller hair could be yours” with a whole new product range targeted at thinning hair. Even for evidence-based scientists, rationality goes out the window when faced with fear and the potential of hope, however unlikely. The hairdresser was kind enough to doubt my need for the product but was only too happy to sell me the entire range given my disposition. He warned me “It works on your scalp so if you feel it tingling on your scalp, you’ll know it’s working.”

Over the next two weeks, I diligently used the entire product range, and indeed, soon after I felt a tingling on my scalp. “Ooh, I can really feel it working!” I thought to myself and liberally applied more product. The tingling got stronger. I inspected my hair daily. “Hmm” I thought to myself, my hair is looking fuller. More product slapping. Hang about, this product is starting to itch more than tingle now. That must be a sign of all the new hairs that are sprouting out of my scalp, because I know that when new hairs grow they can sometimes itch. More product. What fabulous hair I now have, well worth the itch because as everyone knows: “you must suffer for beauty”.

A week later, I was clearing out the detritus of school letters and notes that had formed at the bottom of Big Sis’s school bag. Oops, I have not yet paid the school dinner money. Thank goodness, I am in time to give permission to a school trip.

Then, I saw it and the penny dropped.

“There has been an outbreak of nits in your child’s class”.

OMG.

It was quite something other than new-age, hair-growing potion that had been working on my scalp and my vain mis-belief had led me to tolerate it blindly!

For the next 3 weeks instead of gentle, herbal, hair-regeneration and scalp renewal product, I was in the chemist hoarding chemical agents, the more toxic the better. None of the homeopathic agents for me, I was for all-out chemical warfare and instead of wishing for hair growth, I was happily pulling out my own hair with a fine toothed nit comb shouting “Out damn nits!”

Vanity really doesn’t pay.

Half term without the other half

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This half term I am braving the entire week with the kids without the other half.

Despite working 8am-8pm most days, Banker declared he also has to work the half term. I have recently come to the conclusion that the term “working class” to mean a low-waged  worker (previously miner or factory worker, but more latterly I’m presuming a tele-marketer or warehouse picker) is now a total misnomer because, let’s face it, only a very few landed gentry or Russians these days don’t work, and the majority of wealthy (rather than Über-rich) people are putting the hours in. Why don’t we update the nomenclature and call a spade a spade? The “Well-renumerated” class and the “Poorly-Renumerated” class; or the overpaid and the exploited classes?

Previously I have taken the kids for 2 days to Brighton by myself and last Summer I took the kids around New York by day by myself but this is the first full 5 days/ 4 nights. I know this is completely wimpy because single parents, widows and widowers do this sort of thing all the time, but hey, I AM A WIMP.

Softening the blow, I decided to check into a luxury family Hotel: The Ickworth Hotel, near Bury St Edmunds. This was a second choice: luxury hotels these days being cheaper (£290 per night including breakfast and adult’s dinner) than Centre Parcs (£390 a night self-catering) which I found surprising. The economy I think is gained by ditching the husband, as in a hotel a family of three takes up only a double room with extra camp bed wheeled in, while Centre Parcs caters strictly to your average family of 4 so you in effect pay for an empty bed if going it alone.

Ickworth was a known entity as my family have stayed here before, albeit the last time Big Sis was in nappies, Lil Bro was on the breast and I was on the Tena Ladies. Then it was all – “Wow, this hotel room has a nappy bin and access to a microwave to heat up Ella’s kitchen pouches” and “Thank God, the staff appear unconcerned that my kid is head butting the antique furniture with a bucket on her head”. So how does this hotel that markets itself to families, particularly of young children fare for a 7 year old, 9 year old and 40-something year old?

Rooms

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We had a small family room: a double bed and an extra camp bed rolled in. Not spacious, but perfectly adequate as we were certainly going to spend most of the day outside anyway. Décor is all old furniture upcycled with modern fabrics: so appropriately country house but grand enough to give city kids a bit of a Wow factor. Not quite the on-trend Babington House, but that’s also reflected in the price tag so I am not complaining. No mini fridge which was a bummer because I had to stash the pork pies I’d bought for lunches (not included in the room tariff) in the sock drawer instead.

Service

The Reception staff are friendly to children and when I couldn’t get the DVD player to work, they sent a nice man around: “You need to plug the DVD player into the TV” – oops.

Food

Food can be taken in the Conservatory for families or in the Candlelit fine dining setting for those that choose to use the Baby Listening Service or on-site babysitters. There is also a High Tea available for toddlers, but we tried this last time we came and I can only describe it as hell. Imagine 10 sleep deprived families each trying desperately to feed babies and toddlers at the same time, with anxiety heightened by the fact that this is “THE relaxing, couple bonding holiday” and the baby-sitter and romantic candlelit dinner has been booked so the baby has to be well fed and asleep in 30 minutes flat come hell or high water. Yeah, that kind of vibe. Thankfully this time, I could go for the Conservatory option. The food is average to good, but the menu stayed unchanged all week so I ate pretty much everything on the menu. Portions are rather huge so the kids were able to share my rather generous nightly 3 course allowance.

Atmosphere

Prepare to be Bodened and mini-Bodened. Yes, this is Boden central. If blond kids, check collared shirts and bright cords are not your scene then forget about it. I have the resilience of a stubborn pig so feel not the social pressure, but in the week of people watching I saw only one Black British family venture nervously forth into the Conservatory in their trendy leisure wear and they never returned. Towards the end of the week, a couple of Asian families that had drunk from the Boden cool-aid trough appeared; as did my doppelganger:

Big Sis: Ooh look mum, there’s a lady like you. She’s Chinese but married to a white guy.

Blegh. I am now a cliché.

The ethos is strictly “conventional family” and I noted that I was the only lone parent there in a week. I imagined the other parents looking sadly over at our table for 3 wondering about the death or divorce that had befallen me. “And since our Papa died, we can’t afford Boden clothing any longer…”

Activities

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One of the attractions of the hotel was the availability of on-site facilities for kids. A literal stable full of bikes and bike helmets meant we didn’t need the pfaff of bringing all our kit up with us, and a navigable, traffic-free country park within which city kids wobbly on their wheels, could safely practice in was ideal for us. An on-site swimming pool heated to the temperature of “warm-bath” is also within flip-flopping distance. Not quite the full on tidal pool and water slides of Centre Parcs, but in the morning and at lunchtimes, it’s possible to get the whole pool to ourselves which at half term is a luxury. Tennis courts, trampolines, croquet and football are all available, as well as a bank of family board games to play in the perfectly crafted “homely lounges” available. Unfortunately, they are all packed in the late afternoons, but hey, it is half term. The kids and I hole up in our room to play scrabble. I make them promise not to cry if I win. Yes, I am that mean mother that won’t let her children win at Scrabble. Cards, chess, Monopoly,  sure – but there  is no messing about in Scrabble.

The basement hosts kids craft activities and a games room where my tech-deprived two slink off to from time to time to play Wii Bowling and Air Hockey. They befriend a kid who spends the day in his Boden pyjamas; such is the “home away from home” feel of the place. In the evenings there is a cinema, but there were no adults there so I felt a bit of a spare part wandering about my room while my kids watched the movie. Yes, when you finally get rid of the darn kids, you end up moping for them. If Banker were with me, we could’ve hit the bar, but as it was it was kind of lonesome. The rest of the week we opt for borrowing family-friendly DVDs (Harry Potter, Cool Runnings) from the hotel to cuddle up and watch in our room.

Day Outings:

On day 1, we ventured out for some “educational activity”. As a Chinese parent, going on holiday without at least one “educational outing” can induce stomach cramps and nausea, so it is best to get it out of the way first thing so that you can breathe a little easier the rest of the holiday. I choose West Stow Saxon Village. It’s basically a couple of mock-Saxon out buildings strewn with what I presume are volunteers dressed in mock Saxon garb pretending to be Saxons. There are some ladies moulding mud to make a Saxon oven, another lady crocheting some Saxon cloth and another whittling wood. There are a couple of teenage boys pretending to be Smithies banging away on bits of B&Q iron attempting to make an iron dragonfly. Lil Bro is fascinated by this and keeps returning to check on the progress of the dragonfly. After 3 hours they have basically twisted one piece of iron and hammered out 2 feet. At the last return they’ve shut up shop and are eating Tesco’s finest buttered raisin toast in Saxon garb. There’s also a child friendly museum where kids (and adults) can also dress in Saxon garb, don a Saxon helmet and look at remains of artefacts that were actually dug up at West Stow. Quite cool except that it brings on lectures from Big Sis regarding the Neolithic and Mesolithic periods and all about querning which they have apparently been learning about at school. Quite the Hermoine Granger our Bis Sis, fantastic yet also slightly wearing. When I had thought about an “educational outing” I had meant educational for them, not for me! I bundle them off to some archery activity just in time as Big Sis looking up at the clouds says “Ooh, look at the Stratus clouds Mummy – we’ve been learning about cloud formations at school…”

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On Day 4, I pack both kids off to Barrow Farm Stables (a 20 minute drive away) for a “Pony Experience” day. Sadly Lil Bro is the only boy (why can’t boys do ponies?) but they both seem to enjoy themselves, and this time, no moping about for me as I have booked myself in for treatments at the hotel’s spa. Yipee.

On our final day, we will visit Ickworth House, the National Trust Property next door to the hotel. Hotel guests get free entry and there are family friendly Halloween activities on, so that’s a good bonus. We’ll finish off on afternoon tea then head back to London.

The Children’s verdict

The kids have had a blast. They are requesting to come back again next half term. “The people here and the other children are all so nice”; and it turns out that the kid in Boden pyjamas had asked my kids the question that all adults wondered but never dared ask:

“Is your dad dead?”

Big Sis: No, he’s working in London.

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Is it just me that hides in the toilet at conferences…?

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Today, I have been at the British Mecca for Psychiatrists, the annual conference of the Royal College of Psychiatrists. We have taken over the ICC in Birmingham where the entrails of the Tory party conference are still being tidied away. I did have a double take moment of “Lord, I’m at the wrong conference” when I was greeted with the “A Country That Works For Everyone” signage which dwarfed our college’s diminutive logo. The juxtaposition being even greater because within the medical profession, the psychiatrists are probably the most left leaning, our life’s work being in the care of some of the most discriminated and disadvantaged in society who are not usually the Conservative party faithful.

I’m not really a “conference” person. Brown-nosing and networking brings me out in hives, but I have been around long enough to know just enough people to make small talk to. At shrink-fest this usually involves grumbling about:

  • Lack of in-patient beds
  • Being mistaken for a psychologist
  • Not being recognised as “proper doctors”
  • Lack of medical students wanting to train in our wonderful specialty

Mostly, I am robust enough to endure colleagues darting-off mid conversation to talk to someone else of greater importance. Occasionally, I bump into old supervisors and I have to admit to them that I’ve chucked in my research and pretend to be blissfully happy about this decision. Other times I catch sight of another female ex-researcher and we indulge in metaphorical hand-holding and sighs of “it’s so hard with children”.  If it gets too much, I hide out in the loos checking social media. People post me pictures of dead animals (anti-hunting friends – don’t ask).

It might sound awfully depressing, but I also learnt these amazing nuggets:

From the wonderful Dr Andrea Danese, an Italian contemporary who heads up the Stress Lab at the Institute of Psychiatry. He once gave me a good recipe for pesto and today, he taught me this:

  • If you get a nasty cut that gets infected, the skin gets red and “inflamed”. If we took a sample of your blood, we would find raised levels of proteins e.g. C-Reactive Proteins which are called inflammatory markers.
  • Stress can cause an inflammatory response, just like an infection in quality but milder. This is to prepare the body to fight stress, in the same way that your body prepares itself to fight an infection.
  • Children and adults with depression have raised inflammatory markers.
  • These markers are even more raised if there was evidence of early life stress such as childhood maltreatment.
  • Adults with raised baseline inflammatory markers are more likely to have recurrent and chronic depression which does not respond to traditional anti-depressant treatments.
  • Anti-inflammatory agents usually used as pain killers after surgery (COX-2 inhibitors) have been successful in treating depression, particularly in people with high baseline inflammatory markers.

I know, this sounds dull to you, but to shrinks this is like: Yay! Another drug (cheap too) – maybe they won’t confuse us with psychologists anymore?

I also learnt from Professor Ian Goodyear (Head of Child Psychiatry at Cambridge University) that in his longitudinal studies of depression he divides us parents into the following groups which form a measure of “suboptimal family environment”:

  • Optimal (that’s me of course)
  • Aberrant (well-meaning but missing in action or clueless)
  • Discordant (bickering and self-interested)
  • Hazardous (deliberately cruel and abusive)
  • Not surprisingly, the majority of children raised by “hazardous” parents end up with all kinds of mental health problems.

And from Professor Eric Taylor, the grand don of my field neuropsychiatry:

  • 20-70% of children with ADHD continue to have symptoms into adulthood.
  • 50% have another psychiatric diagnosis by age 27 years (mainly anti-social behaviour, drug misuse or depression).
  • Children with ADHD with no friends and unsupportive, hostile parents at age 7 years are more likely to develop conduct problems and antisocial behaviour.
  • If a child with ADHD lasts to age 17 years without engaging in anti-social behaviour, their parents can heave a large sigh of relief because they will very unlikely ever engage in this type of behaviour (they may still be susceptible to depression unfortunately).

The best part of conference?

The hotel to retire to overnight. Totally kid-free: gym, luxuriating bath, telly, bed and totally guilt-free and legitimate because “I’m working!”.

Roll on day 2!