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:
- 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.
- 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.
- 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.
- 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)
- 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):
- 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.
- 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.
- 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.
- 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 .
- 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.
- 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.
- 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.
- 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.
- 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
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:
To all girls and boys out there who are embarking on the same journey as Molly in the next 2 months.
You will be Brilliant wherever you go to school!
Helping children to identify their own emotions
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?
What makes a child anti-social?
The media is full of the rise of anti-social behaviour (e.g. violence, aggression, bullying, fighting, lying, stealing, vandalism, fire-setting, drug and alcohol abuse, cruelty to animals) in children and youth offending, but what is the cause of childhood antisocial behaviour and are all anti-social children the same? What is the role of parenting?
Are all anti-social children the same?
There is evidence that not all children with anti-social behaviour are the same. Some children may show a phase of anti-social behaviour in adolescence but this passes and they settle down in adulthood. Far more concerning are children with a life-long tendency to anti-social behaviour. These children tend to be anti-social from a younger age and behaviour is more extreme (e.g. cruelty to animals at age 5 years), but even amongst these children there is evidence of different subgroups. Much research is focused on differentiating groups of anti-social children to see if we can better understand them.
One differentiating factor found is lack of empathy. Empathy is the ability to share someone else’s feelings and experiences by imagining what it would be like to be in that person’s situation. Psychologically speaking, this requires two different types of processes: a “thinking” part: the ability to see things from another person’s point of view; and secondly a “feeling” part: the ability to recognise emotion in others and to feel it in oneself. People without empathy are described as being callous and unemotional. To be anti-social, violent or aggressive is easy if you do not empathise with the victim, so it is no surprise that >90% of children with callous-unemotional traits are involved in some form of anti-social behaviour.
How does empathy affect anti-social behaviour?
Researchers have been interested in children that lack empathy for a while now because of its links to extreme anti-social behaviour, and the definition of “psychopathy/ sociopathy” (this is a criminal justice not mental health term) includes having this lack of empathy. The childhood precursor to this psychopathy label is “callous-unemotional traits” (as it is pretty harsh and pessimistic to label kids as psychopaths), and even this terminology has recently been rebranded as “limited prosocial intent” so that it sounds less pejorative; but this is just semantics, we are essentially talking about the same thing: people that have shallow feelings with lack of empathy and guilt.
My colleague, Essi Viding does research into these traits and wrote a great summary paper (2012), the findings of which I wanted to share as I thought it was fascinating. It turns out that if you study ASBO kids (kids with anti-social behaviour), you will find that 50% of them have these callous-unemotional traits. These children don’t really care about others’ feelings and tend to show no remorse for wrong-doing. It is this group of kids that have the most serious and long lasting problems.
What is the difference then psychologically and biologically between children that commit antisocial behaviour with and without empathy?
In experiments where anti-social kids are hooked up to show responses (for instance heart, skin and eye-tracking monitors or brain scans) to photos/ voice recordings of other people in pain or grief, the children with callous-unemotional traits showed no or reduced physical or brain response. Most people will wince in shared pain if shown pictures or exposed to sounds of others in pain, but these children don’t. When these children were asked to play a game where not following the rules led to punishment, they continued to flaunt the rules and did not seem to learn from punishment. There is biological support for these findings with differences in brain scans in areas of the brain linked to emotion processing and reinforcement learning pathways in callous anti-social children.
In contrast, the anti-social children with empathy showed the same aversive responses as children not involved in anti-social behaviour to pictures and sounds of pain and grief, and learnt quickly from punishment. However when they are shown threatening faces, they over-respond with emotion and when they are shown neutral and ambiguous facial expressions, they identified them as being threatening. Brain scans back up these differences. The anti-social children with empathy tended to have abnormal amygdala development. This is the area of the brain involved in fear and anxiety processing. These anti-social children have normal empathy but have a heightened awareness of threat, which explains why they perceive neutral faces as threatening. In a world where everyone is viewed as threatening, hostile or an enemy, it can make sense to be combative, aggressive and violent. This is that bully in the playground that says “Are you looking at me?” – when you weren’t even looking at them.
Genetic studies have also supported this divide, finding that there is strong inheritance of callous nature, whereas anti-social behaviour without callousness was not inherited but generated by environmental factors such as harsh or inadequate parenting, or an interplay between these environmental factors and genes associated with anxiety or heightened emotion.
Finally, it has also been found that the children in the different groups respond differently to parenting strategies. Punishment and traditional sanction-based strategies (time-out, withdrawal of privileges) works well for empathic anti-social children, but has no effect on callous children. Callous children only respond to positive reinforcement (praise) and rewards.
What causes anti-social behaviour?
This type of evidence has led to different theoretical models for two groups of children involved in anti-social behaviour.
Group 1: Genetic predisposition. Antisocial and callous kids: these children are thought to lack empathy as they do not find other people’s distress aversive and because they fail to be able to learn from punishment. It is easy to be aggressive and cruel if you are unable to feel guilt and if the suffering of others doesn’t bother you. It is easy to continue to behave in this way life-long if you are unable to learn from punishment. These difficulties are often inherited in brain structure.
Group 2: Environmental Causation: Anti-social but not callous kids: these children have abnormal socialisation because they have a heightened sense of threat, and view the world as hostile towards them. They exhibit aggression and cruelty as a result of living in unstable and threatening environments which has shaped their brains and psychology to respond in this way as a means of coping and survival. Their anti-social behaviour is often in the context of a peer group within which there is support and empathy.
What has this got to do with parenting?
Whether we like it or not, parents are the first line defence against anti-social behaviour in society. By better understanding the causes of anti-social behaviour and by understanding our children, we can best adapt our parenting to prevent our children becoming anti-social. Although children in group 1 with genetic predisposition are the more difficult to help, they can be supported by fostering self-esteem. They will respond better to motivation to act in a pro-social way, rather than harsh punishment which will not deter them. Anti-social behaviour in children with empathy can be prevented by strong loving families that place appropriate boundaries and sanctions. For these children, wider society has a great role to play in generating or preventing anti-social behaviour, as tolerant, peaceful and accepting societies can offer protection whilst violent, unstable and alienating societies can fuel them.
Anti-social behaviour in children with and without callous-unemotional traits. Viding et al. (2012) Journal of the Royal Society of Medicine. 195-200.
Why parents should have zero-tolerance for sibling rivalry
I was recently asked for some advice, as is an occupational hazard. “We’re about to have a second child. How do we prepare our child for the arrival of a sibling, because of the inevitable jealousy?” To my surprise, even before I could answer; my husband who has been well versed in my opinions answered for me.
“She has zero-tolerance on siblings not getting along.”
I was surprised at his succinct synopsis of my position, but “yes”, that is indeed my view. For me, the bond that I have with my two sisters is very important. Even though personality-wise we probably would not have been in the same circle of friends had we been peers, as sisters we are closer than the pre-election polls. Even though I rarely socialise with my siblings outside family events, if anything in my life happened, they would be the first people that I would contact and vice versa. I would never be alone in a crisis because I know that they would be supporting me – come what may. Friendships and marriages may come and go, parents will pass away, but siblings are with you, living in your time and generation – for life.
This is not just me being whimsical but is born out in science. Warm, supportive sibling relationships that lack conflict are related to having better psychological wellbeing as children and into adulthood (Buhrmester and Furman1990; Buist et al. 2013; Kim et al. 2007). The reverse is also true; hostile and aggressive sibling relationships are associated with higher levels of anxiety, depression, low self-esteem and anti-social behaviour (Campione-Barr et al. 2013; Dunn et al. 1994a, b; Padilla-Walker et al. 2010; Stocker 1994).
Maybe this is nothing to do with sibling relationship, but related to parenting and genetics? Argumentative parents have argumentative children that don’t get on and become argumentative and anti-social adults. This doesn’t seem to be the case. In fact, the literature suggests that warm, collaborative sibling relationships instill resilience (an invisible protective shield if you will) in children. For example, there is evidence that good sibling relationships protect children from all manner of adversity from bickering parents that fight all the time, negative life events (such as natural disaster and death of a loved one), high risk neighbourhoods, low-income backgrounds and bullying (Jenkins and Smith 1990; Tucker et al. 2013, Gass et al. 2007, Criss and Shaw 2005; Widmer and Weiss 2000, Bowes et al. 2010). Very recently published work suggests that siblings can even protect against the negative impact of parental mental health problems. Keeton (2015) found that in children of parents who met clinical criteria for anxiety disorder, the psychological impact of having a parent with anxiety disorder on children was moderated by the quality of the relationships between the children. In effect, the closeness of siblings allowed children to protect each other from the negative impact of a parent suffering a significant mental health problem. All in all, the evidence suggests that sibling relationships are just as important in a child’s psychological development as parents and friends.
This makes sense to me. Much adolescent and adult unhappiness comes from feeling “alone”/ “unaccepted”/ “friendless”/ “unsupported”. I have met many unhappy adults in my time as an adult psychiatrist of whom I just thought “You know what? You’d be fine if you just had a supportive friend.” That’s just exactly what a brother or sister could and should be; and whilst as parents we have little or no say in who our children choose to be friends with in adolescence and adult life, we have much control over whether siblings get along or not, and are perfectly placed to ensure that our children, via their siblings, have a strong support network for life.
So why have we as a population of parents come to expect sibling rivalry and discord? When we see it happening, we shrug our shoulders and say “siblings –eh?” We may take some cursory action “Don’t hit your sister”, “Get off your brother’s back and put down that brick that you were using to pummel his head”, but all in all, we assume that this is run of the mill sibling behaviour. In effect, we at best tolerate it, at worst encourage it. Romulus and Remus were raised by a wolf. I am not sure what happened with the Millibands…
My own childhood experiences were different. My mother came from a family of 7 extremely close siblings. Even though they live on different continents and their ages outspan a decade, they still go on holiday together and skype each other regularly. They laugh, joke, bitch and support each other as much now as pensioners as they did when they were children. My mother told me that in her family the older children were each allocated a younger child to look after growing up. Second Uncle had to piggy back my mother on long outings and my mother in turn had to rock third Uncle to sleep. I am sure that this responsibility and encouragement of care fostered an affection that has lasted into their old age.
In turn, I remember very clearly my mother explicitly saying to my sisters and I as children “You three are best friends. You are all each other have and must support each other.” I remember thinking sulkily at the time; I am so not best friends with these two. That one has just pulled my hair, and that one has just scratched my face. But we moved several times as children, first from Taiwan to Wales and then Wales to London, changing primary schools 4 times in 8 years, and so it turned out to be true. While friends came and went, “Laurel and Hardy” as I liked to imagine them then or “The Two Ugly Sisters” (to my narcissistic Cinderella off course) were always with me. And guess what, as adults, we are like best friends.
So what of my own children?
Banker was right. I take a zero-tolerance view of siblings not getting along. Like my mother, I insist to them that “they are best friends” daily, whether they like it or not. Sure they fight all the time, but underneath I know that they love each other dearly. When Lil Bro had a hard day in the school playground, Big Sis gave him advice. When an umbrella at a cafe blew over and grazed Big Sis spilling her drink, Lil Bro immediately gave her his. And in the evenings when they snuggle up together, I swear, its the sweetest moment for a parent.
Here are a few other things that I did/ try to do, all of which being non-scientific and are just my interpretation of what might help siblings get along.
- My number one advice is to ensure that your children feel loved and secure in themselves. Children who have “secure attachment” to their parents have all manner of better prospects throughout childhood and into adulthood. The more secure a child feels in themselves, the less prone they will be to jealousy, and the more generous they will be to their siblings. So ensuring a child grows up feeling secure from the outset helps a great deal.
- Prepare for a new sibling. Throughout pregnancy, the prospect of Lil Bro’s arrival was talked about as a massive positive. A little brother for you to help me look after. A little brother to play with you. Read books about new babies and about siblings that get along (Topsy and Tim is good for this). Buy your child a baby doll and play together at looking after it. Be as realistic about this as possible as this will help role play and rehearse what is to come. Massively praise any caring actions and discourage rough handling.
- Allow a bond to be made with a new sibling. I know that parents can be precious about babies, but being overly-guarded and excluding a child from their baby sibling can lead to loss of opportunity for siblings to bond, and also the older sibling feeling somehow excluded. Where possible, always involve siblings. Place the baby on the sibling’s lap and help them cuddle the new sibling and play with them. This is perfectly safe as long as children are well-prepped and you are supervising.
- Deal with jealousy. Jealousy between siblings will be inevitable at times even with secure children, but how you manage it can dampen or amplify its existence. Firstly, you must anticipate situations where this may occur and notice it when it happens. Then, rather than ignore it, it should be addressed as soon as possible. For instance, when there is competition for attention, this should be verbalised, acknowledged and problems solved. “I know you want me to play with you, but I am feeding your brother. But tell you what, he will be asleep after this, and then I can play with you.” Or when they get older “I know I am spending the day with your sister because I am taking her to see her favourite ballet, but next week, I will take you to the zoo.” Many young children feel angry and frustrated when they feel excluded or unfairly treated in favour of another, but cannot understand the reasoning behind it or be able to label it as “jealousy”. It’s up to parents to notice it and label it and explain it. Jealousy is a natural emotion; it is how we handle this emotion that needs to be addressed rather than attempting to avoid or suppress an irrepressible natural feeling. Unaddressed jealousy may lead to lashing out, aggression towards their sibling, or deliberate misbehaviour in order to get attention which is never a good thing.
- Behavioural management always applies. The tenet of behavioural management is to heavily praise and reward behaviours you wish to see again and to ignore and discourage behaviours that you do not wish to see again. If you wish to see caring behaviour between your siblings, you need to reinforce it with praise and rewards. If you would rather they did not bicker and fight, there need to be consequences each and every time this happens. I know that some parents think that siblings should “just naturally love each other” and I am as happy-clappy as the next person, but even I know that “love” can be manipulated to some extent. Some people refuse to praise and reward things that they “expect” children to do naturally, but I’m a great fan of praise (see my previous blog post on this) and evidence shows that behavioural management works.
- Us vs them. During my family therapy training I read somewhere that the only healthy grouping of people within a family is parents vs children. Families that have any other combination are more vulnerable e.g. a family which splits into two with a mother and son vs father and daughter or mother and children vs father. Keeping the healthy dynamic should always be borne in mind. Using this dynamic, it is possible to foster closer sibling unity as people tend to unite against a common oppressor. Yes, you the parents are the oppressor in this scenario. Don’t be tempted to side with a child, enjoy your role as the villain and reap the rewards of sibling cohesion.
- Encourage collaboration. Treating children as a team can be helpful to collaboration. Rewards can be given to both children as a team, punishments doled out to both as a team. This will facilitate helping behaviour and help siblings see each other as partners rather than competitors. Encourage mutual praise. For families in a rut that come to see me for therapy, I tend to suggest that before bedtime, each child is to say something good that the sibling has done that day and praise them. It may be forced praise to begin with, but even forced praise is better than no praise and over time it may and likely will become genuine and overspill into the everyday (particularly with young children).
- Promote exposure and shared experience. One way to help them get along is to allow them to have common experiences and exposure to each other. This is not possible if they attend different schools. This may be a bit unpopular in the UK where for some reason boys and girls from 4 onwards are farmed off to single sex schools, or siblings of different abilities are segregated early on into selective schools. I am totally and whole-heartedly in favour of keeping siblings in the same school, especially at primary school where I think education should play second fiddle to social and emotional development. A close sibling relationship is more important to me than KS2 results. A supportive sibling is there for life, who of us can remember our primary school grades? My children go to co-ed school. This way, their support for each other can start young. I am delighted to hear that Big Sis crosses the playground to give her Lil Bro a kiss and hug when he needs it. Not possible if she is not there.
- Adopt a policy of zero-tolerance on siblings not getting on. Expecting and or accepting that siblings do not need to get on, and that this is “normal” is the main reason for inaction. So this last point is probably the most important, because action is the first step.
Bowes, L., Maughan, B., Caspi, A., Moffitt, T. E., & Arseneault, L. (2010). Families promote emotional and behavioural resilience to bullying: evidence of an environmental effect. Journal of Child Psychology and Psychiatry, 51, 809–817.
Buhrmester, D., & Furman, W. (1990). Perceptions of sibling relationships during middle childhood and adolescence. Child Development, 61, 1387–1398.
Buist, K. L., Dekovic, M., & Prinzie, P. (2013). Sibling relationship quality and psychopathology of children and adolescents: a meta-analysis.Clinical Psychology Review, 33, 97–106.
Campione-Barr, N., Greer, K. B., & Kruse, A. (2013). Differential associations between domains of sibling conflict and adolescent emotional adjustment. Child Development, 84, 938–954.
Criss, M. M., & Shaw, D. S. (2005). Sibling relationships as contexts for delinquency training in low-income families. Journal of Family Psychology, 19, 592–600.
Dunn, J., Slomkowski, C., & Beardsall, L. (1994a). Sibling relationships from the preschool period through middle childhood and early adolescence.Developmental Psychology, 30, 315–324.
Dunn, J., Slomkowski, C., Beardsall, L., & Rende, R. (1994b). Adjustment in middle childhood and early adolescence: links with earlier and contemporary sibling relationships. Child Psychology and Psychiatry and Allied Disciplines, 35, 491–504
Gass, K., Jenkins, J., & Dunn, J. (2007). Are sibling relationships protective? A longitudinal study. Journal of Child Psychology and Psychiatry, 48, 167–175.
Jenkins, J. M., & Smith, M. A. (1990). Factors protecting children living in disharmonious homes: maternal reports. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 60–69.
Kim, J., McHale, S. M., Crouter, A. C., & Osgood, W. (2007). Longitudinal linkages between sibling relationships and adjustment from middle childhood through adolescence. Developmental Psychology, 43, 960–973.
Padilla-Walker, L., Harper, J. M., & Jensen, A. C. (2010). Self-regulation as a mediator between sibling relationship quality and early adolescents’ positive and negative outcomes. Journal of Family Psychology, 24, 419–428
Stocker, C. M., Burwell, R. A., & Briggs, M. L. (2002). Sibling conflict in middle childhood predicts children’s adjustment in early adolescence.Journal of Family Psychology, 16, 50–57.
Tucker, C. J., Holt, M., & Wiesen-Martin, D. (2013). Inter-parental conflict and sibling warmth during adolescence: associations with female depression in emerging adulthood. Psychological Reports, 112, 243–251
Widmer, E. D., & Weiss, C. C. (2000). Do older siblings make a difference? The effects of older sibling support and older sibling adjustment on the adjustment of socially disadvantaged adolescents. Journal of Research on Adolescence, 10, 1–27.
All You Need is Love
Simple isn’t it?
Cheesy as it is, I believe in this; so much so that this was the song that was played as my husband and I exited the church at our wedding. But if love is all you need, then in terms of parenting how and why do we sometimes get it wrong?
I think that sometimes people forget that “love” is like money; it’s no good in theoretical or inaccessible form. Having a million pound Trust Fund accessible when you reach the age of 85 years is not of much use to anyone; ultimately you need to be able to FEEL the power of it for it to have value. In my line of work, almost all parents will say that they love their children and I believe this to be true. However, the percentage of children that FEEL that their parents love them is way lower. It is therefore one thing to love your children. It is another to make them believe/ feel in their hearts/ know to the core/ have no doubt of the fact that they are loved. The former can be done from the office or at the kitchen sink; the latter is much harder work.
Knowing that you are loved/ lovable is at the core of our function. In Cognitive Behavioural Therapy for depression in both adolescents and adults, when we search back with clients for “core negative beliefs” (the fundamental cognitive processing bias in people with depression), it is amazing how predictable and limited the core beliefs are that cripple so many good people; the most common being “I am not good enough/ I am unlovable”.
When are these core beliefs formed?
In early childhood.
Who/ what contributes to the formation of these core beliefs?
I think that sometimes parents get confused about love. They confuse it with something that needs to be earned, won or is conditional. They think that unconditional love is excessive; an extravagance that will “spoil” children, denying it may be a motivator. They, and in turn their children come to believe that achievement (or something that they need to be or do) leads to love. Many great and successful people have grown up believing this model. It makes sense that achievement leads to “being worthy of love” and self-esteem is built on achievement and love. Many people are driven to success with a desire to “make their parents proud”.
But there is a second model where a fundamental core of love (unconditional and for no reason other than being) can lead to self-esteem in its own right and this self-esteem on a basis of love can drive achievement all on its own. The unconditional love and support of parents is commonplace in acceptance speeches for awards of all kinds from Nobel prizes to Oscars.
This second model is infinitely stronger than the first model presented. In the first model if love is dependent on achievement, it can be a very bitter pill to swallow if achievements wane and self-esteem and love (which was built on the rocky foundation of achievement) is lost, leaving people in effect stripped of everything. Some parents of course will never be proud of their children, they don’t have it in them and people are left chasing a dream. This type of model can explain how many successful and amazing people can feel they have nothing or are perpetually “not good enough”. In the second model, even if achievements wane and the self-esteem is dented, love is untouched and the source of everything lives on.
Making some one feel loved is hard work, but for parents I think it is important to stress that the effort in love is front loaded. Just as at the start of a new romance you might abandon the grey bloomers for lingerie, refrain from passing wind, frequently ask about your new partner’s day, always go on holiday together, so “romancing” (putting extra elbow grease into making someone feel loved and special) your child is also required at the start. Once a secure loving relationship is established, then inevitable liberties will be taken, but if the work of the early years has been solid, then nothing can shake the secure foundations of love.
As I mentioned I am a great believer of the fundamental importance of love and with regard to my own children I am operating on the basis of the second model. I want my and my husband’s love to be the fuel for our children’s success (or failure, we will love them anyway). As a parent it is difficult to know “How to make children feel loved”, and believe it or not this is not a topic covered at medical school, in a psychology degree or psychiatric training. There is no scientific basis and don’t let any pseudo-science, pop-psychology book tell you otherwise. We as parents are all left to figure this out for ourselves and enact in the best way that we can. The things I figure are listed below:
1) Cuddles are good. Surely nothing says love as much as kisses and cuddles? Sod the Victorians and stiff upper lips, I’m for open affection. Often.
2) Laughing is good. What says “love” more than enjoying each other’s company? One of the vows I made when I worked full-time was that I would laugh with my children every day, and we did, and we still do.
3) Being there is good. I know that I can’t always be there for my children but I make sure that I (or my husband) am there every time it matters. School plays, sports days, class assemblies, concerts and parents’ days – we haven’t yet missed one. I wave like a frantic loon to ensure that they KNOW I am there. Embarrassing I know, but why take time off work to go if they don’t even know I made it…?
4) Being really there is better. It can’t be right just to show your face on the special occasions, part of “love” is about sharing the mundane. Being around at least some of the time to catch the joke, the thought, the upset in real time. Some things are lost in the re-telling. You can love from a distance but can you make someone FEEL loved without really spending much time with them?
5) Understanding matters. What says love more than knowing what the other person is thinking? I often finish Banker’s sentences; I can do this with the children now too. Talking about, listening and exchanging experiences and feelings regularly is the basis of being able to know and understand someone. Children’s experiences and feelings are just as significant as adult experiences even if they might seem less important. A child being told off by a teacher will hurt as much to them as an adult being told off by their boss.
6) Respect matters. I don’t think you can engender love without respect. This means listening and valuing your children’s opinions, even if they are wrong and never denigrating or humiliating them.
7) Saying it out loud matters. I am a big believer of the three words “I love you”. I think it is necessary even if it is not sufficient. Banker is shy of these words but if you want to engender unquestionable love why hold back? Go the whole hog. Say it every day, 5, 10, 20 times a day if you like – contrary to popular belief if you say it continually to the same people, the power is not diluted. At this age, children may not always understand nuance and behaviour and verbalising your emotions and intentions help to bring things home. Once after telling off Lil Bro, he cried and said “You don’t love me anymore”. Since then I have been extra good at verbalising and spelling it out:
“I will love you if you are clever, I will love you if you are not, I will love you if you are fat, I will love you if you are thin. I will love you if you are nice to me. I will love you even if you are horrible to me. Even when I am shouting at you, I love you. I love you for being you. You will always be beautiful and smart in my eyes. I am proud of you for being you. You will always have my support. I am always here for you. Nothing will change that. I love you.”
For an adult it comes across a bit stalker-ish I know, but for young children it’s good and clear (I hope).
This is by no means a correct or exhaustive list and until Big Sis and Lil Bro are adults, I will have no idea whether my list is effective at all. My consolation is that given that my intentions are blogged, they cannot say I didn’t think about this, and if I failed to let my love be truly felt, they will know that I failed trying.