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…
One of my bug-bears regarding mainstream advice for parents is the extreme focus on “Dos and Don’ts”. Having been asked to write a few articles for mainstream media, I often sigh when I am asked to produce a list of my top ‘dos and don’ts of parenting’.
Incidentally, it would be the following:
- Use sunscreen on your children
- Vaccinate your children
- Sexually abuse your children
- Physically abuse your children
- Emotionally abuse your children
- Physically or emotionally neglect your children
But this isn’t usually what people are after.
I know what people are after: Don’t allow your children on social media/ Don’t allow your children to watch TV/ Don’t tell your daughters that they are beautiful/ Don’t praise your children for being intelligent/ Do praise your children for effort/ Do encourage exercise/ Do read with your children/ Don’t push your children to achieve/ Do push your children to achieve.
The advice may be catchy and ‘sound’ sensible and I could even throw in a few science sounding sound bites to support my case, but really – it is meaningless and often based on fluff and anecdote rather than hard science. The reality is that in the words of Ben Goldacre: “I think you’ll find it’s a bit more complicated than that” and like most things, parenting does not exist in the black and white, but 50 shades of grey.
“Black and white thinking” is often an undesirable symptom of conditions such as depression, personality disorder and autism spectrum disorder. In depression for example people can feel that making a small mistake is a disaster because in the binary world of ‘black and white’ or ‘perfection and imperfection’, small mistakes necessitate categorisation in the ‘imperfect’ pile. People with personality disorder may tend to classify people as “good or bad”, those who are good are put on a pedestal, but if they cause even minor offence, they then become enemy number 1 – because there are no in-between options. In autism spectrum disorder, there is much frustration, anger and a sense of injustice with queue-jumpers and rule infringers, because often there is only “right and wrong”. In all cases, black and white thinking is a negative: it does not reflect reality, discourages adaptability and perceptions of nuance and as such causes unnecessary distress.
So why does the media wish to encourage its audience to think in such maladaptive ways? And how can we protect ourselves from binary thinking?
In cognitive behavioural therapy for children with black and white thinking, one of the purposes of therapy is to challenge black and white thinking: to map out every shade of grey and to consider every caveat.
I think we parents could also do with some of this in our lives to stop our own binary thinking regarding how we parent:
Mapping out Shades of Grey:
(If black is no and white is yes)
Does looking like a hot mess mean I am a bad parent? Black
Does having a messy house mean I am a bad parent? Slate
Does doing the school run in my PJs mean I’m a bad parent? Ash
Does shouting at my child in anger mean I am a bad parent? Pigeon
Does physically abusing my child mean I am a bad parent? Snow
If I give my children ready meals am I a bad parent?
- What if it is not every night?
- What if I am a time poor working parent?
- What if I am a time poor single parent?
- What if it allows me to spend more quality time with my child?
- What if it allows me to help my child with their homework?
- What if I have 4 children?
- What if I have a new baby?
- What if it is a hipster vegan and gluten free ready-meal?
I know that binary parenting advice is an easy-to-understand way of delivering information, but I think that it is about time that we trusted the intelligence and judgement of parents a little more. The focus should be on providing good quality information and education and not on sound bites to be dogmatically followed. I hope that my blogs and book reflect this ethos. I don’t want people to ‘do as I do’ or ‘do as I say’ but to reflect on their own parenting and find their own path with a clear understanding of the implications of compromises that we must all make. And to embrace grey in their lives like they would Jamie Dornan if they got the chance…!
Watching Molly do cartwheels the other day, I discovered a new psychiatric syndrome: somatopsychosis. It’s a very rare condition and she may be the only sufferer largely due to her terrible parent: me.
Most of us are aware of the miraculous power of our minds over our bodies and the inextricable links between psychological problems and physical problems. At the most basic, feeling physically unwell can make us feel sad about not being able to do things we wanted to do, or anxious that we may have a serious or life-threatening illness. Being a medical student was the worst. Reading lists of symptoms of rare neurological diseases was bound to bring on symptoms of blurred vision, pins and needles and lethargy such that a self-diagnosed brain tumour became a convincing reality. Conversely, when we experience bereavement, adversity or tragedy, we often feel it physically as “heartache” or “headache” or “tiredness” and “sleeplessness”. The term “psychosomatic” is basically a fancy way of saying bodily (somatic) symptoms for which there is a psychological (psycho) basis.
Children are no different and due to their immature abilities to identify and express emotions, their propensity to cite psychological problems as physical ones are more frequent. For children, who may have less understanding that psychological problems stem from the head, the gut is the most frequent organ assigned to physical problems. Children who are worried at school may experience genuine stomach aches or constipation which miraculously remit at the weekends and on holidays. For teenagers and adults, the neurological often (but not always) begins to preside with headaches and migraines becoming more prevalent presentations of psychosomatic symptoms.
Psychosomatic symptoms more commonly arise in children who are less able to understand, identify and report their feelings and emotions. Therefore younger children, and children with learning difficulties and or autistic spectrum disorders are more vulnerable. It may also occur in children where reporting feelings and emotions is not possible, discouraged or seen as a sign of weakness or failure. Often children may have experienced past or current physical problems and therefore have a good understanding of how to solicit help or get their needs met for physical problems. Often parents can contribute to symptoms by their own fears and anxieties about their child’s physical health. This is particularly so if the child has a long standing medical condition or has been unwell in the past. Doctors and health professionals can add their own anxieties “of missing a rare disorder” into the mix with repeated investigations and suggested treatments to help uncover and treat an underlying biological basis to problems, and neglect to consider that the underlying problems may be psychological.
If that is the long established thinking on psychosomatic symptoms, what then is my new disorder of “somatopsychosis”? Well, exactly the reverse: psychological symptoms caused by physical ones. This sounds highly unusual, and indeed, Molly is the only recognised case report of this pathological condition that I have just made up. Here is how it works:
Some doctors, like myself (I hope this is the case and I am not an unusually hard-hearted anomaly), have a skewed sense of pain severity due to our dealings with pain at the very severe end. At times it can border on the down-right unsympathetic: when my husband complains of woozy head and sniffles, it’s most definitely man-flu of no significance and he should take Lemsip, go to bed and quit complaining. When an adult patient complains of pain from a blood test, I sometimes mentally think “Come on – it’s a skin prick – I’ve just sewn someone’s entire arm back on!” and don’t let me get started on people that wince in extreme agony from having a blood pressure taken. I am of course professional, kind and sympathetic to my patients, but I am also human, so I hope you will forgive the occasional internal eye-roll at such “wimpish” behaviour.
Unfortunately for my children, professionalism doesn’t wholly apply at home and although broken legs, cuts that are likely to leave scars and high temperatures are met with the usual heightened maternal anxiety (including vivid nightmares of misaligned bones or fractures that disturb the bone growth plates that only people of medical training contemplate) I admit to a general propensity to a lack of sympathy to minor physical pain. As such poor Molly and D have learnt that a grazed knee will earn a dusting off, a quick wound wash, a hug and a wipe of the tears, but then an expectation that the episode is now over and they are to carry on playing. A bumped knee will unlikely earn more than an “Oh dear, you’ll get a nasty bruise” or sometimes, I admit to even worse: “Well, that’s what you get for charging around without looking where you are going.”
As a child psychiatrist on the other hand, identifying and expressing feelings and emotions are a different kettle of fish. From a young age, both children have been encouraged to talk to me about their internal lives, what has worried them at school and all angles are thoroughly investigated and talked through with utmost attention.
It appears that this table-turning of the usual scenario where parents pay immense attention to physical pain and tend to access less of their children’s internal worlds can have its own unhealthy consequences. Here’s what happened:
Molly: Whee! look at me! I can do really good cartwheels now!
Me: You’d better watch out, doing cartwheels on a slippy rug is not the best idea…
Molly: Ouch! [Blubber, blubber]
Me: I told you so.
Molly: You don’t know what a terrible day I had. Girls were being mean to me at school.
Me: [???? What the hell? Where did that come from?]
I had to suppress a smile as I realised what was happening. Molly subconsciously knew that I wasn’t going to give her sympathy for a bumped bottom, but a potential peer interaction problem would give her the comfort and attention she needed at that time of physical pain.
AAARGHH! I have generated somatopsychosis! At least my early recognition of this oddity has reminded me to be more sympathetic to my children and change my ways. I absolutely don’t want her to subconsciously fabricate mental health problems to gain attention. It does go to show though, the frightening power of our day to day words and actions on our children, and the critical importance of what we DO and DON’T give attention and kindness for.
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.
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.
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!
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.
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.
Since Amy Chua’s book on tiger parenting exposed the prevalent Chinese ethos in parenting, life has been hard. It’s impossible for a Chinese parent to have a child play well at a music concert without arched eyebrows from other parents thinking “Well, she must make them practice till all hours” and a good class report cannot go by without mutterings of “Well, her children must be tutored beyond belief”. Indeed, parents have come up to me in the school playground specifically to ask my advice about tutors, when anyone who reads my blog knows, I am anti professional tuition and am resisting the pressure to get a tutor and certainly know no tutors (although I reserve the right to crumble to the tutor fad closer to 11+!). Come parents evening, I generally nod obediently and keep my mouth shut, cowering behind Banker and poke him into action to ask the questions that we want answered lest the teacher labels me as “That typical Chinese tiger mother”. Banker, being Caucasian is allowed to ask questions about the children’s education without prejudice.
It was a surprise then that I recently encountered where the Caucasian Tiger Mothers are.
Big Sis recently sat a ballet exam. I am ambivalent on the issue of ballet. I have to confess that I did arrange for Big Sis to start ballet at age 3 years as who can resist the cuteness of little dumpling girls toddling about in pink tutus? I presumed that by age 7 years, she would have grown out of it as the discipline, the classical music and the strictness, didn’t seem to me to be overtly appealing to children. I thought she may have asked to change to drama or street dance, which are probably my preferences and were alternative options that I have muted each year. But no, Madam loves ballet. So I dutifully send her each week and give her due encouragement, and I attend the ballet shows and clap enthusiastically, but all the while thinking to myself: when will she get fed up of this as I don’t want her pursuing ballet seriously and developing an eating disorder in adolescence. It’s a prejudice I know, but for me ballet and eating disorders are just linked in my brain, and given a preference I’d like to think that Big Sis would’ve said “yes” to rocking out with the Skater Boy rather than ruefully going to his concert in years to come.
Big Sis and I ran like a pair of insane loons to this ballet exam, as typically we were LATE. Big Sis had her hair in a pony-tail, only by now, it was all tumbling out and her face was sweating like a pig from having been told to run like a madman or face a telling off by a stern Russian for tardiness. Big Sis was wearing white school socks instead of tights as it was a baking hot day and who wants to wear tights in the heat? Big Sis and I had just stuffed our faces with chocolate digestives because we were a bit peckish and crumbs tumbled from pink taffeta as we barreled in through the doors huffing and puffing.
When we arrived, we were met by the other girls and parents. 90% of the girls were tall, blond and with thigh girth smaller than my arms. Every girl without exception had their hair neatly pulled back into a perfect bun. Gel, wax and constellations of Kirby grips took a vice like hold on hair lest a strand fall out of place. Most of the girls had a full face of make-up on; they all wore tights not crumbs. Oops, was there a memo I missed about a dress code or were we to have intuited this? Parents fussed about and guided the girls as they dutifully underwent elaborate warm up stretches in the corridor. Meanwhile Big Sis stood in the corner fanning her sweaty nose.
“Phew” I said. “They’re running late so we haven’t missed it. We were running, now we are sweating like pigs.” I attempted to explain to another parent.
Arched eyebrows at my disorganization and pitying smiles from other parents, and I got the sense that I had not correctly judged the seriousness of this ballet exam. Then, what I hadn’t anticipated. The Spanish inquisition:
“So when did Big Sis move into this ballet class?”
“Are you sure she is at the correct exam? Some of her class mates were being examined in the earlier exam.”
“My daughter is doing ballet 3 times a week. How many times a week is Big Sis doing ballet?”
And so on.
As I muttered “I dunno. We came at the time we were told”, I started to feel perplexed about this excessive interest into what I felt to be an irrelevant extra-curricular activity that I was forced to enthuse about because my kid found it fun. Then I began to feel a strange sense of familiarity at the questions I was being asked. These questions were recognizable and I and others I know have asked these questions before. They were just like the questions Chinese parents ask each other about maths and English exams!
“So how long has your child been at Kumon?”
“Which grade piano is your child taking this year?”
“How many times a week do you set them extra maths homework?”
If and when my kids are required to sit for academic exams, you can bet that we would be early, sitting outside the exam hall probably swotting up on home-made exam cards of some description.
So this is where the white Tiger Mothers hang out.
It’s sort of cool to feel vindication and that it is not just the Chinese that are a tad pushy after all. It’s just that for the Chinese the focus of achievement is on academics and music, whilst for Westerners it’s sport. Banker recalls similar parents at swim meets when he swam in junior national swim teams in South Africa. Many of his team mates rebelled against their ambitious parents and refused to continue swimming in adolescence because of it. It’s funny that I am sure that Judy Murray (and any parent of a top athlete) did her fair share of threatening, cajoling and bribing her sons to get out of bed and get to training for long hours when they didn’t want to, yet she is a national treasure, whilst a parent that used similar parenting practices to target academic achievement would be vilified.
Having initially felt intimidated and antagonized, I felt serenely at one with these other parents. Still, as a Chinese parent I can’t for the life of me understand why ballet should be the target of such efforts. At least with academics, half-hearted success at maths will still land your child a decent job, whilst even the top students in a ballet (or any sports) class are unlikely to make a career of it…
Each to their own I guess.
OK, I have to fess up. I am moving house this week and have nothing prepared. So here is an essay I wrote a while back to explain my work in gene-environment interaction. I know, it sounds scary, but its really simple and I’m sure that this “story” will help you understand.
I’m here at Mr. Almighty’s Cloud Street Headquarters to interview him on his plans for a family friendly casino.
“Mr. Almighty, it’s great to meet you! Tell me the concept for your casino.”
Mr. Almighty: It’s ingenious really. My casino actively encourages participation of whole families. Although single people are encouraged to come, it’s in the hope that when they have children, they can continue to come here as a family and I’ll have a continued source of customers!
“Very clever. What sort of gambling facilities will you have? Slot machines, roulette, ‘Blackjack’?”
Mr. Almighty: Ah, well! I’m a ‘Blackjack’ man myself, but my enthusiasm spreads to all card games and so I’ve dedicated my casino to cards. We’ll have ‘Poker’, ‘Snap’, ‘Bridge’, ‘Old Maid’, ‘Rummy’, as well as ‘Blackjack’ off course. In fact, you name a card game and we’ll certainly be playing it. I’ve divided the venue into sections so that a different card game will be played in each, so called ‘gaming environment’.
“A very catchy name.”
Mr. Almighty: Yes. I think our advertising boys did a good job on that one.
“What’s so special about a casino dedicated to card games for families?”
Mr. Almighty: Hah! Well, unlike other casinos, there’s a twist. My casino will be exclusive: ‘Members Only’ I mean…
“There’s nothing new about that!”
Mr. Almighty: Wait, I haven’t finished. On joining, I deal all members 14 playing cards. They must play with the same 14 cards that they were dealt on joining for the duration of their membership. The only exception will be for members’ children. We anticipate there’ll be several billions as the casino expands, so I’d be here all day dealing out cards to kids if there was no exception made! So, I’ve devised a simpler plan for them. They will be blindfolded and asked to randomly pick their cards from the hands of their parents: half from their mother, and half from their father. From then on, the same rules apply: “You play with the cards you’re dealt”! That’s the slogan our advertising department is adopting for our poster campaign!
“But there’s a terrible flaw in your plan! What if I joined and received a terrible hand? I’d have to play with that for the duration of my membership and keep losing! I might as well give up!”
Mr. Almighty: No, no – that needn’t happen. You, like so many others, see things at face value and don’t see the complexities in the matter. Whether you win or lose depends not only on your cards but a whole host of factors. For starters: how well you play the game. Parenting is potentially important for this, at least in the beginning. Even if a child has a great hand, if his parents haven’t taught him the rules of the game, he’s pretty sure to lose.
“Yes, I suppose so.”
Mr. Almighty: Later on, he might have more chance to play with friends or have tuition from teachers and be able to learn skills for card playing from them.
“So, his chances of success and failure might be influenced by his peer group and school environment?”
Mr. Almighty: Indeed.
“But, once you’ve learnt the rules of the game, your potential winnings are still dictated by the cards you’re dealt. You’d be stuffed if you had no ‘Aces’ or ‘Picture cards’.”
Mr Almighty: Not so! That’s the beauty of my casino. There are many chances to win. As I’ve said, we play all the card games in the world here, not just one! The ‘Aces’ and ‘Picture cards’ might serve you well in a game of ‘Bridge’, where high scoring cards are valued, but in ‘Old Maid’ where they are penalized, they will cause you nothing but grief! And in ‘Snap’, well, a ‘two’ is as good as any ‘Ace’ so long as you find a pair.
“O.K. So how well you do depends on the interaction between your cards and your ‘gaming environment’. A hand full of ‘Aces’ in a ‘Bridge’ game spells success, but the same ‘Aces’ when playing ‘Old Maid’ spell disaster. So the handicap I predicted isn’t necessarily so, and it’s a matter of finding the optimal combination of game played and cards possessed.”
Mr. Almighty: Exactly!
“Even so, how well you do in the long run is still dependent on your cards isn’t it?”
Mr. Almighty: In some respects. I can’t say that your cards will not ultimately limit your potential but there are still further factors that could influence prospects.
“Besides your cards, acquired knowledge of the game and the game being played, I can’t think of any thing else that would influence progress.”
Mr. Almighty: I see you’re not a regular card player! Otherwise you would know that there is a lot more to card playing, not least the abilities of your opponents, or ‘gaming society’ as our advertising boys like to call them.
“O.k. I suppose if I were playing with novices, I’d certainly have a better chance of winning.”
Mr. Almighty: Now you’re catching on! As you can see, there are lots of ways you can still win with a deficient hand of cards. You choose a game you’ve been taught to play well, a ‘gaming environment’ where your cards are valued and where your fellow card players are suited to allow you to thrive.
“So, I could look at my hand and in effect change my prospects by selecting a ‘gaming environment’ dependent on my cards.”
Mr. Almighty: Yes, indeed there’s likely to be a great deal of correlation between your cards and your selected environment. But it’s not always easy to tell from the outset which is the best ‘environment’ for your hand. I’m not going to label the environments ‘Professional Poker Player’s table – avoid unless you have a Royal Flush’ or ‘Beginner’s Bridge – you’ll win big here even if you have no Picture Cards’. What usually happens is that there is a fair amount of trial and error before some satisfactory environment is found.
“But clever manipulation of the ‘gaming environment’ can make good from a poor hand.”
Mr. Almighty: Indeed. And these are just factors I’ve thought of so far. I’m sure if more research was done in this area, more significant environmental and social factors will be found to allow players who receive a poor hand to win.
“That’s amazing! But tell me, how can this venture possibly make money? You’ve said players with terrible cards can still succeed by choosing the correct ‘gaming environment’. If players got wise they’d keep winning and you’d go bankrupt!”
Mr. Almighty: Well, I have a few tricks up my sleeve. I didn’t wish to impose this restriction, but the reality is that to stay economically viable as a business, I must. I have had to impose a cost attached to changing ‘gaming environments’. You will have to start playing in the same ‘environment’ as your parents. Otherwise, I’d be bankrupt by the babysitting fees alone! If you want to change environments, you or your family will have to pay a fee, and it’s not cheap. It’s sad but true, some poor buggers get stuck in an environment totally at odds with their cards and they just carry on losing.
“Let me get this straight. If my parents play ‘Poker’, then I have to start off playing ‘Poker’ even if my hand is better suited to ‘Snap’. In order to play ‘Snap’ and make it big, I need financial backing?”
Mr. Almighty: Yes. That’s the gist of it. I have to make money somehow! If only the government would give us casino proprietors more money, I’d love to let my members play in their optimal ‘gaming environments’ and watch them flourish. Unfortunately, I can’t afford to do that.
“Isn’t there another way? What if between my parents they have the cards to give me a ‘Royal Flush’ which would make me almost guaranteed to win at ‘Poker’. Couldn’t they pay a fee to engineer it so that they select which cards I inherit, rather than my picking them randomly? Or, could I modify my hand and change certain cards for ones that might suit my circumstances better?”
Mr. Almighty: That certainly would allow you to win. It’s a contentious issue though! Some would even call it cheating! But I can see where you’re coming from. If I was constantly playing to lose with no prospect of winning, and with the knowledge that my children would inherit a poor hand and little financial resource to change their lot, I’d quite wish to be able to do the same thing too. I often see players with no ‘pairs’ or ‘Picture cards’ continuously losing their savings at the ‘Poker’ table and I think, what if I could give him a pair of ‘Aces’ or two. Unfortunately, if I sanctioned card changes, all my members would be queuing up to change their cards and I would have no peace! As it turns out, there are many intelligent members who’ve devised ways of ‘card modification’. But there’s no point changing your cards willy nilly. The trick is to research your ‘gaming environment’ and ‘society’ and strategically find the correct card to change. By changing specific cards, some have been able to turn the tides of their fortune. Sometimes, it can rejuvenate whole families who’d lost hope, not to mention the benefits to their future generations. Other times it’s used for the wrong purposes, and I totally disagree with it, but am powerless to stop it. It’s really up to members to decide how much ‘card modification’ they can tolerate. There’s a committee that monitors it. I try to keep out of it, though they often try and bring me in to their debates!
“But it could ultimately affect your business. If all this ‘modification’ was allowed to go on, everyone would have ‘Aces’ and ‘Royal Flushes’ in their hand and you’d go bankrupt!”
Mr. Almighty: Not necessarily. The members can modify cards behind my back all they like, but they need ultimately to bear in mind that if everyone had ‘Aces’ and ‘Royal Flushes’, the whole ‘gaming society’ would change. There’d be no members with losing hands and you’d have to be an even better card player to succeed. There will always be winners and losers just the same. In any case, don’t you know the first thing about casinos? The house always wins. I have one last trick up my sleeve and that is, I have the right to close down any ‘gaming environment’ I choose, at any time.
“How would that insure your success?”
Mr. Almighty: Well, if all my members were gaining ‘Aces’ and ‘Royal Flushes’ to win at ‘Poker’, then they would be taking a large gamble. I could close down all my ‘Poker’ tables and turn them into ‘Old Maid’ gaming environments at my whim. That way, I could turn all the winners into losers and losers into winners whenever I choose!
“Caution and the importance of environment is the order of the day then?”
Mr. Almighty: Indeed.
“It certainly sounds like a fascinating venture! One thing I wondered though, your advertising guys seem to have coined great names like ‘gaming environments’ and ‘gaming societies’, but couldn’t they think of a more catchy name for the cards?”
Mr Almighty: Yes, they’re working on that, so far, they’ve only come up with ‘genes’.
“‘Genes’. That might just take off! Tell me, what are you going to call your new casino?”
Mr. God Almighty: Well, actually, the prototype has already been running successfully for several millennia, and I think I’ll launch the real thing with the same name as it’s a good a name as any. I call it ‘LIFE’.
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.
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Over the last few weeks I have been asked by a few people to write something on managing behaviour of children. This is one of the biggest challenges for parents, and yet I had put off writing about this as it is not as easy to give advice on this as it sounds. The “tips” that friends were asking for basically amount to what we in the industry call “behavioural management”. Ways in which parents can magically “change” or “manage” their children’s behaviour. Sadly, there is no magic tip, only all the things that you have already heard of and tried. Behavioural management tries to spell out what is and is not desirable behaviour and strategies try to tip the balance of choice towards behaviours that are desirable. Well known strategies include “the naughty mat” or “time out”, “ignoring” your child’s mild bad behaviour and also the blessed “reward chart”. If you want to read up on behavioural management an excellent book is “The Incredible Years” by Webster-Stratton. I won’t précis what I feel is a thorough account of good behavioural management, but instead ask:
Does behavioural management work?
The answer in theory is unequivocally “yes”.
But, so often in practice is “no”.
This is because behavioural management is easiest to implement when your child is “typical” and has no other problems, and you (the parent) are brilliant, have no problems and are super consistent in everything you do both with your co-parent and school.
Which basically means “no” or only “a bit”– as when does the above situation ever happen?
Here are two reasons why your child may not be “typical”:
Neurodevelopmental problems, in particular learning difficulty can heavily impact behaviour. In young children, aggression and temper tantrums are typical responses to frustration, but by school age, some control should have been gained over these behaviours. If a child is developmentally delayed, then their ability to behave should be compared to their developmental age rather than chronological age. A 16 year old boy with the developmental level of a 4 year old; can be expected to behave in line with a 4 year old. For a four year old, temper tantrums and hitting out are common responses to frustration, the trouble is that being hit by a 16 year old boy in a temper tantrum has very different consequences to being hit by a 4 year old, and yet, the child “can’t” help responding in this way. These children are often clients in child mental health services as parenting children with severe learning difficulties can be extremely challenging. Other neurodevelopmental disorders also cause behavioural problems. In ADHD children with problems with attention cannot listen to or follow instructions as well as other children. They will tend to act without thinking and may do things that they regret later because they acted without thinking. Children with Autistic Spectrum Disorder may have behavioural problems as they are having difficulty in understanding what is being expected of them and poor social understanding can lead to many more frustrations on a daily basis. Standard behavioural management may not work in these groups of children and behavioural management needs to be adapted to the child’s difficulties. In general it is harder to implement and with more varied results than in children without neurodevelopmental difficulties.
Children who are having emotional problems may have difficulties in behaviour. Emotions and behaviour are inextricably linked. When we feel down or stressed out, our behaviour changes. Some of us reach for chocolate, some for alcohol, some people become withdrawn and unsociable, other people become irritable and angry. It is important to assess emotional aspects of your child’s life if their behaviour changes or deteriorates. Children may not always volunteer their states of mind to you. They may not be able to label their emotions, or to express themselves. They may be afraid to talk about these things. Their unhappiness and frustrations are displayed in their behaviour rather than in words. It is your responsibility as a parent to notice, to ask, to label for them, to give them words, to give them permission to talk about their difficulties. To guess and to investigate from asking teachers and friends if nothing is forthcoming. It may be that they are being bullied at school, it may be that they are picking up on the stress in your marriage, it may be something trivial, but if you don’t notice/ enquire, you won’t know and their change in behaviour will just be called “bad behaviour” or “acting out”. In these cases, behavioural management will not work well. Rewards will feel irrelevant, ignoring and punishment will feel like persecution, negative attention will be better than no attention and rejection is a welcome confirmation of their own self-loathing. Finding out what is wrong, offering security will work better here. Unattended emotional problems in children can impact personality and aid development of long-lasting traits that can lead to “bad behaviour” becoming habitual and “part of” a person’s personality that can no longer be easily mended.
In children without these additional problems, the limiting factor to good behaviour is usually the parent not the child.
Lack of sustained motivation:
In the defining clinical trial for children with ADHD where they compared medication to behavioural management (The MTA Study), behavioural management achieved equal outcomes compared to medication. But wait, here the behavioural management programme used highly trained psychologists to work with highly motivated parents and teachers to obtain this outcome. Real-life trials (what we call pragmatic trials) using existing services, which tend not to heavily involve the schools (as the Department of Education is separate from the Department of Health), and non-selected patient groups, that have looked at the efficacy of community parenting and behavioural management programmes have netted unimpressive results. It is not that children’s behaviour cannot be managed; it is that the will of society and parents, is insufficient.
I know this all too well. Big Sis has a weekly spelling test. On the weeks where I have my act together, we sit and learn the words and I test her on the words each day to make sure that at the end of the week, she gets full marks and I reward her for this attainment. This is basically behavioural management in action: co-working towards a set goal that is achievable, achieved and rewarded. This works fantastically well, thumbs up and smiles all around. Once she has done this for a few weeks, I get complacent and I think, well now – maybe I can just give it a skip this week, she and I can both have a relax and we’ll just have a quick look at the words the night before. She gets a couple of mistakes. That’s basically my anecdote for behavioural management. It genuinely works until one day, you can’t be bothered and it all goes a bit wobbly again. The limiting factor is me, not Big Sis.
Wobbles in my behavioural management can also be seen when I am stressed or distracted. One time when I was very stressed waiting for a phone call regarding a job offer; the children were extremely badly behaved – “for no reason”. I was snappy and shouted at them and they just wouldn’t do what they were told – “it was as if they knew exactly when to wind me up”. Eventually, the phone call came, and I had got the job. That afternoon, they were very well behaved. The change had been in me, and their behaviour merely reflected my state and parenting capability, not something innate in them.
Unrealistic parental expectation:
When we talk about “bad behaviour” we all mean different things and we all have different thresholds as to what is meant by “bad”. Some friends and relatives come by our house and make “tutting” sounds when they see our kids glued to the TV, leave the table at meal times on a whim to dance around the kitchen, bonk each other on the head with cushions and generally shout at each other and at us. To me, this is not bad behaviour – this is just life in our household! Equally, I raise a brow when I see children that never say “please” or “thank you” and run away from their parents on the street, while this is not something that bothers them. When parents complain that their children “Will not do as they are told”, the severity of the issue rather depends on what they are being told to do. If they will not do 60 minutes of piano practice every night, that is rather different from refusing to do their homework, or refusing to stop watching TV; and “good” and “bad” behaviour is sooo dependent on what the parental and school expectation is. Often there are cultural and generational expectations of how children should behave. A normal child in a school with high behavioural expectations may be deemed to have “bad behaviour”, a normal child in one culture may be deemed badly behaved in another. The behaviour is relative and in order to assess behaviour properly, it is important to first evaluate that the expectations are reasonable. There is a limit to how much a child can “change” and they will not bother to attempt to change behaviour if they feel that the bar is being set too high.
One of the main saboteurs of a good behavioural management programme is “other people”. The well-intentioned/ or not so well-intentioned other half who disagrees with what you are doing. By not supporting you, they are de facto sabotaging the behavioural management plan because children are such buggers that they can spot disagreement a mile off and work it to their advantage. Much like MPs claiming expenses and benefit fraudsters, they are not averse to trying to get away with as much as they can. Playing one parent off the other must be a favourite game for children. In my opinion parents who want to succeed at behavioural management need to get on board together, or not bother. A similar conundrum exists with the school. If children are told one thing at home and another at school, the “authority” of “the rules” is undermined. It is a good idea when implementing behavioural management to discuss plans with the child’s school so that the same message is delivered to the child.
So in summary, if emotional problems are excluded, behavioural management delivered consistently and well will definitely improve your child’s behaviour, even if they have additional difficulties; but it is by no means a magic wand. It takes hard toil, stamina, guts, persistence and tears, but can reward you with likeable human beings. Isn’t that the essence of parenting?
If you want to know more about behavioural management please buy/ beg/ steal/ borrow: The Incredible Years, by Carolyn Webster-Stratton. This is the programme recommended by my colleague Professor Stephen Scott OBE of the UK’s National Parenting Academy. I have read it cover to cover and it’s good common sense.
Carolyn Webster-Stratton. The Incredible Years. ISBN 978-1-892222-04-06. http://www.incredibleyears.com
The MTA Cooperative Group (1999) A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Archives of General Psychiatry. 56:1073-1086
A few weeks ago I had a conversation with a professor. She asked me how my children were. Being conscious that my part-time status should not account for nothing, I bragged:
“Oh, my daughter is in the final of the Borough Poetry competition and my 5 year old son is playing chess”.
What surprised me was her response.
“Oh – you see, that proves it’s all “G””
(G is the behavioural geneticists’ abbreviation for genetic effect – yes, we behavioural geneticists actually do talk in terms of “G” and “E” (environmental effect) in common parlance rather than actual coherent words).
“Oh” I said, “I was about to say that it proves it’s all “E””.
Of course, we all know that both “G” and “E” play an effect in outcome, but it is funny to see how (even in two people that study it) our interpretation of science is coloured by our own personal view; or perhaps rather, we skew the science to suit our own needs and to support our chosen behaviours.
My personal view is that parenting matters. I would not have gone part-time and sacrificed career advancement if I did not believe that I would be making a significant positive impact on the outcome of my children. I am more likely to see positive outcomes in my children as being directly related to my input, rather than what would have happened regardless if I was there or not.
If you believe that outcomes are solely genetically determined, then parenting no longer becomes important, and you may as well excel at work and farm out childcare. Equally, if you have chosen to excel at work and farm out childcare, it would suit you very well to believe that “it’s all about G”.
So here’s the route to Big Sis’s poetry success and how come Lil Bro is playing chess at 5 years, and you can decide for yourself on the G and E in these instances.
Big Sis is good with words. She is interested in them and from as young as 3 years she would always ask questions about the meaning of words:
Big Sis: What does imagination mean?
Me: It’s something that you think about in your head.
Later, when I asked her to concentrate on colouring within the lines:
Big Sis: What does concentration mean?
Me: It’s when you use your head to think about something.
Big Sis: No. That’s your imagination.
At that point, I bought her a dictionary so that she did not need to rely on my lack of defining prowess; the point being that she was interested in words and their meaning from a young age and I provided her with the tools to pursue this.
In addition, I read to Big Sis (and Lil Bro) every night from the age of 1 year, until they could read chapter books for themselves, and I will still read to them more challenging books when we are on holiday. I will define (to the best of my ability) difficult words and ask questions to check that they understand what I have read to them.
I have a book of poems my sisters and I wrote when we were Big Sis’s age. My father encouraged us to write them and he had them bound in a fancy book. They are absolutely hideous (all basic rhymes and no substance – “I love school. It’s so cool.” – you get the tragic idea) but strangely appealing to young children. Sometimes I would get this book out and read them to the children.
When I found out that Big Sis was studying poetry at school, I went to Waterstones to buy TS Elliot’s “Old Possum’s Book of Practical Cats”. We have a well-loved cat, and so I thought that this would be an accessible poetry choice for Big Sis. Indeed it was. We read all the poems together. Lil Bro takes to Macavity, Big Sis to the Pekes and the Pollicles. We will soon be taking advantage of the return of the “Cats” musical at the West End.
In one poem, TS Elliot says “How else can a cat keep its tail perpendicular?”
Big Sis asked for a definition of “perpendicular”.
I explained that it means when something is at right-angles to something else. I stand up and demonstrate with my arms perpendicular. At that moment, our cat jumps out from under the bed with her tail up. “There look” – I say pointing, “that’s what it means to have a tail that is perpendicular.” Big Sis understands.
“But”, I say to Big Sis, “I think that Mr Elliot has another meaning when he asks this.”
“Show me what you look like when you are sad or ashamed of yourself.”
Big Sis, the master of drama, slumps and hunches over; slinking away.
“Now show me how you look when you are proud.”
Big Sis sits up straight and tall.
“Look”, I say, “You are “perpendicular” to the ground when you are proud. I think this is what TS Elliot means; he is talking about pride rather than the position of the cat’s tail.”
Later, Big Sis is practising ballet moves in the hallway.
“Mum!” She shouts.
“My leg is perpendicular.”
Lil Bro has always had excellent spatial awareness. One Christmas just after his second birthday I thought about presents to get him. Being Chinese, the first toys that come to mind are educational ones. I thought I would get him a jigsaw, something he could realistically manage like a 3-piece. His Aunty, who is also Chinese and so of the same “educational toys” mind set also buys him jigsaws – Thomas the Tank Engine ones; only, she has no children and so did not appreciate how many pieces a 2 year old could realistically do – and bought him 6, 10 and 12 piece jigsaws.
One evening, I was cooking dinner so I put Lil Bro at the table with the 3 piece jigsaws. He wanted the Thomas ones, so I put those out as well, just to keep the peace while I cooked. The next minute, I turned around and there he was sitting with the 6 piece puzzle completed. I nearly dropped my saucepan.
“OK, then clever clogs” I thought, here’s the 10 piece.
That was also pretty much consumed.
My Christmas present was a complete waste of money, he never did 3-pieces. By the time he was 3, 24-35 piece jigsaws were no problem. We even played “Jigsaw-offs” – infant versus geriatric; where Lil Bro and my mother would race as to who could finish an identical 24 piece jigsaw faster. Lil Bro was victorious.
By 4 years old 50 and 72 pieces were fine. By that time, I had emptied out several toyshops of their jigsaws.
At weekends, when Big Sis was at her swimming lesson, Lil Bro and I would sit in the coffee shop next door and eat porridge. The coffee shop had chess and draughts sets for customers to play with. To kill the time, I taught Lil Bro to play draughts and then chess. I am not the greatest chess player myself. I tend to take pieces with no overarching strategy; pretty much ending most games with no conclusion as my bishop and king chase the opponent’s knight and king hopelessly around the board. Still, by 4 years, Lil Bro knew how the pieces moved. I installed a chess game on to the ipad at home and encouraged the children to play it.
By chance, there is a chess club that runs in the same community centre that the children go to Chinese classes at (they go to be at one with being “Chinese” – their Chinese is even more hopeless than mine). One day, Lil Bro, aged 4 years said “I want to go there and play chess”. Given that the time clashed with their Chinese class. I said it wasn’t possible, but when it came to the summer holidays, I asked if they wanted to go to Chess Summer Camp for a week.
Big Sis was not keen.
I said to Lil Bro, “Your sister doesn’t want to go. Are you sure you want to go, even on your own?”
He said yes.
I went to check with the Chess Camp leader – wasn’t he too young?
The Chess Camp leader said some of the best players in the club were 5-6 year olds. Still, I wasn’t happy to send Lil Bro on his own and I eventually managed to twist Big Sis’s arm to go with him.
After a week of chess camp, and the initial enthusiasm, we carried on playing chess occasionally now and then. I didn’t think anything further on it. Then 3 months later, Lil Bro says to me “I want to go to chess club”.
Man! I thought. I wrack the local websites for chess clubs that are not going to clash with their Chinese class and are not too expensive. Finally, I find a cheap club on a Saturday afternoon at the local library. It’s good, but there is one teacher to eight children at greatly varying ages and abilities. Plus, smack bang in the middle of Saturday afternoon is not the most convenient time.
I get the chess teacher’s contact details. I ring around a few mothers I know whose children might be interested in chess. I set up a chess club for 3 boys after school in a local coffee shop.
So…what do you make of it?
My view is this: clearly, both Big Sis and Lil Bro have genetic predispositions to be good at certain things. I come from a family of mathematicians and engineers; Banker from a family of lawyers and linguists. Go figure that these genes are knocking about our chromosomes.
But can that be all?
What if I hadn’t been there to notice?
What if I had noticed but done nothing about it?
What if I had noticed it but derided intellectual pursuits and tried to knock it out of them?
I am pretty sure that Big Sis would still have enjoyed and been good at writing and Lil Bro would have found chess by himself at a later age. But would they have been in the final of a poetry competition at age 7 years, and been playing chess aged 5 years?
Do these things matter?
Might they not reach the same end-point in adulthood?
That is the more interesting question that is so hard to answer because of the lack of the counter-factual. But my view is this: if life is a journey and your outcome is your destination; genes will drop you off at the airport. If you are lucky it will be London City Airport, if you are not so lucky it will be Luton Airport Parkway. Parenting provides your back-pack: it can be empty; or it can be full of maps, restaurant and hotel reviews, travel guides, good books, a compass, a thermos of cocoa and a bag of chocolate chip cookies. It might not be everything you need, but it sure helps you on the way.
Ultimately, where you go from there is up to you.