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…
So, Molly is in Year 6 now and I’m sure that I am not the only parent in the anxiety provoking situation of considering secondary transition. I am in the fortunate position (minus a few holidays and luxuries) of being able to consider a private education for my children. This rubs against my preference for all children, from any background, to be able to receive the best possible education, particularly as my siblings and I were all state educated. But where we live in London, in the vicinity of dozens of the top private schools in the country, the difference in available quality of education is all too stark. The draw of these selective schools to the local population, means that many academically able children are removed from the state education system with some demographic consequences for some of the local state schools. While we never considered a private primary education, a private secondary education was always on the cards. Of course, we also applied for the local grammar school for Molly, one that I myself attended in the 80s (see my blog on this), but unfortunately, Molly didn’t make it through the selection process (although I have managed to remain tutor-free). Not altogether surprising since we were told that there were 3500 candidates for 100 places – worse odds (35:1) than Oxbridge (10:1) but still far easier than getting on Love Island (2500:1)! The remaining selective school exam onslaught is in January with weeks required to be cleared from my diary for exams and subsequent interviews and my wallet some-what lighter for the registration fees.
I’m Chinese. I take education seriously. But equally, I am a child psychiatrist and I take mental health even more seriously. Optimal performance in any domain is impaired by poor mental health (as is happiness) and this consideration needs to come first and foremost. When Molly was told that she had not made it through the grammar school exams, she was understandably temporarily disappointed and subdued, but she was readily reassured, and within the hour was back to her usual happy self and has been looking onward and upward. There has been no dent in her self-esteem that I can discern, rather, there has been a smidgeon of increased effort in her work ethic. Given that we have come through and managed the first hurdle of school “rejection” relatively unscathed; I feel somewhat able to advise on some ways that I found useful in combatting rejection dejection.
- Start early and go slow:Adapting to big changes and making a big lifestyle change is always more stressful than making small, incremental changes over time. If you have the long term goal of children sitting selective school exams, I would always advise starting early with a small amount of work (30 minutes a day) up to Year 5 and building incrementally to a reasonable amount of work (1 hour a day) in Year 5 and Year 6. As our state primary school does not give much homework, this is very manageable. Children, who are not used to doing work regularly at home, will be more stressed if they are suddenly loaded up with tutors and work towards exam time, and this also emphasizes the fact that these exams are ‘super important’ which drives anxiety. If little and often has been part of life from the start, then exam preparation remains part of normal life and the attention and importance of exams (and therefore their outcomes) can be normalised.
- Let Life Go On:It is really important that children get selected into schools that are academically suited to them. If your child has extra-curricular activities that they enjoy as down-time, or that they would wish to continue in secondary school, then it is really important that these continue throughout the period approaching exams. If a child requires to stop everything else in their life in order to work towards exams, the likelihood is that they may be selected into a school where they cannot keep up with the class unless they continue to work at this heightened level. This leaves children in the stressful and vulnerable position of potentially giving up enjoyable extra-curricular activities forever. Extra-curricular activities are usually enjoyable and act as a source of stress release and social interaction. Some parents think that it is advantageous to ‘sneak’ spoon fed children into highly academic schools, but believe me, this is never advantageous. If children are unable to keep up they will be ‘managed out’ of these schools which can sometimes be ruthless about maintaining their league table status, and if a child has to work all-out to keep up, then this has consequences on their mental health.
- Realistic expectations and realistic explanations: I have a notion that self-awareness is the key to happiness. That if we understand ourselves and perform to our expectations then we are happy. Unhappiness arises when we do not know who we are or fail to live up to our own expectations of ourselves. This is of course more likely to happen if our expectations of ourselves are unrealistic. For many of us, myself included, I only truly felt that I started knowing who I was in my late twenties, and now in my forties, I am perfectly content with my own flawed self. Imperfect but comfortable in my imperfection – like an old pair of shoes. For the typical 11-year old child where identity is yet to be fully formed, ‘expectations’ are defined by parents. To prevent children feeling like they have fallen short, try to ensure that expectations are set at ‘realistic’. Asking school teachers, reviewing children’s independent work and having an idea of the academic level required for particular selective schools is important when choosing schools for your children. It is OK to be ambitious and choose some schools which may be a stretch, but if you are doing this, then explain it clearly to your child that there is no expectation to get into these schools, but that they are worth a punt. I take the school selection decision as a spread betting exercise and have opted for a selection of schools with varying academic vigour and will let fate decide. State school options are included in this spread bet and are talked up as being as appropriate as the private school options.
- Preparing for Failure:Children will always take things harder if they are not prepared. Many children, particularly the high-achieving and confident children that tend to apply for selective schools, have never experienced failure before. Make sure that failure is discussed openly well before exam time. Put your own failures on the table and demonstrate that failure is not something to be embarrassed about, but a normal part of life. Inculcate the mantras: “Strength is not in the never falling, but in the getting up after a fall.’ And “If you are not constantly failing, you are not really stretching yourself.” I will explain this latter statement. Children who participate in competitive sports will have a wealth of analogies that can be used to demonstrate this. Thankfully Molly does a spot of competitive swimming and is used to constant failure as the thing with swimming is that once you get to the top of a group, you get moved to the next group and start at the bottom again: succeed at school swimming, attend club swimming, succeed at club swimming, attend county swimming, succeed at county swimming, attend regional swimming and so on and so on. Unless you are Rebecca Adlington, somewhere along the line you will fail, fail, fail! What excellent life experience! I highly recommend this as an extra-curricular activity for acclimatising to failure! The truth is this: if you are succeeding easily constantly, your pond is too small. Of course, discussing failure openly can also bring up hiccups. During an explanation of why it was no problem not to get into the grammar school (before it actually happened), Molly pipes up: ‘You don’t think I’m going to get in do you?” – it’s always a good idea to answer these questions honestly: “You know what Molly? I think you have a good chance, but I really don’t know because there are a lot of other clever girls out there who all have a good chance. But it doesn’t matter if you don’t get in because it just means that the school is not suited to YOU, and there are other good schools that will be.”
- Contain your judgement.Children around this period are hawks to information and opinions about various schools. Much of it is hogwash because ‘one man’s beef is another man’s poison’. Literally. A highly-academic school can propel some girls to glittering careers, but the same school can contribute to a different girl to commit suicide. It’s all about ‘fit’. Therefore, it is no good listening to the judgements of other parents to make decisions about your own children, and its no good transferring judgements about schools to your children. They will take these comments from you as gospel and it will affect their mindset and they will tell their friends, spreading irrelevant judgements. Although I have chosen a variety of schools, I never talk of a preferred school and merely state that all of them are good. Other parents find this extremely frustration and keep pushing me with “But REALLY, which one is your preferred school?” and my honest-truth is REALLY– my preferred school is the one that offers a place to my daughter! It helps not to pay too much attention to the school propaganda machine and prospectuses which imply that they will be the only ones to hone and sculpt your child’s mind in the right way. In my opinion, there is no such thing as ‘one partner who was destined to be my lifelong love’ (sorry hubby) – there are many people in this world who we could each have fallen in love with; and equally there are many, many schools which will do a good job at educating my children. Unless you are an Oscar winning actor, if you have a ‘preferred school’ that you have singled out as being ‘the ONE’, it will be very difficult to hide disappointment from your children if they don’t get in. Anyone who has gone through the house buying process in the UK will have experience of the disappointment of being ‘gazumped out of our dream home’ and quickly realises that the scatter gun offering on many perfectly acceptable houses and THEN loving the one that you exchange on is a much better strategy.
Also – I am a control freak and if anyone is going to be ‘shaping my child’s mind and attitudes’ – it’s going to be ME! Mu ha ha ha ha. (For as long as possible anyway!)
- Contain your own anxiety. OK, I have to fess up that every 8-10 weeks I do have an anxiety wobbly where I worry that no selective school will take my money and accept my daughter to their school and that by some freak influx of 11 year olds to my local area, we will now live too far away to get into the good local state school. At least though, I recognise this anxiety wobbly for what it is and am able to mostly keep it to myself, give myself a good slap around the chops and saying: ‘stop catastrophising’. I doubt any parent can really get through this period without a stitch of worry and anxiety, but the best advice is to ‘Keep Calm and Carry On’ and preferably try not to show your anxiety to your children as your anxiety is fuel for their anxiety.
- Pride and unconditional love. If you are a bit shy about expressing your emotions to your children, now is a really good time to release yourself from your shackles. Go all out on expressing pride and unconditional love. This does not mean that you let children off the hard work that they are likely required to do, but that the effort that they put in is noted, praised and whole-heartedly appreciated, as well as their non-academic attributes that make them the lovable person they are.
- Silver Linings.When failure happens, make sure that you accept it. Highlight the silver linings to yourself and your child. It’s better that you actually BELIEVE these silver linings, other-wise your child will know that you are just trying to make them feel better and see it as fake. If you can, convince and accept it yourself first then you’ll be able to deliver the silver linings genuinely. You might feel some innate need to contest the failure and imagine some mistake has been made and feel a need to make an appeal. Alternatively, you might feel that it is necessary to make up an excuse as to why your child didn’t get in to a particular school or feel embarrassed to divulge failure to family and friends. All of these common parental behaviours meant to make your child feel better often have the paradoxical effect of making the failure hurt more for your child as they highlight your disappointment and disbelief in the legitimate outcome. As I said, unless you are an Oscar winning actor, try to be genuinely happy with the outcome as if you feel disappointed, your children will know about it however much you try to keep it from them. Many 10 year old children’s main wish is to make their parents proud. Conversely, feeling that you have made your parents ashamed or disappointed can feel like agony.
To all parents embarking on the same journey as me in the next 2 months:
To all girls and boys out there who are embarking on the same journey as Molly in the next 2 months.
You will be Brilliant wherever you go to school!
Many parents are happy to spend time and effort daily to teach our children to read and write, but very few of us sit down with our children daily to talk about emotions. Yet difficulties in managing emotions have a direct impact on learning and is the major reason that children get excluded from school. Getting in the habit of talking about emotions should happen early on. In my book “Inside Out Parenting”, I talk about teaching managing emotions with the same effort and at the same time as teaching our children to manage their motions (toilet training). We should spend as much time and effort encouraging our children to tell us that they ‘need a cuddle’ as we would teaching them to tell us that they ‘need a pee’. If talking about our common experiences of emotion is habitual from toddlerdom, it will become part of our natural repertoire and free us for a life time.
Remember when our children were babies and they cried if they were wet/ hungry/ thirsty or tired? Children who have difficulty identifying their emotions are in the same boat. They convey distress in one way (usually anger) which does not help others identify what is actually wrong. In clinic, it is often evident that many families (parents and children alike) can only identify and express one negative emotion: ANGER – and all manner of other nuanced emotions: frustration/ boredom/ jealousy/ sadness/ pain/ irritation/ annoyance/ unfairness/ grief/ hunger just become subsumed under ‘anger’. This inability to identify and define emotions and their cause is impairing as the solutions for relieving distress in each case is very different. The more that we as parents can actively support and teach our children to identify emotions and physical states, the easier our children will find it to manage their emotions.
Emotions can be tricky things to identify, particularly so for children who have learning disability or autism spectrum disorder who may not understand where the discomfort is coming from. Negative emotions like frustration, anger, jealousy and sadness feel intensely uncomfortable and unless we have an understanding of the cause and temporary nature of the feeling and ways to deal with it, then it can cause immense distress to children, adults and all around them. I will give a funny first-world problem example:
When Molly was around 6 years old, she had quite a temper and one dinner time she complained incessantly about the dinner that I had cooked. Having had rather a long day and spent time trying to prepare a nice dinner, I didn’t feel like listening to her complaints any longer and as she is usually well-fed and watered, I sent her to bed without her dinner. Around 11pm, down comes Molly in immense distress and sorrowful tears.
Molly: Mummy! I’m dying. I’ve got a pain in my tummy and it really hurts.
Me: You’re hungry, that’s all.
Molly: No, it’s not that. It’s the most pain I’ve ever felt in my life. I really think it’s serious. I waited ages and it’s not going away, it’s getting worse and worse. I’m frightened.
Me: OK. But eat this first and then we can call the doctor if it still hurts.
Molly [buttered toast later]: Mummy. The pain has gone.
From then on, Molly was able to identify what ‘hunger’ felt like and the solution. If we are on hand to explain to children their emotions as and when they experience them, then they will learn what these emotions are and how to handle them. Of course, sometimes in the heat of the emotion children may not accept your explanation: try telling an over-tired child that they are tired and you’ll get the most vehement denials – but reinforcing your explanations the following day when they are calm can help, as can witnessing the same symptoms in their siblings and having these pointed out. Molly became quite the pro at tutting “He’s over-tired” when D was raging due to tiredness.
Sometimes, we need to do a bit of investigative work to find out the cause of negative emotions: for instance the source of jealousy or frustration, but if we find it, normalise it and explain it, it generally helps for the next time around. If we are there to catch emotion forming and can head it off, all the better:
Me: I can see Molly that you are upset that your brother got a massive Lego set from Grandma for his Christmas present and you got a book. But this doesn’t mean that they love you any less, it just means that they happened to know what he wanted and weren’t quite sure what to get you. Tell you what, why don’t the two of us go and buy you something else as an extra present tomorrow?
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.
For many parents it’s back to school this week, a time of mixed emotions. I’m sure that I am not alone in feeling a sense of relief (thank God I’m no longer responsible for them 24/7 or for organising who will be responsible for them 24/7), sadness (how the heck did they get this big? A minute ago I was wiping their bottom) and anxiety (how will they get on with their new teacher?).
The “Back to School” prep has all been done. This year, thanks to a last minute job application form that was due, the majority was delegated to Banker. For the first time, he braved John Lewis alone with the kids to battle over the last Size 3 Geox, AND he ironed on all the name labels on the new uniforms. This latter he did correctly this time as last year when he was assigned this task he spent an hour ironing on sticker name labels (used for books and pencil cases etc) rather than the iron-on name labels (used for clothing). They obviously didn’t stick and I had an absolute barney as I had to repeat the task. This year all was done to standard, which goes to show that these parenting tasks need not be the preserve of mums (if we are happy to tolerate a hiccup or two)! All I did was get Lil Bro his back-to-school haircut and then they were set.
As soon as my kids saw their friends they were off without a backward glance.
I toddled off to the shops. It was with sadness that on my return from the shops, a good hour after the school bell had tolled that I saw a mum and her son outside the school gates. I heard a snapshot of their conversation “Just go in and talk to the others. It’ll be fine.” It occurred to me that for some families, “back-to-school” is not just a logistic nightmare of name labels, new shoes and haircuts, but a return to a battle-ground and heartache.
As an autism specialist, it is not uncommon for my clients to loathe school and in extremis to refuse to go to school. Anxiety is the most common co-morbidity in children with autism, and it is also the most common mental health problem in primary school aged children. So here are a few pointers on school refusal:
Try to find the cause for anxiety
- Encourage your child to feel safe to talk to you about their problems. This requires a non-judgemental attitude and a guarantee of confidence and that they will not get into trouble. They will also need to know that they will be taken seriously, and that you will have the resources and strength to help them. Many children I see in clinic do not disclose bullying to parents as “it will worry them”, “they won’t believe me”, “they will only confront the situation and make it worse” or “they won’t be able to do anything”.
- Often it is not sufficient to ask your child why they will not/ do not want to go to school. Persistent badgering on this question may cause more harm than good if it is not forthcoming given encouragement. Sometimes your child may not fully understand their own emotions or the cause of their emotions and therefore cannot tell you even if they wanted to. In this instance, it is up to you to speak to teachers and friends and come up with your best guesses. Discuss these hunches with your child in a non-judgemental way: “If I were in your shoes, I’d be a little scared of your new teacher…” and see whether any of them chime with your child. This is a favourite child psychiatrist strategy of mine as usually one of your guesses will be correct and when you see a child’s face respond to you verbalising their darkest emotions, you can tell that you’ve got to the heart of it and work can begin.
If you find a cause then dealing with the cause will be your next step. Some common causes for school refusal in primary aged children are:
- bullying/ social ostracisation by peers
- bullying/ fear of a teacher/ fear of being told off
- anxiety about a particular subject: fear of failure in an academic subject, fear of being ridiculed in P.E.
- anxiety about leaving the parent (separation anxiety) for fear something may happen to the parent.
Sometimes, there is no one-single cause and anxiety may be generalised or the sum of minor anxieties that can overwhelm. Working through each one, however minor, can be important.
Dealing with the cause should always involve:
- Working together with the school. The natural parental instinct is to do your utmost to protect your child which can mean confronting the school staff or the parents of other children. Try to stay calm and keep an even head – whatever happens, getting other parents and teachers on side will lead to better outcomes for your child than making adversaries.
- Supporting your child. As well as in relation to the identified cause, increasing your child’s self-esteem, resilience and social skills will always help.
- Sometimes, parents will allow children to stay off school due to school refusal. It is important to remember that this can inadvertently encourage problems as you are in effect teaching your child that crying and fussing will lead to a day off school. Sometimes it is impossible to get a child into school, but if this is the case, then schoolwork should be done at home rather than a pleasurable day at home watching TV and playing computer games. An incredibly boring or taxing day of chores at home may lead some children to the conclusion that school is preferable!
- If at all possible, get children back into school as quickly as possible because the longer that they are off school, the harder it will be to get them back.
I’m writing from the eaves of the in-laws’ farmhouse in the middle of nowhere in rural France. Sunlight is pouring in from the mosquito netted windows where the shutters, traditional of the region, have been flung open against the two foot thick walls.
Outside, set against the gently undulating silver of wheat fields that form patchworks with the bright-yellow of the sunflower fields, a blue oasis nestles like a magnet to small brown children. I can hear their high pitched squeals and splashes of water as they cannon-ball/ dive/ slide/ leap into their granny’s pool. The sun is forever shining; the ipad-hardened eyes of gritty-city children have opened to the simple delights of warm weather and water. This is not the chlorine infused, electrically heated sanatorium-like institutions where they are used to being drilled to swim strokes, but a splashing/ shouting/ dive-bombing free-for-all under the semi-watchful eye of Banker relaxing on a sun lounger.
And the best part?
I don’t have to be there.
I can hole up in a room of my own with my laptop. I feel I can only now truly understand Virginia’s sentiments.
September is upon us and I wonder if there are other parents out there like me who are finally feeling free? Feeling that for the most part the intensive back-breaking part of our job as a parent has been broken. The start-up we started has flourished and is headed for break-even. That we can finally breathe.
This time last year, I was still weighted with nervous anticipation about how Lil Bro would fair at school and mourning the loss of small kissable feet and their replacement with sweaty ones laden with verrucas. This year, having seen Lil Bro gain in confidence and social skill over the last year and Big Sis continue to thrive, I feel differently; almost as if a weight has been lifted; a strange mixture of relief, freedom and entitlement. As the kids approach 8 and 6 years, not even the most chauvinist can dare say that their needs now require the “maternal” instinct. Having given up sleep, life and career for the best part of a decade, I feel excitement that these next years might be my time to reclaim my life. That “me-time” that had been consigned to history might actually make a re-appearance and that I might actually be able to take time to feed my soul with books, art, writing rather than my children broccoli, cucumber and disliked super-foods. Requisite selflessness can now secede into my more natural selfish position.
That yoga class, that recipe, that job opportunity, those designer clothes, that hair-cut, that book I meant to write. That woman I meant to be. It now seems so much more possible. I would have shouted it to the roof tops “THERE IS LIGHT AT THE END OF THE TUNNEL!”, had I not known it to be inhabited by a family of loirs.
Then in strops Big Sis, wet and dripping, fresh from the pool; a vision in pink which is now “so babyish” but whose body had failed to grow as quickly as her attitudes meaning that she is still forced by me to wear the pink goggles, swimming costume and flip flops. She is closely followed by a trail of wet footprints.
Big Sis: Where’s my towel?
Me: I don’t know. Where did you leave it when you last used it?
Big Sis: I dunno
Me: Well, where did your father say it was?
Big Sis: I didn’t ask him. I came to ask you.
Me [incredulous]: You walked 50 metres from the pool where your father was and where your towel is most likely to be, to ask me hiding up a flight of stairs on my laptop having been nowhere near the pool today where your towel is because you think I might know?!!
Did I say a light at the end of the tunnel? I meant a firefly…
I recently read an article from the British Medical Association which advised that obesity in children needed to be tackled by all doctors, teachers and social workers, much in the same way as child protection matters; that the crisis in childhood obesity was such that it was beyond something that only health professionals should help manage.
The facts on childhood obesity and its negative impact on health outcomes are overwhelming. In 2012 almost 30% of children aged 2-15 years were estimated to be obese (Solmi 2015); and childhood obesity is associated with adult obesity and negative outcomes including diabetes, heart disease, stroke, asthma, polycystic ovaries, joint problems, poor mental health and cancer (Solmi 2015). Worryingly, with the increase in children’s waistlines, some of these conditions, only associated with adult poor health when I was at medical school (e.g. type 2 diabetes), are now regularly seen in childhood and adolescence (Solmi 2015).
And yet, as a clinician who is aware of all this, I still find it hard to do what the British Medical Association advises me to do. How exactly do I tell a teenage girl presenting with depression and low self-esteem in my clinic “Err, by the way, on top of everything else, you are over-weight.” You can see why that might not go down so well. Of course, if a child brings it up themselves, we jump at the chance to provide help, and in instances where children are clearly obese, I muster the courage to bring it forward as an issue, but where a child is just “overweight” rather an obese; I struggle to bring it up if it is not brought forward as an issue. Who wants angry parents shouting “We came here for your advice on mental health and you tell us our son is fat?” It’s not necessarily how I’d like to spend a morning, and yet, the best prevention for obesity is to curtail problems at this “over-weight” point before “obesity” has set in and psychological and behavioural patterns are entrenched. A quick consult of my medical colleagues and they say the same, unless the condition being consulted on is related to obesity, it is not brought forward routinely. Not many GPs are saying “Here’s the antibiotic for your chest infection, and by the way, I notice you are overweight so would you like a diet plan too?” I wonder if any teachers are actively calling out students and advising them of their weight issues, I would think that that was also pretty hard. Yet, if people in frontline contact with children getting increasingly poorer in health before their eyes do not stop to notify or intervene, what hope is there for prevention? Further as overweight children become the norm, we start to adjust our markers of normality and children who on measurement are overweight go unnoticed.
The issue of weight is a tricky one because of the links between weight, body image and self-esteem. Can you inform someone of their increasingly dangerous weight without affecting their self-esteem? If my own cowardly inaction is representative of most people, it would seem that most people think that you cannot; and there is a strong public perception that preserving self-esteem is more critical than informing someone that their current lifestyle choices may lead them to an early grave. The fear of precipitating low self-esteem and an eating disorder tends to ride high in people’s minds. Yet the prevalence of eating disorders is minute compared to the overwhelming problem of obesity. Reports indicate that even amongst the most at risk groups (females aged 10-19) the highest reported rates of anorexia only reach 34.6 per 100 000 population and bulimia 35.8 per 100 000. Do the maths, and that’s less than 1% of the population compared to 30% suffering from obesity.
The weight issue came up for me a few years back. My frugal upbringing meant that I grew up with the mantra of “Finish everything on your plate” and wasting food was a cardinal sin. I was denied chocolates and cakes, not because of worries about the waistline but purely because my parents couldn’t afford treats. The two unfortunate consequences of this upbringing on my own parenting were a) I continued my parents’ line of a waste not want not attitude to food; but b) I wanted to indulge my children with the cakes I never had.
So it shouldn’t have been such a surprise when Big Sis came home with the school health visitor card showing that she was 50th percentile for height but 75th percentile on weight; but it was a big surprise to me (it is optimal health-wise to be on the same percentile for weight as height). In my eyes, she did not look in any way over weight, yet, on paper, her percentiles were heading that way. When I told other mums about it, they all without fail thought denial was an appropriate option. “No, she’s fine, you shouldn’t worry.”; “It’s a mistake” or “You mustn’t let her know.” The thing was, I wasn’t worried, but there was no way that I was going to be in denial about it, and I worry that this type of supportive advice from other parents whilst well-intentioned is counter-productive. It may dissuade parents from taking action and lead to a false sense of security.
That night as Banker piled Big Sis’ plate up high with pasta and insisted she finish it as it was a waste to leave it, I made skewed eyes at him and squeaked side-ways out of my mouth “She doesn’t have to. If she’s full, she doesn’t have to finish it.” From then on, I consciously ensured that there were more healthy snacks around the house and *tried* to curtail the grandparents’ habit of allowing children free reign to chocolate and Oreos. The whole family got involved in more sport at the weekends. It wasn’t a big deal, but it needed to be in my consciousness so I could act. I don’t think that Big Sis’s self-esteem is linked to her weight and I hope to prevent it ever becoming so.
I do wish that we could talk more openly about weight without hurting people’s feelings. I hope that one day society can move towards consciously uncoupling self-esteem from weight; and weight can become a purely physical health concern (like a verruca?), and maybe then doctors, teachers and parents could better prevent this major and deadly health problem.
Currin, Schmidt, Treasure & Jick. Time trends in eating disorder incidence. The British Journal of Psychiatry Jan 2005, 186 (2) 132-135.
Solmi & Morris. Association between childhood obesity and use of regular medications in the UK: longitudinal cohort study of children aged 5–11 years. BMJ Open 2015
I was recently asked for some advice, as is an occupational hazard. “We’re about to have a second child. How do we prepare our child for the arrival of a sibling, because of the inevitable jealousy?” To my surprise, even before I could answer; my husband who has been well versed in my opinions answered for me.
“She has zero-tolerance on siblings not getting along.”
I was surprised at his succinct synopsis of my position, but “yes”, that is indeed my view. For me, the bond that I have with my two sisters is very important. Even though personality-wise we probably would not have been in the same circle of friends had we been peers, as sisters we are closer than the pre-election polls. Even though I rarely socialise with my siblings outside family events, if anything in my life happened, they would be the first people that I would contact and vice versa. I would never be alone in a crisis because I know that they would be supporting me – come what may. Friendships and marriages may come and go, parents will pass away, but siblings are with you, living in your time and generation – for life.
This is not just me being whimsical but is born out in science. Warm, supportive sibling relationships that lack conflict are related to having better psychological wellbeing as children and into adulthood (Buhrmester and Furman1990; Buist et al. 2013; Kim et al. 2007). The reverse is also true; hostile and aggressive sibling relationships are associated with higher levels of anxiety, depression, low self-esteem and anti-social behaviour (Campione-Barr et al. 2013; Dunn et al. 1994a, b; Padilla-Walker et al. 2010; Stocker 1994).
Maybe this is nothing to do with sibling relationship, but related to parenting and genetics? Argumentative parents have argumentative children that don’t get on and become argumentative and anti-social adults. This doesn’t seem to be the case. In fact, the literature suggests that warm, collaborative sibling relationships instill resilience (an invisible protective shield if you will) in children. For example, there is evidence that good sibling relationships protect children from all manner of adversity from bickering parents that fight all the time, negative life events (such as natural disaster and death of a loved one), high risk neighbourhoods, low-income backgrounds and bullying (Jenkins and Smith 1990; Tucker et al. 2013, Gass et al. 2007, Criss and Shaw 2005; Widmer and Weiss 2000, Bowes et al. 2010). Very recently published work suggests that siblings can even protect against the negative impact of parental mental health problems. Keeton (2015) found that in children of parents who met clinical criteria for anxiety disorder, the psychological impact of having a parent with anxiety disorder on children was moderated by the quality of the relationships between the children. In effect, the closeness of siblings allowed children to protect each other from the negative impact of a parent suffering a significant mental health problem. All in all, the evidence suggests that sibling relationships are just as important in a child’s psychological development as parents and friends.
This makes sense to me. Much adolescent and adult unhappiness comes from feeling “alone”/ “unaccepted”/ “friendless”/ “unsupported”. I have met many unhappy adults in my time as an adult psychiatrist of whom I just thought “You know what? You’d be fine if you just had a supportive friend.” That’s just exactly what a brother or sister could and should be; and whilst as parents we have little or no say in who our children choose to be friends with in adolescence and adult life, we have much control over whether siblings get along or not, and are perfectly placed to ensure that our children, via their siblings, have a strong support network for life.
So why have we as a population of parents come to expect sibling rivalry and discord? When we see it happening, we shrug our shoulders and say “siblings –eh?” We may take some cursory action “Don’t hit your sister”, “Get off your brother’s back and put down that brick that you were using to pummel his head”, but all in all, we assume that this is run of the mill sibling behaviour. In effect, we at best tolerate it, at worst encourage it. Romulus and Remus were raised by a wolf. I am not sure what happened with the Millibands…
My own childhood experiences were different. My mother came from a family of 7 extremely close siblings. Even though they live on different continents and their ages outspan a decade, they still go on holiday together and skype each other regularly. They laugh, joke, bitch and support each other as much now as pensioners as they did when they were children. My mother told me that in her family the older children were each allocated a younger child to look after growing up. Second Uncle had to piggy back my mother on long outings and my mother in turn had to rock third Uncle to sleep. I am sure that this responsibility and encouragement of care fostered an affection that has lasted into their old age.
In turn, I remember very clearly my mother explicitly saying to my sisters and I as children “You three are best friends. You are all each other have and must support each other.” I remember thinking sulkily at the time; I am so not best friends with these two. That one has just pulled my hair, and that one has just scratched my face. But we moved several times as children, first from Taiwan to Wales and then Wales to London, changing primary schools 4 times in 8 years, and so it turned out to be true. While friends came and went, “Laurel and Hardy” as I liked to imagine them then or “The Two Ugly Sisters” (to my narcissistic Cinderella off course) were always with me. And guess what, as adults, we are like best friends.
So what of my own children?
Banker was right. I take a zero-tolerance view of siblings not getting along. Like my mother, I insist to them that “they are best friends” daily, whether they like it or not. Sure they fight all the time, but underneath I know that they love each other dearly. When Lil Bro had a hard day in the school playground, Big Sis gave him advice. When an umbrella at a cafe blew over and grazed Big Sis spilling her drink, Lil Bro immediately gave her his. And in the evenings when they snuggle up together, I swear, its the sweetest moment for a parent.
Here are a few other things that I did/ try to do, all of which being non-scientific and are just my interpretation of what might help siblings get along.
- My number one advice is to ensure that your children feel loved and secure in themselves. Children who have “secure attachment” to their parents have all manner of better prospects throughout childhood and into adulthood. The more secure a child feels in themselves, the less prone they will be to jealousy, and the more generous they will be to their siblings. So ensuring a child grows up feeling secure from the outset helps a great deal.
- Prepare for a new sibling. Throughout pregnancy, the prospect of Lil Bro’s arrival was talked about as a massive positive. A little brother for you to help me look after. A little brother to play with you. Read books about new babies and about siblings that get along (Topsy and Tim is good for this). Buy your child a baby doll and play together at looking after it. Be as realistic about this as possible as this will help role play and rehearse what is to come. Massively praise any caring actions and discourage rough handling.
- Allow a bond to be made with a new sibling. I know that parents can be precious about babies, but being overly-guarded and excluding a child from their baby sibling can lead to loss of opportunity for siblings to bond, and also the older sibling feeling somehow excluded. Where possible, always involve siblings. Place the baby on the sibling’s lap and help them cuddle the new sibling and play with them. This is perfectly safe as long as children are well-prepped and you are supervising.
- Deal with jealousy. Jealousy between siblings will be inevitable at times even with secure children, but how you manage it can dampen or amplify its existence. Firstly, you must anticipate situations where this may occur and notice it when it happens. Then, rather than ignore it, it should be addressed as soon as possible. For instance, when there is competition for attention, this should be verbalised, acknowledged and problems solved. “I know you want me to play with you, but I am feeding your brother. But tell you what, he will be asleep after this, and then I can play with you.” Or when they get older “I know I am spending the day with your sister because I am taking her to see her favourite ballet, but next week, I will take you to the zoo.” Many young children feel angry and frustrated when they feel excluded or unfairly treated in favour of another, but cannot understand the reasoning behind it or be able to label it as “jealousy”. It’s up to parents to notice it and label it and explain it. Jealousy is a natural emotion; it is how we handle this emotion that needs to be addressed rather than attempting to avoid or suppress an irrepressible natural feeling. Unaddressed jealousy may lead to lashing out, aggression towards their sibling, or deliberate misbehaviour in order to get attention which is never a good thing.
- Behavioural management always applies. The tenet of behavioural management is to heavily praise and reward behaviours you wish to see again and to ignore and discourage behaviours that you do not wish to see again. If you wish to see caring behaviour between your siblings, you need to reinforce it with praise and rewards. If you would rather they did not bicker and fight, there need to be consequences each and every time this happens. I know that some parents think that siblings should “just naturally love each other” and I am as happy-clappy as the next person, but even I know that “love” can be manipulated to some extent. Some people refuse to praise and reward things that they “expect” children to do naturally, but I’m a great fan of praise (see my previous blog post on this) and evidence shows that behavioural management works.
- Us vs them. During my family therapy training I read somewhere that the only healthy grouping of people within a family is parents vs children. Families that have any other combination are more vulnerable e.g. a family which splits into two with a mother and son vs father and daughter or mother and children vs father. Keeping the healthy dynamic should always be borne in mind. Using this dynamic, it is possible to foster closer sibling unity as people tend to unite against a common oppressor. Yes, you the parents are the oppressor in this scenario. Don’t be tempted to side with a child, enjoy your role as the villain and reap the rewards of sibling cohesion.
- Encourage collaboration. Treating children as a team can be helpful to collaboration. Rewards can be given to both children as a team, punishments doled out to both as a team. This will facilitate helping behaviour and help siblings see each other as partners rather than competitors. Encourage mutual praise. For families in a rut that come to see me for therapy, I tend to suggest that before bedtime, each child is to say something good that the sibling has done that day and praise them. It may be forced praise to begin with, but even forced praise is better than no praise and over time it may and likely will become genuine and overspill into the everyday (particularly with young children).
- Promote exposure and shared experience. One way to help them get along is to allow them to have common experiences and exposure to each other. This is not possible if they attend different schools. This may be a bit unpopular in the UK where for some reason boys and girls from 4 onwards are farmed off to single sex schools, or siblings of different abilities are segregated early on into selective schools. I am totally and whole-heartedly in favour of keeping siblings in the same school, especially at primary school where I think education should play second fiddle to social and emotional development. A close sibling relationship is more important to me than KS2 results. A supportive sibling is there for life, who of us can remember our primary school grades? My children go to co-ed school. This way, their support for each other can start young. I am delighted to hear that Big Sis crosses the playground to give her Lil Bro a kiss and hug when he needs it. Not possible if she is not there.
- Adopt a policy of zero-tolerance on siblings not getting on. Expecting and or accepting that siblings do not need to get on, and that this is “normal” is the main reason for inaction. So this last point is probably the most important, because action is the first step.
Bowes, L., Maughan, B., Caspi, A., Moffitt, T. E., & Arseneault, L. (2010). Families promote emotional and behavioural resilience to bullying: evidence of an environmental effect. Journal of Child Psychology and Psychiatry, 51, 809–817.
Buhrmester, D., & Furman, W. (1990). Perceptions of sibling relationships during middle childhood and adolescence. Child Development, 61, 1387–1398.
Buist, K. L., Dekovic, M., & Prinzie, P. (2013). Sibling relationship quality and psychopathology of children and adolescents: a meta-analysis.Clinical Psychology Review, 33, 97–106.
Campione-Barr, N., Greer, K. B., & Kruse, A. (2013). Differential associations between domains of sibling conflict and adolescent emotional adjustment. Child Development, 84, 938–954.
Criss, M. M., & Shaw, D. S. (2005). Sibling relationships as contexts for delinquency training in low-income families. Journal of Family Psychology, 19, 592–600.
Dunn, J., Slomkowski, C., & Beardsall, L. (1994a). Sibling relationships from the preschool period through middle childhood and early adolescence.Developmental Psychology, 30, 315–324.
Dunn, J., Slomkowski, C., Beardsall, L., & Rende, R. (1994b). Adjustment in middle childhood and early adolescence: links with earlier and contemporary sibling relationships. Child Psychology and Psychiatry and Allied Disciplines, 35, 491–504
Gass, K., Jenkins, J., & Dunn, J. (2007). Are sibling relationships protective? A longitudinal study. Journal of Child Psychology and Psychiatry, 48, 167–175.
Jenkins, J. M., & Smith, M. A. (1990). Factors protecting children living in disharmonious homes: maternal reports. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 60–69.
Kim, J., McHale, S. M., Crouter, A. C., & Osgood, W. (2007). Longitudinal linkages between sibling relationships and adjustment from middle childhood through adolescence. Developmental Psychology, 43, 960–973.
Padilla-Walker, L., Harper, J. M., & Jensen, A. C. (2010). Self-regulation as a mediator between sibling relationship quality and early adolescents’ positive and negative outcomes. Journal of Family Psychology, 24, 419–428
Stocker, C. M., Burwell, R. A., & Briggs, M. L. (2002). Sibling conflict in middle childhood predicts children’s adjustment in early adolescence.Journal of Family Psychology, 16, 50–57.
Tucker, C. J., Holt, M., & Wiesen-Martin, D. (2013). Inter-parental conflict and sibling warmth during adolescence: associations with female depression in emerging adulthood. Psychological Reports, 112, 243–251
Widmer, E. D., & Weiss, C. C. (2000). Do older siblings make a difference? The effects of older sibling support and older sibling adjustment on the adjustment of socially disadvantaged adolescents. Journal of Research on Adolescence, 10, 1–27.
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.