It’s here! Inside Out Parenting

Inside Out Parenting jkt

 

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

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

 

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

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

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

 

 

Children’s Sleep

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Lil Bro: Mummy – I can’t sleep

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

Lil Bro: But I can’t sleep.

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

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

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

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

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

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

What constitutes a sleep problem?

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

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

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

Struggling to fall off to sleep

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

Night waking

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

Co-sleeping

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

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

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

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

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

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

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

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

Resources:

 

References:

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

 

 

Public Library to Publishing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The best part of conference?

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

Roll on day 2!

Back to life…but not as I know it

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Whoop whoop!

Yes! The kids are finally back at school and the extracurricular circus is almost organised. For those sensible enough to avoid enrolling children into a hundred and one activities, I salute you – because really, the logistics are too much! Having been rather gung-ho on the extra-curricular clubs when Big Sis and Lil Bro were little, I am now paying the price. The plan had been to shove them into as many classes as possible during the 3 days that I work and grandma looks after them.  This was a vain attempt to stop said grandma allowing them to veg on her couch watching Power Rangers Dino Charge and feeding them chocolate and hand peeled grapes like mini Romans for 3 hours each day. Instead, they were taken to some life-skill enhancing activity: ballet/ street-dance/ swimming/ tennis/ football/ chess before 2 hours of grandma allowing them to veg on her couch watching Power Rangers Dino Charge and feeding them chocolate and hand peeled grapes like mini Romans. Don’t ask me how come my beloved mother who locked me in my room until I could recite my times-tables at the age of 5 years, and who I had been counting on to knock some discipline into my kids has transformed into dobby the house elf.

Anyhoo, the unforseen pig of it all is that as the kids get older, the darn things get better at their life-enhancing skills and progress to different classes which are now OUTSIDE my 3 working days and the kids are back watching Power Rangers Dino Charge and being fed chocolate and hand peeled grapes like mini Romans on my work days, while I am left slogging them to ballet/ street-dance/ swimming/ tennis/ football/ chess on days when I am in charge. Don’t even ask about the crazy timetabling because Big Sis’s swimming now clashes with Lil Bro’s street dance, and I have to fathom if logistically I can get from the piano teacher to the swimming pool in 10 minutes…(I’m thinking potentially possible if Big Sis plays piano in her swimming costume). Man it sucks.

The good news is that not only has daily life returned after the chaos of the holidays because the kids are back in their school routine again, but my blogging life has returned – (Yay!). I’m hoping that some of you may have missed me (yes – I am talking to you dear sister) and will pick back up where we left off for the fortnightly Friday blogs.

In explanation of my long absence, I am pleased to say that much fun was had the last 6 months indulging the fantastic and unreal opportunity to pen a parenting book. Bluebird, the life-style imprint behind the lovely Joe Wicks and his midget trees have backed and bought my story. Thank You! I am so looking forward to this crazy new journey which is a world away from cutting NHS waiting times.

They say that there is a book in all of us and many people harbour a dream of writing a book. Many of us have half written manuscripts in our dusty drawers or notebooks and hard drives of half-formed ideas.  For decades I was one of them. My aged computer still contains very early drafts of a parenting book that I had the audacity to pen before even having children. Needless to say, these naïve and sentimental ponderings were a pile of crap and if the me of today had encountered the me of then, I’d have spared no hesitation in giving myself a tight slap and saying: “Have you ever met a child you twat?” Although I don’t think that you need to be a parent to give advice on parenting, an ounce of realism helps.

And so it turns out that although having children was the nail in the coffin of my treadmill professional career, being chucked off the treadmill gave me time and opportunity to explore other areas of myself and take a chance on an old and buried dream. It was the beginning of this new journey. What has been a heartening realisation is that while my having children was seen by my traditional profession as a weakness, for my writing it has been my greatest strength. I can only encourage others that if ever you fail because of a “weakness”, just change the story and it may turn out that your “weakness” is your greatest strength.

And if you have a dusty notebook or neglected files on your hard drive, maybe it’s time to have another look…

See my book’s news (although that long title will change)

The Return of the Mum

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Shrink Grows Kids is 2 years old! And more exciting things are happening: I have been offered two book deals and am about to sign up with the lovely people at Pan Macmillan for my first ever book. So thank you to everyone who has read and supported my little site. Your reads gave me the confidence to continue and it has led me to things beyond my imagination.

Those who followed my journey from the start may have realised by the tone of some of my blog posts that I started this blog as a child psychiatrist that had been somewhat cast aside by her profession for her decision to work a maximum of 3-days a week such that she could be there for her children. Working so little is highly frowned upon in a profession where apparently working till 10pm and on Saturdays is deemed a standard working week (thanks Mr Hunt). In the battle of children vs career, for me children had to win out.

It’s a tough decision faced by many driven parents and I respect the individual choices made by others even if they differ from mine. For me, I am lucky enough to be married to a banker who pays the mortgage and financially as my post-tax income would have been equivalent to quality childcare, money was negligible in the decision making. Unluckily, being married to a banker means that for much of the time parenting responsibility falls to me as Banker is often out of the house before 06:30am and not back again until 8pm, if he is even in the country. Thus I squarely felt the responsibility of how our children turned out was down to me. As a child psychiatrist who spends days and years hearing and helping children and families that have struggled, it seemed implausible not to at least attempt to practice what I believe and preach: spend time with children.

For quite some years I took positions that allowed me to work a 3-day week by virtue of my being over-qualified and under-paid and saw friends and colleagues speed by in the race to the top. It was not without its frustrations, anger, tears, self-hatred and despair. What was the least anticipated, yet most destructive was the loss of identity. I would never have seen myself as one for airs and graces and felt that I took people on face-value, but it was amazing how naked I felt when stripped of a prestigious job title. Signing on reluctantly for gym membership post-baby fat one time I felt wounded to see that the lady had listened to my description of my work circumstances and had written: Occupation: House-wife/ Doctor.

I had never identified myself as a house-wife. A mother yes, but not a house-wife. I don’t and doubt I ever will darn my husband’s socks (although once my mother-in-law did offer to teach me).

It was with this inkling that I wanted something more that I tentatively set up my blog. Slowly by slowly, with your help, a sense of confidence and purpose grew that even if the system would not support me, I could use my skills to support myself. I started speaking to friends  about work outside of the NHS which although I loved, had rejected me for my lack of ambition/ work-ethic/ dedication because of my insistence on limited hours. We set up a little private practice which has been doing great. This led to more confidence in my ability, to connections and friendships which have led to more and more opportunities, which have eventually culminated into a return to a prestigious NHS position on MY TERMS – 3 days a week. Alongside, the material from my blog has continued to grow, albeit slowly of late, and I am still pinching myself that a publisher is willing to support me in growing it into a book. Never in my wildest dreams did I think that I could or would become a writer.

My horoscope predicted that 2016 could be one of the best years of my life (so be happy all Pisceans) and I am really looking forward to the year. My message to other parents that chose children over career is to say “Believe in yourself”, give it time, you never know where it might lead you and soon you’ll be back on top.

THANKS FOR SUPPORTING MY BLOG.

WATCH THIS SPACE FOR NEWS OF MY BOOK!

Here are some posts from rock bottom that might help:

Dear Me

Advice to My Former Self – Desperate Working Mother of Two Young Children

Did You Get Maternal Adjustment Disorder?
 

 

This Boy Can

This boy can

I love Sport England’s “This Girl Can” campaign to get girls into sport with glossy ads showing ordinary girls and women of all shapes, sizes and colours enjoying sport. Set to high octane music it oozes adrenaline, power, energy and confidence. It’s about sport, but also ultimately about self-esteem. Its underlying message is that women should be confident about themselves and their bodies, which is a great message which is why the campaign has been so acclaimed. There have been a number of other positive Ad Campaigns empowering women to achieve, study maths and science, aim high, aspire and be ambitious. GREAT! Despite all that women have achieved in the last 100 years, I can attest that women still underestimate their ability in the workplace and this media encouragement is totally welcome.

However, it doesn’t work on its own.

How do I know this? Because I, and all girls that were fed through an ambitious, high expectation girls’ school in the nineties already heard this message and were already ambitious and aiming high. We flew the flag, but like the generations before us were cut down to size when we reached the higher echelons of our organisations, or the minute we fell pregnant. Many of us even felt bitter towards the encouragement that we received as young women because we were fed a dream that society could not yet deliver.

The bottom-line is that there is only so much women can change and society’s current solution of “encouraging women to change” (codified in encouraging women to become “more” confident/ ambitious/ this-that-and-the-other) in order to fit into pre-existing male oriented organisations and structures has not worked. Not only has it not worked, but it continues to perpetuate the myth that the reason that inequality has not yet been achieved is because women have not put in enough effort into changing “they do not put themselves forward”, “they shy away from leadership positions”, “they choose to opt out”. The implication is still “Women are not good enough”.

This perspective turns a blind eye to the fact that it is also institutions and their cultures that need changing. Women are being put off by bullying and macho cultures exemplified but not limited to the goings-on in British politics (men are driven to suicide by it, so why would women want to engage?).

And, if society wishes there to be a next generation, SOMEONE needs to look after the children. For many of us, we believe this strongly and fundamentally should be parents. If we continue to one-sidedly empower girls and women to take on rewarding and powerful careers, what is society’s solution to “parenting” and “family-life”?

What is the solution?

It may not seem attractive at first (but isn’t it the job of slick Madmen to make it so?), but I believe that for every “This Girl Can” ad that goes out; there should also be a “This Boy Can” ad. Footage of boys crying, talking about their emotions, helping another child, reading, drawing, dancing, dressing up as a Princess. Footage of men sticking on plasters, listening to the ideas of their female colleagues, talking to their daughters, nursing their elderly parents, helping children with their homework, picking up children from school, doing the laundry, cleaning the house, cooking the family dinner. These latter activities are the really important things that keep Britain going. The Engine of Britain is not just the boardroom, but the living room, dining room and kitchens across the country. Without the domestic engines, no one could get to work. As long as these activities, pivotal to family life, are undervalued and represented as “female” or lower order tasks, there can be no escape for women from the home and no “respect” for women overall.

Many boys and men already do these things and they need to know that their efforts are appreciated and the ones that are not doing these things need to be empowered and enabled to do so, else any women’s empowerment program will be futile. As long as we continue to view ambition, aspiration, hard-work, determination and ruthlessness as the only virtues worth rewarding and publicising, we are devaluing and undermining the equally valuable virtues of compassion, loyalty, understanding and sensitivity. As such we marginalise the fantastic people who possess these traits and create future generations with warped and unbalanced ideals. Much as I applaud campaigns to improve body confidence, body image problems in women will continue to be problematic as long as there are men who objectify women. While empowering girls is good, we must also focus on educating boys, and I feel that this part is lacking.

Whilst many may feel that traits are gender specific (typically masculine: ambition, determination etc.; and feminine: compassion, empathy etc.). I don’t believe this to be the case but that from a young age children are taught to emphasize these traits within themselves and suppress other traits to conform to gender expectations. While great Ad Campaigns like “This Girl Can” try to address this imbalance for girls, what we desperately need in concert is a “This Boy Can” campaign to empower boys to truly be themselves.

I really hope that someone steps up to the mantel and does it.

What makes a child anti-social?

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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.

Reference:
Anti-social behaviour in children with and without callous-unemotional traits. Viding et al. (2012) Journal of the Royal Society of Medicine. 195-200.

Patchwork Childcare

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Whoa! Where did September go?

Apologies for going quiet for a month but things have been hectic, what with school start, new job and September being conference season for child psychiatrists. The last month has been about patch working childcare and prioritising, which sadly meant no time to blog. I’m hoping that it will calm down a bit now that October is here. Phew!

Unfortunately the new and hard won London NHS Consultant job has meant that I can no longer drop off the children at school on the 3 days a week that I work. I am not quite sure who worked out the logistics that school should start at 8:50 am, and work should start at 9am, because who in London can get to work in 10 minutes….? And which childminder would want to come for just an hour of work in the morning to take children to school?

Then there was the afterschool care. I am lucky that my mother has always taken the children 2 days a week after school. I say, “lucky” – but of course, luck has little to do with it. I purposefully moved home to the other side of London from my job expressly for this purpose so I have to endure a 75 minute commute each way. I just had one afternoon to fill, so a Nanny or Au Pair was not needed, and I had fought hard to get a part-time job to stave off this need for full-time childcare. After meeting a few young ladies over the summer that might have potentially been able to take the kids after school a day a week, I settled on one and sat on my laurels thinking the problem was solved. One week before school start and I text to confirm arrangements, only she has disappeared off the face of the earth. I suddenly felt immensely sick that just as I was about to return to “a career” where I had left off, I was struck down again by the nagging problem “who will look after my kids?”

I thought about starting a breakfast club at the school with a rota of parents or paying a parent of another child in Big Sis or Lil Bro’s class to take them. I looked into which other parents might be interested. And as each cock-a-mamy plan fell through, the same sinking feeling. It was then that I had my revelation. The solution was so simple that looking back I cannot believe that I didn’t think of it immediately.

Before I tell you the solution, I want to share with you an old brain teaser:

A teenage boy who grew up having never met his father has a terrible road traffic accident. He is rushed to hospital and straight into emergency theatre, the surgeons gather around ready to operate, but just then the lead surgeon looks at the boy’s face and gasps saying “I can’t operate, this is my son”. What has happened?

Before you make some sort of long winded reply about how the surgeon recognised the boy to be his son because they looked so similar, I will tell you that the answer is that the surgeon is the boy’s mother. Yes, a FEMALE lead surgeon.

And so, you can see how many of us can be blinded by gender stereotypes. Hopefully, you might fathom that my solution to my childcare problems was to make Banker involved. Yes – men can do childcare! He was made to drop the children at school, at least one of the days I was at work, and also told to make arrangements for the children to go to after school club once a week. Why should I be the only one suffering an ulcer over this?

Just as I was taken aback by my realisation that fathers could actually contribute to regular weekly childcare duties, rather than just at the weekend, he too was surprised to be asked! I am amazed that he had sat through my endless rantings of “maybe we could pay so-and-so to take the children”, without once suggesting that part of this responsibility was his, and he could offer a solution. There ensued of course the typical grumblings… “important job”… “impossible” … “money” … “promotion”… “blah” … “blah” …”blah”.

However, I was lucky enough to know that one of his colleagues was able to wrangle a late start to drop his children off at school a few days a week. You see this colleague had just spent a tonne of money fighting for shared custody of his children following a divorce such that he could have the privilege of taking them to school half of the week. So I pointed out to my darling banker that I was offering him exactly this privilege without the expense of divorce and custody battle. Bargain!

Humour aside though, surely childcare arrangements are a shared responsibility, why does it so often fall to mothers? Even when fathers are doing childcare, it is because the mothers have told them to do so and given them explicit instructions of where things are and what to do. I for one would like some time off from the thinking and planning as well as the doing. And how come good divorced fathers are so great at arranging time off “important” work to be with their kids?

Contentious, but I will put it out there just for contention: Maybe if they had always done so they mightn’t be divorced?

 

A Room of One’s Own

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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?!!

AAARGGGH!

Did I say a light at the end of the tunnel? I meant a firefly…

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