Why parents should have zero-tolerance for sibling rivalry

jack n jill

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.

 

References

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.

Advice to my former self: desperate working mother of two young children

Dear Me

Looking back over the last few years, tumultuous and unhappy times for my career, I think about the advice that I would have given my former self with hindsight and the knowledge that it’s all worked OK. Hindsight, as they say is 20:20 and created hindsight in the form of imaginary letters from your future self, is a therapeutic technique used in Motivational Enhancement Therapy, a treatment for addiction and eating disorders. Guess what? It turns out that YOU are the best person to give yourself advice as no-one knows you, your motivations and foibles as well as yourself. If only we could all have a future self to guide us. Having not had this advantage, here’s a letter to me of 5 years ago, when I was working full-time with a 2 year old and a <1 year old – in case there are others who feel desperate like I did then and are in need of a “future-self” to advise them and put things in perspective.

Dear Me 2010,

I understand where you are. Sometimes you look in the mirror and you don’t recognise yourself. You go through the motions of the day feeling detached and dissociated from life. On dark days you believe this will be the rest of your life, your education was for nought, your identity to be forsaken for drudgery, your ambitions to be sacrificed at the alter of society’s expectation of “motherhood”. Sometimes you contemplate if life is worth living.

I understand; I have been there.

The unrelenting sleepless nights.

The flabby belly and sagging boobs.

The “comfy” clothes and orthopaedic shoes.

The eau de puke.

The no time alone to think. Who would have thought that going to the toilet alone would become a privilege?

The chores, the routines and the day-to-day responsibilities. Anything the children need or want. Anything the children do/ don’t do/ say/ don’t say/ eat/ don’t eat; any harm/ potential harm/ possibility of harm that might befall them, anywhere they need to be/ not be  – it’s down to you. You always thought you’d be a great mother, but now you are not so sure. Now you have to listen obediently to snide remarks and “well-intentioned” advice on motherhood like a chastened schoolgirl.

The up-keep of a gruelling work-load that you try to squeeze into a shorter day, lest colleagues and superiors arch an eye-brow or make a comment about the decline in your performance and insinuate that you are not “pulling your weight”. The anxiety that you will be next in the redundancy line; despite all your qualifications and achievements. Unemployment has never even been on your radar. How could it have been? You were great at your job. But now you hear the whisperings. It is a possibility.

The tension in your relationship. That lovely man that promised to support you is now on another planet. Working the same hours you both used to work, wining and dining clients late at night because “Some-one has to continue their career trajectory to put bread on the table” and “Why should both careers suffer?”, “We talked about this, you wanted to be the main parent” and “Well if you can’t manage then why don’t we just hire a nanny?”. The seething resentment inside “Why does he get to carry on as if nothing has happened?”, “Why doesn’t he understand?” Maybe he doesn’t care anymore. Maybe we have “grown apart”?

And above all the resounding clang of self-doubt. 

Maybe you weren’t so good at your job after all. How arrogant of you to believe that you were capable of achieving your ambitions – going forward, it’s about leadership and personality and do you really think that you have it in you? Maybe you deserve to be unemployed. Maybe you should resign and preserve your dignity. No one would judge you for it, you are a “mother” after all; this is what respectable women do, leave work to raise their children. Besides your salary is going straight to the childcare provider; your bank account a mere conduit. Financially you’d be better off taking that redundancy package. And children need their mothers. You can’t have everything. You have to compromise: work or motherhood.

Or maybe you are just not cut out for parenting? What a fool you were to believe that you could be the guardian and inspiration for anybody. You can barely look after yourself! What pathetic fool retreats into tears over a baby and acquiesces to the demands of a toddler? Spare the children this incompetence and get a 24/7 nanny for heaven’s sake – they’ll be better off. You can’t have everything. You have to compromise: work or motherhood.

Maybe your partner just doesn’t love you anymore? Why else would he not understand? Why else would he not help you? How can he love you anymore with your track-suit pants and stretch marks when there are younger women at his work who still wear high-heeled shoes, make-up and have actually combed their hair? Why else would he work long hours and not come home? Did he ever love you? You’ve let yourself go. You’ve neglected your duty as a wife.

Dear Me (2010), my advice is this:

  • Believe in yourself as a parent. Your children need YOU, and you are the best parent that they will get. Everyone has wobbles now and then, nobody is perfect. If you are having a bad day, it’s a bad day – not a bad person. All good parenting starts with wondering if you are doing it right, only bad parents never question their actions and don’t seek to improve.
  • Believe in your abilities at work. Don’t listen to the voices telling you to quit. They mean well, but they have got it wrong. Your employers are behaving in their own short-term interests, not in your interests or the long term interests of society. Only you know what is good for you and your family. Working full-time with full-time childcare or being a stay-at-home mother is an honest choice for many but there should be another way for people that want it. Work is more than a payslip. It is an identity, a social network, a status. It is power in a relationship. It is independence. Men understand this well, which is why they are much less keen to let it go. Don’t let the difficulties of 5 to 10 years stall a potential career of another 30 years (let’s not forget we will all be working into our late 60s!). Push for employers and society to change. Parental responsibility should be gender neutral. If all parents (male and female) pushed together for better work-life balance, employers would change. If you don’t push for change, who will?
  • Make your partner your ally. He loves you. If he doesn’t understand then make him understand. Make him put himself in your shoes. Tell him how you feel. Make him pull his weight at home. They are his children too. Children need their fathers as well as their mothers. Never be taken for granted, and always expect respect. Make him support your career. It will be tough. There will be confrontation and arguments. It is worth it. It may be the saving of a woman, a marriage, a family.
  • Don’t give up on “having it all”. A fulfilling work role with pro-rata pay AND being there for the children. Proper part-time work. Not full-time work for part-time pay, not a demotion to back office tasks or a move to a less prestigious organization, but the proper work that you are qualified to do for three days a week. I know that you will be told a million times that it is not possible. You will be pressurised to make a choice. You will want to give up. You will have to at times take that full-time work for part-time pay, take that demotion, move to a less prestigious organisation. But never give up on your ambition. Keep pressing, keep spreading the word about what you want, about what is right, keep vigilant and above all do not give up. Stay in the game. The “impossible” is only impossible until one person does it. Don’t go changing, make society change.

Along the way, you will meet some great people; some in similar situations and others in unexpected places. Two things they say will help you:

“If no one has done it before, it doesn’t mean it’s not possible; it means you have to do it.”

And

“Carry on doing what you enjoy doing”

Dear Me 2010, it works out well for you.

In 2015 you are still happily married. You have two great kids who KNOW their mother and KNOW their mother is always there for them. You eventually get offered a 3-day-a-week Consultant post at the best organisation for Child Psychiatry in Europe and sessions at the best Children’s Hospital in the UK.

It can work out.

Just hold on.

Just keep going.

Don’t give up.

 

Love from Me 2015.

C’mon Kumon?

Maths

As we enter SATS season, I’m on my education rant again. In the Far East, six year olds know their times tables up to 12, a target that has been set by the UK government for children of 11 years. A target that has been required to be set as it has thus far been largely unmet. Growing up, my sisters and I were ridiculed on holidays back to Taiwan when our cousins (subject to the rigorous mathematics curriculum and public adoration of anyone deemed “good” at maths) performed long divisions in their head that had us reaching for our calculators.

“So what?” we would retort, “Why bother when we can use a calculator?”

Shamefully, this is the same retort used by the new tech savvy generation for whom spell-check and mobile phone calculators have deemed a brain unnecessary. Sure, I still agree to some extent that complex maths should be done using a calculator, but basic mental arithmetic and an understanding of mathematical concepts should be basic universal knowledge. A good friend of mine (who is an actuary) volunteers as a maths teacher to adults in a South African township as he believes that it is numeracy and mathematical ability that will take people out of poverty.

Why is the general level of maths so bad?

Actuary blames the lack of availability of good maths teachers, and Banker reckons this is as people that are good at maths can be paid more in the city than in teaching. I blame the bad PR that maths gets in general and society’s acceptance that “maths is hard” and “maths is for nerds”. This rep doesn’t exist in the Far East, as evidenced in the recent film ‘X+Y’, where the Asperger’s boy “anti-hero” who has a flair for maths and is an outcast in the UK, is viewed as a “Hero” and legitimate mainstream love interest by the Chinese girl when transplanted to maths camp in Taiwan. Maybe when we in the UK learn to fancy girls and boys that can solve quadratic equations as much as girls and boys that can write love poems in the manner of Keats, we could have a maths renaissance.

It seems though that things are changing and that I am not the only one disgruntled by the apathy and low expectations for maths even under the supposed hard target-setting “Gove-ian” government, as the number of Kumon centres spreading fast across the UK can attest. When posters at my local tube station are inviting me to set up my own Kumon maths teaching centre in order to earn shed loads of money, one can only imagine that the demand for better maths education is such now that the government should think harder about supplying more and better teaching lest the gap between the Kumon-haves and Kumon have-nots should widen.

The Pros & Cons of Kumon

For those unfamiliar with Kumon, it is a Japanese system of learning maths focused on daily practice of maths using generic maths worksheets targeted at your child’s level. You attend a special “Kumon Centre” to get your worksheets marked and some advice on corrections; then you get set more worksheets to do at home until your next attendance at the centre. For this you pay a not-insignificant subscription fee, albeit less than a personal maths tutor.

You might think that being a maths-ophile that I would love Kumon, but you’d be wrong. Whilst I am a fan of improving mathematical ability, and am in no doubt that practicing maths on a daily basis will significantly improve your child’s mathematical ability, I am not convinced by it enough to send my own children, although I have to admit that I have never set foot in a Kumon centre, but have spoken to many people that use Kumon and have investigated the website and promotional literature.

Can it be in any way fun?

The advertising may suggest that the “centres” are fun places of learning, and that the specially designed worksheets “will make maths enjoyable”, however from what I have seen, the centres are just rented halls where children sit and do worksheets. The worksheets are similar to any other worksheets printable from on-line sites or workbooks purchasable from WHSmiths. There is likely to be added value of having worksheets targeted at your child’s individual ability rather than their chronological age, but they are no more “fun”. Even the Kumon logo depicts an unhappy face. I always wondered if this was supposed to resemble the children going in or coming out of Kumon, neither seemed to send a positive message.

It still relies on parental discipline

I could see the attraction of handing over my innumerate child and being handed back a child that was numerate and confident at maths with no effort from me, but from my observations of Kumon parents, that’s not the case. No, Kumon mums (I don’t like to bring gender into it but I have only yet met Kumon mums and Kumon nannies) are frazzled as they are the ones that need to uphold the discipline to make the said innumerate child do the blessed worksheets throughout the week.

Evaluation is still teacher led

Whilst parents are required to nag children to complete their worksheets, it is the teacher that evaluates and monitors progress and sets the agenda. Maybe I am just too much of a control freak, but I think that parents should have a role in this. Some parents love Kumon (and maths tutors and private schools) and actively avoid “evaluating” their children’s ability. They see it as somehow making a value judgement on their child and this being somehow unhealthy as they should always believe that their child’s ability is SUPER. Some such parents get a nasty surprise if their children underperform and pass disappointment on to their children; others blame the teachers for not getting the best out of their SUPER-able child.

I believe in the reverse. I think that evaluating and monitoring your child’s ability is essential so that as a parent you have an accurate, realistic and evidence-based picture of your child so that you can guide them into the appropriate school/ university/ career. There is no value-judgement as your child IS SUPER no matter what their ability.

Two-tier education

As I alluded to earlier, I believe that Kumon is just another way in which the middle-classes can pull away from the mainstream. We shouldn’t need Kumon; we should be putting pressure on the government for the betterment of overall maths education. The proliferation and promotion of “professionals” in maths tuition undermines the very real and practical advancements that can be made with primary maths learning by parental involvement in reinforcing school maths. Most parents who are sending their children to Kumon have at least primary school level education and should be able to help their children with maths at this level without the requirement of paid professionals. If increased efforts were made to educate parents on supporting their child’s education, children from all backgrounds would benefit.

What did I do?

I am speaking from the middle of my maths journey with my children. I cannot in all certainty confess ultimate success, nor admit to a pain and frustration free experience to date. Most of what I did and am doing is based on trial and many errors. I summate the optimum strategies that I have garnered not the entirety of my experience which contains many expletives, failures and revisions. Although I can confess that both my children are performing at the top end of their respective classes at maths, I cannot negate the real effects of genetics on this outcome. Irrespective of this, I am happy with the choices I made and so am sharing my limited insights with you, in case you may find it of value.

I introduced numbers to my kids at the same time that letters were introduced. Literacy and numeracy are to be given parity in my book. Children are just as capable of learning a sequence of numbers as they are a sequence of letters. From when my children were a young age I carried a notebook around with me and if there was a period of “waiting time”, for instance waiting to be served in a coffee shop, I would draw puzzles (mazes, matching puzzles, counting puzzles) for my children. If they were completed easily, I would make the next one harder. If they were too hard, I would make the next one easier.

maths 1

As the children grew older, these puzzles moved towards proper mathematics. Rather than only being served up in “dead-time”, they were served up daily. Initially this was done in the evenings when I got home from work, but on finding the children (and indeed me) too tired at this time of day, I switched it to the mornings. This worked a lot better as the children were fresh and my over-enthusiastic tendency to set more and more work was naturally curtailed by the requirement to send children to school and get to work on time. The initial protests subsided and they came to realise this was the routine from now on.

Friends looked at me like I was bonkers when I told them that I wrote my own maths worksheets for the kids, but what better way to tailor work for your children? By having daily exposure to what my children found easy and hard, I could not only have an in-depth understanding of their precise ability, but also be in the best position to set and manipulate their next worksheet. If single digit additions were proving easy, then you can bet that double digit additions were thrown into the mix on the next worksheet. However, if there were too many tears and frustrations, the next few worksheets would be deliberately easy to restore confidence. By writing your own worksheets, you can not only tailor your child’s learning but heavily manipulate their confidence.

maths 2

When abstract problems became taxing, I found that re-framing problems into applied mathematics sorted the problem. Big Sis struggled immensely with problems such as “What number is half-way between 26 and 36?” She cried. Many times. I tried to explain it many times unsuccessfully: “You can either add the two numbers together and halve the total; or, you can add to the smaller number half the difference between the two numbers”. Not surprisingly, Big Sis developed glazed over eyes and hands over ears “la-la-la – not-listening” pose much to my annoyance. Then one time, lashing out in desperation I happened to say: “I give you 26 sweets and I give Lil Bro 36 sweets…”, then before I could even finish my sentence, Big Sis declares “That’s not fair! He shouldn’t get more than me! We should both get…(counting)… 31 sweets each” and “Bingo”. The war was won. From then on, problems were made real and Big Sis relished calculating “real world” problems. When Banker ran the barbecue at the school fair, maths worksheets were laden with problems of “Your friend Henry wants to buy 3 hot dogs from your dad. Hot dogs are £3 each, how much does he need to spend? What change must your dad give him from a £10 note?” At birthday time when Digi-birds were requested, “How many Digi-birds can you buy with the £30 your grandma will give you?” Go-figure, self-interest really helps with maths. Maths was made useful if not fun. There were no more complaints.

maths3

Once confidence was gained at maths, we moved on to shop-bought workbooks. If workbooks were a struggle, then the same book would be reworked again, being very easy the second time around, not only to consolidate knowledge but to boost confidence. The message “Maths can be easy”. And because I am evaluating and monitoring progress, as well as her teacher, nothing said at parents’ evening surprised me. I can pick up a Key Stage 1 Maths paper and know almost exactly which questions Big Sis will answer correctly and which she will struggle with.

Why is this important?

When the 11+ exams come around and performance will matter, I don’t need to rely on the opinion of others, I can be (almost) confident about my children’s performance and if I do not think that they will succeed, then they will not sit the exam. The bar will be set at achievable. Expectations can be managed in advance, disappointments avoided, and crucially self-esteem preserved. Self-esteem, confidence and a continued keenness to learn always matter more than the final mark at this age, and arguably at all ages as life is a marathon not a sprint. Contrary to popular belief that children who are being set regular work are “pressurised”, I believe the reverse. The “pressure” comes from the weight of parental expectation not parental preparation.

If you have the time and inclination, give Kumon a miss, roll up your sleeves and give it a go. There are frustrations and discipline required (but this is required of Kumon too) but there is also satisfaction and delight when you witness the penny drop and the passing of knowledge and the instillation of confidence.

I remember fondly my mother teaching me maths (despite my tears and tantrums) and I hope as adults my children will feel the same way.

Managing your child’s behaviour: Can’t behave, Won’t behave?

Incredible years

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:

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.

Emotional problems:

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.

Parental problems:

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.

Inconsistency:

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.

References:

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

Freaky Friday: My Mothers’ Day Post

Heels

Its mothers’ day again which always gets me thinking about my own mother and how the passing of time changes our relationship. Over the last few years I have been having “Freaky Friday”- mother-daughter role reversal experiences.

As my parents are getting older, the hospital appointments start mounting and I am required to accompany them to hospital. Visits home have sometimes involved the adjudication of “childish spats” between my parents where both parents are sulking in different rooms in their house refusing to talk to each other. Then there was the incident with the phone bill.

My mother, who is now retired, kindly helps out with school pick-ups  a few days a week when I am at work. To help me to be able to co-ordinate with her better, I purchased her an android mobile phone and a phone contract as she and my father were living in the dark ages of land-line and a Nokia that was never turned on.  She was delighted and I showed her the functions and informed her of the contract of 300 free minutes call time. I had been reassured by my sister that that was sufficient because “Mum is sensible, she has a landline. She won’t need more than that a month on the mobile”.

A few months passed and the phone was working brilliantly. If I had a change of plan – “Big Sis has  a play date – you don’t need to pick her up today” I could get hold of my mother straight away. Her phone contract was tied to my mobile phone contract and was paid monthly by my direct debit arrangement. As I rarely exceed my phone contract limitations, I rarely check my monthly phone bills.

Then one day, I decided to sort out my finances and go through my accounts. To my shock and horror, my mobile phone bills had gone from £24.00 a month to between £150 and £500 pounds a month! I went back to look through my on-line statements that I had not checked. There in full-colour, including helpful pie-charts were the breakdowns of the calls made from my account and my account for my mother. Let’s just say that someone was eating the lion’s share of that pie, and it wasn’t me. 300 free minutes were just the tip of the iceberg in my mother’s social life.

Helpful that mobile phone companies are these days, they also give you a full listing of every single number that had been called: several phone calls to Taiwan and several hour long conversations with various friends and family were all listed.

You can only imagine the conversations that followed, the net result of which was me frogmarching my shame-faced mother (“You said it was unlimited minutes”) down to the Vodafone shop to have her phone account transferred to her own name and most importantly billing account. Although I was not exactly pleased with the out-of-pocket expenses, the humour of the situation was not lost on me and it was my own fault to assume that my mother would be “well-behaved”, and comforting to know that far from being lonely and isolated as many retired people are, she has a very active social life!

I was a strange mixture of smug and shaken at the realisation that roles had been reversed. I was the “grown-up”, “responsible” adult now. I could “take care” of other people now, in fact, it was now my “responsibility”. Visions fast forward to a time when I will have to sponge bathe my parents and mush up their food as they can no longer chew, and other things that only doctors and elderly care-workers can really imagine (like the time when helping an elderly patient out of a chair she pee-ed on my feet in open-toe sandals).

Then, last week I was sick in bed with the flu. As all parents understand being “sick in bed with the flu” is meaningless to young children. It does not mean you can’t still be woken up at 6am by bouncing on your bed. It does not mean you can lie in bed and avoid the school run. It does not mean that you avoid helping them with their homework and stopping their squabbling and beating each other to a pulp. As a parent “being sick in bed” means that that’s where you should be, but you are in fact still doing everything that you are required to do at home only in a bad tempered manner and periodically shouting “Can’t you behave, I’m sick!”

On the third day of this, my mother calls.

I tell her that I am sick.

She tells me that she will pick up the children from school, take them to her house, give them dinner and bring them back in the evening. She asks me what I want to eat for dinner. She will cook it and bring it around when she drops the kids back.

 

That’s when I realise that there is no role reversal.

She is still my mother.

No one looks after you quite like your mother.

Thanks Mum.

Happy Mothers’ Day!

My International Women’s Day post: A gender for parenting

Dick can't help

It’s International Women’s Day again! Last year I griped about the career prospect inequalities for women and I am pleased to say that although it’s not exactly “all change at the top”, I think that the world is waking up to women in the workplace and the agenda for change here has started rolling into place. So this year, I am moving the gender agenda on…

A few months ago I attended a fascinating talk on the impact of post-natal depression in mothers on their children. As you can probably already guess, the impact is not just for the duration of the mother’s depression, but due to the massive development of the baby’s brain in the first year of life in response to its environment, problems in its “environment” (which is largely provided by the baby’s primary carer) can be life-long. For mothers to get depression (or worse still, psychosis) at this time is crippling as not only does it affect them for the duration of their illness, but can impact the child LIFE-LONG. I don’t think any other mental illness can have such a profound effect.

The talk went into much detail about the observed negative outcomes in children and the mechanisms that led to these outcomes. In brief, lack of love, warmth, responsive parenting, talking and interacting with babies in “motherese” lead to abnormal or insufficient normal brain connections in the baby (motherese is the repetitive and sing-song baby-like voice that mothers adopt when talking to babies that is infinitely nauseating to non-parents – isn’t it darling? Yeees-it is! Yeees –it is!). Many clinical trials have been undertaken to treat post-natal depression to prevent these negative outcomes in children, such as cognitive behavioural therapy (CBT) and anti-depressant medication, but all with marginal effects. Really interesting stuff that I am sure I will blog about in more detail another time.

A PhD student had done some interesting work around the ability of depressed mothers to differentiate between a distressed cry and a non-distressed cry from various recordings of a baby crying. Depressed mothers can typically not differentiate the cries and find all cries aversive. Interestingly though, depressed mothers that had been musically-trained (played grade 4 or above piano) continued to be able to distinguish a distress cry from a non-distressed cry from her baby presumably because of their superior ear in differentiating musicality in sounds. This led to the suggestion that training in music may be protective in some way for the negative impact of maternal depression as these mothers preserved the ability to identify distress in their babies. Someone suggested teaching mothers the piano in pregnancy.

When questions went to the floor, other people suggested a blast of oxytocin nasal spray. Oxytocin is the “mothering” hormone released in pregnancy and during breast feeding and given to apes has been found to increase “maternal behaviour”.

Tentatively, I put up my hand. From the back of the hall (I have not yet escaped my student-style sitting at the back of packed lecture theatre habits) I wait my turn to be picked. “Umm – wouldn’t it just be easier to ask the dads to step up and do the parenting bit?”

It struck me as obvious that if the best anti-depressants were contra-indicated in breast feeding, and available anti-depressants were not achieving good enough effects and CBT was taking too long to treat mothers, that one should look not to new and under-developed drugs like oxytocin or expensive and frankly bizarre suggestions of NHS funded piano lessons for mothers to “cure” the mother; but to additional support that could take over the “warmth, love, responsive parenting, engagement and social interaction” with the baby. The clue was in the term “parenting”. Dads are parents too.

What amazed me was the response.

Maybe I had asked a silly question. Maybe there were already piles of research, unread by me; that excluded fathers from nurturing a baby. There was an awkward silence as if I had breached some sort of sacred unspoken code of conduct. There followed mutterings from the row of my esteemed male colleagues sitting in the front row. I imagined that they were saying “Trust ­her (rampant feminist implied) to bring this up!”

The speaker responded to my question thus (as verbatim as I can remember but cannot be vouched to be word for word): “Yes, but people don’t respond well to being told to do things, and of course there is already a large role for fathers to support their wives. Often fathers are at work and are not available to do this.”

Yowzers!

I wondered if I had time travelled to the 1960s.

Can it be that in the 21st century, my esteemed, brilliant, talented, caring profession is still stuck in a time-warp? Decades after my predecessors saddled mothers with terms such as “Refrigerator mother”, “Schizophrenogenic mother”, “Good-enough mother”, “Tell me about your mother” and volumes on the paramount importance of maternal bonding and maternal attachment – can it be that we have not moved on from the primeval importance of mothers to babies? I am not disputing Bowlby here; I agree that attachment is vital. My dispute is with the gender requirement. Why can’t fathers bond and attach to their children – particularly if the mother is down or out?

My view on the issue is this:

Parental bonding and responsive parenting to babies is vital.

Biology provides some mothers with an advantage over fathers for bonding through pregnancy, birth and breast-feeding hormones. This hormonally driven advantage is lost once mothers stop breast feeding. In the UK, less than 1% of mothers last to 6 months of breast feeding. The hormones do not make mothers “better” at bonding, but makes them “desire” to bond and care for their young – kick starting the supposed “maternal instinct”. If there is a strong “desire” to parent, maternity hormones are completely unnecessary, which is why mothers who adopt babies are still perfectly wonderful mothers without having exposure to any maternity hormones. Believe me when I say that it was not oxytocin that told me that if my baby is crying I should pick her up, and if my baby is crying and her nappy stinks that I should change the nappy. That’s just common sense and I don’t need hormones for that.

Some mothers lack this advantage over fathers (having low levels of hormones or being unresponsive to hormones) and have no “maternal instinct” and are uninterested in babies (in the same way that many men lack the “aggressive instinct” that they are supposedly stereotyped to possess). Many men possess a “nurturing instinct”, in the same way that many women possess an “aggressive instinct”.

Some mothers get post-natal depression and are completely incapable or are severely handicapped in bonding and responsive parenting.

The conclusion should therefore be that fathers who have a strong desire to bond and care for their babies are no worse parents than mothers. Once mothers have stopped breast-feeding, they and their husbands are equally placed biologically to provide the love, care and nurture that is required to support a baby’s development. If a mother has post-natal depression or is uninterested or incapable of parenting for whatever reason, than the father is better placed to provide the love, care and support (provided he is not also disinterested or depressed), and particularly if he is warm and loving.

And yet, no one is shouting this from the rooftops, because there is no evidence to support this.

Just piles and piles of research on the bad outcomes for babies raised by mothers with problems.

Why is that?

Because in the past, it was the mother’s role to nurture babies and look after children. The body of evidence regarding mothers has built up over time. People writing research proposals and funding bodies granting money for research want to see an evidence base for the work that researchers they fund are building on. There is very little that has been done on fathers as the main carers for babies because up until the last few decades, this just happened so rarely. Even today, the vast majority of funded research in the parenting area relates to looking at mothers and their children. There is no evidence that fathers can care for babies, but equally, there is no evidence that they can’t. There remain large personal and societal incentives for many people and organisations NOT to produce research and data that may support equality in parenting capability. Yet, anecdotally, the gay dads that I have met (both personally and professionally) have largely been fantastically capable of love, warmth and responsive parenting and I am just sad for the many children whose lives are inordinately altered by mothers with post-natal depression where fathers have not stepped in.

The next stage in gender equality is surely to evaluate if the skewed evidence that we have been fed by parenting researchers who lived through a different society is scientifically relevant going forward, and to generate new evidence on parenting; where parenting is not just a proxy for “mothering”. My profession should be at the fore front of this, advocating for this research to take place and stamping out the gender bias in parenting. For if going forwards we are moving towards equality within the workplace (which we are), are we as child psychiatrists going to hinder this progression by continuing the rhetoric of hanging the responsibility of childcare on to aspirant mothers, or are we going to apathetically hang back and allow governments to enact it’s solution: to hand childcare over to the state? I believe we should speak with one loud voice for parental responsibility for parenting. Both parents in concert where possible and gender being irrelevant.

I am reminded of Harlow’s controversial primate experiments. The baby monkey chose to lay with the wire frame dummy covered in faux fur that gave it warmth and comfort, rather than the wire frame monkey that gave it milk. It is love that matters not mammary glands, and I am confident in my assertion that mothers and fathers are equally capable of that.

How family ski holiday hell can protect your child from perfectionism

Skiing

Last week I was on the obligatory family ski holiday. Around this time of year, there is no getting away from it for those of us privileged enough to be in the demographic that “does ski holidays”. For most people, the dilemma is about “to dump” or “not dump” the children. Whizzing down black runs is not something one can achieve with a baby or toddler in tow.  If your children are old enough to learn to ski, then “dumping” the children in ski school becomes legitimatised as “teaching your child a life skill”, a “healthy sporting activity” or for the tigers “brownie points for extra-curricular activity on the child’s CV”. There will be those who opt for all day children’s ski school and others who opt for ski resorts with all manner of childcare facilities so that they can get a good days skiing in. Reserve a place at the resort crèche where the children will participate in all manner of “arty-crafty activity” and they will mix with European children and might even learn a little French or German. Wunderbar! Hire a chalet nanny, or hell, bring your own nanny (or grandparents) with you. Why not? It’s your holiday as well right?

I have no problem with “dumping children”, but what I dislike is the pretence surrounding it. Why not just be honest and say “I love skiing and this is the one chance a year I get to do it”? If you are going to do it, indulge and do it guilt free. We all need a break sometimes. However, I would refrain from framing it in your mind as a “family holiday” and make sure you have a “proper” family holiday where you actually engage with your children as well. Even better, take turns with your spouse to go during term time without the children – they will feel less “dumped” that way. Given that most people that can afford extravagant ski holidays are also the ones working long hours and not spending quality time with their children, holiday contact is really important, and if the only holidays you have involve a crèche and a nanny then you have to begin to think about the impact of this on relationships with children.  I opt for morning session ski school and family time in the afternoon. Banker is quite good at taking Lil Bro skiing between his legs and Big Sis can now ski independently. Banker says he gets great satisfaction watching the children’s skiing coming along. Haven’t I trained him well?

I have a different reason for finding family ski holidays a chore.

I don’t ski.

Not having grown-up wealthy, skiing every winter was not part of my childhood. By the time that I was earning enough money for ski holidays, I was spending my money on holidays to South Africa to visit Banker as we spent 3 years living in different continents and holidays were our only time together. By the time that we eventually managed to live in the same place, I was the lone “non-skiier” of my friends and I didn’t fancy being the hole in the donut of other people’s ski holidays.

I had happily been avoiding ski holidays to no great regret. “Oh no, I can’t come skiing, we are off to explore the temples at Angkor Watt”; “Oh, sorry, maybe next time, I’m off to climb the Himalayas”; until kids. Given that my kids are de facto wealthy by UK-not-London standards (Big Sis has proclaimed herself “Rich” – when I questioned this, she replied “I will be when you two die.” Typical Big Sis!) – was I going to stand in the way of their wealth-based leisure pursuits?

I have in mind independent secondary school and Russell Group University ski tours and ruddy faced chaps called Tristan and Hugo that might wish to invite Big Sis to a family ski holiday; or blond, horsey gals called Cressida that might require Lil Bro to deliver chocolates to her. Did I want to deprive them these opportunities?

So I have been forced onto the slopes against my will by my diligent parenting ethos. My ski instruction to date has so far consisted of 3 hours with a private ski instructor. Ski instructors are usually of the buff 20 year old variety so it is no great torture, particularly as I spent many parts of the 3 hours being hoisted and supported by them (“Oh dear, I’ve fallen down again!”). This time however, the private instructors were all fully booked so I was left to my own skill (or lack thereof) and my darling husband.

Think of the second Bridget Jones movie and you get the idea of how I spent the last week, only worse as frankly, Renee Zellwegger would look great in a paper bag. Think: short, Chinese person dressed head-to-toe in Decathalon with sporadic catalepsy. No button lift was able to keep me upright and even flat terrain was insufficient to guarantee that I could stand. There was the time that a failed turn left me skiing backwards for a time screeching like a banshee till I fell forwards and tried aimlessly to use my fingers to stop my downward trajectory so that I left a trail of scratch marks in the snow like a demented cat failing to cling on for dear life in a cartoon. There was the time my ample bottom fell off the miniscule button of the button lift, but fearing that I would be left alone half way up a mountain slope, I carried on holding on to the lift with my arms so that I was dragged on my backside for several metres before I decided I had better let go. Or the time that I fell over for no apparent reason whilst attempting to embark a button lift and couldn’t get back up and in a truly British way, not wanting to hold up the queue of teenagers waiting to get on the lift, I heroically gestured that they ought to “Don’t mind me” and encouraged them to just step over me in the interests of the queue. Speak nothing of the slope-side verbal exchanges with Banker, incredulous at my ineptitude when I tried to put my skis back on with my skis pointing downhill.  Let’s just say that I measure the success of my skiing by the ability to descend a slope alive. If no bones have been broken, it has been a successful day.

Then there was the time that I hurtled down the piste, poles akimbo at constant risk of entanglement with my skis, ineffective snow plough engaged, heart and lungs in my throat, in perfect uncontrolled freefall, shouting “sorry” every 5 seconds as I cut across paths of furious proficient skiers and forcing snowboarders on their knees as they are forced to divert their course unexpectedly, as my life flashed before me. Only then to glance sideways to see Big Sis and an orderly row of bibbed midgets skiing calmly, gracefully and naturally down the slope past me.

Ah, it’s all worth it. Hope Cressida and Hugo will be thankful.

In hindsight though, I think there is a further benefit of my ineptitude. In this age of heightened perfectionism sending eating disorders and depression in children soaring, what better role model can there be for the nonsensicalness of it all than a parent who is prepared to put participation in front of looking good and doing well. For all the talk of promoting “non-competitive” competitive sports at school and inviting motivational speakers into schools to discuss successes that have come from failures, surely the most impact to children on this matter can come from parents who are not afraid to demonstrate failure and can wear it with a smile?

And I sure do epic fails and falls well!

Assess your child’s mental health and other great resources for parents

Little Effra Pictures

This week I have been working on a resources page for the site as there are some great, free resources out there that I think are unknown to parents and under-utilised. The resources page will permanently feature on this site now, so please let other people know about it. I hope to continue to populate this resource page with new and wonderful things so do check back occasionally to the resource page.

Information

FREE Child Psychiatry Textbook

Youth in Mind is a great resource from Professor Robert Goodman a fantastic researcher in epidemiology in children’s mental health who has taught and helped me with research in the past. The website is a bit basic, but don’t let this fool you into thinking it is not legitimate; it’s just that high-flying academics have more time for research than prettying-up a website. On the bottom of the home page, you can access a download of Goodman and Scott’s textbook on Child & Adolescent Psychiatry. All psychiatrists read this book for the Membership exams for the Royal College of Psychiatrists so if you digest this book, it is probably as much as most generic psychiatrists know. Unless you are a budding psychiatrist, I am not recommending you read this cover to cover, but if you want an authoritative and comprehensive view of a particular issue, it’s a really useful reference. And FREE. Robert is a truly generous academic and I know that he negotiated with the publishers for this content to be made free particularly for colleagues practicing in the developing countries, but it does mean that this resource is now available for everyone.

For Parents

Assess you child’s strengths and difficulties

Also from Youth in Mind, you can navigate in your own language to an on-line questionnaire, the Strengths and Difficulties Questionnaire (SDQ) which you can complete on-line for your child. The SDQ is one of the most frequently used screens for mental health problems worldwide and will help highlight your child’s strengths and difficulties in key domains. The web-site will give you specific instructions and will also give you a feedback report about your child’s strengths and difficulties. A teacher version is also available, and the combination of both parent and teacher reports will give a more accurate summary. For teenagers there is also a child self-report version. Of course, no on-line questionnaire can replace a medical assessment if you are worried about your child, but it can prompt you to think about your child broadly and to consider if there are any concerns that warrant further exploration.

For Teachers

Learn how to help a child you work with

For teachers, social workers, youth group leaders and anyone working with children MindED is a great e-learning resource that will undoubtedly help you help the children you are working with. It was set up as a collaboration between the Department of Health and the Royal College of Psychiatrists as well as Paediatrics, so is a good resource.

For Young People

Headmeds

This is a website targeted at young people so that they can get informed about the medications that they may be being prescribed. It is funded by the charity Young Minds and is also very good.

Autism

The National Autistic Society Website

Still the go-to site for autism information for parents. There are regional branches of the NAS and they will give you information about resources, services and support groups locally.

Education

The Book People

What would I do without the brilliant Book People? The majority of presents that we give to other children for their birthdays come from here (Sssshh – they are so cheap – don’t tell). Books make great presents, and the Book People even do cheap but beautiful birthday cards. I hate cheap plastic tat, and so we always give a book as the party-bag present at parties too. At a pound-or-so a book (including greats such as Roald Dahl and Diary of a Wimpy Kid), it beats plastic tat and a glow-stick any day. The full Roald Dahl collection (15 books, potentially a year’s worth of reading) can be purchased for the price of two cinema tickets, and the full set of David Walliams audio-books kept the kids quiet on many a long drive. Great adult and cookery books too!

Does parenting help chess and poetry?

chess

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:

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:

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?

No.

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.

Shrink grows kids: One year on

One Year on

Shrinkgrowskids is officially a year old, and I am so glad that I have made it to this milestone! Thank you to the 117 subscribers and the many more regular visitors. Shrinkgrowskids is being read in 102 countries worldwide, and especially in the UK, USA, Australia, France and Brazil. If you are reading this in Brazil, “Hello!” I do not know who you are but thanks for your time!

When I started writing a year ago, part of the impetus was as I was frustrated that a Consultant Child Psychiatrist was unable to find work that fit in with parenting responsibility. During the school day I wanted to do something with my knowledge, not just the dishes. I would meet up with other women (lawyer, business consultant and tech consultant) in local coffee shops complaining about the career paths that we had given-up out of necessity, not truly free will. Over the year, I have come to realize that times-they-are-a-changing and that there is nothing that can hold back the tide of change for equality any longer.

Employers will increasingly be encouraged to promote women

Men will become increasingly involved in parenting

Men and women will become treated more equally at work

Parents will not automatically be assumed to be mothers

Children will be happier raised by parents of both genders

I am finally seeing and living through change. I might get to witness the end-game of feminism in my life-time. Thanks to the major research funding bodies colluding to only fund research in institutions that are putting in place strategies for gender equality, over the last year, my University has been falling over itself to send women like me on Women’s Development Programs and Mentoring schemes. Although some schemes need fine tuning and we are yet to confirm if lip-service converts into true commitment; with a gun-to-its-head it really looks like progress is going to be made on this. Thank you funding bodies!

This leads me to believe that progress and change can and will eventually filter to all professions, we just need more “financial-guns-to-heads”. Many of my friends in the city say “yes, but it won’t work in banking/ law/ accountancy/ consultancy”; because “of the nature of their work” and “client expectations”. Yet, who dictates “the nature of their work” and why do “clients expect” things to be delivered at awkward times of the day (or rather night)…? We as a society do not have to accept the status quo. We can press for change. Given incentive everything can change.

It reminds me of the arguments made by people opposed to the European Working Time Directives (EWTD; European laws that prohibited doctors from working more than a 48 hour week) for doctors when I was a trainee. In those days, we worked 96 hours a week. On some weekends, we worked Saturday 9am through until noon on Monday. I’m telling you the sleep deprivation of motherhood was nothing compared to this and after this experience all-night breast feeding was a doddle. Believe me, it is far easier to wake up and slap a baby to your breast than it is to wake up to catheterise a gentleman. It was thought “impossible” for the system to change to allow doctors to work less because of the “vital” work that we doctors were doing. How could patient care be transferred safely from one doctor to another? Impossible!

Well, as it turns out, all doctors have now moved to shift work without a massive rise in the death rate of patients. Indeed arguably care is better as doctors have had a decent amount of rest. I can never forget the poor patient that sat in hospital for a whole week without being seen by any doctors as my colleague on a weekend shift had forgotten to put his name on our patient list. The medical system was forced to change by financial penalties for non-compliance, bringing with it a surge of female applications to medical school. Medicine is still not ideal, men still dominate the upper echelons and prestigious specialties, but at least the days of long hours culture is gone. It is not beyond the wit of man to change systems in other institutions to afford their employees a better work-life balance; their talented junior women a real shot at success and their talented junior men a shot at being a decent father. They just need the financial incentives, because at the end of the day, money is the only cattle prod that works.

Indeed, it is money (or rather lack of it) that will likely be the solution to my other bug-bear: the lack of high-functioning part-time jobs in medicine. After struggling to find a position in London happy to take me on a part-time basis, it turns out that the NHS are so short of money that they are now happy to employ part-time Consultants. Not because they value retaining female staff or work-life balance, but because they no longer have enough money to pay for full-time consultants. Either way, it is good for me and other parents who wish to work part-time as a Consultant in the NHS. Fingers crossed that over the coming years something will turn-up for me. In the mean-time I’m thoroughly enjoying my University position that allows me to interact with some of the greatest minds in Child Psychiatry, and on my days off, as waiting lists have exploded in the NHS; private practice is booming. It is hard to argue against well-paid work that can easily be fit in between the school drop-off and pick-up. It’s sad that this can only be done in the private sector, particularly for a die hard NHS supporter like me.

What of my coffee-morning compatriots? After a period of part-time work at a lower level, the lawyer has succumbed and returned to full-time work at Big Law Firm and has employed a nanny. The business consultant has set up her own successful business, which operates on her terms within school hours. The tech consultant moved out of London and is content to be a stay-at-home mother. We all moved on, and its now pretty hard for any of us to find time for a cuppa. Maybe its that the children are growing, maybe its a sign of the times, but good women can no longer be kept down.

The other day a younger male friend who just got engaged told me he was thinking about taking his wife’s name…

Who knows where we will be a year from now?

In the meantime, I hope you will continue to read my blog. Here are some of my reflections on parenthood from the last year.

mum

Mothers and Motherhood

Did you get Maternal Adjustment Disorder (MAD)?

_GSB5183

The changing role of fathers

swimming

Pass on a passion