Category Archives: Sunday Times Columns 2012

Not just a few worries and quirks: children and OCD

notobsessiveI had always known the 10-year old was an anxious child. Her parents had referred her for therapy as they felt she lacked confidence, was falling behind at school and seemed very secretive. I had spent many sessions with her, building trust and developing a relationship, and we had talked about her worries at school, the conflict between her parents at home.

But it took some months before she finally confessed to me that she thought she was “weird”. Thoughts invaded her mind and she couldn’t ignore them, upsetting thoughts that bad things might happen.

Specifically, she felt she had to check and recheck that she had tightened the tap after she washed her hands, as she couldn’t shake the feeling that she might leave the tap open and cause a flood.  This need to close taps and tighten them, to the point she would hurt her hands, had extended to her glue lid, the cap of her juice bottle – in fact to all items that needed closing.

She was very ashamed of her thoughts and behaviours and was sure she was a “freak”. “I just can’t stop myself,” she whispered. “What if I don’t check the tap and I flood the house?”

It was then that I knew that she wasn’t simply a nervous child, but was suffering from a serious form of anxiety disorder called Obsessive Compulsive Disorder (OCD).

It is estimated that about 1 in 200 children has Obsessive Compulsive Disorder (OCD) and that 80% of adults with OCD have had significant symptoms before the age of 18.

In children and adolescents OCD involves obsessive thoughts about things like:

  • contamination, dirt and germs,
  • illness,
  • putting things in order, arranging things symmetrically,
  • lucky or unlucky numbers,
  • the possibility of hurting others or causing something bad to happen,
  • danger to family or friends, and
  • losing or breaking things.

Children with OCD can’t simply choose not to think these thoughts; they cannot just put the ideas out of their mind and think positively. The thoughts feel intrusive and overwhelming and cause enormous distress to the child.

Children with OCD generally ‘deal with’ these obsessional thoughts, anxiety and preoccupations by carrying out particular repetitive actions. These actions quickly become compulsive rituals, examples of which are checking, hand washing, counting things, performing an action in exactly the same way every time, repeating a behaviour a specific number of times, and collecting and hoarding things.

It’s as if the child believes that the rituals will undo any possible harm and magically reduce anxiety and make things feel right. But in truth these compulsions are enormously time-consuming and increasingly interfere with all aspects of the child’s life.

Experts are not exactly sure what causes OCD, which can run in families. Some theories suggest that it involves serotonin, a chemical in the brain also called a neurotransmitter. When something blocks the flow of serotonin, the brain overreacts and misreads information. Instead of ordinary thoughts being filtered out, the OCD mind lingers on them and sparks off fear or worry like an overactive alarm system.

OCD can be a difficult condition to treat. Early diagnosis is not easy as children are often secretive about their obsessions and compulsions. But if untreated, childhood OCD tends to persist into adulthood and is associated with long-term negative outcomes, so it’s worth being proactive if you start to suspect your child is showing features of the disorder.

Below are some of the positive steps you can take.

Consult an expert

As with most difficult mental health issues, the support and expertise of an expert is often vital. First, this person will help you to distinguish between what is manageable anxiety and what is OCD. Second, even children with the most knowledgeable and accepting parents will often withhold certain worries and acts from them, but talk about them with an expert.

A combination of psychotherapy and medication might be suggested by a professional, but first do some research and inform yourself thoroughly before deciding how to move forward.

Prepare the family

If everyone in the family  understands what OCD is and that the behaviours that come with it are part of the condition, this creates a more understanding home environment. Also try to run a fairly structured home so that compulsive rituals don’t stand out as much and are less exacerbated by chaos.

Talk to your child

This is obvious. Be honest and open about the condition and talk about it with your child, without ever forcing the issue. You are a parent with a family to run and limits to set, not a psychologist. The more difficult work of dealing with OCD might need to be dealt with by an expert.

Deal with school

For the OCD child, stresses at school are usually worse than at home. Adults who teach your child will not be as well informed as you learn to become, and other children are often not tolerant or understanding. Therefore, meet all those who will come into contact with your child and help to educate them.

Managing and treating OCD is a challenge but possible – as the famous 18th century writer, OCD and Tourette’s sufferer Dr Samuel Johnson said, “Great works are performed not by strength, but perseverance.”

OCD hand

For useful links to resources in South Africa and internationally I can recommend the website of the South African Depression and Anxiety Group (SADAG) – http://www.sadag.org

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Opening up new worlds and our children’s eyes and minds

I have been following my husband’s Writing Safari blog, he is recording a tour he has arranged and is running for 16 of his pupils. and it reminded me of this piece I wrote last year April while on a family holiday in Paris. 

When I was young my family holiday was a drive to the sea punctuated by picnic stops to eat egg or polony sandwiches by the side of the road. But I wanted to be like other kids, whose parents weren’t as wholesome as mine – they stopped at the Golden Egg for toasted sarmies and chips.

Oldest house in Paris

Oldest house in Paris

I didn’t have any friends who went overseas, the Golden Egg and the Durban beachfront being about as good as it got. Now, as I write this, my own family and I are sitting in the Marais district of Paris, around the corner from the city’s oldest house (dating from the 1200s) and surrounded by new and ancient culture. It makes me think about how fortunate some of us are to be able to travel to faraway places and to expose our children to the wider reaches of the world.

Sometimes that means a journey from the KZN heartland in a dilapidated school bus to the coast, a trip that the woman who works for me was never able to make when she was a child, despite living only 200kms from the ocean; at other times it means a drive across the border or a flight over the ocean.

I’d like to believe, perhaps romantically, that exposing my son to French culture and history, having him greet waiters and shop assistants in his limited French, climbing the Eiffel Tower with children of all nationalities, standing on the spot from which thousands of Jewish French children were sent to concentration camps, spotting cannonball damage from the French Revolution in the Bastille area, helps to start conversations about freedom, dignity and humanity from a different angle. And that all of this broadens his mind.

But it’s also true that the children of fellow tourists and residents in Paris all look rather the same, dressed in Nike trainers, sweatshirts emblazoned with the names of American colleges, tapping busily on iPhones, chewing gum and sharing iPod headphones.

Perhaps there is another message in that. When I was young the wave of other cultures, whether from overseas or across the hill in the nearby township, was barely a ripple by the time it washed up on my shores. Now culture flows ceaselessly backwards and forwards across the world and some of the unique differences might have been lost.

Nevertheless, under pressure people fall back on cultural differences and old hates rise up again very quickly. We see this in South Africa. One politician’s use of the word ‘refugee’ can arouse fierce, historical hurts, while a rise in bread prices can lead to stoning of Somalian shopkeepers.

That’s why I believe that exposing your children as much as possible to other cultures in your own country and across the world serves a powerful purpose – to see the connections we have with other cultures and tie our humanity to them. The choice is then theirs as to how to live their lives and create an ethical system, although it’s likely their values will still largely work off yours.

There are also those who argue forcefully for raising children within their distinct culture, with rules and rituals for how to dress, speak, what to eat, when to perform particular actions, and even whom to marry and associate with.

Whatever approach you take, here are a couple of questions that I think are worth asking of your children as they grow up:

  • Do some of your friends and acquaintances expand you as a person, sharing different ways of life with you and giving you access to interesting new ideas, making you more curious about life; or are they always just the same as you, do they narrow you down and support your prejudices and stereotypes?
  • Do your beliefs and lifestyle encourage or at least allow you to connect with other groups different from you, willing to see a common humanity, or do they alienate you from others and demonise others?

Here are some things that parents and schools can do to broaden children’s minds and open their eyes:

  • Teach children a second or third language,
  • Allow children to learn about cultures and religions different from their own,
  • Travel,
  • Explore other African countries (an academic or cultural school tour doesn’t only have to go to Europe – what about Namibia, Ghana or Kenya?),
  • Set up exchange programmes with schools and communities in your own country, and
  • Go to national monuments and museums that acknowledge the histories and experiences of the diversity of people.

black-family-globe

Sleepover’s don’t need to be nightmares

Slumber party or night of the living dead?sleepover image

It’s 2.00am and out of the blackness of sleep something materialises in my room. It’s at my elbow, shaking me awake. I grope through the mist, trying to catch up to my racing heart. It’s my son’s 8-year old friend, sleeping over for the first time. He can’t sleep. So neither can I.

The sleepover, or its Americanised girlie version, the slumber party, is one of the modern rituals of childhood. Children and teenagers beg parents to allow them to host or attend sleepovers, with the promise of pillow fights and midnight feasts, the tests of ghost stories and truth or dare.

What can go wrong? Well for starters: imagine a giggling gaggle of hyped-up tweens and teens, transforming into squabbling, sleep-deprived, grumpy monsters ruining the rest of your family weekend.

Other parents have darker imaginations, depending of what they’ve read in the newspaper or which stories they’ve heard that week. Pornography, paedophiles, sex, drugs, alcohol or neglectful parents, take your pick.

Sleepovers are a rite of passage, a plunge into deeper waters. Whether you host one or send your child to someone else’s, you might feel as if your child is not ready. For some parents the shallow end of life is a much safer place to be. I understand this. I understand it completely.

When my son packed his things to stay over at his best friend’s, I smiled encouragingly through the lump in my throat as he left home for his first night out. He dragged a huge bag behind him, walking innocently forward. I trusted the hosting family but not chance, the possibility of some violent intrusion into their home, some horrible, random stroke of fate that I should be there to experience with him.

If you think I’m bad, try my husband. “What if a small rusting bit of a satellite breaks off, falls a few thousand kilometres and hits their house?” he asked, only half-joking.

Unsurprisingly, our son survived. There was no act of God or shift in the earth’s crust. I’d just forgotten about his sleepwalking, of course, a habit he’d recently started and which we had yet to understand properly.  I was probably sleeping fitfully when he fell out of the top bunk of his friend’s top bunk in the middle of the night, crashing onto the carpet, where his friend’s mom found him a few seconds later, sleeping peacefully.

My son was 7 years old at the time, but what is the correct age for sleepovers? There is no right time, of course. Some parents will be in their early twenties, others in their fifties – they just have to deal with it as maturely as possible.

Parents might refuse to allow their child a sleepover at a friend because of safety concerns and the fear of something going wrong, or just because they have different attitudes, values and parenting styles to those of the hosts.

Equally, not all children want to sleep out. Sometimes it’s the parents dying for a child-free Saturday night but their child says no.

Properly planned and supervised sleepovers are a fantastic way for children to consolidate friendships, expand their horizons and learn about how other families live. It helps children practise being flexible and autonomous within safe boundaries. It also helps parents practise letting go.

Some tips:

  • Make sure you know the family where your child will be spending the night. You should also ask what level of parent supervision will be provided and which other children might be sleeping over. And if you feel uncomfortable, you can say no;
  • If you host a sleepover, be vigilant, be responsible, keep them short, and don’t have too many kids over to sleep at one time. Remember Lord of the Flies?;
  • Don’t schedule sleepovers for every weekend or they lose their specialness and also start compromising family time and other activities;
  • Children should never be pressurised into sleeping out if they feel unsafe or uncertain;
  • If they would like to go but are nervous, put a plan in place that allows for you to make contact with your children and the host family, say goodnight and, if necessary, make a plan allowing them to come home if there anxiety gets the better of them;
  • Avoid a pattern of your child asking if he can sleep out, and then always phoning you in the middle of the night to be fetched. If this is happening, then your child is not ready for sleepovers – take a break and try again in a few month’s time; and
  • For anxious parents of younger children, consider something I read about, which is ‘sleep unders’, ‘half-overs’, or ‘late nights’. The children go off in their pyjamas, take junk food, play all the games they want, but at a certain point are fetched and tucked in under their own roof, where their parents can feel safe.

The author Elizabeth Stone wrote: “Making the decision to have a child – it is momentous. It is to decide forever to have your heart go walking around outside your body. ” And sleepovers, the precursors to leaving home, allow your heart to brave some tentative baby steps.

Parents make the difference

I wrote this column at the start of 2012. Matric results for the previous year had just been released and it made me think about what contributes to academic success – is it all a matter of the school your child goes to, or the amount of extra resources (and money) you devote to your child? And what about those parents who are not equipped themselves to make up for the distressing deficiencies in many parts of the State school system? How can all parents make a difference?

Parents often believe that they need a lot from experts to help make their children successful. That good school with its waiting list. That brilliant maths teacher whose students all seem to get distinctions. The occupational therapist who improves your son’s poor fine-motor coordination. The educational psychologist who recommends that your child get a scribe for exams.

As useful as any one of these experts is, think of him or her as only one runner in a relay race waiting for you, the parent, to pass on the baton. Unfortunately, some parents hand over the baton well after the others. These are parents who are less aware of or interested in the requirements of their children’s education, and the result is their children may forever struggle to catch up.

It’s a common sense belief that some parents or communities are better at preparing their children for school and careers than others, but how do we know this to be actually true? Various studies have confirmed this, one of which was published recently.

Every three years an international development agency, the Organization for Economic Cooperation and Development (OECD), tests 15-year olds from various developed countries, focusing on numeracy and literacy. Past studies have shown that the most skilled and well trained teachers have a significant impact on children’s school results and future success.

But the OECD recently undertook to investigate the role of parents. By 2009 the parents of 5000 students in 18 countries had been interviewed and the test results of their children correlated with the parents’ practices in the home.

One of the findings from the OECD research, as reported in The New York Times is:

“Fifteen-year-old students whose parents often read books with them during the first year of primary school show markedly higher scores … than students whose parents read with them infrequently or not at all.”

Andreas Schleicher, Special Advisor on Education Policy to the OECD, also said, “Just asking your child how was their school day and showing genuine interest in the learning that they are doing can have the same impact as hours of private tutoring.”

Another interesting conclusion from the study was that even in poorer and less educated communities, where individual parents frequently read books to their children in grade one, the children of those more involved parents scored about 14 points higher than other children from the same background.

This finding has potentially huge implications for our country where, clearly, far too many children every year grow up in communities where parents, because of a history of educational disadvantage and deprivation, don’t really understand what schools require and are poorly equipped to prepare their children for school.

What I like most about these findings is how they point to very simple actions that any parent or caregiver can take immediately that will have long term benefits for their children.

Outside of the expensive, well resourced world of private schools and some of the better state schools, education is in a dire situation in South Africa. It’s something that we should be righteously angry about. The best minds in our government should be specifically tasked with saving our country from the future nightmare of masses of uneducated, illiterate and unemployable 18-year olds.

There are many reasons why the government’s responses to poor education results have been polite, beaurocratic and policy-focused rather than tackling real obstacles on the ground. There are powerful constitutiencies that would need to be taken on and, to be fair, the government already spends a huge proportion of its money on education.

However, the OECD report suggests there are steps we, as parents, can take now to help our children that don’t require challenging obstructive constituencies or spending lots of money.

In the meantime the best we can do for our children is to take action ourselves. Spread the word in your community about the importance of parental involvement in all aspects of education. At the very least, keep books, magazines and newspapers in your house. Read and tell stories to your pre-school children. Read and talk about what you’ve read in front of your children. Turn off the TV sometimes.

And when your children start school, ask them questions about their school day, about what they’ve learnt, what projects and group work they are doing. Attend school functions and parent-teacher meetings. Monitor your child’s progress, not in order to make sure they are coming first in class, but to show them that you care about how they are learning and are interested in what they are thinking.  

You can’t wait for the government to fix the schools or rely only on the experts to help your children. You can make the difference. 

What parents can do about bullying: helping girls manage relational aggression

Girls bully too. They may not always mean to, but they do. They may initiate the activity as the “Queen Bees “ of a group, perpetuate the behaviour by acting as “wannabees’’or “sidekicks”, or just let it happen by being passive bystanders. Rather than fists and stones, their weapons of choice are their tongue and their thumbs, with which text messages are sent out to the gang of friends. In an instant, someone is unfriended and a systematic programme of verbal abuse and ostracisation begins.

In a previous column   I wrote about this relational aggression amongst girls. This week I want to make some suggestions about what parents can do about it.

First, look to thine own self. We don’t always think of it but adults are often bullies. If you bully colleagues or friends, ignoring their phone calls, dismissing their ideas publically, leaving them out of social events, your daughter is bound to see this as a model for social interactions. ‘Ah,’ she might think, ‘so that’s how I deal with my insecurities. Strengthen my standing in the group by turning the others against a common enemy.’

Next, have a pre-emptive conversation with your daughter about bullying, preferably around age 10 when it most commonly starts.  Talk to her about what relational aggression looks like, ask if she has seen it around her and talk about strategies she can use if it does happen one day. Teach and model healthy assertiveness.

Make it clear to her and her friends that not only will you not tolerate relational aggression, but you will always be there for them if they need to talk about it in future. This increases the chance that a victim you know will ask for your help before things get too bad, bearing in mind that victims of relational aggression often keep silent.

Advise your daughter not to invest her all at school, in one group of friends or one area of activity. Encourage her to have some friends and interests away from school. School can be a hothouse of insecurities and jealousies, sealed off from other influences. A girl who has friends and activities out of school has a much better chance of keeping her perspective on bullies in school.

One of my clients was a teenage girl who really struggled to integrate with other girls at her new school. Somehow she just couldn’t crack the codes of behaviour and be accepted. “I honestly don’t know what I’m doing wrong,” she would say. She turned out fine in the end not so much because of anything I did or said (although counselling is another important remedy) but because she was highly involved in the equestrian world, where she had other friends, from other schools and earned commendations for her achievements.

For the same reason (having other areas of emotional investment) a girl excelling at a particular academic or extra-mural activity in school might suffer less when she is harassed by her social group.

Then there’s writing. Jassy Mackenzie, a Johannesburg crime novelist, says that writing her first novel helped her to come to terms with a brush with crime. In the same way, journaling or keeping a private diary helps many girls to clarify their feelings, record incidents and have a safe place just to be. Encourage your daughter to write about all her feelings, and to include writing about positive experiences and emotions too.

Also, listen to your daughter and don’t minimise her feelings. I am reminded of Alice Sebold’s autobiographical account, called ‘Lucky’, about her rape at Syracuse University. When she reports the crime to the police the first thing they tell her is that she is lucky because another girl was raped and murdered in the same spot. Minimising feelings in this way is a failure to understand an individual’s particular experience, added to the fact that adolescence has a unique character and intensity that adults can rarely fully remember and understand.

Of course, remember that any story you hear you will only be part of the story. While you listen, keep an open mind and don’t jump to any hasty conclusions.

But it is always important to take action.

Encourage your daughter to report bullying and harrassment, with your active support if necessary. Often people are afraid that reporting and intervening will make the problem worse. But it is very important that you bring these issues to the attention of school management.  Schools need to take relational aggression as seriously as physical aggression. All schools should have comprehensive anti-bullying policies and positive social behaviour programmes in place.

For while sticks and stones may break girls bones, words (and malicious rumours and cyber harassment and social ostracization) can break their spirits and their hearts.drawing-bullying4

Sugar and Spice and Being Horrid

Sugar and spice and all things nice, that’s what little girls are made of. Except, it seems, when they’re cracking bottles over each other’s heads, calling each other fat cows, spreading offensive, defamatory rumours or disinviting each other from parties, Facebook and Blackberry Messenger.

I’m sure many parents were distressed by recent reports of the 15-year old schoolgirl at Krugersdorp High School in Johannesburg who attacked a fellow pupil with a glass bottle. This incident seemed to be at the tail end of a string of bullying and harassing incidents that had passed between these particular girls.

We should be distressed but not surprised. 

Many teachers, parents and psychologists have become increasingly aware over the last couple of years of an apparent rise in female bullying. This is sometimes called ‘relational aggression’ as physical assault usually plays only a small part in the pattern of behaviour.

Relational aggression includes spreading rumours, verbally insulting, exclusion from friendship groups and hostile and dismissive body language. It is different from the normal conflicts that occasionally flare up between girls, in that the aggression is persistent and relentless, usually targeting on one or two individuals. It can happen anywhere and in any age group, but it is most commonly played out in school settings and is most intense in the middle school, between grades 6 to 10.  

As I said earlier, I believe girl-on-girl bullying has become more common, partly as a result of the availability of more instant forms of communication. A study of young people, conducted in South Africa in 2009 by the Centre for Justice and Crime Prevention, found that about 25% of them had been bullied by means of text messages, and that almost 70% of text messaging bullies had been bullied themselves through sms. 

Why is this verbal bullying more common amongst girls? Partly it’s because girls generally invest more in friendships than boys do, and so the stakes are much higher, the hurt greater, when conflicts arise. Words are the instrument of affection but also the weapon of choice.

Any girl can be a victim or aggressor, and many issues can incite incidents. But one common thread that runs through these fights is the social isolation of a victim so that the status of the in-group is enhanced. Ring-leaders of the in-groups might resent competition from the victim or want more attention for themselves, and it’s not uncommon for those leaders to have an unstable self-esteem, one that is easily threatened by new voices and competing influences.

The chief bully in the group is often a seemingly popular and charming girl whom parents and teachers like and give lots of attention to. In other words, not the sort of person who would automatically be suspected of such behaviour. queen bee and enabler

The American parenting educator, Rosalind Wiseman, describes these girls as “queen bees”. She points out that other girls often hover around queen bees out of fear of being excluded from their approval, and that the queen bee (or mean girl or ruler of the clique) is often not well liked by her peers, but that she makes them afraid.

Complicating matters for all parties – parents, targets and teachers – is that the very nature of relational aggression makes it more difficult to detect and take seriously.

If a girl comes to you and says that her friends have started turning away from her when she approaches, rolling their eyes at her when she speaks, or telling others that she is fat, you might not understand that this is part of a relentless campaign that happens behind your back. Victims often fail to report what has happened and can suffer for a long time without being helped. 

Johannesburg psychologist Lesley Rosenthal adds that “Part of the problem is that girls are socialised to be good and nice and compliant and people pleasers and therefore project a false self to the world. Social competition and aggression are denied and frowned upon as unfeminine. So the behaviour gets expressed covertly, through the bitchy meanness manifest in relational aggression.”

So much for sugar and spice and the world of nursery rhymes. It’s much more the little girl, who had a little curl, “right in the middle of her forehead. When she was good, she was very good indeed, but when she was bad she was horrid.”

Battery Chicken or Free Range Kid?

He was 22 years old when his mother gave him up to the police.

It was 1988, the last spasm of apartheid, and the military police had arrived at his mother’s flat in Durban to track down the military service dodger. But he was living elsewhere in Durban on the Berea, hoping that his mother would deny all knowledge of his existence, or at least his whereabouts.

Instead, she meekly handed over the information and he was located, formally charged and required to attend a tribunal in Pretoria several weeks later. “I wasn’t really surprised,” he said. “She was essentially a good person but fearful and timid, and I never felt she would protect me. When we first arrived in Durban, she dropped my brother at the gate of his new school and told him to approach the headmaster to sort out everything. That was for grade 1.”

Meanwhile, according to Google the ‘problem’ currently appears to be the other way round. In families, fictional and real, and in 1 600 000 internet hits (compared to 55 000 for the term ‘underprotective parent’), overprotectiveness, sometimes referred to as helicopter parenting, is the hot topic.

Modern society is a culture of information. But sometimes we have so much information about every new disaster, crime and moment of misery that it also means we live in a culture of fear. High levels of parental protectiveness seem necessary given the many dangers reported in our newspapers and community crime-watch emails. We are drowning in bad news.

Life can also seem more pressurised, jobs more scarce, the future more uncertain (let’s pretend it’s not 1914 or 1939 or any year of apartheid), so fiercely protecting your child seems to be a basic requirement of effective parenting.

But overstepping one’s parental role, not allowing children to learn from mistakes or fight some battles on their own, can prevent children from developing resilience and learning to manage difficulties.

Underprotective or indifferent parents are a different sort of animal completely. These parents aren’t creating a safe environment in which to allow their child to learn independence, but throwing them to the wolves. This happens when parents were themselves raised by neglectful or abusive parents, or where community or family structures have broken down.

So how to find balance? A parent should be more guide than bodyguard. When your toddler staggers past a sharp-edged table, walk quietly behind him at the ready rather than call out the danger and whisk him aside. Let your 5-year old daughter grapple with her shoelaces rather than always intervene. Advocate how your 10-year old can deal with her friendship dispute rather than automatically phone the friend’s parents. Allow your teenager to fight smaller battles with authority figures on her own – you don’t want to communicate that you have no trust in her strength of character.

What you want to raise is a free range child, not a battery chicken unfit for the normal rigours of
everyday life. The term ‘free-range kid’ was coined by an American writer, Lenore Skenazy. She says a free range child ‘’gets treated as a smart, young, capable individual, not an invalid who needs constant attention and help. For instance, in the suburbs, many school PTAs have figured out a new way to raise money (God bless ‘em): They auction off the prime drop-off spot right in front of the school — the shortest distance between car and door. But at the mall, or movie theater or dentist’s office, that would be considered the handicapped parking spot — the one you need if you are really disabled.”