There has been a plethora of difficult news stories to hit our screens recently: from child abuse involving high profile, previously well regarded alleged perpetrators to mass violence resulting in multiple deaths. While the media can help to inform and educate, it can unfortunately […]
There is a lot written in social media and print about being a good parent, good enough parent, ‘the best you can be parent’. We hear of the importance of looking after ourselves as parents before or so we can best look after our little people. Anyone who has travelled by aeroplane will have heard the air hostesses instructing parents to put on their own oxygen masks first before attending to their child. It seems counterintuitive, but let’s look at the detail as to why this matters.
Self-care – who takes care of the parent? When the parent is constantly giving to others, do they ever think about how much they are giving of themselves? It’s probably not something that parents ask themselves or even consider often, until they are overwhelmed, feeling exhausted and irritable with their children. Then comes the guilt because they are not being the parent that they ideally want to be.
Let’s put it simply. We cannot give what we haven’t got. So if you, as a parent, are not looking after yourself, not showing yourself the love you show your loved ones, not treat yourself the way you want others to treat you (i.e., with respect), this not only affects you but potentially every member of your family.
Children can be viewed as the barometers of the parent’s functioning. Their behavioural outbursts or emotionality or sensitivity may reflect their parents’ imbalance of ‘all work and looking after the family’ but not themselves. When the parents are balanced (i.e., calm, consistent, non-reactive) there is a much better chance the children will be too. Hence the very important flow on effect of parent self-care.
Self-care includes aspects such as sufficient sleep, regular physical movement, nutrition, rest and relaxation, social connection, and engagement in pleasurable activities. Self-care is giving yourself a break, to recharge, taking time off. Self-care shows you matter. It models to your family the importance of your needs, that each member of the family is important. It reduces stress. Self-care is good for your well-being and that of your family.
Further engagement in each of these aspects of self-care demonstrates and models to your little people important life, coping and self-regulation skills. This is much more powerful than anything you could say or ‘lecture’ your child about. Demonstrating to your child that when you’re frustrated you engage in deep breathing, or when you’re anxious you run a bath, or at the end of the day if you’re tired you go to bed a bit earlier, and so on, are invaluable life lessons.
Self-care doesn’t have to be time intensive. Even engaging in breathing exercises for 2 minutes or watching the clouds, or listening to your preferred music is likely to shift your energy and provide you with a little joy. Getting up a little earlier than your little people to plan or consider your intentions for the day, perhaps whilst you sip a cup of tea, is also important self-care. You’ll likely be more calm, and therefore more intentional in your interactions with your loved ones and less reactive overall.
Our team of highly skilled and professional clinical psychologists are able to compassionately support your journey to being the parent you want to be, that makes your heart sing, a parent who prioritises their own self-care because they acknowledge their own importance and their own needs; and that ultimately flows on to a more contented family. Opening yourself to growth by learning and incorporating skills such as relaxation and mindfulness of thoughts and emotions techniques, means you are prioritising your own wellbeing and that of each member of your family.
Dr Jasmine Pang describes the impact early adverse childhood experiences have on individual later-life health and well-being, with advice for general practitioners and health providers in how to provide trauma-informed care.
Primary health settings provide a unique environment for the provision of trauma informed care. Many trauma survivors do not seek mental health services but look for help in primary care settings. Neither patient nor providers may be aware of the link between their current physical complaints and the connection to past trauma. Yet research has clearly shown a wide-ranging impact of Adverse Childhood Experiences (ACE).
The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and the links to later-life health and well-being. ACEs investigated included emotional abuse, physical abuse, sexual abuse, household intimate partner violence, household substance abuse, household mental illness, parental separation or divorce and incarcerated household members.
Results of the study found that almost two thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The study also found a graded dose response relationship between ACEs and negative health and well being outcomes across the life course.
The study showed that as the number of ACEs increases so does the risk for the following-
- Fetal death
- Health-related quality of life
- Illicit drug use
- Ischemic heart disease
- Liver disease
- Poor work performance
- Financial stress
- Risk for intimate partner violence
- Multiple sexual partners
- Sexually transmitted diseases
- Suicide attempts
- Unintended pregnancies
- Early initiation of smoking
- Early initiation of sexual activity
- Adolescent pregnancy
- Risk for sexual violence
- Poor academic achievement
ACEs continue to have a lifelong impact from conception to death as it disrupts neurodevelopment. This results in social, emotional and cognitive impairment, which causes the adoption of high health risk behaviours leading to disease, disability and social problems.
Role of General Practitioners
Despite the increasing evidence of the lifelong health impact of ACEs, research shows that less than one-third of primary care doctors screen for ACEs on a regular basis . This was often due to a lack of knowledge of the prevalence of ACEs, discomfort with asking screening questions and perceived role. Yet, the primary care physician is uniquely positioned to play a critical role in the identification of ACEs and facilitating appropriate treatment. Interacting with adults, children and their families at regular intervals can allow patients and providers to develop a trusting relationship, which can facilitate the disclosure of ACEs. Contrary to popular belief, research has shown that screening for adversity is acceptable amongst patients. In an adult primary care setting, 79% of patients were comfortable being asked about ACEs and 86% felt comfortable being screened for ACEs. However, patients would only disclose if asked directly in a safe supportive manner. In a study at the Health Appraisal Clinic at Kaiser Permanente of San Diego, there was a 35% decrease in office visits and an 11% decrease in emergency room visits among participants compared to the prior year when they started screening for ACEs. Addressing childhood adversity in medical settings offers clinicians a more complete picture of important social determinants of health and has a great potential to improve health care utilization and encourage help seeking behavior.
What is trauma informed care?
A programme, organization or system that is trauma informed realizes the widespread impact of trauma and understands potential paths for healing; recognizes the signs and symptoms of trauma in staff, clients and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, practices and settings.
What can General Practitioners do?
- Learn more about the provision of trauma informed care and about trauma. Understand that “problem behaviours” may be manifestations or symptoms of trauma, or coping skills that served to protect them when surviving their trauma.
- Routinely ask patients about trauma history and trauma symptoms. This can be done using formal screening tools (E.g. Primary Care PTSD Screen, Brief Trauma Questionnaire) or by asking if patients had ever experienced one of the 10 ACEs identified in the ACEs study. Find out more about how to do so in a way that patients can feel supported to disclose.
- Discuss the impact of identified traumatic events if the patient screens positive. Not everybody who has experienced ACEs have ongoing difficulties. It is important to explore if current functioning has been impacted and the patient continues to experience distress from the traumatic experience
- Provide a referral if needed
- Follow up with the patient
 Weinreb, L., et al (2010) Primary Care Companion Journal of Clinical Psychiatry, Screening of trauma in adult primary care settings, 12(6)
 Goldstein, E., Athale, N., Sciolla, A. F., & Catz, S. L. (2017). Patient Preferences for Discussing Childhood Trauma in Primary Care. The Permanente Journal, 21.
 Felitti, V. J., & Anda, R. F. (2014). The lifelong effects of adverse childhood experiences. Chadwick’s child maltreatment: sexual abuse and psychological maltreatment, 2, 203-15.
This article was written by Dr Jasmine Pang at Benchmark Psychology. Jasmine has a particular interest in supporting children, adolescents, parents and adults who have experienced traumatic or difficult life circumstances and is passionate about ensuring high quality services be made available to them.
Something’s not quite right
James was like any other 9-year-old, but at the first mention of school his whole body would shrink and he would stare at the floor. Even though he had some good friends and wasn’t being bullied, he really didn’t like school. He didn’t have any ‘obvious’ issues, but he just couldn’t seem to keep up with the schoolwork and even started to call himself ‘the dumb kid’.
Chloe needed constant help to do her homework and was embarrassed to read in front of others. She was losing her confidence and every day became a battle to make it through the afternoon. Her parents were worried because they could see that if they didn’t do something she would be left behind, and their cheerful little girl would slowly withdraw away.
Parents are the experts on their children. They know their children better than anyone else, and they know when things aren't quite right.
Ryan has always seemed a little different from his brother. He didn’t play the same games and would spend hours alone, lost in “Ryan’s World”. He seemed to be a bright kid, but he never quite got it when it came to friends. One moment he would be smiling up at his parents and the next he would be on the ground. His parents were lost for how to help him.
The myth of watch and wait
These stories are ones we hear every day. Unfortunately, parents concerned about their child’s development are all too often told to ‘watch and wait’. They’re told that they are just ‘anxious’ parents and that their child’s problems are ‘just a phase’. These messages are not only invalidating for parents – they leave children behind and leave families and educators lost.
The path to helping children develop begins with understanding.
Parents are the experts on their children. They are number one. They know their children better than anyone else, and they know when things aren't quite right. Trusting this intuition as a parent and getting support as soon as possible, can help children reach their potential and be the best they can be before a small problem becomes a big one.
Finding a path for your child
Sometimes parents feel like they’ve tried everything to help their child and nothing seems to make much difference. They feel like they are sailing in the dark – not knowing which direction to turn. The real issue is that often we don’t have a clear understanding of the child’s thinking style or view of the world.
The path to helping children who are experiencing challenges in their social, emotional, behavioural, or academic development begins with understanding. A developmental assessment can provide this key and open up the pathway to change.Assessments for children can include a range of developmental areas. For example, cognitive assessments help parents to understand their child’s way of looking at the world.
Assessments for children can include a range of developmental areas. For example, cognitive assessments help parents to understand their child’s way of looking at the world, and can detect if a child is struggling to keep up, if they need more help, or if they have difficulty with a particular area of learning (such as problems with reading or paying attention). Assessments can also target specific developmental challenges, such as Autism Spectrum Disorders or Asperger’s Syndrome, Attention Deficit Hyperactivity Disorder, and clinical anxiety.
At Benchmark Psychology, we have a team of clinicians experienced in a range of developmental assessments for children and young people. Assessments are conducted directly by registered a clinical psychologist or clinical neuropsychologist with experience in assessments and postgraduate university qualifications.
We only use the gold-standard measures for assessment, such as the Weschler Intelligence Scale for Children (WISC), Weschler Individual Attainment Scale (WIAT), and Autism Diagnostic Observation Schedule (ADOS-2).
Every family is engaged in their child’s assessment process from start to finish. Parents receive a written report, outlining the assessment steps, the findings, and detailed recommendations to help parents decide where to from here. Parents also attend a feedback session with the clinician to go through the report together, discuss the results, and ask any questions.
Benchmark Psychology also offer families full assessment packages at a low cost (compared to other psychological practices in South-East Queensland).
To find out more or book an assessment today, call (07) 3349 5511 or visit benchmarkpsychology.com.au/services/cognitive-assessment/ for information about cognitive assessments or
benchmarkpsychology.com.au/autism-spectrum-disorders-assessment/ for autism spectrum disorders assessment.
This post was written for us by Dr Grace Sweeney and Dr Richard Wellauer from Benchmark Psychology.
Dr Aaron Frost gives some advice not only on how much screen time children should have access to, but also on what type of screen time causes the most problems.
How much screen time is too much ?
I get asked this question at least half a dozen times per week. Parents are worried about the amount of time their kids want to spend sitting in front of the TV, iPad, DS, PlayStation, Xbox and various other consoles and hand held devices. They often tell me things like, “my kids are absolutely feral after they spend a big chunk of time playing games”.
When I ask, "why don't you just remove the screens?", I get one or both of the following replies:
“I need the time, and leaving them on a computer to play games gives me a chance to catch up”,
“All my kids' friends are online, and this is how they communicate with each other, I don’t want him/her missing out”.
There are some real potential benefits of having technology in children’s lives, but it can often come at a cost. The challenge for todays’ parent is to figure out how to get the greatest benefits for the lowest costs.
Before I say anything further, it is worth highlighting that the American Academy of Paediatrics has released well researched guidelines clearly stating that two hours per day of screen time is the upper limit for a child. This is really helpful advice, and sets a good limit. But what I want to talk about in this article in what type of screen time rather than how much.
In my observations both as a parent and a child psychologist, there are three basic types of screen-based activities that a child engages in, and each appear to have different consequences.
The first is mindless screen time. This includes games such as candy crush, Plants vs Zombies, binge watching ABC for Kids, and most console games. Children spending large chunks of time engaged in mindless screen time will often seem most ‘feral’ immediately afterward. There are a two main reasons for this. Firstly, children engaged in mindless screen time are less likely to eat, drink and go to the toilet; emotions and behaviour in kids are driven by basic biology far more than most of us realise. Secondly, research conducted by Dr Grant Devilly and his colleagues found one of the main problems with mindless video games is that they don’t have a clear end point. When a child is reading a book, it is easy to put it down at the end of a page, however, when a child is killing zombies, or lining up shiny jewels there is no clear end. When they are finally forced off the game by their parents, children then experience high levels of anger and resentment. This is often where the “feral” mood sets in.
Mindless screen time should be avoided as much as possible, and it is up to parents to limit children’s exposure to this. Mindless video games are designed by their manufacturers to be compulsive, which is how they become best sellers. They are the junk food of screen time; a bit is ok every now and then, but too much too often is going to cause problems.
The second type of screen-based activity is engaged, and actualy involves the child’s brain being active. Some of these screen activities are educational, most are not, but the key point here is that the child is mentally stimulated and fully engaged. Please note that I am not a games reviewer, and do not endorse or have not been paid by any of these companies, but here are some examples to give you an idea of what to look for when shopping for games.
This game is aimed at younger children learning to read. It is engaging and educational, and designed to have small chunks of learning which matches the attention span of the children it is aimed at. There are lots of natural breaks, and it is easy to say to a child “come off the computer when this level is finished”.
Tiny Bang Story
This has been a recent discovery for our family. It involves a beautifully hand drawn world that has experienced a tiny explosion that has jumbled up all of the technology. The task of the child is to find all of the pieces and to put the world back together, one level at a time. It involves lots of lateral thinking, creative problem solving, and again there are many natural breaks for the child to step away form the screen.
This game involves a series of deceptively simple puzzles. In each puzzle, the child has to move a ball from its start point to an end point by drawing things. Everything they draw has real properties in physics. For example, if you draw a square in the air, gravity will make it drop the ground. If the square hits another object on the way down, this will cause the object it hits to move relative to the length of the drop and the size of the object. Children have to figure out how to solve each puzzle using the properties of the objects they draw. Once again, their brain is engaged, and there are lots of natural breaks incorporated.
This type of active screen time appears to be far less unhealthy for children (up to the time limits above). They are less likely to have huge tantrums when finishing, and the compulsive nature to their play is greatly reduced. These games are also excellent as they offer great opportunities for you and your child to do something together. You would be amazed at how quickly the entire family will get involved in trying to figure out how to push a tiny red ball up a hill.
The final type of screen time is creative, and involves children using their imagination to create things using a computer. Examples include Crayola DigiTools, iMovie, Photoshop, Lego Island and even a game like Minecraft. The key element to all of these games is that the child uses their imagination and is creating things. When a child is using one of these applications, their behaviour afterward appears to be no worse than if they had spent an hour drawing pictures or painting. Obviously, it is important that computer based creativity doesn’t replace real world creativity, but these types of screen based activity should be looked at more in the light of a modern version of arts and craft.
However, even these type of activities don’t always get a completely clean bill of health. Some of these activities have a multiplayer component which can be just as addictive as any mindless computer game. While there is nothing fundamentally wrong with multiplayer games, the social element draws some children (especially those who are less socially successful in real life) into spending far more time on these games than they had intended, and this can lead to them becoming very compulsive.
They key point here is that as parents it is important for us to learn about what our kids are playing. What they are playing is at least as important as how long they are playing. It is worth spending the time getting to understand the games they are interested in and what it is about these games that is attractive. Think about the mix of mindless games, vs creative and engaged games, and notice how your child reacts to both long and short periods of playing these games. Who knows, you might find a game you both enjoy, which can become a real relationship building activity for you.
Please note: Aaron has not received any kind of payment for his opinions regarding these particular products.