[Posted on 18 March, 2019 by Helen Minnis]
When my children were small, a saying became briefly popular among Scottish parents – the “SMOG”: the Smug Mother Of Girls. We could argue forever about whether boys are actually harder to parent than girls, but I think there are two deep truths inherent in this statement: 1. some children are harder to parent than others 2. parents of “easy” children can be a bit smug about it. Clinicians can be smug too – probably imagining that if only they had had the opportunity to parent that particular child, he or she might not have those behavioural problems. I suspect that these attitudes, even when unspoken, cause untold damage to parents’ confidence, perpetuate the stigma around “parenting problems” and prevent families seeking the help they need for their child.
We, as clinicians, should know better. Russel Barkley, in his wonderful Birgit Olsson Lecture last year, pointed out that the most stressful children to parent are children with ADHD. We have known for decades that children with developmental disabilities are more likely to be abused and neglected 1. The fact that some children are harder to parent than others is old news – but it’s news that, as clinicians, we haven’t yet absorbed.
And it’s a confusing story for parents. We know that in the overwhelming majority of situations parenting only needs to be “good enough”2, not perfect. Some of us are strict and like to tightly structure our children’s lives while others among us are more “free-range” – and it probably doesn’t make that much of a difference, as long as we have some basic rules and are mostly kind. So does parenting make a difference or doesn’t it? When our children are doing well, we like to take the credit for it (I saw you sneaking those pictures of the school prize-giving back into your wallet!). We suspect that all that effort to get them to bed on time and supervise their homework was the secret. Then we are amazed when friends’ children do just as well – even though they did things very differently. Science tells us that attachment relationships are crucial for children’s safety and health and that sensitive parenting is hugely important – yet attachment patterns are usually secure, even in some of the most dire of social circumstances3.
The great behavioural geneticist Robert Plomin tells us that the way we parent our children won’t make a massive difference to children’s outcomes4. I suspect this is true for about 90% of us, but about 10% of children have neurodevelopmental problems; for their families, parenting can be a much more challenging task and those all-so-crucial attachment relationships can be harder to build. This was forcibly brought home to me in a conversation I had with an occupational therapist who works through a neonatal intensive care unit. Earlier this year, she was working with a mother and her 5 month old baby. The little girl had a chromosomal disorder. The occupational therapist asked the mother what her goals were for the occupational therapy. She said “I just want a cuddle from my baby”. This mother was articulating the knowledge that all parents instinctively have – that children need to exhibit attachment behaviours, such as reaching out to be picked up, and that our role as parents is to respond to these. It took until she was 20 months old, and some intensive occupational therapy, before the little girl could lean her head against her mother’s face and this crucial relationship foundation stone could be laid.
We also know that many ESSENCE problems run in families. Imagine trying to parent a hyperactive and argumentative child if you yourself struggle with impulsivity and a low frustration tolerance. On the other hand, parents who themselves have ESSENCE problems can be more accepting of children whose temperaments and quirks they fondly recognise. When parents are well supported to support their children – and neurodiversity in the family is embraced – children with ESSENCE can thrive. Our most successful businesses and institutions are, I’m sure, often led by people whose ADHD gives them huge energy and creativity (harnessed with the help of a good admin team) or people with autism whose intensity of focus allows them to follow through against all the odds. In Britain, we love our “British Eccentrics” and I’m sure quite a few of them have been our Prime Ministers over the centuries! In our neurodiverse world, support and adaptation is the key and nowhere is this truer than in parenting.
As clinicians, we need to stop being smug. We need to realise that the stressed parent of a child with an ESSENCE problem who has come to consult us is walking a challenging path. We have never walked in his or her shoes. Parents in this situation deserve all our respect and support – and this might be the important ingredient that helps them get the support they need for their child.