Just Faking It?: Exploring issues of the mind and body underlying somatising disorders
Friday 3 February 2017
Hilton Southampton, Bracken Place, Chilworth, SO16 3RB
Somatic symptoms can be distressing and have a negative impact on day-to-day life. When the amount of distress that is experienced and the degree to which functioning is affected seem disproportionate or when no medical explanation for these symptoms can be found, management and treatment of these difficulties becomes infinitely more complex.
Covering a wide range of topics, this conference explores key issues in our understanding and management of young people with somatisation disorders.
This conference is suitable for those working with children and young people in primary care, education, social care and youth-based services as well as those working in both physical and mental health.
Content covered during the day includes:
· A look back at the concept of hysteria, its changing meaning and its fit in modern day psychiatry;
· An exploration of the complex issues encountered when navigating the interfaces between somatisation and safeguarding;
· An overview of the evidence base for treating functional symptoms as well as the skills needed for engaging young people with assessment and treatment of these;
· Examination of non-attendance at school and how this is understood;
There is a vast market in courses/ books/websites to help parents who are struggling with their children’s behaviour. Fortunately, they are all founded on the same core principles, which are summarised below. What one is essentially doing is implementing new habits, forming new structures of reward and consequences to make the organisation (family) run more smoothly and improving interpersonal relationships. (It is a process that should be familiar to anyone working in the NHS, who will also understand its difficulty!)
In order for behavioural management to be effective, it needs to be based on a ‘good enough’ relationship. At some level, the child needs to care about the parent’s feelings, and also feel good about themselves, to cope with the changes the parent wants.
Promoting the emotional security of the relationship through shared activities is useful, so any shared activity is worthwhile, but play is paramount for younger children. Play led by the child for a short (10 minute) period is advised, but any play where the adult attention is on the child is useful.
‘Catching them being good’ and noticing when they have made small positive steps is a powerful tool.
Targeted praise: vague, general praise (aren’t you a good boy) has been shown to be worse than none at all, whereas specific praise (I like how you did X) is beneficial.
Much attention is focused on children’s screen time, but it is perhaps more important that parents limit the time they are unavailable to their children due to phone conversations, Facebook etc. Unlike most household tasks, these cannot be combined with conversation with the child. Parents must learn to distinguish between listening to the child respectfully and granting the child’s every wish, as learning to tolerate a degree of frustration is an important step in emotional development. .
A routine is important for children to feel safe and reassure them that the adults are in control. This can be very mundane, like a list of tasks involved in getting ready in the morning, or fun, like a weekly film night.
There need to be rules, binding upon the adults and children. These need to be simple, unambiguous, and (initially) few, perhaps 2 or 3. These rules should specifically target unwanted behaviours (eg don’t hit, rather than be good). Patterns of behaviour take a long time and much effort to change, using positive and negative encouragement and the power of habit, so sometimes it is more productive to target only one behaviour at a time to start off with.
Planning for situations does not require strategic genius. Parents know the situations where children have trouble, so before they enter a supermarket, for example, it is useful to stop, and calmly tell the child what is expected, what is not allowed, and what the consequences of positive and negative behaviour will be.
None of the above will have any effect unless parents are consistent, in several ways:
* consistency over time.
* consistency across all parents and carers
* consistency across settings and contexts.
Rules cannot be dependeant on parents’ moods or energy levels. Occasional rule lapses act as ‘intermittent reinforcement’, shown to be the single most powerful way to ensure that the behaviour that is being targeted continues with a vengeance.
This is perhaps the most important element, yet often overlooked by parenting manuals selling a quick fix. Behavioural management works, but takes time, and there is often an ‘extinction burst’ of increased unwelcome behaviour before things start to improve, as the child reacts against the new boundaries. Parents need to be prepared for this.
As well as patience across weeks, parents need patience across hours, to be able to abandon a shopping trip, wait out a tantrum, or stay calm in the face of sibling conflict when shouting would, in the short term, be quicker.
Please read our introductory post before reading this
As always, you need to know
a) generic advice
b) a formulation that tells you why this child has problems now.
You can then adapt the former according to the latter.
Sleep schedule: Your child’s bedtime and waketime should be about the same time everyday. There should not be more than 1 hour’s difference in bedtime and waketime between school nights and non-school nights. Make your child’s bedtime early so that he can get enough sleep.
Bedtime routine: Your child should have a 20-minute to 30-minute bedtime routine that is the same every night. The routine should include calm activities, such as reading a book or talking about the day, with the last part occurring in the room where your child sleeps.
Bedroom: Your child’s bedroom should be comfortable, quiet, and dark. A nightlight is fine, as a completely dark room can be scary for some children. Your child will sleep better in a room that is cool (less than 75°F). Also, avoid using your child’s bedroom for “time out” or other punishment. You want your child to think of the bedroom as a good place, not a bad one.
Snack: Your child should not go to bed hungry. A light snack (such as milk and cookies) before bed is a good idea. Heavy meals within an hour or two of bedtime, however, may interfere with sleep.
Caffeine: Your child should avoid caffeine for at least 3 to 4 hours before bedtime, although it’s best to avoid it totally. Caffeine can be found in many types of soda, energy drinks, coffee, iced tea, and chocolate.
Evening activities: The hour before bed should be a quiet time. Your child should not get involved in high-energy activities, such as rough play or playing outside, or stimulating activities such as computer games.
Television: Keep the television set out of your child’s bedroom. Children can easily develop the bad habit of “needing” the television to fall asleep. It is also much more difficult to control your child’s television viewing if the set is in the bedroom. Keep all other electronic devices out of the bedroom too, such as computers, cell phones, and hand-held computer games.
Naps: Naps should be geared to your child’s age and developmental needs. However, very long naps or too many naps should be avoided, as too much daytime sleep can result in your child sleeping less at night.
Exercise: Your child should spend time outside every day and get daily exercise.
Sleep problems resistant to first-line advice
Most parents presenting with young children with sleep problems are frustrated by the child’s inability to settle to sleep alone, or by their frequent night wakings. We will not discuss infant sleep, but concentrate on the pre-school child.
Social factors: Historically and cross-culturally, it is highly unusual to expect young children to sleep alone. Nonetheless that is the UK norm, and it is acheivable for most families.
Psychological: Going to sleep alone is a form of separation, and like all separations must be prepared for. If the child is in an anxious or fearful state this will require very slow withdrawal of the protective adult. Usually, if the fear is external to the adult, e.g. of the dark, gradual withdrawal is effective, but where the fear is of the adult, or more commonly about the adult, e.g. in domestic violence, then more specialist work may be needed.
Sleep is also a habit, and habits form very strongly in pre-school children. If sleep is usually with an adult, or in the light, changes to this should be carefully applied one at a time. Likewise, if the physical situation (light, noise, presence of adult) is different between sleep onset and the (normal) awakenings that occur every 1-2 hours, then full arousal will often result.
There is an association between some forms of insecure attachment and sleep problems, and also maternal depression. The precise relationship is unclear, however, and probably varies from family to family.
Biological:sleep is a biological phenomenon, and is therefore affected by biological mechanisms. Chronic symptoms e.g. pain or GI symptoms may prevent sleep, but equally phenomena such as epileptic seizures can disrupt the diurnal rhythm. A far more common way to interfere with sleep initiation is to watch a back-lit screen close to bedtime. These appear to suppress endogenous melatonin secretion, and thus the psysiological ‘cue’ to sleep, and so should be avoided within an hour of bedtime.
Louie, 4, has a tantrum every night at bedtime. His health visitor has advised mum to shut the bedroom door and ignore him, but it’s not working.
4p grid constructed as follows:
|Predisposing||Preterm birth||Maternal anxiety|
|Precipitating||Break-up of parents’ relationship||Domestic violence|
|Perpetuating||Screen use in bedroom up till bedtime||Anxiety re: mum||Mum unavailable due to depression|
|Protective||Healthy, good communicator||Good relationship with mum during the day||Family well-supported by grandparents|
This leads to some simple, hopefully helpful interventions:
- Stop screen time
- Mum to seek counselling/ treatment for depression.
- Grandparents asked to help with domestic tasks so mum can spend time with Louie
- Gradual withdrawal of mum from bedroom at bedtime, following good ‘wind-down’.
Date: 24th January 2017
Venue: Central Edinburgh
This is a one-day training course designed to provide an understanding of the causes of poor sleep in children and young people with additional needs, including an overview of sleep processes and the support that you can offer to families. Further info can be found at our website: http://www.sleepscotland.org/
If you’re not already an individual member of CoramBAAF, read this:
For £100 per year you can be a part of the leading membership association for adoption and fostering agencies and professionals.
So if you want to:
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- Be a part of the largest professional community involved in adoption and fostering issues in the UK
If you would like to find out more about membership, please visit the CoramBAAF website by clicking here
Worryingly, over two children in every primary school class will have a diagnosable mental health condition and one child in eight will have one or more mental health conditions at any time. With half of all diagnosable mental health disorders established by the age of 14, there is a strong case to promote children and young people’s mental health.
Up until now, school teams and support staff have not had clear information about robust, evidence-based tools to help them measure and monitor wellbeing – the toolkit provides a practical step by step guide to achieve this.
The toolkit will be of interest to senior leadership teams and those with particular responsibilities for Special Educational Needs and Disabilities (SEND), inclusion, Personal Social Health and Economic education (PSHE), welfare or pastoral support and mental health support. It will also be of interest to partners from the health, voluntary and community service sector who are supporting schools and colleges to improve mental health outcomes for children, young people and their families.
To help schools and colleges think through why and how they might choose to measure student mental wellbeing
To encourage schools and colleges to make use of, and to signpost them to a range of validated (tried and tested/ robust) survey questions and instruments that can help them to do this.
To share insights from schools and colleges that are doing this already.
One from the good article bad title bin.
Eating Disorders Summit: Rapid Early Intervention & Developing a Gold Standard Service
Monday 16 January 2017 De Vere West One Conference Centre, London
The National Eating Disorders Summit will focus on ensuring rapid early intervention for people with eating disorders, in line with the national waiting time standard, and developing a gold standard service including dedicated community eating disorder services. Through national updates, lived experience and practical case studies the conference will also look at how you can implement the new National Standards for eating disorders as outlined in the five year forward view implementation plan published in July 2016. The conference will also address preventing relapse, commissioning effective eating disorder services and looking forward to the NICE Guidance on Eating Disorders: Recognition and Treatment which is due to be published in April 2017.
For further information and to book your place visit
Follow the conference on Twitter #EatingDisorders
Meeting the National Reporting Requirements for Female Genital Mutilation (FGM)
Monday 23 January 2017
De Vere West One, London
Chaired by Vanessa Lodge Chair of the National FGM Steering Group at NHS England, this conference looks at improving services, safeguarding, and meeting the national reporting requirements for Female Genital Mutilation (FGM). Through national updates, extended sessions and case studies the conference will look at your obligations with regard to reporting FGM, safeguarding those at risk of FGM, and providing effective services for victims of FGM.
For further information and to book your place visit
Follow this conference on Twitter #FGM2017
Transforming Mental Health Services for Children & Young Adults
Monday 30 January 2017
De Vere West One, London
This conference is aimed at all mental health professionals in front line services who have a role in supporting young peoples mental health & well being. The day will focus on The Five Year Forward View for Mental Health set out by the government in 2016 with the aim of creating a transformed service by 2020. Through national updates and case studies from current pilot sites this conference will detail the progress already being made to achieve The Five Year Forward View and give practical advice and guidance for professionals on how to achieve improvement within their service.
For further information and to book your place visit
Follow the conference on Twitter #CAMHS
Safeguarding Children & Young Adults: Level 3 Mandatory Safeguarding Training in Accordance with the Intercollegiate Guidelines
Monday 16 January 2017
De Vere, West One, London
The course is interactive and aims to highlight the key principles of safeguarding children and young people, with a view to embedding best practice in safeguarding in accordance with the core UK legislative framework and guidance.
Healthcare and allied professionals requiring level 3 mandatory safeguarding children and young adults training and those professionals requiring an insight into safeguarding principles and best practice.
Certificates for this training counts as the 3 yearly safeguarding children training in accordance with Intercollegiate guidelines.
For further information and to book your place visit http://www.healthcareconferencesuk.co.uk/safeguarding-children-and-young-adults-level-3-safeguarding-training or email email@example.com
We are proud to show you our programme for the winter meeting this year- it looks absolutely great! The meeting will be on the 26th and 27th January 2017.
The programme is here: Highgate 2017 Programme Final 23Sep16a
Register online here: http://www.participant.co.uk/pmha_highgate
Or, if you don’t trust this internet thing everyone’s talking about these days, here’s a paper application form: Winter Meeting 2017 Paper Application form
You may not have read the government’s response to the House of Commons’ Education committee, which undertook an extensive enquiry into the health and well-being of looked-after children. I don’t blame you, so let me save you the bother.
Education committee says:
LAC children have terrible mental health outcomes (interestingly almost the whole report is about mental, not physical health)
They often have poor access to CAMHS and other mental health support services, especially if their placement is not stable.
They are often hard to reach, and their difficulties do not fit into neat categories, so need a flexible approach to referral and therapy.
I would add: The current system of medical monitoring is excessively focused on exhaustive information gathering, and fastidious paperwork, over mental health and focusing on the child’s current needs.
In summary, the government’s response is “no, everything is just fine, and anything that isn’t fine is the local authorities fault”. Again and again they reject the recommendations, some kicked to the long grass while their expert reference group spends 18 months coming to the same conclusions as the committee, some dismissed because Future in Mind solved mental health.
Deeply disappointing but sadly, not a surprise.