Category Archives: Discussion

“Children who exhibit the most severe and persistent anti-social behaviour are being failed by the system”

There has been a mixed response to the item about children with “Callous Unemotional Traits” on the BBC Radio 4 Today programme this morning.

 

(Clip here)

An interview with both parents and the young person just after 7.30am, was followed by discussion from leading psychiatrist, Professor Stephen Scott, after 8.00 and then a final segment asking if children with severe behavioural problems are being failed by ‘the system’ just before the end of the programme. Justin Webb‘s sensitive interview highlighted the regular violence and abuse experienced by the family, which leads them now to seek residential school or accommodation under section 20 for their son ‘Max’, as there is no other prospect of change in sight. Max is adopted but his difficulties were explained not so much by early trauma as by a psychopathic trait: Callous Unemotional Trait, which leaves him unable to feel empathy for others, or understand the problems with his behaviour. The overall message was: With an estimation of 1 in 100 adults exhibiting psychopathic traits (and overwhelmingly represented amongst the prison population), should we not be paying more attention to these children who seem to be heading that way, to find ways of moderating their behaviour and teaching / modelling greater empathetic behaviour, if not feelings. Multi-systemic therapy was suggested as one possible route, but the need for significant improvement in the provision of mental health services for young people was emphasised, both from a humanitarian / medical point of view and in view of the costs incurred in ignoring the issue.

So why the mixed response?

It was great to have such prominence given to the difficulties experienced by families in accessing help when they are being abused by their children – and these parents left no doubt that they considered their experience the equivalent of intimate partner violence.  The figure of 1 in 100 children being affected in some way by this condition was alarming (in the context of the many other additional causes that we know about), and there was no suggestion that this was the only explanation for abuse from child to parent, but it lent some weight to the general statistical discussion. There was some suggestion that children could be helped towards more appropriate social behaviour through rewards systems and positive reinforcement, notwithstanding the unlikely improvement in genuine demonstrations of empathy.

BUT….

The overwhelming sense of hopelessness was very strong. Not only was this a condition that might not be treatable, but the very means of help and support is out of reach for many as mental health services, particularly for young people, remain so poorly resourced. I think some parents felt that this was yet another possible diagnosis amongst so many others; and with still no real sense of definition of the problem or official recognition.

Family Futures, an independent adoption support agency, have written a response which you can read here. They remind us of the need to consider the whole picture and not to be hasty in ruling out the effects of early trauma on the developing brain.

I will remain optimistic because that is in my nature. And because the more coverage the better from my point of view – though clearly if you are a parent experiencing abuse on a daily basis, this is small comfort. I would like to know more about the condition, and to see for myself how it fits into the existing understanding and models of child to parent violence and abuse that we already have.

The radio interviews will be available for the next four weeks.

 

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#CPV: What does it look like, part 3. “It happened again tonight”

I am publishing this twitter thread from September 10th, with permission from Ian, who tweets as @DiaryAutism.

I think it adds something to the recent musings about the intent issue, and about the different issues for families where there is an autism diagnosis (here and here for instance); and leaves absolutely no room for any doubt about how it feels, for this person, to be a parent in that situation.

 

The most powerful emotion I have ever felt is the love for and desire to protect my children

It’s not that I’d take a bullet for them. It’s that I’d run through a brick wall to take a bullet for them

Parental love is all consuming and utterly life changing. Nothing else comes close

So when that love is repaid with violence it causes a great deal of cognitive dissonance. Just what the F is happening?

Of course it’s love you want to respond with, your child is not lashing out, they’re in distress. They need a hug from Dad

Which is exactly the opposite of what they want. In that moment, for whatever reason, you are not Dad. You are a target

E normally leads with the head. Not normally a butt, but something to push you away

But you can’t get away because he’s advancing on you and is normally digging his finger tips into your forearms

I say fingertips rather than nails because we’ve learnt the hard way to keep those bad boys short

By this point your soothing voice and pleas to calm down are drowned out by his screams. Screams that bare his teeth. Now it gets scary

Both your hands are busy trying to control his scratches, and he tries to bite you. How do you stop it?

A lot of the time you don’t and you let him sink his teeth into a part of your arm that has long since calloused up

Why? Because it gives you a momentary chance to get hold of something that might distract him. A toy, some food – anything.

By this point adrenaline is flooding your body and Fight or Flight has well and truly kicked in.

What to do? Flight? No chance! That’s my boy; he’s upset! I’ve got to stay and help

Fight? It’d be a lie to say that fighting back isn’t an enormously strong desire, especially if my wife or other children are at risk

But that parental lock kicks in – I’m not going to hurt him, therefore the only choice is to let him hurt me

And then – it’s over. Whatever caused the outburst has disappeared as quickly and as mysteriously as it took over

E will return to normal within a few moments and more often than not will be smiling before you’ve stopped bleeding

The welts, cuts & bruises are the least of your worries now though as that adrenaline you didn’t use to Fight or Flight floods your emotions

The worst part isn’t when it’s happening, it’s the powerlessness you feel afterwards. In feeling that love thrown back so brutally

We’ve had a bad weekend. 2 violent incidents, the first of which resulted in a short trip to hospital for me

But it’s a bad weekend on the back of a pretty good summer. I honestly can’t recall the last time this happened & that is such a good thing

It just goes to show; we’ll never not love him, he’ll never be able to control it always & we’ll never be truly out of the woods /end

Reading other threads, and other commentary, I am very aware that other families may not share the strength of conviction that Ian articulates. It is important that we do not build unhelpful levels of expectation, nor that we rush to heap further shame and pain on those who may experience things differently. 

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Summer #CPV harvest

I am often asked how I come across the news, articles and publications that I tweet and blog about, in relation to child to parent violence (CPV). My original rationale for this site was along the lines of  “I do it so you don’t have to”, but of course things are never that straight forward, and the truth is much more like “we do this together”. But here goes: Continue reading

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Child to parent violence: an unhelpful phrase?

Once upon a time, when I didn’t know so much about “parent abuse” it seemed a little exciting to be at the forefront of a new phenomenon. It felt important to speak clearly and categorically, for clarity, and the avoidance of misunderstanding – which was commonplace. “Parent abuse? You mean abuse BY parents? No? You must mean older people then?” Now it seems that the more I learn, the less certain I am about anything – other than the fact that many, many more parents than we would like to think about are struggling daily with much, much more than anyone should ever have to face within their family. Continue reading

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Cake – or no cake?

I spent last Friday at the NVR UK 2017 conference in London, where it was great to catch up with colleagues and people I had previously only known through twitter, to make new friends, and to learn how the practice of Non Violent Resistance (NVR) can be applied to all areas of life.

There were two keynote speeches, followed by a series of workshops; and one I was particularly interested in was about the establishment of parent groups connected with de Wiekslag, an organisation in Belgium working with high risk young people and their families. These groups are for parents of young people exhibiting very serious challenging behaviour (including violence to parents), or engaging in school refusal, self harm or running away, and they are described as “slow open groups”, with no course beginning or end, and parents can attend for as long as they like, or need – typically 9 to 12 months. When they leave, a place becomes available for another family. Continue reading

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#CPV: What does it look like, part 2. Intent stuff

One of the issues that makes it difficult for us all to talk about child to parent violence and abuse is the fact that there is no one agreed definition. The one I tend to use when speaking to people is that proposed by Amanda Holt:

“A pattern of behaviour, instigated by a child or young person, which involves using verbal, financial, physical and /or emotional means to practice power and exert control over a parent”, and “the power that is practised is, to some extent, intentional, and the control that is exerted over a parent is achieved through fear, such that a parent unhealthily adapts his / her own behaviour to accommodate the child.” Continue reading

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Child on Parent Violence: Beginning of a paradigm shift?

I am grateful to Dr Girish Vaidya, Clinical Director at Sheffield Children’s NHS Foundation Trust, for allowing me to repost this recent blog on his experience of discussing CPV with colleagues.

Originally published on April 8, 2017

Al Coates and Dr Wendy Thorley’s 3 reports (the last of which is linked here) into an online research project provided fascinating reading and prompted me to present the subject in a CPD seminar for fellow psychiatrists in Sheffield’s Child and Adolescent Mental Health Service (CAMHS). I was particularly keen to share the findings of the reports, my fellow professionals’ experience of this issue and how they managed to address it.

It was heartening to hear that all my colleagues were aware of the issue. When I invited them to think about the impact on the families experiencing, their guesswork was entirely in line with the findings from Al Coates and Dr Thorley’s investigation. What this meant was that once seized of the behaviour as a problem, professionals were able to consider its consequences to the children, families and wider society.

There were also some examples that colleagues offered. One Learning Disability CAMHS Consultant recalled how she was horrified when confronted with a suggestion from social services that a child – who had earlier required 5 people to restrain him – had been advised to be returned home to his frail mother. Quite a few chipped with their experience of Sheffield Children’s Social Services and expressed their pleasant surprise at the speed of response and collaborative nature of working. It was also acknowledged, much in line with what Mary Aspinall – Miles said at a recent conference, that “parents should consider carefully before calling the police”.

So, what should parents (and professionals) do when dealing with a difficult subject like Child on Parent Violence?

My fellow psychiatrists were keen that professionals and parents work out a ‘pre-emptive emergency plan’ so that parents are not left in a dilemma about what they should do. A couple of colleagues were passionate about treating CPV on the same level of child abuse. They were also aware of the Sheffield Domestic Abuse Coordination Team’s MARAC (Multi Agency Risk Assessment Conference). Some suggested that parents should be asked about their ability to cope vs. their ability to manage their life.

Reassuringly, there was a near universal desire to have a ‘rating scale’ on the lines of various risk rating scales that professionals use, to have a common language about CPV. (I am not aware if there is any such scale and if there is, would be keen to know about it). If there isn’t a scale, my colleagues are keen to work with anyone to help develop one.

Writing this, I am reminded of an incident many years ago when one family’s holiday came in for professional scrutiny. The child had been inflicting severe violence on his parents which had destroyed many a family holiday for the rest of the family. Parents decided that they wanted to do something which didn’t wreck their other children’s holiday. They planned to take separate holidays – father with the other children and mother with the lad. They would swap the following year. It was deemed to be a demonstration of family pathology that they didn’t manage to have a family holiday without a fight. I felt that was being a bit too harsh since the family were trying to find a way out of a very challenging situation not fully appreciated by professionals. What do you think? Would you agree with Hannah Meadows’ assertion that self-care is an intelligent response to dealing with long term stress? Or would you rather that the family learn to live with the CPV on holiday?

What next?

Feedback from the CPD seminar suggested that this is just the beginning of our journey. Professionals want to know more, need to know more so that they can support more. Everyone agreed that it was a less discussed issue in clinical discussions and many emphasised that they would be on the lookout for CPV in their clinical practice in the future.

Let us continue the conversation…………………………..

If you are keen to collaborate on scientifically researching this challenge, we – as an organisation and I as a Clinical Director – would be keen to work with you.

 You will find the original here.

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