Saturday, 19 August 2017

'Pre-parties' and a 'tactical vomit' again! Can parents really provide a 'safe space' for young people to drink?

It's hard to believe that it was four years ago that I first wrote about the 'tactical vomit' phenomenon! If you were around at that time you may remember that I was asked by a Year 10 girl what I thought about the 'benefits' of a 'tactical vomit' ... now, as I said in that blog entry, maybe I had missed something when  I was a teenager but I had never heard of this. It took a little time and quite a few conversations with friends, colleagues and some young people to really get what she was talking about ... As I said then, there were certainly some people who had a vague idea of what she was referring to but almost everybody was surprised about the age of the girl who asked me about the practice.

For the uninitiated, here is a part of an email I received from another Year 10 girl who I asked to describe a 'tactical vomit' and how it was used by young people of her age:

"Before we go out to a party for the night we usually meet at someone else's house and have a few drinks beforehand. Sometimes someone drinks too much and it gets to a point that we know she won't be able to get into the party we're going to because she looks too drunk and the parents or security guards wouldn't let her in ... That's when we would have a tactical vomit - she would go into the toilet and stick her fingers down her throat or drink a glass of salty water to throw up and sober herself up. After a bit of time she'll feel a little better and we can go to the party and get in."

What we are essentially talking about here is 'self-stomach pumping'! As I said at the time, this is not an entirely new phenomenon. In fact, there are a range of definitions describing the practice available on the web, with some websites actually providing advice on how to make yourself vomit. Now, if you're in your late teens or early 20s and surrounded by friends who may have a bit of life experience and you think that this might be a good idea for you, go for it! What continues to concern me is how young some of these teens are and, more importantly, where are the parents who are meant to be supervising them at these 'pre-party' events?

In the past couple of weeks I've been asked about a tactical vomit at least three times, all in the context of drinking too much at a 'pre-party' and then having to try to sober up to ensure that they could get into the 'real party' of the night. So what is it with these so-called 'pre's' and where are the parents who should be monitoring what these very young teens are doing?

I've discussed the 'pre's' phenomenon many times over the years. These began with the 'pre-formal' drinks that some parents host before school events (something I just can't understand - providing alcohol to young people, no matter how small an amount, and then sending them off to a school function where teachers have to supervise - it's so unfair to the staff and potentially, so dangerous!). Unfortunately, these aren't new and have been around for many years. What is new, however, is the whole idea of the 'pre-party'. Some of these are hosted by parents, where those attending are either provided, or bring their own alcohol and drink it before attending a potentially 'dry' party later on that evening. To the best of my knowledge, the parties where parents provide alcohol, or tolerate or 'turn a blind eye' to drinking, usually don't start until around 15-years-old. That said, there are certainly 'pre's' that 14-year-olds attend where alcohol is consumed. That's no surprise when you hear what some parents are doing at even younger ages ... I was recently told by a parent that her 11-year-old daughter was invited to a 'pre-sleepover', where the girls attending were provided with a mocktail at the door as they entered! Why would anyone host an event like this and why would you be giving a mocktail to an 11-year-old?

From what I've heard from young people about the 'pre's' they attend, some of the main features of these events are as follows:
  • they are usually quite small, comprising of just their close friendship group
  • the main purpose of many (but certainly not all) of these is to preload with alcohol before the main event of the night, particularly if it is a 'dry' event, i.e., security will be present and alcohol is not permitted
  • they are much more popular with girls than with young men, often because females often use them to get dressed and 'made-up' (sometimes changing into clothing that their parents would not necessarily deem appropriate)
  • some parents do allow alcohol to be consumed but that is certainly not always the case
  • although parents can sometimes be there, often a home will be chosen specifically because they won't be there. These events are held early and are short (a couple of hours at most), enabling teens to arrive, do what they need to do and leave - all in the time it can take for parents to see a movie or go out for dinner!
  • as they're held earlier in the evening (or in some cases, the late afternoon), teens are much more likely to be able to convince their parents to let them get to the house by themselves, thus avoiding any issues with meeting other parents and the like
I was talking to a Year 11 girl this week and when I asked her about 'pre's' and whether she went to them she said the following:

"I don't drink alcohol so there's no point to me going to them. Lots of my friends go and get drunk before the party but I don't bother anymore. When we were younger in Year 7 and 8, 'pre's' were all about getting dressed up, putting on make-up and getting ready, but now they're all about drinking."

When I asked one of her friends she was with about parent supervision at these events, she said she rarely saw parents when she attended:

"If someone is home, you don't really see them. They kind of leave us alone to do our thing. I've never been to a 'pre' where the parents have given alcohol to us but I don't think we've had to hide our drinking from them since we were in Year 9. They just know that it's safer for us to drink in their house than in the park." 

And there it is again ... that old chestnut, it's safer to let them drink in the home because "at least they're not drinking in a park!" Maybe I could agree with that statement if there was any sign at all of parental monitoring of the drinking that takes place at these events, but there clearly isn't any ... When 14- and 15-year-olds are getting so drunk at 'pre's' that they actually have to put their fingers down their throats and vomit in an effort to enable them to go to where they're planning to go next, you have to wonder if there any monitoring happening at all!

Now I am sure that there are some parents who truly believe that providing a 'safe space' for their teen to drink is entirely appropriate. If that is what you believe is right for your child and your family, all power to you! I have no problem with that at all, what you do with your child is your business. It's when a home is opened up for other parents' children that I have an issue, particularly for 15-year-olds. If you're going to hold a 'pre' at your home and you're going to allow other children to drink there, make sure everyone of their parents know about it. Monitoring your own child's drinking in a 'safe space' may not be that hard, trying to do the same for a group of teens may prove much more difficult!

I am now starting to believe that the 'pre's' are now becoming more dangerous events than the parties they precede. Anecdotally, parents certainly appear to be putting much more effort to ensuring the parties they put on in the home are as safe as possible. It takes a brave parent to host a teenage party and when time and energy are put into planning these events, most go off reasonably successfully. You don't see the same effort applied to the 'pre' and this is why we are increasingly seeing very young teens turning up at the door of a party incredibly intoxicated (i.e., 14-year-old girls too drunk to walk and boys of the same age throwing up on the front garden of a party as they fall out of a taxi). Where are the parents of these young people who are so at-risk? Did they bother to find out anything about the 'pre' that their child was going to? And what about the parents hosting the 'pre's' - did they see these teens before they left their house to make sure they were safe and well?

I'm certainly not saying that you shouldn't let your teen go to these events - please don't use what I say as a 'big stick' and say "Paul Dillon said ...". If your child wants to attend, you should try your best to let them - saying 'no' to them all the time is not going to make it easy for anyone. But do your due diligence and find out more about the events your son or daughter wants to attend on a Saturday night, not just the party but the 'pre-party' as well. Will there be parents actively supervising? Will alcohol be permitted or tolerated? How will they be getting from the 'pre' to the actual party? Based on the information you collect, you can then make a decision on whether they can go or not and what 'caveats' you need to place on their attendance to ensure their safety.

As I've said many times before, if a teen wants to drink, there is very little that any parent can do to stop that from happening. Were your parents able to stop you? That said, parents should make every effort to make it as difficult as humanly possible for them to access alcohol for as long they can. Hosting events for young teens to drink alcohol and then sending them off to someone else's home for the rest of the evening makes little sense and, is in fact, incredibly dangerous (and unbelievably unfair to the host parents of the next party). The concept of tactical vomiting is a great example of potentially dangerous behaviour associated with this idea of providing a 'safe space' for young people to drink.

Saturday, 12 August 2017

Teen brains and getting them to do things: Why limiting the number of instructions and making messages clear is so important

We've long known that in the first few years of their lives a child's brain goes through a tremendous 'growth spurt' and, during this time, they learn so much. Almost in spite of you, they are able to pick up on every little thing that goes on around them and it is often difficult for parents to keep up with the constant changes that are taking place. The teen years, on the other hand, are not usually seen as a key time for positive changes! This is a time usually associated with risk-taking behaviour and few parents realize that even during this difficult period, adolescent brains are continuing to develop. In fact, if teens are given the opportunity, this can actually be, as neuroscientist, mother and author of the book The Teenage Brain, Frances Jensen describes it, a "golden age for their brains!"

After the growth spurt that occurs around 10-13 years of age (a time when new neurons and synapses are being created, forming new pathways) the teen brain starts to 'prune' these pathways. The brain does not need to keep all that has been produced and so, with experience, the unused pathways are eliminated. This is often referred to as the 'use it or lose it' stage and actually leads to the adolescent brain becoming a "leaner, more efficient adult mental "machine.""

Although it may not always seem like it, the teen years are actually a time when the brain is learning at peak efficiency. In her book, Jensen highlights research that has found that one third of 13-17-year-olds actually "significantly raise their IQ" during this time of their life - there is indeed positive stuff happening! Unfortunately, there are other things that aren't functioning as well, including attention, self-discipline, task completion and emotions. These under-performing areas can often lead parents to feel incredibly frustrated, particularly when it comes to getting a teen to do anything, whether it be their homework, household chores or even just getting up to the dinner table ... To help parents in this area, Jensen suggests the mantra "one thing at a time" ...

"Try not to overwhelm your teenagers with instructions. Remember, although they look as though they can multitask, in truth they're not very good at it. Even just encouraging them to stop and think about what they need to do and when they need to do it will help increase blood flow to the areas of the brain involved in multitasking and slowly strengthen them. This goes for giving instructions and directions, too. Write them down for your teen in addition to giving them orally, and limit the instructions to one or two points, not three, four or five. You can also help your teen manage time and organize tasks by giving them calendars and suggesting they write down their daily schedules. By doing so on a regular basis, they train their own brains." 

Remember, you're trying to keep them using the pathways in the brain that you want them to keep. Giving your teen clear and simple instructions that are easy to understand strengthens those pathways. This idea is also incredibly important when it comes to setting limits and making rules.

I've referred to Robert MacKenzie's book, Setting Limits with Your Strong-Willed Teen a number of times recently. It's a great resource for parents, particularly for those who have that one child who just seems to love to 'push all your buttons' ... constantly! In one chapter of his book he provides some simple guidelines for giving a "clear, firm limit-setting message", none of which are particularly revolutionary, but a couple of them reinforce the notion of 'simple and clear':
  • keep the focus on behaviour - whatever you say should be about behaviour and not on attitude, feelings or worth of your teen
  • be specific and direct - what is it you want them to do (the fewer the words the better)?
  • use your normal voice - the tone of your voice can shift the focus away from behaviour onto feelings
  • specify the consequences for noncompliance - make it extremely clear about what will happen if they don't do as you ask
Using these tips, an example of a limit around attendance at a party or gathering or discussion around drinking alcohol could be as follows:

"I will be picking you up at 11.00pm. You need to be outside waiting at the letterbox at that time. If you are late you won't be going to a party next week." 

"You can go to the party but you know our rules around drinking - you are not allowed to drink alcohol. If you do drink, and we find out, you will not be allowed to go to the next party you want to go to."

The instructions are simple and can't be misinterpreted, (i.e., be at the letterbox at 11.00pm, you are not allowed to drink alcohol) and there aren't too many of them, ensuring the limit you have set is able to be managed effectively by the teen brain. Remember, giving instructions like this not only protects them from risky behaviour and potentially keeps them safer, it also 'trains their brain', reinforcing important neural pathways. The consequence of not following the request is also clear - all that remains is for you to follow-through should they not comply. What you don't want to do is to try to lay out limits in this area and make statements such as these:

"Now I want you home at a reasonable hour - I don't want to see you come home like you did last weekend. If you're too late I won't be happy and there'll be trouble." 

"You know how we feel about drinking. We would be terribly disappointed if we found out you had drunk alcohol at the party. Can you imagine what it would be like for us to get a phone call from a hospital saying that you had been brought in after drinking too much?" 

These are unclear and potentially confusing, leaving them open to interpretation. Who works out what "a reasonable hour" is, you or your teen? What does "too late" mean? You can guarantee their view on what time is suitable is dramatically different to yours. Do they actually know how you feel about drinking? As for potential consequences, "there'll be trouble" doesn't provide any real idea of what will actually happen should they come home late, and although telling your child you would be disappointed if they were caught drinking is important, it needs to be followed up with an unambiguous statement about what that behaviour will result in. Open-ended questions, such as asking them to see the situation from your perspective, are unlikely to be helpful when setting limits.

At the same time, parents also need to remember that much of a teen's response to the world is driven by emotion, not reason. This emotional response has huge consequences when it comes to asking them to follow rules and do other things that are asked of them, particularly when it comes to giving them instructions. During adolescence there is much less activity in the frontal lobes than there is for adults, making it harder for them to handle their emotions. This is why they can fly off the handle at the smallest thing and why so many parents suddenly start experiencing slamming doors, throwing things and screaming during the teen years.

This means, that as a parent, you've got to try to remove as much of the emotion out of your request as possible. Trying to throw a guilt-trip on a teen is not always going to work. I'm not saying you shouldn't tell them how you feel and how their behaviour has affected you and the rest of the family, but when it comes to the instruction you give them about limits and rules - remove the emotion! As MacKenzie suggests, you need to make it about the behaviour and not them ... You can almost guarantee that they will bring it back to them (remember the world, as well as the sun and all the stars revolve around them at this time in their life!), but if you limit the number of instructions you give them and make whatever it is that you want them do clear and simple, not only could it have a positive impact on their brain development, but it could make it all just a little easier for you ...

References
Jensen, F.E. & Ellis Nutt, A. (2015). The Teenage Brain. Harper Collins: New York.
MacKenzie, R.J. (2015). Setting Limits with Your Strong-Willed Teen. Harmony Books: New York.

Saturday, 5 August 2017

Teen brains and driving: The one 'request' all parents should ask of P-platers

As the eldest of three sons, I was the first to get my driver's licence. After the initial shock that I actually passed my driving test the first time (I am a terrible driver - my father says I don't drive a car, I aim it!), Dad sat my brothers and I down and shared with us his one rule when it came to driving, i.e., he never wanted for one of us to be behind the wheel and the other two to be passengers in the car. His explanation was simple - young drivers aren't experienced and accidents happen, to have one of his sons in a car crash would be bad enough, to have all three in that vehicle would be devastating.

Over 4 decades later I cannot think of a time when the three of us have ever been in a car together with one of us driving! For some reason the discussion we had all  those years ago just stuck!

This rule certainly did not come about as a result of my Dad's extensive knowledge of research in the area (in fact, I doubt whether any really existed back then), it simply came out of his love for his kids and awareness that young drivers are more likely to make mistakes. In recent years we have seen so much research conducted in this area and when you look at what we know now my Dad was away ahead of his time!

When you look at the Australian statistics around young drivers, and particularly P-platers, it is no surprise that parents are concerned ...
  • 45% of all young injury deaths are due to road traffic crashes
  • almost half of all hospitalisations of young people are drivers, another quarter are passengers
  • young drivers (17-25 years) represent one-quarter of road deaths, but are only 10-15% of the licensed driver population
  • a 17-year-old with a P1 licence is 4 times more likely to be involved in a fatal crash than a driver over 26 years
Most importantly, studies have now identified passengers and number of passengers as key factors associated with increased fatal crash risk for young drivers, with one US study's (Chen et al, 2000) results bound to cause great concern for any parent of a P-plater. As shown in the infographic above, compared to driving with no passengers, a 16- or 17-year-old driver's risk of death per mile:
  • increases 44% when carrying one passenger younger than 21
  • doubles (increases 102%) when carrying two passengers younger than 21
  • quadruples (rising 339%) when carrying three or more passengers younger than 21
Interestingly, having an older person in the car seems to have the reverse effect, decreasing the risk of death by 62 per cent when passengers aged 35 or older are present.

These findings mirror those tragic stories of groups of Australian teens being killed in car crashes involving P-platers. Too often these involve three or four young people being in the car when the accident happened. As a result of growing research, as well as in response to the deaths that have occurred, we have seen some countries, including Australia, impose restrictions on the number of peer passengers young drivers are permitted.

I can remember when NSW first introduced legislation limiting the number of passengers P-platers were allowed to have in their car. I fought it hard! In my dealings with young drivers, particularly around drink driving, I have always heavily promoted the concept of the 'designated driver' and believed then (and still do) that the vast majority of teens would never even consider driving home from a party after drinking. It is important to acknowledge that some studies have found that having passengers in a car can have positive effects on drivers, although these are reduced the younger they are. Passengers can help keep drivers alert, help them navigate, operate the radio or other communication devices such as mobile phones and even take over driving when necessary. Limiting the number of passengers P-platers were allowed to transport seemed incredibly unfair to me ... I then attended a conference in Geneva and heard about some research that changed everything ...

A Dutch study found that the older a driver gets their driving licence, the lower the initial risk (Vlakvled, 2004). You could have as many lessons as you wanted but the earlier you started driving, the more likely you were to have a crash. If you started driving after 21, with fewer lessons, your risk of a crash dropped and further reduced the older you got. There just seemed to be something about young drivers that put them more at risk. Experience certainly mattered (and that is why we are seeing many jurisdictions continue to increase the number of hours learner drivers must complete before getting their licence), with crash rates over time being lowest for those who got their licence at age 18 and highest for drivers licensed at ages 30–40 (i.e., if you got your licence early you were less likely to have a crash later in life), but why was there this initial 'high risk' time?

There is now growing evidence to suggest that this could be due to brain development. Recent research has found that between the ages of 18-19 and 21-22 there is a 10 per cent reduction in accident rates, even when driving experience is taken into account. Gender also appears to be a factor, with three times as many males being involved in crashes. When you look at this data and match it to what we know about adolescent brain development, it clearly matches up ...

We now know that the brain doesn't finish developing as early as we once thought, with females fully developed at around 21-22 years and males much later (at around 25-26 years at the earliest). When you look at the crash data, it's at that age when you start seeing rates of crashes and casualties/fatalities significantly decrease. Yes, they're becoming more experienced drivers but they're also getting a fully-developed brain.

We know that several parts of the brain are used when driving. These include:
  • frontal lobe – dealing with judgement and decision making 
  • parietal lobe – managing information from all the senses
  • occipital lobe - the visual cortex, interpreting visual information the driver receives
  • temporal lobe – dealing with sounds heard by the driver
  • cerebellum and other areas outside the cortex – controls muscle movement and balance
We know that the brain develops in a back to front pattern, with the frontal lobe the last to 'complete'. With that in mind, one recent study attempted to find out the impact of this development, particularly the prefrontal cortex (PFC), had on driving (Foy et al, 2016). The results were not necessarily surprising but incredibly important. They found that younger drivers had reduced PFC activity compared to older drivers and concluded that "the reduced activation in younger drivers may be related to prefrontal maturation which could contribute to the increased crash risk seen in this population."

What I found particularly interesting and important when it comes to messages for parents of P-platers is that this 'increased crash risk' was not necessarily due to less impulse control but insufficient perception and attention leading to driver error – i.e., driving had not yet become an "automatic task". Most of us as adults can relate to driving on 'auto-pilot' at some time or another, i.e., that time when you're driving along and all of a sudden realize that you're in the next suburb and you can't quite remember those three sets of traffic lights you must have gone through. As experienced drivers with fully-developed brains, we are able to drive on 'auto-pilot' and still react to sudden or unexpected events ... young drivers are unable to do this ...
I think we tend to believe that the multiple deaths that occur on the roads with P-platers behind the wheel are simply the result of passengers urging the driver to take greater risks, or being distracted by talking, movement or some other activity. Certainly, research has shown that 6 out of 10 young driver crashes are due to distraction of some kind, but it is now becoming more evident that brain development may also be playing a role in these tragic events. It doesn't necessarily have to be a group of 'lads' in a car that leads to an accident, having any same-age peers (no matter how responsible they may be) increases the risk of a crash because a P-plater does not have a fully-developed brain and driving has not yet become 'automatic' ...
By the time your son or daughter starts driving they are well and truly becoming young adults. If they are living in your home, they should still abide by your rules, but when it comes to driving, there is very little you can do to control what they do behind the wheel of a car once they leave your driveway. I reckon my Dad got it right, at least to some degree - he was thinking of his family and ensuring that if something went wrong he didn't lose all of us, what we know now is a little more complex ... For parents of P-platers I would recommend that you try to get them to agree to just one simple request when they start driving and that is as follows:
"Whenever possible, never drive with anymore than one passenger whilst on your P-plates"
Now I realize that this could be a hard-ask but it's certainly worth a try. When you look at the figures (and you can try showing them but realistically they're at an age where they just don't think it will happen to them!), trying to push them in this direction is well worth the effort. The vast majority of P-platers wouldn't even consider drink driving (their parents are more likely to do that than they are!) but they think nothing of having a couple of friends in the car and the evidence is clear that this is a significant risk ...

References
Chen, L., Baker, S., Braver, E., & Li, G. (2000). Carrying passengers as a risk factor for crashes fatal to 16- and 17-year-old drivers. JAMA 283, 1578-1582.
Foy, H.J., Runham, P. & Chapman, P. (2016). Prefrontal cortex activation and young driver behaviour: A fNIRS study. PLoS ONE 11
Vlakveld, W.P. (2004). New policy proposals for novice drivers in the Netherlands. Behavioural Research in Road Safety: Fourteenth Seminar, 194–204. 

Saturday, 29 July 2017

The importance of having the 'alcohol and other drug talk': One mother's plea for others not to wait until it is too late

I can't imagine what it must be like for a parent to get a phone call from a hospital saying that their teen has been brought into the emergency department after drinking too much or having taken an illicit drug of some kind. To get a call like this when your daughter is only 13-years-old must even be more confronting! A few weeks ago I was contacted by a mother (let's call her Maria) who had recently received such a call. She asked whether I would consider sharing her story with other parents in the hope that, in doing so, she could possibly prevent others from going through the nightmare her and her husband had experienced. To protect Maria's daughter and other people involved, we have changed the names and slightly altered some of the events ...

"Our 13-year-old daughter (Sophie) had just started Year 8. She has always had lots of friends, most of whom we know very well. We also know most of their parents, a few of whom we even socialize with at school functions and the like. She had never asked to go to any large parties but she has been regularly going to sleepovers at her friends' homes since primary school. We have seen you present at Sophie's school a couple of times and we do all the things that you recommend - talking to the host parents and taking her and picking her up - so we weren't at all prepared for what happened a couple of weeks ago."

"My husband (Brett) had taken her to a sleepover (hosted by parents we know well) and when he got home we were all prepared for a quiet night. I had texted her at about 9.00pm to say goodnight and promptly received a text back and thought all was fine. Just after 11.00pm I received a call from the mother hosting the sleepover (Jessie) to tell me that she had just called an ambulance for Sophie. At the time all I heard was the word 'ambulance' and everything else became a blur - I remember hearing something about alcohol and vodka but at the time it simply didn't register. Brett took the phone and I remember very little about the conversation he had with her and the subsequent trip to the hospital ... When we finally got to see our little girl, she was in a hospital bed on life support, connected to tubes and a drip and drained of all colour. I have little recollection of the next few hours but I now know that it was 'touch-and-go' for quite some time. Sophie and her friends had managed to get their hands on a bottle of vodka (we believe via an older sister of one of the girls). They had played a drinking game (at 13!) that they had seen on social media (at 13!) and Sophie had drunk almost a third of the bottle in less than 30 minutes!"

"At the time (and in the days after) I was so angry with Jessie and what had happened at her home but since learning what actually happened, I realize that she had done her best. The whole drinking episode lasted less than an hour. The sleepover was actually well organized and monitored (she hadn't just left them to their own devices - she had been 'actively supervising' as you call it). If Jessie hadn't have checked in and found her when she did (some of the other girls actually tried to hide her when she had passed out) and immediately called an ambulance, Sophie may not be with us today."

"Over the past weeks my husband and I have come to realize that we had let our daughter down by simply not having the 'alcohol talk' with her. We had always planned to at some stage but Sophie is not one of the more well-developed and mature girls in her year and we thought we had more time. She had given us no reason for us to believe that things were changing - there were no new friends, no change in behaviour - so we just kept thinking that we would wait. Can I say to anyone reading this, don't wait! Have the alcohol and other drug conversation as early as you can. We don't know whether having that talk would have prevented this terrible thing from happening to our family but it may have done and I wouldn't wish this experience on anyone ..."  

As I said to Maria, I have no idea whether having the 'alcohol talk' with her daughter would have stopped her participating in a drinking game at a sleepover, so I don't think that she and her husband should beat themselves up over this, but I do agree that every parent should have this conversation sooner rather than later!

Unfortunately, most parents make the decision to talk to their child about drugs when a crisis situation occurs. This 'crisis' can be as serious as finding out that their child may actually be using drugs or drinking alcohol or as simple as when their child is invited to a teenage party for the first time. Trying to have a discussion about alcohol and other drug use at a time like this is unlikely to be a positive experience for either you or your child. Your teenager will feel uncomfortable at best, and threatened at worst, by this issue being raised at this time. As a result, you are likely to feel frustrated and angry at their response, leading to greater friction and a breakdown in the parent-child relationship.

It is important to remember that it is impossible for any relationship to exist without positive communication. The most important thing to remember when it comes to talking about any difficult subject is that it's not a five-minute 'talk' — it's about building an ongoing dialogue. Of course, there will need to be an opening conversation and that can be difficult but once you've broken the ice it will get easier. As your children grow up, they will need more and more information, so start early and build on the conversation as your teenager matures.

There are lots of opportunities for parents to introduce the issue of alcohol and other drugs to their children. Rather than setting aside a specific time in the day to sit down with your child and raise the topic, thus making the whole experience like a school lesson, parents should look for opportunities in everyday life to talk about the issue. Here are just a couple of tips to consider to help start the conversation or ensure that it goes as smoothly as possible:
  • Start the conversation in the car. There's no better place to discuss a difficult issue than when it's just you and your teen (or pre-teen) in a car - they can't get away and they don't have to look at you!
  • Start by talking about their peers and what they're doing. Young people can get very defensive when you ask them about their behaviour but they're often more than happy to talk about others. It can even be easier if you talk about classmates and not their friendship group - they're much more likely to tell you about those kids that they don't particularly like and what they think about their behaviour
  • Use what you see in the media to start the conversation. Unlike the talk in the car, this is best done in a family context. News stories, movies and TV programs, even popular music can contain alcohol and other drug themes – asking a simple question about something you've just seen or heard while watching TV and getting their views on it can plant a seed that you can use at a later date
  • Use your own alcohol use as a conversation starter. If you drink wine with the family meal or you have a brown paper bag with a couple of bottles in it under your arm when you go out socialising, take the opportunity at that time to quickly discuss the role alcohol plays in your life and the rules you follow when you drink, e.g., you never drink and drive. Ask them what rules do they think they will have when they get older and they choose to drink. What rules do they think would be important?
  • Don't try to cover everything in one talk. The first couple of chats (possibly even grunts from their end!) may just be about trying to find out what they're thinking about the issue and their level of exposure. Setting rules and boundaries at this time could be problematic. You should certainly clarify your expectations around their behaviour in this area if it is appropriate to do so, but try to discuss your values in a more general sense rather than explicitly laying down rules at this time

You may not believe you have much of an influence over your teenager but your children are going to learn an awful lot about your attitudes and beliefs towards alcohol and drug use from these type of conversations. They may not always be easy but they'll be well worth the effort! One more thing to remember is that all the starter conversations (those mentioned above) should be relatively low-key and informal if they are to be successful, however, when it comes down to the 'let's talk about rules' discussion, both parents should be there, if at all possible, and it should be conducted in a reasonably formal manner (we're not talking 'judge and jury' here but sitting down together, no distractions or other children present). Of course this isn't always easy, particularly in a split family, but if it can be done it illustrates a united front and if there are any negotiations that are to be made, everybody is on the same page.

Maria and I have had a couple of conversations about what she believes she and her husband could or should have said to Sophie if they had actually had the 'talk'. She admits that the issue of underage drinking had never been raised (as she said, she didn't believe there was any need to - there were no obvious warning signs that she may be even considering experimenting) and acknowledges a simple discussion about the role alcohol played in their family would have been useful. Talking about your values and the use and misuse of alcohol, as well as your expectations about how they will deal with alcohol in the future is important. The one thing, however, that she really regrets raising with Sophie is 'outs' - helping her to develop simple strategies should she find herself in a situation where she feels pressured to take part in potentially risky activities.

One word of warning though …. if your child does not wish to enter the conversation for whatever reason, do not push. Talking about difficult subjects like this can be embarrassing for an adolescent and any effort to make them can actually be counterproductive. Do and say what you can and then back off, making sure you leave the door open for them to come to you should they ever wish to discuss the issue and move on. At some point another opportunity will arise (even if unfortunately it ends up being due to a crisis of some kind), take a step back and wait for another opportunity to arise when you are able to start a positive dialogue. It will happen!

Saturday, 22 July 2017

What does research tell us parents can do when it comes to alcohol and does 'one size fit all'? Does your child's temperament make a difference?

Regular readers of my blog may have noticed that I've been a bit quiet over the past couple of weeks. Unfortunately, it's not because I went on holiday or did anything particularly exciting, sadly I was bed-ridden with shingles! Wow it's painful and I've been told that the only way you really get over it was to have complete rest, so that's what I did ... well, almost! The one thing that I have been able to do is to catch up with some reading ... I had a couple of books I wanted to get finished and a whole pile of journal articles that I have had on my desk for a while. I thought I'd share a couple of things that I found really interesting.

Every parent wants their child to have a healthy attitude around alcohol, whether they choose to drink in the future or not. Unfortunately, many continue to believe that they can do little to influence their child's drinking behaviour, particularly during the adolescent years, however, the evidence continues to say that this is simply not true. So what can parents do and in really practical terms, what does the research say works?

Earlier this year an Australian study (Yap et al, 2017) was published that conducted a review of longitudinal studies that examined a range of parenting factors (that could be potentially influenced or modified) that were associated with adolescent alcohol initiation and levels of later use or misuse. What the researchers were attempting to do was to identify what behaviours are protective (i.e., what things can parents do to delay drinking and future problems with alcohol?) and what factors are more likely to lead to drinking at an earlier age and lead to issues as they got older (i.e., what should be avoided)? They identified 12 parenting factors, including the provision of alcohol; parental monitoring; rules about alcohol; parental discipline; and favourable attitudes towards alcohol use.
It's a really great piece of work (based on a review of 131 studies in this area) and once you get through all of the statistical analysis, the authors identify four protective factors that parents should attempt to increase and they are as follows:
  • parental monitoring
  • parent-child relationship quality
  • parental support
  • parental involvement
There are no real surprises here but the authors are very clear in the following statement - "... by being more aware of their adolescents' activities, whereabouts and friends, parents can help to protect their adolescents from later alcohol misuse". This supports the mantra that I have been spruiking for many years - if you want to prevent, or at the very least, delay early drinking or even illicit drug use - 'Know where your child is, know who they're with and know when they'll be home!' I get it that's not always easy, particularly as they get older and you want to give them more freedom as they become young adults, but when they're 14 or 15-years-old, it's a must. As I always say, start this early and it won't be so difficult in the later years ...

When it comes to risk factors, the authors highlighted three behaviours that parents should attempt to reduce or avoid. Once again, there were no real shocks, but some parents may find them a little unsettling, with the following being identified:
  • provision of alcohol
  • favourable attitudes towards alcohol use
  • parental alcohol use
The authors acknowledged that a recommendation that parents should not allow their children to drink underage or provide them alcohol at home or for parties is a controversial one, particularly within cultures where giving children a sip at a family meal is regarded as appropriate and protective. That said, they state "this review provided clear evidence to back up policies and recommendations against parental provision in cultures where tolerance of binge drinking is the norm". This is a very clear statement to Australian parents as the evidence is very clear in this country that we are a nation of 'binge drinkers'.

Now when good quality research comes out like this, with very clear recommendations about what parents should and shouldn't do, I'm sure there are some people who sit there and say "But I did all that stuff and it didn't work for me!" I certainly hear from many distraught parents from who believe they 'did absolutely everything right' but still find themselves with a teen who is totally out of control. They've either been arrested for drug offences, sneaking out of the house at all hours of the night and sometimes not returning for days, been hospitalised after a drinking binge and the list goes on and on ... So often, in the conversations I have with them they inevitably say "I don't know where it all went wrong, we have had no issues with our other children ..."

Why is it that what we knows works for most teens simply doesn't have the same effect on others? Of course, every teen is different but is there something about some young people that just makes them more resistant to rules, boundaries and consequences? A month or two ago I wrote about a wonderful book I had started to read written by Robert MacKenzie called Setting Limits with Your Strong-Willed Teen - it really is a great read and I thoroughly recommend it to any parent struggling with an adolescent who is 'pushing all their buttons'!

MacKenzie doesn't talk about 'rules' per se, rather he discusses 'limits' and 'limit setting'. According to the author, all teens test the limits being imposed on them, (i.e., when a parent asks their child to do something or change their behaviour) and they do this by conducting what he refers to as 'research' (i.e., trying to establish just how much the person means what they say). This is often referred to as 'pushing the boundaries' by other parenting experts and is used by teens to see just how far they can go without crossing the line. Now I think it is well understood that not all teens test limits in the same way, but what I found fascinating in this book is how it stressed that 'teen temperament' plays a vital role in this area.

Three types of teen temperament and how they respond to 'limit setting' are discussed:
  • compliant teens (around 55% of teens match this profile according to Mackenzie) – these teens don't push their parents too much as their underlying desire is to please and cooperate. They accept the information their parents or teachers provide them and usually don't require a lot of consequences to complete their 'research', therefore accepting the limits imposed on them without too much conflict
  • strong-willed teens (10% of teens) – these young people test frequently and they require regular revision of consequences before they are willing to accept parents' authority and follow rules. MacKenzie provides an example of a strong-willed teen called Daniel and describes him as follows - "To him, the word stop is just a theory or hypothesis. He's more interested in what will happen if he doesn't stop, and he knows how to find out. He continues to test ..." I'm sure there are many parents out there who can relate to a teen like that!
  • fence sitters (35% of teens) – this is a mixed group that can go either way depending upon the situation. These teens are more likely to co-operate when they encounter clear, firm limits. However, they will have no issue testing rules and authority when the limits are unclear or when they see others getting away with something. The author stresses that this group requires "generous helpings of consequences to complete their research"
I'm sure many parents reading this will relate to at least one of these 'types' and if you have more than one child, I can almost guarantee that you have at least one of them that fits into a different category than the others! What MacKenzie stresses is that when you set limits (or create rules) for a teen it is vital that you need to acknowledge the different temperament you are working with ... and if you are lucky enough to have a 'strong-willed' one, well, it's going to be a heck of a lot tougher!

I cannot recommend this book strongly enough, not only to parents but to anyone who works with young people. If you find yourself with a teen who is 'strong-willed' and is testing you at every turn, this book is a must! It provides practical advice on how to set limits, how to develop appropriate consequences and even how to deliver them in a way that will hopefully minimise conflict. 

Research continues to show that parents continue to have a powerful influence on their child's attitudes and behaviours around alcohol use, even during their adolescence. Effective and age-appropriate parental monitoring during the teen years has been proven time and time again to be protective and the provision of alcohol to teens is a risk factor and should be avoided ('delay, delay, delay' being the key). That said, when it comes to rules and boundaries (or 'limit setting') in this or any other area, every child is different and their temperament is going to affect how you parent ... It's not going to be as simple as the evidence seems to suggest ...

Identifying and acknowledging what type of teen you have (and that if you have more than one, they may all be very different) is the first step in applying what the research says to your family situation. For some teens, simply setting rules and monitoring them will be enough to keep them protected and will likely instil positive values and attitudes without too much effort. Unfortunately, for others, they will continue to push boundaries and test you over and over again to see just how far they can go. It's not going to be easy but hopefully it'll be worth it in the end!

References
MacKenzie, R.J. (2015). Setting Limits with Your Strong-Willed Teen. Harmony Books: New York.
Yap, M., Cheong, T., Zaravinos-Tsakos, F., Lubman, D., & Jorm, A. (2017). Modifiable parenting factors associated with adolescent alcohol misuse: a systematic review and meta-analysis of longitudinal studies. Addiction 112, 1142-1162.