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.