Self-Help for Adults on the Autism Spectrum

In another blog post for Mental Health Awareness Week award winning JKP author Dr. Lee A. Wilkinson discusses some of the challenges facing adults on the autism spectrum—

The dramatic increase in the prevalence of autism spectrum conditions among children and adolescents and the correspondingly large number of youth transitioning into adulthood has created an urgent need to address the problems faced by many adults on the autism spectrum. Nearly a half million youth with autism will enter adulthood over the next decade and most will continue to require some level of support. In addition, there is a large and diverse group of adults whose autistic traits were not identified in childhood and have not received the appropriate interventions and services. Although autism symptoms may improve with age, co-occurring mental health issues may worsen in adolescence or adulthood. As a result, there are a significant number of adults on the spectrum who are now seeking help to deal with feelings of social isolation, interpersonal difficulties, anxiety, depressed mood, and coping problems. Unfortunately, mental health problems such as anxiety and depression and even the diagnosis of an autism spectrum condition itself often go unrecognized. Although the rate of co-occurring mental health issues for adults on the spectrum is high, accessing services to address these symptoms is frequently difficult and the extent of the problem will only increase as more and more youth transition to adulthood.

Evidence is beginning to emerge for interventions addressing the mental health needs of this growing and underserved group of adults, including cognitive-behavioral therapy (CBT). CBT has direct applicability to adults on the autism spectrum who often have difficulty understanding, managing, and expressing emotions. It has been shown to be effective in changing the way a person thinks about and responds to feelings such as anxiety and depression. With CBT, the individual learns skills to modify thoughts and beliefs through a variety of strategies which improve interaction with others in helpful and appropriate ways, thereby promoting self-regulation and mental health. It is a goal oriented approach and primarily emphasizes here-and-now problems, regardless of one’s past history, traits, or diagnosis. CBT also provides a more structured approach than other types of psychotherapy, relies less on insight and judgment than other models, and focuses on practical problem-solving. Moreover, because individuals learn self-help in treatment they are often able to maintain their improvement after therapy has been completed. Evidence-based CBT holds considerable promise as an effective intervention for improving the quality of life and psychological well-being of adults on the autism spectrum.

Despite the availability of effective psychological treatments for anxiety and depression, a substantial number of adults on the autism spectrum do not seek professional help. Common obstacles to mental health care access include limited availability and affordability of services, confidentiality issues, lack of insurance coverage, frequent delays and long waiting periods, and social stigma. Likewise, many service providers do not have the experience or expertise to work with individuals on the autism spectrum, particularly those with co-occurring mental health issues. Self-help interventions represent an increasingly popular alternative to therapist-delivered psychological therapies, offering the potential of increased access to cost-effective treatment for a range of different mental health issues. They provide an opportunity for the individual to gain some useful insights and begin to work through their problems with limited guidance from a therapist or mental health professional. Research has clearly shown that self-help strategies are effective, practical, and acceptable for many individuals in reducing mental health problems such as mild to moderate anxiety and depression, often alone or with other forms of treatment. Self-help interventions have the potential to play an important role in providing effective treatment to the large proportion of adults on the spectrum who are experiencing mental health issues.

While there is no shortage of books describing the controversies and challenges related to the diagnosis and treatment of autism spectrum conditions, there is a need for a practical resource for adults on the spectrum that promotes self-understanding and directly teaches effective ways of coping with their emotional challenges. Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT presents strategies derived from cognitive-behavioral therapy (CBT), adapted specifically for adults with autism, to help them overcome anxiety and depression, and improve their psychological well-being. The author takes the best of CBT therapeutic techniques to facilitate greater self-understanding, self-advocacy, and better decision-making in life-span activities such as employment and interpersonal relationships. This self-help guide provides evidence-based tools that can be used to learn new ways of thinking, feeling, and doing. It includes questionnaires, forms/worksheets, and exercises to help the reader:

  • Evaluate his or her autistic traits and discover their cognitive style.
  • Identify and modify the thoughts and beliefs that underlie and maintain the cycles of anxiety, depression, and anger.
  • Apply therapeutic techniques such as mindfulness, positive self-talk, guided imagery, and problem solving.
  • Accept the past and achieve unconditional self-acceptance.
  • Deal effectively with perfectionism and low frustration tolerance.
  • Avoid procrastination and learn to maintain positive changes to their progress

Used alone or in combination with therapy, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT is an essential self-help book for adults across the spectrum looking for ways to understand and cope with their emotional challenges and improve their psychological well-being.

 

About the Author

Lee A. Wilkinson, PhD, NCSP, CPsychol, AFBPsS is a licensed and nationally certified school psychologist, chartered psychologist, registered psychologist, and certified cognitive-behavioral therapist. He has published widely on the topic of autism spectrum disorders both in the US and internationally. Dr. Wilkinson is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, also published by Jessica Kingsley Publishers and editor of a recent volume in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.

Talking to children about schizophrenia

In a special blog post for Mental Health Awareness Week, we’ve asked Alice Hoyle, author of Pretend Friends, to share her thoughts on therapeutic storybooks for children. 

Hoyle---Pretend-Friends

I always wanted to be a writer or a teacher. Since teaching was more likely to pay my bills I went down the route of educating the masses, whilst still scribbling down the odd poem or story when the mood took me (mainly when suffering avoidance stress from a major deadline!).  I wrote my first published story Pretend Friends whilst doing some Masters research into inclusive storybooks.  It was then that I realised there were very few story books to support discussions about serious mental illness with young children. There were a few books about depression but nothing to help explain about symptoms of psychosis such as hearing voices.  So I decided to write my own story (partly in a spectacular effort of procrastination from said Masters!).

The idea for using the concept of ‘pretend friends’ as an analogy for schizophrenia came to me when spending time with my children and someone close to our family who has experienced psychosis.  My eldest was talking about her imaginary friend Hector and the adventures they were going to go on. It struck me we are not concerned when children have imaginary friends but when adults hear voices it is a different matter. Pretend friends is an analogy children can relate to which simplifies some of the complexities of experiencing psychosis or living with schizophrenia to a level children can understand.

The key messages outlined in the book  are gentle, non-scary, age-appropriate explanations about what it might be like to live with hearing voices or experiencing things that other people don’t experience.  The story explores the adventures of Little Bea and her imaginary friend Nye-Nye, and compares them with the experiences of Big Jay and his pretend friends (the voices he hears).  The story asks for people to be kind to people like Big Jay and to “love them just as they are”.

Another important message to include was to make sure that the main character, Little Bea, was absolved of any big responsibility to make Big Jay better, and that ways of supporting Big Jay in his recovery were explained.  I didn’t want a child to feel worried or upset or that they needed to take on caring responsibilities if they found out someone close to their family was hearing voices. That should be a grown-up’s job!

I am so pleased that this book has been published as I think it is vitally important to start talking about mental health from a young age. This way children can learn to look after their own mental health, and to support their peers if they are experiencing issues of their own.  I decided to donate all my royalties to the charity Rethink Mental Illness as writing this book wasn’t about making money, but about supporting families like my own with a tool that can help them have conversations about serious mental illness.  After all, as a parent, I want my children to grow up to be kind and accept people for who they are, and not to worry or be scared of people who are different from them. As a health educator I want the same for all children.  I truly believe that supporting children to understand mental illness, will help our society to become more inclusive, supportive and kind.

Alice Hoyle works as an Associate Advisory Teacher of Personal, Social, Health & Economic (PSHE) Education for the PSHE Association.  Alice lives in Bath with her husband, two daughters and a plethora of pretend friends including Elfie, Li-Li, Ariella and Micub. Alice would love to hear from you if the story of Pretend Friends helps your family in some way, you can find her on Twitter as @AliceHoylePSHE.

The Story Behind Luna’s Red Hat

Featuring suicide in a picture book may sound like an unlikely combination to some people, which is why we’ve asked Emmi Smid, author of Luna’s Red Hat to explain what motivated her to write and illustrate Luna’s story.

That art is a necessity to society’s well-being and structure is, in my humble opinion, a fact; creative people have the ability to shine a light on important matters from different perspectives. Through their words, visuals and sounds, these products of creativity encourage us to ‘think outside the box’, touch people’s hearts and bring people closer together.

My background originates in Fine Art. With my above-mentioned image of “The Artist” in mind, I struggled to find the ‘use’ for my own art within our modern day society. What do I have to offer that could potentially add something positive to how we think about and deal with current social matters?

During my time at the University of Brighton, where I read for a Masters degree called Sequential Design/Illustration, I started revaluing the importance of the picture book, and how a balanced ‘marriage’ between words and pictures can teach not only children, but also adults, simple but profound lessons in life. So, I started by revisiting my collection of picture books that handle the topic of death: Michael Rosen’s Sad Book, Wolf Erlbruch’s Duck, Death and the Tulip, Oliver Jeffers’ The Heart and the Bottle, among others. Then the penny dropped. As beautiful and heartfelt as each of these picture books were, none of them touched upon the topic of loss through suicide. I noticed this because I have lost loved ones to suicide. I was 16 when my friend Bram committed suicide. We were the same age, and we were raised on the same street. We went to primary school together, and after that to secondary school. As far as I knew Bram was always going to be a part of my life, until he wasn’t. His sudden death came as a shock to all of us – Bram’s family first of all, my family, our mutual friends and their families, our teachers, the school, there was a real ripple effect.

In the spring of 2009, when I was 21 and had moved from my home country the Netherlands to England to study Fine Art at University College Falmouth, my aunt Judith committed suicide. She left behind her two daughters, Merel and Silke, aged 14 and 10 at the time. Being away from home, I felt rather disconnected from my family. I was concerned about my cousins – with all of us struggling to grasp the notion of suicide and getting our lives back on track, how were my cousins going to deal with this at their age? I felt powerless and useless.

Fast-forward to January 2014, and there I was discussing the idea of designing a picture book about dealing with loss through suicide with one of my tutors at the University of Brighton. I was very passionate about the idea but the fact that there weren’t many books about the topic made me doubt myself. “If you are not sure, then maybe you should start by finding out why there aren’t many children’s books about suicide?” my tutor suggested. So I sat down and came up with a number of reasons why: the notion of death is difficult enough for children, let alone dying by apparent ‘choice’; we live in a society where children are wrapped up in cotton wool and are protected from real life for as long as possible; Suicide is still a social taboo.

None of these reasons felt very satisfying – in fact, the more I thought about it, the stronger the urge became to confront and perhaps even tackle those reasons. Children are as clever as adults, with the difference that they lack life experience. The only way for adults to help children gain life experience is to provide them with the tools to deal with life, as and when it happens. Social taboos are created and perpetuated the same way: it all boils down to our own lack of tools to be able to empathise rather than judge, communicate rather than ignore, and confront rather than beat around the bush.

Unfortunately, people commit suicide. I have felt isolated and lonely when trying to deal with overcoming the loss of my friend and my aunt, and I have seen the effects it has had on my family and friends. If we adults are struggling, then how will young children deal with such a loss? Determined and on a mission, I created the first series of sketches telling Luna’s story:

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I posted the sketches on my blog and asked people for feedback. The reply of Alexis Deacon (writer and illustrator of picture books such as Beegu) made me take a step back and reconsider my approach: “You might try offsetting the sadness with moments of humour or just exploring different kinds of sadness. After all, the message is an important one and you are more likely to reach a wider audience if you don’t club people round the head with it!”

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Considering the sensitivity of the topic, I also decided to get feedback from specialists in the field. During my research I read the book Couldn’t You Stay for Me? by Dutch bereavement specialist Dr Riet Fiddelaers-Jaspers and contacted her. Riet has been an immense help ever since, providing me with feedback regarding different stages of grief and sharing her expertise with me. She also agreed to write the ‘Guide for Parents’, her contribution in the back of Luna’s Red Hat, which is designed to help parents, carers, teachers and professionals to support and communicate with children who have lost a loved one through suicide.

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In search for feedback from parents who have been through similar situations, I contacted Belgian bereavement institution Werkgroep Verder. They agreed to share my manuscript with some of their clients, and I received some very useful and eye-opening replies. The one that got to me most was feedback regarding one of my illustrations. I wanted to show Luna being overwhelmed by her own anger, through drawing a big metaphorical red wave of anger behind her. A parent rightfully pointed out that one never knows whether the child was exposed to the incident, and that “splashes of red liquid” may cause further pain. I instantly decided to make the wave blue instead.

luna 1

 

Designing Luna’s Red Hat has been a tough but blessed learning curve, personally as well as professionally. There are many more insights into the process that I could show you, but the main insight I would like to share with you, is that we can learn to embrace our losses together, however heartbreaking they may be. I wasn’t able to physically be there for my cousins Merel and Silke when they lost their mother, but I dedicate this book to them. If Luna’s Red Hat could provide parents and their children with a new perspective or hope in even the slightest way possible, then that would mean the world to me.

Emmi Smid is a children’s book author and illustrator. She was born in the Netherlands but currently lives and works in Brighton, UK. Learn more about Luna’s Red Hat here.

 

luna 2

 

Thoughts behind ‘The Music of Being’

Levinge_Music-of-Being_978-1-84905-576-5_colourjpg-printIn The Music of Being, Alison Levinge explains the approaches of key child development theorists and explores how they apply to and inform the practice of music therapy. In this article, she discusses the inspiration behind writing this unique book and how she feels Winnicott’s theories resonate with the central aspects of music therapy.

We only have to observe a mother with her baby to realize that we are deeply musical beings. Training as a musician, combined with an understanding of human development, has led me to consider the significance of this medium and in particular, its value as a therapeutic tool.

No matter what our musical preferences may be, whatever our age, where we live or more significantly, in what ways we may find life difficult, music can enable us to connect more deeply to who we really are. And this can happen even when we are yet to be born!

Our early experiences are impressed upon not only our physical being but also upon our cognitive and psychological states of mind. But what is it like to be a baby? How do we let people know what we are feeling? How do we ask for what we need when we do not have words? Above all, what is it that we require in order to help us along the journey of life in a healthy way? Through helping children and adults who have difficulties, I discovered the value of music and its remarkable ability to engage a child or adult in a relationship. I discovered music, in fact, is a universal language.

In the world of words, there are many who have studied early development. Donald Winnicott, a pediatrician and psychoanalyst, is one who dedicated his life to the study of babies with their mothers and it can be said, was an early prime mover in the field. My book evolved through interweaving some of Winnicott’s ideas with my experiences as a therapist, combined with my understanding of a musical relationship. Music can allow us to express ourselves in so many ways that words may not.

 

Alison Levinge, PHD, LGSM(MT), Cert.Ed., is a music therapy practitioner and researcher. She specializes in music therapy with children experiencing early developmental difficulties and issues relating to bereavement. She teaches and lectures internationally and is based in Bristol, UK. Read more on her book The Music of Being or order your copy here.

A sneak peek into Luna’s Red Hat

It is spring. Luna is in the park, wearing her Mum’s red hat. The sun is shining, but today is not a day for feeling sunny: it was a year ago today that Luna’s mum committed suicide. Fear, anger, and guilt are just some of the emotions that Luna is coping with. Luckily, her Dad is there to help Luna with her emotions and questions.

 

An extract from Luna's Red Hat

An extract from Luna’s Red Hat

Emmi Smid is a children’s book author and illustrator. She was born in the Netherlands but currently lives and works in Brighton, UK. Emmi wrote Luna’s Red Hat for her cousins, who would have wanted to have a book like this when they were younger.

Driving Change through Simple Acts of Kindness

Celebrating the 30th anniversary of the anti-bullying national charity Kidscape, 12 charities come together in How to Create Kind Schools to offer an insight on their specific projects and techniques, but who all share a single hope – that no child at school feels scared, isolated or excluded. In this interview, Jenny Hulme offers her insights on the importance of introducing kindness through projects at school and the drive for positive change by creating a more successful setting for children.

 

Why do wHulme-Knights_How-to-Create-K_978-1-84905-591-8_colourjpg-webe need to learn to be kind?

We encourage children to treat others as they’d like to be treated, and trust they’ll do the right thing. Life is complicated, though, and if the culture of our school or workplace is inequitable, we can find the things we value (kindness, security, opportunity, friendship) in conflict with each other. Children who turn to Kidscape for help are often as bewildered by the bystanders as they are by the bullies; bystanders being those children who they thought were kind, or considered friends, but who do nothing to stand up for them when the bullying starts. When that happens, children who are bullied often blame themselves and that knocks their confidence even more.

 

Why is this so important in schools now?

This is where the learning can come in, driving change by providing the information, skills and confidence children need – we all need – to be able to live our values, follow our better instincts.

 

Did you have a favourite project from the 12?

They were all mesmerising in different ways, and every school I visited taught me something new. I think if I had to direct teachers to one chapter first from How to Create Kind Schools, it might be the peer mentoring chapter, if only because it answers questions a lot of teachers posed to me. They often see play times as the ‘hardest lesson’ of the day for children, and also – sometimes – one that is in some way out of their control. They are, naturally, reluctant to ‘force children to play together’ and quite rightly want to see children developing social skills and friendships in free time.

This chapter also very simply answers some concerns teachers have about finding the time to do anything else in their over-packed day. The chapter illustrates that – while there was some investment of time to set up the scheme – it paid back in so many ways, including enhancing teaching time, reducing time dealing with upsets or bullying, improving attendance and attainment. All the projects in this book had the same positive impact on schools, but I think the peer mentoring scheme might open hearts and minds to just how positive that impact could be.

 

What do you hope schools will take from How to Create Kind Schools?

How to Create Kind Schools highlights the idea that it is the children themselves who can drive change, and become the greatest ambassadors for inclusion, diversity and kindness. But that only happens when they’re given the skills and education, environment and support to empower them to make a difference.

I also hope it will raise awareness of the phenomenal work Kidscape does – and the tools and training they can provide to help every teacher in the UK make their anti-bullying policy more effective.

 

What makes How to Create Kind Schools different?

It is wonderful to have 12 charities in one book, all working to the same end. I hope that it provides a meeting place for parents and teachers to quickly and easily share the successes they’ve had and the lessons they’ve learned, and also to signpost others to the charities that helped them make a positive change.

 

How can our experience with kindness or unkindness at school impact us as adults?

So many adults I speak to say they are only learning now, in their adulthood, how kindness can enrich their lives, as they work and live alongside people from different social and religious backgrounds, of all abilities and disabilities.

I have heard from schools how the impact of kindness at schools on later life can be undervalued. In some schools there is still a feeling that bullying is part and parcel of growing up, preparing children for adulthood in some way.

It’s clear, though, that bullying brings no benefits at all, to the bully or the bullied. It can, instead, trigger a cycle of victimization that can last a lifetime. Studies have shown victims of bullying, including children who are very able, stand a much lower chance of doing well at school and are more likely to experience depression, anxiety and poor physical health as adults.

 

So how do we teach kindness?

Research into the phenomenon of bystanding demonstrates that groups who are given a seminar on compassion, or a better understanding of an  issue were, indeed, more likely to go against the majority and help someone in need.  However, the schools and charities I visited illustrated how complicated bullying is and how much more children require than an instruction to be kind. Children really do know that they should be kind and that bullying is wrong, but they often lack the understanding and skills to do anything about it.

Out of this comes a realization that lessons in kindness and schools’ anti-bullying policies have to break down barriers and create opportunities for children to better understand their peers (perhaps via mentoring or lunch clubs or visiting role models), and to feel how much they can benefit from that process.

The idea is not to single out or patronize children, but to help classes understand each other (their disability, family situation, sexual orientation or religion) and nurture friendships in a more proactive way. Marginalized children then rediscover their confidence and value and place in the group, while the children who had misunderstood them are given the chance to come out of their comfort zone or clique and learn about their differences.

 

A version of this interview appeared in Psychologies Magazine (April edition).

Jenny Hulme is a freelance journalist, writer and PR consultant. For more information on Jenny Hulme’s book How to Create Kind Schools visit www.jkp.com and about the work of Kidscape visit www.kidscape.org.uk; or let her know your views and the projects you’re involved with on Twitter at @hulmejenny.

 

 

 

Does Your Child or Teen on the spectrum Suffer from Poor Posture?—Look No Further!

The Autism Fitness Handbook is a new edition of a popular program by well-known autism fitness specialist, David S. Geslak.  His book contains a wealth of innovative exercises to boost body image, motor coordination, posture, muscular and cardiovascular fitness and overall health and wellbeing in children and teens on the autism spectrum, and is ideal for use at home or at school.

Designed to address specific areas of difficulty for children, teens and young adults with autism spectrum disorder (ASD) the the following extracted activity is designed to help children and teens improve posture:

The Autism Fitness Handbook Activity—Posture

David S. Geslak is the Founder and Director of Exercise Connection Corporation. He has been developing fitness programs for children and adults with autism spectrum disorders (ASDs) since 2004. He has a bachelor’s degree in Health Promotion and is a Certified Health Fitness Specialist and Certified Strength and Conditioning Specialist. It is David’s mission to educate parents, teachers and other professionals about the benefits of exercise for individuals with ASDs, and lead them towards a healthier and more active lifestyle. David lives in Chicago, Illinois. His company’s website can be found at: www.ecautism.com.

THAT’S MY NAME, DON’T WEAR IT OUT—Activity One

The Asperkid’s Game Plan teaches how to use purposeful structured play to engage the bright minds of Asperkids, building on strengths that they already have and developing core skills that they often struggle with, such as fine motor and social skills.

Full of practical and fun learning games that can be used in the home or classroom, the following extracted activity is designed to find and concretely construct language, to help every Asperkid develop reading and “writing” long before their  motor skills would ever have allowed them to do the same:

Cook O’Toole- The Asperkid’s Game Plan 37-41

Jennifer Cook O’Toole has Asperger syndrome and is the mother to three young Aspie children. She graduated from Brown University, and attended Columbia University’s Graduate School of Social Work. She has previously worked as a social worker, and a teacher in both special needs and mainstream education. She has also served on the Family Advisory Board for Levine Children’s Hospital, North Carolina, and regularly gives presentations at hospitals and local universities on special needs parenting. In 2002 she was nominated for Disney’s Teacher of the Year Award. More recently, she has been honored with the GRASP (Global and Regional Asperger Syndrome Partnership) 2012 Distinguished Spectrumite Medal, as well as the 2012 Temple Grandin Award for outstanding accomplishment and contribution to [her] family and community. She lives near Charlotte, North Carolina.

 

No Shame for Extreme Night Owls

Author of An Occupational Therapist’s Guide to Sleep and Sleep Problems, Andrew Green is an occupational therapist specialising in sleep disorders. In a bid to clear the air about the myths that surround the early bird and nightowl stereotypes,  Andrew gently introduces the sleep disorders that are the root of the stereotypes that haunt those of us who just aren’t very good at sticking to ‘normal’ sleeping hours, if such a thing exists.

Green and Brown - sheep logo

 

In 1735, Benjamin Franklin made known the saying ‘Early to bed, early to rise makes man healthy, wealthy and wise’. Over two centuries later it turns out that the opposite may be nearer the truth. By comparing health and socioeconomic data relating to ‘owls’ and ‘larks’, Gale and Martyn (1998) found no evidence that early rising is actually more beneficial, and concluded that early bedtimes and rising times are not linked with ‘health, socioeconomic, or cognitive advantage [and] if anything, owls were wealthier than larks’ (p.1677). It is possible that Franklin learned in his long life that the earlier saying was inaccurate since the following is also attributed to him, presumably in his later years: ‘I wake up every morning at nine and grab for the morning paper. Then I look at the obituary page. If my name is not on it, I get up’.

In any case, the reality is that people are different and the tendency towards being an owl or a lark is inherited. For most people it is just a tendency – part of natural variation that can be accommodated in normal lifestyles, but at the extremes are circadian rhythm disorders. Circadian rhythms are the natural cycles that determine the timing of numerous body functions, including the sleep-wake cycle. When someone’s rhythm is advanced – when they are an ‘extreme lark’ – they tend to wake earlier and go to bed earlier than the norm; it is a very rare condition and Schrader et al. (1993) found no cases of advanced sleep phase disorder in a sample of 10,000 Norwegian adults. However, the same study found 17 individuals who met diagnostic criteria for delayed sleep phase syndrome (DSPS) – or who were ‘extreme owls’: it is therefore still an uncommon condition although the prevalence in adolescents and young adults may be as high as 10% (Wilson and Nutt 2013).

To have DSPS means that a person is unable to sleep until two hours, or longer, after a more conventional bedtime and naturally tends to wake correspondingly later. It might not seem much but is extremely disruptive to life. Someone with DSPS may not know they have it and think they have insomnia, perhaps going to bed at 11 p.m. in the hope of having eight hours of sleep and not sleeping until 2 or 3 a.m. However, they will still need to get up at 7 a.m. for work or school and have to get through the day. Whereas most people can manage after one short night, perhaps because of an early start for a journey, having DSPS is like having to get up at 4 a.m. every day, having gone to bed at 10 or 11 p.m., and then feeling sleepy every afternoon.

Individuals with DSPS complain that it is difficult to get to work reliably in the morning and that employers, and others, do not understand that they are not just being lazy. Some people are very embarrassed by staying in bed for half the morning. Others are able to adapt to some extent; for example, a research student might be able to work in the library during the night, arrange meetings in the afternoon and still have time to meet friends in the evening. The experience of DSPS has been investigated by Wilhelmsen-Langeland et al. (2012) in a qualitative study involving nine young people (age 16–23) in Norway. Participants talked about the difficulty of staying awake at school, and conflicts with others through being late when meeting, or unavailable to help with chores, for example, during the day, but the failure of others to understand was a key observation. Other people might suggest that they could just go to bed earlier – as if they could just try harder to sleep ahead of their biological preference.

Delayed sleep phase syndrome is a disruption of activity cycles and could be considered a disorder of occupation; it should be of interest to occupational therapists. Medical management could involve use of melatonin at night to encourage earlier sleep (supplementing naturally produced melatonin) and bright light (daylight or full spectrum artificial light that mimics natural light) on rising in the morning in order to help ‘reset the body clock’. In addition to these, chronotherapy involves going to bed successively later, a strategy that seems counter-intuitive, until the desired hours of sleep are reached; it is easier to adjust the timing of sleep by lengthening the day – in the same way that is easier to adjust to jet lag when flying east to west. It is then important to consider how the person keeps to more conventional hours.

In many respects maintaining more regular hours is like following advice for managing insomnia: keeping a consistent rising time (essential) – and seeing daylight on waking; avoiding daytime sleep that might delay night time sleep; doing regular exercise and having regular activity; having a clear winding down routine. In winding down it is preferable not only to avoid the mental or emotional stimulation that might accompany use of a computer late at night (and the temptation to play ‘just one more game’, for example) but also to avoid the blue light that is emitted by computer screens and televisions, which can suppress the production of melatonin.

Despite all such effort, however, it is likely that the individual is always going to be later than average and well-advised to avoid work that involves early starts. Finally, extreme owls might remember that there is no need for shame in rising late, which they cannot help. As Gale and Martyn put it, ‘there is no justification for early risers to affect moral superiority’ (p.1677).

References
 Gale, C. and Martyn, C. (1998) ‘Larks an owls and health, wealth, and wisdom.’ British Medical Journal 317, 1675–1677.
 Schrader, H., Bovim, G. and Sand, T. (1993) ‘The prevalence of delayed and advanced sleep phase syndromes.’ Journal of Sleep Research 2, 1, 51–55.
 Wilhelmsen-Langeland, A., Dundas, I., West Saxvig, I., Pallesen, S., Nordhus, I.-H. and Bjorvatn, B. (2012) ‘Psychosocial challenges related to delayed sleep phase disorder.’ The Open Sleep Journal 2012, 5, 51–58.
 Wilson, S. and Nutt, D. (2013) Sleep Disorders, 2nd edn. Oxford: Oxford University Press.

Andrew Green trained in occupational therapy in York and is now a specialist occupational therapist in North Bristol NHS Trust’s sleep disorders service at the Rosa Burden Centre. Learn more about his book An Occupational Therapist’s Guide to Sleep and Sleep Problems here.

Three Steps to Improving the Safeguarding of Children

Ofsted’s October 2014 report on the outcomes of the first 33 inspections under their new framework showed that over two thirds of children’s services where either “inadequate” or “require improvement”. Offering a pragmatic and achievable approach to assisting services to build their capacity to meet public, political and professional expectations in his book The Common-Sense Guide to the Safeguarding of Children, author Terry McCarthy outlines his three-step approach to improving the safeguarding of children.

Social workers are expected to enable fundamental and sustained change with parents and carers who often have long-term and entrenched issues relating to their capability, behaviour and life choices. These most commonly concern alcohol and drug use, violence, criminal activity, learning disability, mental health problems and serious emotional difficulties. Often more than one of these elements needs to be addressed to ensure the safety and welfare of children. The challenge is made even more difficult by families often being unwelcoming or fearful of agencies’ involvement, leading to them being evasive or hostile.

Whilst most social workers are highly committed, these complexities, demands and expectations take their toll with many being overwhelmed, stressed and anxious. This can lead to low morale, uncertainty and poor confidence. The impact on the continuity and long term stability of services is often felt through high staff turnover, sickness and shortened careers. For those who do remain in practice the complexities can cause misjudgements, tunnel vision, lack of focus and ineffective practice with practitioners feeling unable to challenge situations or creatively engage with families. This can also lead to process driven practice which meets procedure and policy requirements, committing considerable energy and resources without necessarily leading to significant benefit to children.

McCarthy---Improving-the-Safeguarding-of-Children

The Three Step approach considers how safeguarding agencies, particularly children’s services, can work within available resources to make a real difference. This does not require a major ground shift but rather can be achieved through the accumulative effect of a series of small, easily implemented measures.

Step one: Establish a culture which enables and leads 

This culture should identify how organisational values, attitudes and behaviours are needed to model good parenting. This includes having healthy relationships, good communication, clarity of purpose, conflict resolution, constructive use of authority and creative approaches. It is argued that the “managerial” approach, which focuses on procedure, giving instruction and monitoring compliance, is limited and unlikely to adequately inspire, support and lead practitioners through the highly complex challenge of identifying and address the mistreatment to children.

Step two: Develop a stable, skilled and confident workforce

This presumes that most social workers are reasonably clear about what should be done and why this is required to safeguard children, however often struggle with how they can bring about the required outcomes. Effective practice requires practitioners to be supported to develop focus, understand the complexities and address anxiety which can overwhelm them. The practitioner skills outlined in the book are an expansion of the Performance Capability Framework and it is argued that a blend of supervision, coaching, consultation and case auditing can create a learning environment where best practice is likely to flourish.

Step three: Enable families to change.

This sets out thirteen aspects of effective work with families to ensure that risks to children and the fundamental reasons for these are clearly understood, leading to effective planning which focuses on addressing solutions and ensuring real progress within reasonable timescales. This requires honest, effective and direct relationships with families and partner agencies including clarity about how meetings and involvement with the family and professionals ensure that key aspects of the plan are progressed.

 Terry McCarthy  is a qualified social worker with over 30 years’ experience in children’s services. Read more about The Common-Sense Guide to Improving the Safeguarding of Children here.