Episode 4 - Connie and Lou

Connie and Lou describe their roles in infant mental health and health promotion through their respective psychologist and occupational therapist lenses. Parent and child connection, and the importance of building capability through education and support, is the focus of this podcast.

 

Resources:

Books
Dan Siegal – The Whole Brain Child
Dan Siegal – The Power of Showing Up
Dan Siegal – Parenting From the Inside Out
Ronald Rapee – Helping Your Anxious Child

Websites
www.tuningintokids.org.au
www.raisingchildren.net.au
www.gottman.com
www.aaimh.org.au

Phone Numbers
Maternal Child Health Line - 13 22 29
Parentline -13 22 89

Audio Transcription

Leah Wiseman: Welcome to our Albury Wodonga Health wellbeing and resilience podcast series - to help keep people connected, share our community stories of hope and resilience, and provide information about mental health and local services. I'm your host Leah Wiseman, and today I'm joined by Connie and Lou. They specialise in working with the youngest, and arguably the most vulnerable members of our community - children zero to five years.

Connie and Lou are sharing their wealth of experience in understanding the emotional worlds of little people and sharing their insights on the unique experience of social isolation for children and families.

Connie Cudini: I am Connie, and I am a child and adolescent psychologist and I work at CAMHS, and my role at CAMHS is to specialise in the areas of naught to five - so little kids. And I do lots of different things within that field. I spend a lot of time talking with parents and kids. And I spend a lot of time supporting the agencies that you might visit with your toddler or your infant. So your maternal child health nurse, your doctor or any other service like kindergartens or daycare that you might pop along to with your little person. And my role really is to help them, and the families, make sense of the emotional worlds of little people, because there's a lot we don't know about. And there's a lot of kind of misunderstanding out there about kids that are nought to five and the emotions they have in their mental health.

Louise Scheidl: Thanks Connie. My name is Louise and I'm an occupational therapist, and I work with the CAMHS team as well and I also have another role in the mental health promotion. But I particularly love helping Connie when we work out in clinics that Connie offers for children, nought to five as well as their parents.

Connie Cudini: So we've got lots of different types of clinicians that you might see. Obviously, Lou and I. I'm a psychologist, she's an occupational therapist, but we've also got social workers, and toddler psychiatrists, and family therapists, and psychiatric nurses, speech pathologists as well. So there's a whole range of kind of expertise that we put into understanding little people and their family’s needs at a time. So we like to offer that, I guess, and often kids that pop into our service have reached a really complex end of the difficulties as well too. So, part of Lou and my role is to try and put as much early intervention out there into the community, whether it's with families directly or with services, so that you don't have to end up at a mental health service. So we're really passionate about early intervention, and lots of the parents that I talked to, through maternal child health, are visiting me because they're also passionate about early intervention, and they have that kind of sense that if we can have that kids early we're doing a really great thing.

Leah Wiseman: So you talked about the emotional worlds of little people, Connie, being your area of expertise I guess, and I think that's a really lovely way to describe what it is that you seek to understand and know lots about. I think that there would be plenty of people listening who aren't even aware that children, certainly infants but even up to five can have mental health issues.

Connie Cudini: Yeah, absolutely. Look, I guess, we start really experiencing an emotional world, in our mother's tummies, actually. And we've got lots of evidence these days to show that little children and infants, have a world inside them that we sometimes don't see and we sometimes don't understand and part of the biggest problem for why we've never really understood it and embraced it as a society, and as a culture, is because little people can't talk and they can't tell us what's going on inside them. But I guess, infants certainly from a very very young age can demonstrate pleasure, can demonstrate sadness, can demonstrate fear and pain and that's all stuff that contributes to their emotional world. And sometimes it just is a matter of stopping and looking and knowing and understanding that that little person comes with their whole own set of things that they need to be thought about. So, as kids progress they're not excluded from things like anxiety. We all get that. They're not excluded from things like having poor relationships with other people. We all get that. And this sort of stuff, plays out with little children as well too.

I guess one of the things that happens between naught and five is we have this massive rapid growth in our brains, in our bodies, and in our personalities and it's ever changing and it's really fast, and it's really hard for little people to kind of keep up with that. Which is why we have things like the ‘Terrible Twos’ and that's why we have, you know, difficult transitions to kindergarten and lots of separation anxiety and, you know, lots of kind of behavioural problems that parents are tearing their hair out trying to manage. You know, it's because this rapid growth is unlike anything else in our entire lifespan, and what comes with that is a huge emotional response and a huge emotional reaction that baffles us sometimes as parents. And I guess we're all running around trying to do the best we can and over the years, probing the last 20 years, a lot of the research and a lot of academics in our world have cast their eye towards this age range and recognise pretty quickly that this is a really significant formative time in our lives - that if we don't get some good stuff happening then, and a parenting in a family system and a community system that's good enough around a child, that we can really run into some problems later down in life.

Louise Scheidl: I think that's even more, sort of often you'll hear this term ‘foundational years’. And that's exactly what's going on there's all these foundations on the way a little one will understand the world that they're in, and what to expect of that world. And that's again, as Connie said, that's a lot to do.

Connie Cudini: Because parents and carers is so important, we've learned probably in the more recent times, that the brain actually really is shaped by that nurturing and by that relationship. So what's come out of neuroscience and the study of this early developmental phase, is a real emphasis on how we relate and the importance of our connection with our children.

Lou and I will often pop over to maternal child health centers, and families will come and visit us and we're happy to help them navigate some questions I've got about their kids. One of the biggest kind of presenting issues that families will come and talk about is managing kids that are just out of control, so kids that are just super active and not listening, really hard to put consequences and boundaries around, and it's all good and well for me as a psychologist to offer parenting strategies, but to be honest, most parents are pretty much good enough at that. And what becomes more and more noticeable these days is kids are actually having some real sensory problems so it doesn't matter how good you are as a parent, if you've got a little kid’s body that is just going crazy, which is why I love working with OTS, because they're really fabulous at being able to normalize that for families.

Louise Scheidl: I think the thing is, it's just so true because they are absolutely learning how to be and live in this world. And that's happening very quickly. We are taking in information from our world all the time, through all our senses, and there are times when that may not all come together in a smooth way. The way that a parent can connect with their child or support their child, if they have a bit more understanding of what might be going on for that child in terms of how they see, what they hear, where their bodies in space, the way their balance is - all those sorts of things that take on meaning in the way they live in the world. To help parents understand a little bit more of how they behave, because they may be more sensitive to certain parts of the environment, or in other parts, other times for kids they might need more stimulus from the environment to sort of bring them into that nice sweet spot.

Connie Cudini: And I think OTs are really fabulous also to contribute to that thinking around emotional regulation. I don't know how many people have heard this word - it's a really common word here at the moment - and, you know, when you think about regulating your emotions and needing help with that. But I think OTs are really good at helping with that too, because so much of how kids regulate is in a sensory way. And not only do little people need their parents to say ‘I think you're feeling really angry maybe we need to go and calm down,’ I also need parents to sort of offer some sensory ways of being able to harm and soothe as well. So it's not just about meeting the cognitive needs of the child and the nurturing need it's also about saying ‘your body also needs to calm down.’

Louise Scheidl: And they all connect up. So we have to we have to remind parents often, it's not just about, like you say, talking - they're living in their bodies, not just in in their mind. It’s actually watching what's going on in the way they actually behaving, not just through are they naughty or whatever, but what might their bodies be needing at that moment in time. And if we can start to put that idea or that sense of sense of curiosity in a parent.

Connie Cudini: And look, those sort of strategies are really easy, and parents love them because they're really concrete strategies like introducing D-pressure or introducing more activity or jumping on a trampoline and all that kind of stuff that parent’s love. I guess sometimes what I, you know, talk to parents about is their relationship and their sense of connection. Some people think about it as bonding, some people know it as attachment – there’s lots of different words for it. That’s a bit more baffling for parents to get their head around because it's more really kind of psychobabble stuff and in some ways it's some of the most important things. We can't survive as human beings without a good sense of a connection to someone. The connection we formed with our children is very much almost pre-determined by how we were connected to as children ourselves. So we can get ourselves in quite a pickle as parents sometimes because we kind of play out some stuff that we're not even aware of in our early history, and parents sometimes come with a great deal of stress, they get some practical kind of strategies about how to see their child through a sensory perspective, but then sometimes might need to tease out a little bit more connecting to their child.

Louise Scheidl: I think that part of this is to actually be always keeping in mind that it's the relationship between the parent, carer, and the child that's ultimately the most important to keep. I think from our work and our support of the parents, especially around the little ones, because the parents are creating the world and so by actually just giving them some more information, looking at a little bit different, trying sometimes being a little bit more curious and given permission not to feel like there’s certain ways of bringing kids up or doing things that's being a good parent. That actually, there's some other ways to come around and look at it from. Because that can then create that opportunity for parents to just keep exploring and offering and changing and helping the child understand their own worth.

Connie Cudini: And I think parents of infants and toddlers are really vulnerable. Part of their life cycle when we have kids, is that subconsciously and consciously, we look to our own experience of being parents to be able to figure out what we're doing. And it's a time of life of great reflection I think for adults, and it's a time of life where you also start to realize that hey, maybe how I was treated and related to early in life is not so great. Maybe I don't want to play that out with my kid - or sometimes you're not even aware of it consciously.

So, I find that I get lots of parents coming in wanting to know about their relationship with their child because it's suddenly becomes something that's really important to them. Parents are actually ready to go to talk about that connection and that attachment, and it's something that they get a lot of benefit out of.

Leah Wiseman: I love that you use the word vulnerability around the parent, as well as around the child but because I think that's such an important thing to acknowledge when you are talking about attachment with them, because it's probably the most personal thing you can do is be a parent. And it is important and it's so lovely to hear you describe it as a vulnerable stage for the parent as well as for the child.

Louise Scheidl: I mean, I think if we even look, you know, maybe a bit clicking it out a little bit more into a bigger perspective, you know, this is a really important role in our lives. And in many cases when we have other important roles that we invest a lot of time into, such as our work roles, we go to train. We train for three or four years in these, and we develop up ways I'm going to operate in this role, you know as a worker, whatever it is. But we don't often go to University for three or four years to study to be a mother or father or carer. We're on the run, we’re busy with this little one or two or three maybe, we have these fantasies of ‘I'm going to have this perfect child, I'm going to be a perfect Mother, I'm going to listen to all the podcasts that are around, do everything perfectly.’

Connie Cudini: The social isolation’s afforded a specific opportunity I think, as parents in more recent times. I had a really interesting conversation with the parent the other day about suddenly having all this time to be with my child and she’s right in the sense that we're busy multitasking adults these days and we lose a little bit of that headspace to be fully present with our kids. And being in social isolation where you don't have all those demands is a really interesting time to think about that and to think about ‘how present, am I with my child?’ And in fact the playfulness is sometimes the most important thing a kid needs from their parents because it's within that play that they learn that they are loved. They learn that they are enjoyed, they learn that their mummy and daddy are just as silly as they are, and have taken the time to stop and do something that they like to do, and the sense of security that comes with that is tremendous. So, you know, often Dads will come to me and say ‘oh sometimes we're really rough and we wrestle and you know, is that okay?’ and I say ‘oh my god yes - wrestling and that real rough play with children, in particular boys, is a great place to grow their brain, and to teach them how to regulate.’ So you know, that little boy or that little girl that's wrestling with Dad watches how Dad comes down from a high emotional state and regulates himself, and are learning that you know they're actually learning that in that play.

I guess I spent a lot of time connecting with parents about how to play. I know it sounds crazy and ridiculous. Some parents don't know how to play. Some parents would never played with themselves as children, and that's tough, you know, and other parents are naturally playful.

Louise Scheidl: And coming from an OT point of view play is the number one occupation, if you like. It's the number one thing for a child to learn, that their purpose is through play. They do, they learn, they problem solve, they understand their bodies in space, they understand relationships.

Leah Wiseman: You mentioned before that social isolation for some parents has been an opportunity and I know for me I've felt like it has been an opportunity to do the stuff that you're talking about with my kids. What has been the other side of the coin in terms of this time? Around the pressures that exist within families and the distancing restrictions and that kind of thing?

Connie Cudini: A lot of parents have finding that to some degree life's gotten a little busier, so suddenly they've also got to be a home learner teacher, whatever you want to call us. And you've got actually school your kids on top of also parenting them, and then on top of that also care for them, and nurture them. And then the days you have to work, you work. There's a whole heap of extra demands that people are being faced with at this point in time, and if you've got a family life, or a child that's got extra stress around it, this can be really tough. And if you're not used to all being together in the one house 24/7, whether you're a big family or small family, or whether you relationships are not so well connected. This is a really confronting time for some people, and they're the people that probably come and speak to me, or to the service, or to the GP, or to their maternal child health nurse and say ‘hey, you know this is really difficult’, and that's probably a point at which you need to get a little bit of extra advice on how to manage what's happening at home.

Leah Wiseman: And you mentioned before the podcast recording that you're as busy as ever in your role certainly during this time.

Connie Cudini: It's really interesting, CAMHS as a whole, when we all first went into social isolation, saw a bit of a lessening in the referrals that came through to us and part of that was because the kids were no longer at school and I think at home, being connected to with their parents and enjoying a bit of time that didn't have all the demands that life has for them. But in this age range I think the anxiety just peaked because kids, like I said before, parents worry about their kids in this day and age. You know, they really want to do what's right for them and their little people sometimes need so much more guidance and support in a home setting than say a teenager or an adolescent does. And it becomes really noticeable, I think, when you throw little people in home with the opportunities they have in their day to day life - like Kinder, or playgroup, or heading off to a mother's group, or you know all those outings that form a routine for this little person suddenly changes, and that dynamic can get really stressful.

Louise Scheidl: I think that whole point you were saying before, like for little ones the little nought to fives, you know, as parents and carers, we are more responsible. We are the way that they can regulate themselves. We are the way. So if we're stressed, we will see that through with those little ones. All our children will respond to this stress if you've got more than one child in your family. You'll see them all responding differently and, as you say, the older they are they can maybe regulate. They have more skills of how to regulate themselves, what to do, but little ones don't have as many options.

Connie Cudini: That's right, and the big question that often parents have asked me in this time is, how do I tell them? Like how do I explain to a two year old or a three year old or four year old, that there's this virus out there that is potentially really lethal without scaring the bejesus out of them and creating an anxiety problem, you know? So finding a language with the parent that's a good fit for that child has been a big piece of the work.

Louise Scheidl: And also the messaging that's been coming out, broadly across the community is: number one - it's so vital for parents and carers to number one look after themselves.  Because your little ones in particular are filtering everything, or you’re filtering everything through that stressful layer. So it's really important to just take that moment. Now whether or not that's after they're asleep in bed and you are just sitting on the couch for five minutes just going, ‘oh my god, what a day I’ve had.’

We also know, there are again the other strategies about just being mindful of what's being shown on TV all the time. How much traumas, if you like, impacts that can happen and stress is so safe with bushfires. And if little ones are still seeing excerpts or little clips in a news report that might be talking about something that happened three or four months ago and as adults we understand that. But if the little ones just seeing flames and things, they may still think it's going on. Things that you can do in your household, in your home situation, that can be trying to pre-force this sense of safety and security.

Leah Wiseman: So with that in mind, is there any advice or particular things that you get parents to look out for if they are concerned that their little person is showing signs of poor mental health?

Connie Cudini: Yeah, I think with little kids, it becomes really evident in the kind of daily habits. So if things start to change that are not usual for your child, so they start to sleep worse, they’re not eating the way they normally do, they’re have more kind of emotional outbursts throughout the day, they're not doing the things they like to do ordinarily, becoming more frustrated, more clingy to your parents, to you if you have to leave (not that we're leaving much at the moment) but, you know, parents still notice things like that.

Louise Scheidl: You may find that they may sort of go backwards a little bit with some things, so if they might have been toilet trained and then they might be needing, you know, bedwetting or something like that can even happen where they’re just regressing a little bit or just in the way they feeding themselves. Those little things can occur, and the other thing is to sometimes they can go a little quiet as well. It just didn't quite hear as much.

Connie Cudini: I think the message that I'd like to give to all parents is that you know your kid the best, and you know when something's not right. I think you really need to rely on your own instincts about that, and if you think that they're just not themselves and you suspect it has something to do with the stress that's around them at the moment, then pick up the phone and call someone. Nobody's going to tell you you're a loon bag because parenting is a tough gig, you know. It's hard and when suddenly you're in a situation where you're with you kid all the time, like they're not at daycare or they're not at school, it can be really stressful. And it's really important to know that you can ask for help and you deserve to ask for help.

Leah Wiseman: So we're lucky enough to have the child and adolescent mental health service locally. I guess as a general rule of thumb are people, if they're not able to do that, call their GP?

Connie Cudini: What I say to parents is that as a mental health service we're here for when it gets really, really tough. Really, really complex and you've tried everything, and it just hasn't worked. So I always encourage parents to try some of the more easie to access services. So things like your GP, your maternal child health nurse, have a chat to your kindergarten teacher they can always point you in the right direction. You can access a private psychologist through a GP, but I think community health centers are a great one-stop-shop for a lot of things, and they're really good point information. So if you're just not sure where to go, contact your local community health center and see if there's a service there that can help you kind of navigate what you need, or if they can suggest somewhere else as well too.

Leah Wiseman: Thank you to our guests on today's episode of our Albury Wodonga Health, mental health podcast series - a sense of connection, mental health, wellbeing and resilience. You can find our contact details, an exhaustive resource list, and the entire podcast series at awh.org.au under the mental health tab.