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EDITORIALS: Morris Zwi and Philip Clamp Injury and attention deficit hyperactivity disorder BMJ 2008; 337: a2244 [Full text]

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We don't need more excuses for parent training

Sami Timimi   (25 November 2008)

We don't need more excuses for parent training 25 November 2008
Sami Timimi, Consultant child and adolescent psychiatrists Lincolnshire Partnership NHS Foundation Trust, Ash Villa, Willoughby Road, Sleaford, NG34 8QA Send response to journal: Re: We don't need more excuses for parent training	I enjoyed reading Zwi and Clamp’s review (1). It’s always nice to know that what intuitively makes sense (that kids who are more temperamentally active are more likely to have accidents) is supported by empirical research. However, as no details are provided about the severity and subsequent impairments that such accidents cause to individual children, their suggestion for “early assessment and referral to preventive programmes, such as parent training” (in children as young as two years of age) is problematic. I have two concerns in particular. Firstly, it will further contribute to the process of parenting becoming something that needs a professional’s input to get right. There is already a large ‘army’ of psycho-medical professionals using a rather narrow Western middle class model of parenting that has been sent to turn us mere mortal parents into gibbering neurotics, afraid that whatever we do may prove harmful to our children. This increasing professionalization of parenting can, not only cause a sense of guilt and failure in perfectly ordinary and competent parents, but also risks de-skilling communities who are distanced from their indigenous cultural resources as they come to rely on professionals to ‘get it right’. Secondly, it adds to our current cultural panic about childhood being a period surrounded by intolerable risks. There is an established evidence base (see (2) for example) suggesting that specifically ‘rough and tumble’ play aids neurodevelopment and lack of such play may contribute to the development of ADHD type symptoms. Thus the paradox may be that trying to protect children from the sort of behaviours that are more likely to cause accidents may in itself interfere with healthy development. My children’s school’s headmistress ended up in the national newspapers last year, after an ill-thought out attempt at stopping bullying by banning all physical contact in the playground (a policy that had to be abandoned after this press coverage, much to the delight of my children). As one commentator noted “We would wrap every child in cotton wool if it wasn’t that some are allergic to cotton!” I fear my children (like me) would probably have a similarly sceptical response to the suggestion that parents of two year olds and upwards need parent training to stop their children having accidents. 1. Zwi M, Clamp P. Injury and attention deficit hyperactivity disorder. BMJ 2008;337:a2244 2. Timimi S. Naughty Boys: Anti-Social Behaviour, ADHD, and the Role of Culture. Basingstoke: Palgrave Macmillan, 2005. Competing interests: None declared