Managing Learning Disabilities and Sleep Issues

Hi, this is Panel Beter, and this is the podcast of Triple R's Radio Therapy, a weekly radio show dedicated to health, medicine, and wellbeing. Broadcast live on Triple R from Melbourne, Australia, every Sunday. Hope you enjoy the podcast and feel free to get in touch with us via Radio Therapy's Facebook page. Good morning. You are on Radio Therapy. This is Miss Perry Neam and I'm joined with

Dr. Training Wheels. Good morning. And it is our last show of the year. Merry Everything. Merry Everything to one and all. We have a really interesting show today. I'm really excited for our two guests. We're having a bit of a developmental, you know, journey childhood. Yeah, journey through the life stages kind of chat today. We have Ashra.

I my pronunciation today is going to be really rubbish pre warning. Uh Sam Sidin, who's from Spelled Victoria, and doctor Kate Johnson, who is a spe a sleep psychopsychologist. Speaking of sleep, are you feeling okay? I have to apologize to our listeners. I have hit That lovely stage of pregnancy where my brain doesn't want to work very well. Um please bear with me if I sound like I've got my words slightly jumbled today. I promise there's some neurons firing behind these eyes. You don't swear.

You're doing great. We're re winding down for the year this today, but I think let's jump to some news and we'll uh we'll get going. Let's do it.

How are you, Perineam? What's up? What's what's what's news with you like in the world? Well, news I mean, news is um I feel like it's a busy time of year for everyone at the moment. Um I have two pieces of news. I am not personally disappearing off s uh sort of travelling this year, but I thought I'd start our new segment today with a little PSA. For all of you who are heading away over the Christmas holiday period.

Um A reminder that sometimes if you are heading overseas now that we are out of that lovely covert bubble. that sometimes vaccinations, particularly into younger individuals, actually have a lead time and so you need to get them ahead of when you're planning to go. Um so a little shout out to smarttraveller.gov.au that if you are heading overseas and unsure of the health advice for the region that you are heading to and the vaccines that you need, that you can actually look them up online.

as well as the lead times that you need for the countries that you're visiting. Um, because sometimes you think about it the week before you go and it's a bit too late in terms of actually preventing things. So Um that's my little PSA to those. of you who are lucky enough to be heading overseas or away.

And if you are going away kind of early Jan, now's probably the time, right? Yeah.'Cause a lot of them are sort of the two to four to six week kind of lead time story. Absolutely. So even end of December kind of thing. Run, don't walk. Yeah, book yourself in with your GP. There is also travel medicine clinics that are um through the public health system that you can also get.

Appointments with for vaccinations and things along those lines. And smart travel is so nice you can type in where you're going. Correct. It's country by country. Specific for what are what diseases are endemic in that area. Yeah. It's so handy. They actually have a section for each country called health and that will tell you what issues are currently prevalent in the country, the vaccines that you need and any preventative medicine that they suggest that you take with you.

So I think it's a really good place for families to start because often the medication that we have available to us in Australia is not as easily accessed overseas. Um and if you're travelling with people who are immune compromised or sensitive or younger individuals, the last thing you wanna be doing is trying to go and access medicine if you get stuck in a situation. Prevention is better than cure. Always bang on about in this room. Correct.

My second piece of news is I'd love to give a little shout out to a uh I'm lucky enough to call her a colleague now. Um Dr. Jodi Duckick, who's at Monash University. She was also one of my teachers when I was doing my advanced degree. And she has published. A really interesting study which some people might have seen in on the ABC. There was a recent um publication that talked about her research. basically looking at the fact that one in three women experience urinary incontinence with exercise.

and that it's a major barrier in sport across all ages. And we're talking about women anywhere from the age of eighteen up to eighty five that are participating in exercise. And the fact that this is a major contributing factor. Is that one in three even for women who have never been pregnant? Yes. Wow. Yeah. So one in three women who exercise will experience urinary complications, whether it be leaking, urgency, or anything along those lines.

Um and fifty percent of the people who experience those symptoms will stop exercise because of them. Which is a massive number. And we know in terms of health Um women are actually m we need exercise more than men often, particularly for through hormonal changes and our regulation of our general well being. Um, particularly through our premenopausal to menopausal transition.

And so I think it's a really poignant Reminder that these are common but not normal symptoms that there are people out there, either your GP as a first point of call or your handy dandy local pelvic floor physio um who can actually help you with these things. And if your New Year's resolution coming into the new year is to go, actually I really want to start exercising, but this is a barrier for me.

I really strongly encourage people to seek out some help because we have really good tools to actually help you on this path. And it's one less thing that stops you getting outside and actually looking after yourself in a more productive You know, Perineam I something I love, I don't think I've ever met a pelvic floor physio that doesn't love their job. You know, that isn't like super passionate. Yeah. It must be nice working in such a field of such passionate people. Yeah.

It's so good. And it is so rewarding, right? Like the the change you can see in people's quality of life. I think it's just remarkable. I I personally and this is very much personal opinion, but I think a lot of women's health has been overlooked for a really long t long period of time. and all aspects of that in not just sort of um

kind of covering it over or put slapping a band-aid on it. And I personally love being really productive and empowering women to actually take control of some of the things that really diminish their quality of life. And And have relatively simple solutions in many cases, right? Yeah, often they do and and to champion them because women are amazing.

And blokes. Blokes are pretty good too sometimes, but you know But it's really nice to just empower people and actually get them to see that they can help themselves so much more than they think they can if they've given the guidance. So Happy festivus for everyone. That's my little positive bubble to finish the year on. Bloody brilliant. Yeah. Have you got some new pelvic floor? I do, yeah.

So this one caught my eye because I'm always looking at AI developments in AI, I just think it's fascinating. Um and there was a study published in JAMA the journal of the American Medical Association in October that used an older version of Chat GPT which people who use AI know that that's one of the most advanced um programmes that we have available to the public at the moment, but this is actually not even the most up to date version. So it's from about a year ago.

And they did this study where they grouped people into um physicians, so qualified specialist internal medicine physicians and trainees. highly, highly specialized part of medicine. um into it randomized them into three groups. One was just by themselves, one was the physicians with help uh from chat GPT and the third was chat GPT on its own.

And they were given these clinical vignettes, so sort of quite complicated, unusual at rare presentations, and that were tasked with um determining what the diagnosis was. And the hypothesis from the researchers was that people plus AI would perform the best. Hm. Turns out that people plus AI

are actually about the same as people on their own. Not really very much better. And that seems to be because people have their own unconscious bias. They read this vignette and they think, I reckon it's that because I've seen that before or whatever, you know, they bring their own history with it. And the AI might say, Have you considered this alternative situation? Then the person discounts it. I'm smarter than the computer.

So they actually it didn't help that much. Maybe that's because people didn't know how to use it very well. Maybe it's because it was an older version of Chat PT chat GPT, who knows? But an unexpected finding was that Chat GPT by itself outperformed both the other groups. Interesting. Significantly. Wow. So ChatGPT, AI, in this instance, was a better diagnostician, better at finding the diagnosis.

than s medical specialists. So what you're saying is you shouldn't Google your symptoms but you should chat GPT. I mean kind of. Yeah. So I think what a an interesting takeaway from it is that the way that they wrote the prompt. Mm that were provided to Chat GPT were quite specific. So it wasn't conversational. It wasn't the same as you ringing up your doctor and saying, Hey, I've got a headache.

And you know, that back and forth that that happens with a real person. They were structured in a in a way to optimise the response that was given by AI. So I don't think we're quite at the point where we can just start talking to Chat GPT and get a diagnosis, but I reckon we're not far off. Interesting. So I think it really raises the question of what are doctors gonna be for? What are the skills that doctors are gonna have that

the robots aren't gonna have. I think the reality is, and we're already seeing this in medicine, is there's a lot of sort of those gray area diagnostic calls in terms of yes It's lovely if someone's got one particular condition and you can make a very clear cut answer in terms of medication or things and the complication becomes, okay, never mind the sort of surgeons who are doing the mechanical repairs on the they're the mechanics of the world as far as I'm concerned.

But they're it's it's that decision making of which one do we have to make a priority? Like which one in terms of Treatment order in terms of medication preference. And and which one's more important to A, quality of life, life sparing, all of those things. I reckon the stuff that AI that that AI I think the things so I think there's a few things. One is that procedures

still robots can't do. So you kind of you mentioned that in passing that surgeons are the mechanics of the world, but I think that procedural type of stuff is gonna remain relevant for a long, long time. Yeah. Because robotics is really tricky. Yeah. But I think there's still a human element of medicine that is being underlooked here. Over overlooked. Underlooked. Overlooked. Um and I think the ideal situation with AI is that we have a real person doctor using these AI tools. to help them

Make the best diagnoses ever. So even though the study found that humans plus AI wasn't great, I reckon we can work on that. Get them to work together together better. Get the AI in real time to prompt us, ooh, have you considered oh, don't forget to ask about Ooh, what about the time three weeks ago when they mentioned du da du?

Um that's one thing. But I think that the Ultimately I think there's still gonna be something that comes from talking to a real life person um that a chatbot isn't gonna be able to Provided. Yeah. Um and I think there's the you know, there's all the emotional side of things when you have a difficult diagnosis, the relationship that you forge with your doctor over many years, sometimes many generations. I think that stuff is gonna become more and more important as we

uh become more socialized to rely on robots. Um watch this space. So I think the social skills are gonna become interesting. Even more important than they already are. There you go. Fun time. But let's see. Let's wait. Maybe in a couple of years' time we'll have a robot in here and we can chat to them about it. You know there are really good AI podcasters now. No, I know. So you never know. Yep.

Next year radio therapy will be this is a podcast from Triple R, an independent media organisation in Melbourne, Australia. To find out more about R or to explore many more shows, podcasts, articles, videos and interviews, head to the triple R website at rrr.org.au.

I am delighted to welcome our first guest, Ashraf Samsaddin from the organization Spelled Victoria. For those of you who don't know what Spelled Victoria is, it is the Victorian peak body for specific learning difficulties. Um and there happens to be associated um peak bodies in every state of this country.

Ashraf is a special education consultant and he is his major role at Speld is the organization's educational service. So his job is to basically go out and educate other educators that are looking after our children in terms of what specific learning difficulties are and giving them the tools to help work with people and children who have these particular conditions.

Um, Ashraf came from a long history of working with specific learning difficulties from Singapore and he was at the Dyslexia Association of Singapore for a really long time before he came to Australia. and is an incredible educator and he's here to talk to us today a little bit about what specific learning difficulties actually are and how we go about, you know, supporting Children and adolescents with these conditions so that they can make the most out of their education. So welcome Ashraf.

Hi. Hi Phoebe. Hi Jess. Nice to have you on with us. Thank you for having me here. Can you tell give us a bit of an overview in terms of what do we actually what is a specific learning disabil di uh difficulty? Yeah. I mean uh number one let's start with the term itself, you know. Is it specific living disability, is it specific living disorders?

Is it something else? Uh so the official term that's been used now, uh and that's in accordance to the the Diagnostic uh Statistical Manual version five is the term And so what are some of the sort of more common names for these conditions that people might be aware of?

That's right, that's right. So the the most common form would be for so for example with the specific learning disorders with an impairment in reading that is quite synonymous with dyslexia. And I think most of us are quite familiar with what dyslexia is in that it impacts reading, writing and spelling.

Yeah. And how common are these particular conditions in the sort of general population? So it varies, it depends on the sort of difficulties that we're talking about. Dyslexia being the most researched. yang akan menyebabkan sekurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang-kurang

uh would have uh a similar statistic as well. Um what's interesting though is that um these learning disorders normally co occur together. So for example a child with dyslexia would also have accompanying difficulties in math. So 40% of them would have difficulties in math.

And about sixty percent of them would have difficulties with written expression or difficulties with handwriting. Interesting. So if we're looking at sort of a breakdown of a classic Australian classroom, let's say we've got twenty five students in a classroom. How many of those students are we really seeing affected by these kinds of difficulties?

Right, so anywhere from 2 to about 5. So because dyslexia or learning disorders does come in a, I would say, across a spectrum. So you have some students who are mildly affected with dyslexia or dysgraphia. Uh uh uh. So roughly between two to five. In every class. Yeah. And in terms of our sort of our our schooling system, how many teachers are equipped with education at university to actually be able to handle and manage these kinds of learning difficulties in a classroom setting?

Uh so c unfortunately to say so currently our uh most of our teachers are not equipped or adequately equipped with uh the right knowledge or skill to be able to help our students. Um so although having said that, um there's some education now starting to appear in um in the initial teacher education in the form of maybe one module about learning disabilities. But usually as far as I'm aware And does the prevalence of these conditions change across the age groups?

Um in terms of um like uh primary school to sort of middle school and and senior school? Hm. Uh it doesn't qu the prevalence doesn't quite change. Um The complexity does though. Yeah. Yeah. Uh in a sense that As a child grows up, the issues does compound. ...into social-emotional ones. And of course in particular when intervention is being done on students who are a bit older. There's issues with regards to habits that's been formed that's a bit difficult to undo.

And of course the self esteem issues as associ associated with age and uh the rate of failure that they have encountered during their schooling life, that also plays a factor in how uh dyslexia or learning disorders impact a student. So earlier diagnosis is is effectively better for a a a student in terms of getting support in the classroom environment?

Of course, the earlier the better And you don't even need to sometimes wait for a diagnosis Jika a parent atau a teacher find that a child is lagging behind their peers, it's important for us to give them the adequate support and the right support immediately.

Sorry, listeners bear with us a second. We have a guest in the studio today. Uh Dr. Training Wheels young little one is with us and so you may hear her clo um mm enjoying some time in the studio with us today. Um In terms of what For reader discretion, I have specific learning difficulties and actually was diagnosed via SPELD, which is my association with the organisation. Um and I n I personally n can attest to the value of of early diagnosis and support.

What does support look like for some of these students? What can schools actually do? How do they implement things for these students to change their learning outcome? Right. So that's a great question, Phoebe. Um what sort of support can be given uh to students who have been identified to have a learning disability in school? So for those listeners who are aware at home who might be familiar with this system called this system of support called RTI response to intervention. So it refers to

almost like a three-tier pyramid to ensure that all students are able to receive the support that they need in their academic areas. So tier one would be referring to whole class education. Tier two would be small group intervention and tier three would what we call specialist intervention. Yeah? So um by and large all students at the tier one at the whole class level should be receiving uh support.

In uh an evidence based instruction. So this includes everyone. Does that actually improve the outcomes for non affected individuals in terms of their learning outcomes? Exactly, yes. It improves instruct it improves our performance for all. Yeah. Okay. So this is something that we would hope is actually being implemented. Should just be everywhere. Should be everywhere. Okay. Great.

The Victorian government is now mandating twenty-five minutes or twenty minutes of phonics every day, ex in explicit teaching of phonics, uh come twenty twenty five. So that's good news for a lot of students and for all of us because we now know that okay at least phonics is being taught explicitly in all classrooms and that helps us to I suppose separate students who are

...needing the help the most. Because one of the biggest issues... I was talking to you about Tier 2 and Tier 3, right? One of the biggest issues that schools face... ...would be the overwhelming number of students that they are finding they need to support. Dyslexia or otherwise, right? Because of a lack of good tier 1 instruction. And because of that, uh dyslexic or non dyslexics will have difficulties and therefore teachers or schools are are having difficulty.

Now, you were talking about what sort of support schools can give. It's the Tier 2 and the Tier 3 specialist intervention that schools can give. So, assuming that good evidence-based instruction is given at Tier 1 whole class, Then we are able to then identify in a timely manner students who are lagging behind. Now these students who are lagging behind may or may not have dyslexia at this point. They are just lagging behind.

So once they are given on top of the tier one instruction, small group intensive instruction, then the teachers would be able to intensify, they are able to give uh instruction which is more targeted, and from there they should be able to monitor their progress. And if a child continues.

to lag behind over a period of three to six months, for example, then there is a cause for concern and we can then make a recommendation for the ch that particular child to have uh to to go for an assessment for a learning uh disability.

And what does assessment look like, Ashra? So the assessment for someone with a learning disability would include a few parts. Number one would be a clinical review of the individual's development. Uh medical, educational and family history. So it's quite extensive. So they have parents will have forms to fill in, teachers will have forms to fill in and and all that.

So this will include uh include reports of test scores and teacher observations and also the evaluation of the individual's response to academic intervention. So if they have had tier two intervention, It will c all all of this will come into play. Yeah. Okay. So when I talk about clinical review, this is where all of the testing will come in by the psychologist, the educational psychologist. Yeah. And how long does testing actually take for an individual?

It would take roughly about three hours, three th to four hours, depending on the child, I would say. And that's usually over numerous sessions. It's n it's not just a Uh a one time Spend a day getting exhausted. Um so normally we try to call the students up once.

Mm-hmm. But there will be breaks in between of course. Yeah. And uh for in the case of dyslexia they'll be asked to sit through uh what we call a cognitive assessment and an educational assessment across that time. Or in during that time. What's the sort of demand for these assessments, is there long wait times for people to be able to access them if they think that their child needs an assessment?

Uh yes, there there are long wait times uh for this. So typically the wait time is roughly about six to eight months. Wow. So for those who are going have had their parent teacher interviews for the end of the year and something's been identified. Is there particular places that you would recommend them go and look other than potentially spelled as an organization to get more information about getting assessments or things like that?

Yeah. So spell will be the go to organization for assessments because we do have the expertise uh to do it. There are of course a lot of other uh private educational uh psychologists that uh parents can approach. Yeah. Up there. And what's um Ashraf, do you know the cost of an assessment roughly? Uh so it varies again. So for us it it starts from a thousand five hundred and that is um what uh we try to make it as affordable as possible for parents.

Um to about for the privates it could go up to as high as about two thousand dollars. And is there any kind of Medicare rebate for those kinds of assessments? Well, we wish that we were able to give some kind of rebate to parents, but unfortunately not. It's such a shame, isn't it? Considering that really up to about a fifth of students would benefit from assessment in terms of the yeah. Yeah, yeah, yeah. Exactly, exactly. So you leave shame.

Obviously any classroom is gonna have a diversity of abilities. I'm wondering what you say to parents are sort of red flags? If they're if their kids sort of lagging behind a little bit, what are the sorts of things that are kind of they should look out for. I I guess, you know, given that there's a long wait time and and and these things take a long time and early intervention is better. I think it's important that if we can educate parents

and empower them to kind of get the ball rolling earlier. That hopefully would will be a a good thing.

What are what are the sorts of things that um sort of jump out as red flags as opposed to just kind of a a normal spectrum of different kids are different and have different bodies? That's that's a great question, Jess. Um So with regards to learning disability or learning disorder like dyslexia, dyscalculia and over-expression difficulties or impairment, what we are actually looking out for is... Is uh I would say a resistance to intervention. And what I mean by that is

Um okay, let's start with tier one. So at the tier one whole class level, assuming that the the the teacher is using evidence based instruction, research informed programs and all that good programs. Uh the dyslexic child is um lagging behind in a in when compared against their peers. And the difficulties that they face, be it in math, in writing, or in reading, these difficulties are persistent regardless of...

Or or despite the intervention that's been given, despite the seemingly intelligent child that we see in front of us. Yeah? And these difficulties continue to persist despite tier two intervention that's being given small groups Then the teacher is wondering or or even the parent is g uh wondering, you know, uh oh my child is having difficulties in class, okay I understand. I'm I've I I've now called in a tutor and the tutor is using a good phonics program, but despite

this help being given, they continue to face difficulties. Just not making the progress you would expect. Yeah, that's not making the progress that I'm expecting. Now that doesn't mean that of course you stop giving the intervention. Continue giving the intervention while you wait for the assessment uh to come.

Yeah. Um because that's what they need. Yeah. And if parents suspect that their kids might be you n uh might have a specific learning disorder But they're on the waiting list for assessment and and they're sort of just to stop them twiddling their thumbs, what can they do in the meantime? What are things that they could do maybe even over the summer holidays to sort of give their kids a bit of a leg up so that things may be a bit easier next year?

Yep, yep. So there's plenty that they can do. Number one, uh if the issue is with reading and spelling, then Then what parents can do is to give them a g a good shot in the arm with regards to a a short intensive burst of fauna. So something which is structured, something which is more or explicit. So there's uh plenty of good programs out there. uh like sounds right, like you fly

So these are the structured phonics programs, things like read and structure phonics programs, yeah. And some and some li libraries actually carry these, so it's always a good idea. place to go and have a look at your local library because a lot of them have some of these structured programs available. It's worth mentioning that not all schools follow the Phonics program, which is kind of Which is why in twenty twenty five we're hoping now that it's mandated that that will change. So

Exactly, exactly. That's what we are hoping to happen and because of that we are hoping that more libraries will be equipped with decodable readers where parents can then access and do this sort of support at home. themselves. You know? And what's this what's the spelled website for people who want to know more? It is website is www dot spellvic dot org.au and spell the spell sp L D L D V I C dot org or G dot A U

We're gonna wrap up with you now, Ashraf. Thank you so much for joining us this morning. I think it's a timely reminder for all of those who are coming to their report season that sometimes if It's that conversation with their teacher that it's it's not a and I think for parents this is a reminder, you know, this is not a judgment call on your child, this is a call for help in terms of bringing the best out of them and even though it can feel

overwhelming to get the suggestion that a child might need assessment, can I personally recommend from somebody who was told she needed to have special education and would never finish high school? That you now baby. It's worth the investment in assessment because you just don't know what your kids are p your potential is when they've got the right tools at their disposal. Yeah. That's correct. Yeah. Absolutely. Thank you.

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Our next guest is Dr. Kate Johnson, who is a sleep psychophysiologist. Is that right? Mm-hmm. Cool. There's lots of peas in there and my brain is not wanting to do anything. Um please see previous segment for explanation. Correct. Uh so Kate is not only a very well published and researched individual.

Uh, she's a mum of four and she studied sleep at Stanford Research Institute as well as at a division of Harvard Medical School. She's got about a million publications under her belt in terms of looking at relating to her PhD, which was actually looking at sleep through aging. And she's joining us today to talk a little bit about her research, but now she actually works in a clinical setting helping families normalizing sleep. And I think that's what we'd like to focus on today.

because around this time of year routine goes out the window for lots of individuals and I think it's really hard me includ really Kate's here to help me because I have questions. Um in terms of sleep. So welcome Kate to Triple R. Thank you. I'm so happy to be here. Tell us a little bit about your journey from your PhD into where you're working now.

So well I totally fell into sleep research actually. I was uh training to be a um neuropsychologist and I had to do a research project and someone said to me, Oh, why don't you do a sleep research project? and I was like, didn't even know that that was a thing. And then I did and just As dorky as this sounds, I just fell completely in love with it.

So interesting. I also am in love with sleep. Yeah. Both sleep. When we get it. Both we get it. And the process of studying it. Yeah. Um so I completely changed trajectory. And instead of training to be clinical, I went into full time research um and did that for a long time and it was fascinating. So I went over to um Stanford for a while for about three, almost four years, um, and did research over there. And then spent a year in Boston um looking at Sleep in.

really interesting professions where they do really extended work hours. So um over in the US people like police officers, um firefighters. They don't have the same regulation that we have in Australia and so they do very, very extended um sho work hours. Yeah. So looking at stuff like that, which I just think just thinking about it. Yeah. I just think it's really interesting. So that was all fantastic.

And then what prompted the change to sort of work in sort of children and family setting? So um we just got back from Boston, um and I my then three year old was diagnosed with cancer and through his treatment, which was about three and a half years in total. That decided. there was no chance of working academically or trying to do research because I we were in and out of hospital and he had lots of really unfortunate um

side effects of treatment. So everything just kind of was focused on him for three and a half years. Um but then when he finished treatment, I still Really love talking about sleep and and I still wanted to sort of stay within that area. Um and at that point so we had

three I think I had three children by that stage. And you know, I was noticing that a lot of my friends, you know, who were also having children, were really struggling. And it was And I just felt like there just has to be a better way of talking about this stuff, explaining it and and as you said, like just normalizing it because I just really feel that nowadays

There's just so much misinformation out there that people are so confused. Yeah. And I really just want to strip that back and be like, It's it's really not that complic I mean, yeah not wanting to minimise, but it's just not that complicated.

And I really want people to feel more empowered as opposed to overwhelmed. Which is where I feel like a lot of people are nowadays. So in terms I mean, there's lots of sort of sleep, I guess. ways of thinking. I think a lot of people who've got children would be aware of things like sleep training and the cry it out method and the all of these things. And a lot of those really if you look into them kind of came about in the fifties or earlier.

Have we moved on? Have we got a better way of dealing with sleeping kids? So Sort of. But it sort of depends on how you look at that. Oh, it's such a good question. But it it sort of depends on how you look at it. So I would argue that what we should be doing is much more sort of information or evidence based information for parents about what normative sleep looks like.'Cause I feel like if you understand the system and you understand

what it's supposed to do and how it's supposed to develop, you're much more likely to be able to go, All right, well, this is how I might be able to change this or this is how I might be able to tweak this. Um whereas we have a model at the moment where

We give everybody all this information in the first six weeks, which is completely irrelevant to the rest of development. And Then after you get to the sort of six week mark, you're kind of like left to just w we then wait for problems to appear and then we solve problems.

So we solve problems as opposed to helping people to navigate that normative space. So and then the other part of that question is have we moved on? I mean I think most logical people would not do some of these things that, you know You know, I mean we you can't put a six week old baby on a sleep schedule, for example. You know, most people don't leave their babies in a cot in their room to just scream and scream and scream. I mean, th we just know that these are not useful strategies. Um

Uh so yes, we've moved on in the sense that a lot of people don't. But again, a lot of these strategies come out of that sort of more philosophical space. So it's more about kind of how do you feel from a parenting perspective and you know, do you subscribe to this view and this view? As opposed to I really think if we could strip it back to the basics of how sleep develops. What does that look like?

And then you're much more likely to make decisions that align with your parenting philosophy because you understand that, you know, these are the ages and stages where it's gonna be a bit trickier and this is when the the way that sleep organizers changes. I I think people really need to know that stuff in order to then be able to make decisions about how they want to make change. Evidence is power, right? Exactly. A hundred percent. So what are the sort of

pitfall times. What what sort of ages do people struggle with in terms of sleep for kids? Nowadays people struggle across the entire like the entire development. But until they're twenty five I still struggle. But I would say so for different reasons. So I would say the first six weeks, um

w when it's your first, you really don't know what's you y you can't prepare for it. You you can't even prepare for the the sleep deprivation side of it. You know that it's coming but until you're in it you kind of have to So the first six weeks is sort of that just trying to figure it all out or just to survive. Just to try to survive. Um About three or four months is when the way that the brain is organizing sleep fundamentally changes. And that's a permanent change.

So, you know, people call it like the regress, three months sleep regression and so forth. It's actually not because a regression um is more where you've had a period of sort of stability or growth and then you go backwards and that happens. What happens about that three or four months mark though is

It's a permanent change and it's the development of the the central nervous system and the way that the brain is organising sleep and that causes a lot of issues for people. We can talk about that if we want to, but like that's so that's a really tricky stage for people. Um I I think that probably nine months often is tricky because

It's associated with this explosion of motor development. So you've got um babies that are starting to, you know, sit up and then crawl and then eventually walk and so forth. And that explosion of motor development often can impact sleep for a whole range of reasons. Um I think often Around eighteen months can be tricky because that's often associated with a period of increased slip um separation anxiety. So often Even if your child has been relatively independent and

You know, you often see a regression in terms of I want you to sit with me, I want you to hold my hand, I want you to be in the room with me. So you often see that. Um and then into older kids, like when do we see sort of sleep changes into sort of your sort of primary school age kids and So I would say after so really once you drop that nap mm which we try to keep children napping'til about three, uh ideally. I would say after that you start to see a bit more kind of um

consistency in terms of kind of your expectations of sleep because up until three is when there's just so much change in terms of distribution between day and night. And we know sleep is really fundamental for people's health at all ages.

Through the sort of holiday period and things. what are some of the pitfalls that parents get into with kids in terms of like getting enough sleep, regulating sleep. of those things'cause it can be hard without a routine. Yeah, totally. I think though, I I'd start off by answering that by saying though that it's I think it's important to acknowledge that the wheels often do come off during these periods and that that's okay because I think there's so much pressure around

that it has to be a certain way. And you know I mean t I talk to people all the time that are so anxious about the fact that their kids aren't getting the exact right amount of sleep or they've heard that they have to get X amount of hours and if they don't get X amount of hours, all this stuff's gonna happen. And I would just say, you know, we give guidelines about how much sleep

to be helpful, but it's not meant to be prescriptive. You know, sleep is a very individual thing. Some people need more, some people need slightly less. So it should be used as a guide. So what I'm trying to say in a very long winded way is just that it's okay if you know, Christmas really represents a time when we do push the limits. You know, we come out of routine, we're trying to do all a whole bunch of stuff. So

If that happens, it's not the end of the world. You can always get back on track, you know, as soon as you're kind of through that crazy period. Um But more specifically, you know, I I often do say to people though, try to prioritize like so for example, if your um baby is sleeping three times a day. Try to at least prioritize one of those nafs to be kind of

A good you know, to do it just to be like at home, maybe it's a bit quieter. You know, you're trying to get at least kind of one decent sleep that you can kind of bank. Now obviously that gets harder as you drop naps'cause if you've only got one you've got less to play with. But just trying to kind of bank it where you can can be really helpful. We're gonna jump into some questions that have come through on the text line. Often a hot topic.

Teenagers. Naomi has asked us in a nutshell, what's the deal with teenagers in sleep? Well, teenagers are it's tricky because um their phase is delayed, which means that their biological clock is completely different from what it was in childhood and what it's gonna be as an adult. So they

biologically are going to wake later and go to sleep later. And can I just point out uh I was a developmental biologist before I was a physio, but one of the things that people forget is that teenage phase of sleep is actually until you're like into your early twenties.

children still at home going, Why am I still in bed? Yeah there's a reason. Which is rough when when they still are expected to show up at school at eight thirty or nine o'clock, right? Hundred percent. A hundred percent. And I this is one of the biggest issues is that It's it's not a it's not a laziness thing. It is a biological thing that they cannot

sort of wake up until later and yet we expect them to be at school and learning and on early so. Yeah, a little bit but it's more where they get the sleep that's that significantly different. But then yes, once you get into that kind of like twenty five and on, then you start to see the gradual decrease in sleep across

the rest of the lifespan. Some hot tips for we've talked a little bit on this show about sleep quality and like sleep hygiene. Yes. What does that look like in teens and in children? How do we help them get good So it's all the really boring stuff and I hate to say it, it's all the really boring stuff. It's not like genuinely screens before bed. Yeah. Makes a big difference. So not having screens before bed. Um it's about not having

I mean, not that children are gonna be drinking caffeine, but um, you know, teenagers potentially. Um, it's not having caffeine yeah, you know, before bed. You know, and people always say to me, Oh, but I can drink caffeine and it doesn't impact my sleep and it does. Um it may not.

You may not recognise it, but from a quality of sleep perspective it it does. I'm gonna add in to that as well from some friends who are pediatric pelvic floor physios, no bubbly drinks before bed either, because it makes them go to the toilet way more. Yes. Yep. And then just all those usual things, you know, like having a sort of a a regular

sleep schedule and routine. So the things you do before you go to bed. I mean, this is particularly particularly for children. That routine is the critical thing. And is does it have to be down to the minute or is it kind of like a okay, let's get our routine happening and get them into bed in a sort of particular way? No, it's definitely not down to the minute. And I think this is a problem, is it um like sleep routines and have got such a bad rap because people took them far too

Regimented? Yeah, too too rigidly. Um the whole point of them is about the regularity, not the rigidity. And our bodies like to know when things are gonna happen, so we like to be able to prepare for it. So the regularity is really important, the rigidity, absolutely not. And that kind of Then throws the whole system out. So no, y it definitely doesn't have to be down to the minute. It's much more about just the the sequence of events that your brain associates with this is

What I'm gonna do before I get ready to go to sleep. The best analogy I've ever heard was from a um very dear friend and she said it's a circadic rhythm. It's a rhythm. Just like a piece of music, it tells you when the bridge is coming. The same thing with sleep. So you it's that pattern of behaviour before you go to bed that actually sets your body up to actually wind down for the day.

Yes, completely. Which is a I think that's a really nice way to think about it. Yeah, I think so too. And I think and particularly just to go back to the kids for a second, I think that's what we should all be focusing on is You know, what are the things that your child associates with in terms of going to sleep? And how do they do that? And if it's not working For either you or the child. Have a look at those steps.

And that's where to make the change. And for kids that might have, you know, lots of energy, other conditions where, you know, winding down or self regulation is a challenge, what are some strategies that pa parents or grandparents even listening could sort of put into place if they're having sleepovers over this period? So actually as counterintuitive as it sort of sounds, sometimes actually doing some, you know, um

rough housing play. Like so not like tickling but like that kind of more sort of physical heavy work. Yeah, like physical, like, you know, I don't know, let's look for something on the floor where you're getting someone to actually use their body and to kind of get rid of that energy. That actually can be more useful than saying, let's just sit on the bed and I mean I'm not saying book reading's not

It's a lovely part of the routine. But sometimes you've got to get rid of that energy before you expect someone to be able to lie down.'Cause us as adults, we can expend energy. whenever we want. However we want. Because we're making a conscious choice too. Whereas if we just take a child and say, You've just got to go to bed and lie down and instantly go to sleep, often they can't. So just also looking for those opportunities to be able to

allow them to get rid of some of that energy in their body could be really helpful. Okay. That's really, really helpful. And where can people find out more? Uh well if they want to talk to me. Um Baby Somnia on Instagram. Kate is fabulous and she's got so many really helpful tips and tricks on her Instagram.

Um which is also the other thing. And also over the s uh holiday period if you're unsure about sleeping conditions, check out um safe sleep at red nose. They've got lots and lots of guides on there as well. Yep. Any other tips, Kate? Just just take the pressure off. Just take the pressure off. We love that for our festive message is take the pressure off everyone. We hope

that this year has been fun on radiotherapy. We've loved spending time with you. A big thank you to Dr. Kate Johnson for joining us today and with Ashraf Samsuddin for our guest. We're gonna throw it over to Einstein Gogo and we'll be back with you in the new year. So thank you for joining us. We really appreciate it. Hi, this is Panel Beater. Thanks for listening to the podcast of Triple R's Radio Therapy, a weekly radio show dedicated to health, medicine and wellbeing.

Broadcast live on Triple R from Melbourne, Australia, every Sunday. Hope you enjoyed the podcast. Feel free to get in touch with us via Radio Therapy's Facebook page.