Tim Elliot: Hello and welcome to Lawgical, the legal podcast from Dubai-based law firm, HPL Yamalova & Plewka. Lawgical is the U.A.E.’s first legal podcast. As always, our legal expert with me is Ludmila Yamalova. Ludmila is the Managing Partner at the Dubai-based law firm, HPL Yamalova & Plewka. Good to see you.
Ludmila Yamalova: Great to see you too, Tim. Thank you for being back.
Tim Elliot: Thanks for having me. Dr. Samaa Al Abd is an Egyptian/British Child and Adolescent Consultant Psychiatrist joining us once again. Good to have you here, Dr. Samaa.
Dr. Samaa Al Abd: Thank you.
Tim Elliot: Now, welcome to Lawgical. We’re moving onto Episode 3, or perhaps Chapter 3, in our very special series of podcasts covering both the legal and the psychological aspects of some very specific topics with the help of our special guest. Now, Dr. Samaa, for Episode 3 I’d really like to discuss the issues that you most commonly see, a rise in connection with children, you’re core area of expertise, and also with those issues, how you advise your clients. Let’s start there.
Dr. Samaa Al Abd: I see a whole variety of issues in children and young people, starting from simple behavior problems at school or at home, sleeping problems, obsessive compulsive disorder, young people who have obsessional and compulsive traits, anxiety, depression, suicidality in young people, self-harm, ADHD which is my hobby horse, my specialty. ADHD stands for attention deficit hyperactivity disorder, so these are children who have difficulty with attention and concentration, and they get easily distracted, and some of them are also physically overactive. It is important to recognize all these underlying conditions in children because they might present on the surface of things with behaviors that are not their fault. They might appear to be less compliant, or not compliant with schoolwork, or not interacting with their peers really because there is an underlying problem. Many of these problems can be tackled, can be treated, and children do get better. We have a lot of evidence that these conditions do get better if recognized. In my view, the first step towards making a change is recognizing that there is a problem or there is an issue. Without recognizing an issue, you are not going to tackle it. Again, we go back to our original discussion in the previous episodes of the importance of education and knowledge in parents and young people so the problems get recognized.
Ludmila Yamalova: I know this is a different question to ask, or answer rather, and that is, what are some of the more typical reasons that cause or grounds that ultimately lead to various mental issues in children? I know it is, as I prefaced it, a very difficult question to answer, but are there any specific reasons that exist, particularly in this region? For example, is it because we are all kind of far away from home and we don’t have a support network, or is it because there are so many mixed families, or is it because the legal system does not exist here to perhaps address or allow families and individuals to have their issues addressed, or the medical system does not exist? What are perhaps your three to five top reasons that you in particular in your practice see tend to recur and be more common in terms of being the reasons that create the psychological issues in children?
Dr. Samaa Al Abd: There are reasons that affect children across the board, irrespective of which country they’re living in. They can be divided into genetic reasons or underlying conditions that are inherited, like somebody having black hair because their parents’ hair is black or blond. There are inherited conditions, and they run down in families. That includes, for example, obsessive compulsive disorder and attention deficit hyperactivity disorder. There are also psychosocial issues which are again present and there would be specifically different in different cultures or different communities. The psychosocial issues would include poverty, unemployment of the parent, wider support in the family, whether you have your parent or your brother or sister around to advise and support you. Now, these are issue that would be present across the board. Now, coming back to your question about specific issues in the region, I would highlight some of the psychosocial issues, for example, not having your support because you’ve left your current country of origin and you’re here as an individual unit as a family, so you don’t have the support. Another one is some families I see, they have been changing countries every two or three years because of the employment of the parent, so the young people, the children have to make new friends, start a new school, in some places the teachers change a lot, and they all add up. It’s not that one factor stands out, but when you have multiple factors that interact with each other, whether it’s genetic, whether it’s psychosocial, family support, if you have a parent who has lost their job and they’re unemployed, and they’re really trying to make ends meet, and they are low in mood, that will affect the children obviously, and the marriage, and the partner. They’re all interconnected, and they all need to be identified to work on them.
Tim Elliot: And the more that these problems are not identified, the more these effects level. Can I just pick up on one point there that you made, Dr. Samaa? It interests me, something that you said. If children don’t have that, I suppose one way of putting it is a real foundation in one place, one school, one home for a period of time, how important is it for children to have that solid foundation of the home, the school, the familiarity, and the routine? How important is that for a child’s life?
Dr. Samaa Al Abd: I think it is important. However, children always surprise me how some of them are quite resilient as well. Sometimes it’s the adults actually who find the change more difficult than the children and young people. What applies to one young person does not apply to another one. One young person could be quite resilient, and another one sensitive and really finds change very difficult. These factors will really play an important part depending on the constitution of the child, their genetic makeup, their personality, how they cope. You can have two siblings, sometimes even twins, one is able to cope with these changes and the other one is really unable to cope. Like, I have young people where parents in the U.K., for example, send them to a boarding school. One flourishes at the boarding school and loves it because there is also lots of extracurricular activity, horse riding, and so on, and the other one doesn’t like it at all and gets depressed. We decide, together with the parents, for example, to put them in a day school where they live with their parents. I’m talking about possibly twins, so one has to consider all these different things and look at them individually. Are they happy with what is taking place? Do they need to have that – if a child, for example, a young person needs to have that kind of belonging? Maybe it is good for them to join like a volleyball team where they feel this is something they are interested in doing, it’s an extracurricular activity, it’s a group of young people they feel they belong to. The solutions could be in small things that could be thought of, but again as I said, if you don’t identify this is an issue for that particular person, then you will not be able to address it.
Ludmila Yamalova: One of the peculiar reasons, or differences that we see in this region that perhaps, at least in our observation, that may lead to specialized problems that come out of this region, and it is a blessing and a curse, and that is this country has been very gracious and very generous to many people who come here and set up businesses and set up lives here, and as a result, there has been a lot of wealth. A lot of people came here with wealth. A lot of people have made wealth here. As a result, there have been people who have been – and this is obviously a generalization – but it’s too far from the truth, and that is, there are a lot of well-to-do families who perhaps came into wealth early on in their lives and then they had children. What we see often is that the easy way for them to gratify children or to reward children is by just buying more gifts, buying more things. I am a mother. We are all parents here. Just seeing how even in our community, kids here, they are so used to immediate gratification. Part of it is sort of today’s world anyway, irrespective of where you are in the world. But part of it is also very unique to this region and that is everybody here wears the latest, drives the best, travels to the most amazing places, and these are opportunities that are not available to so many people around the world. What we often see is parents who, first of all, they have the means to buy their children the latest and also provide them with the most interesting and exciting opportunities, such as if you want to go to Legoland, you want to go on a safari, you want to go on a boat. These experiences are so readily available to so many kids here and so one of the things that we see at least in our clients who come to us for various divorce and family type of issues is that the problems that they ultimately realize exist with their children is that they’ve spoiled them. I guess, I’m not sure if this exists in the same way in other countries, but certainly, if I were to compare it to the U.S., it just doesn’t exist as much because in the U.S. you have to be a present parent because you have nobody else to take care of your children. But here, there is so much wealth that kids are exposed to so much fancy stuff so early on, and then there is so much help here in terms of having nannies, drivers, chefs, and such. It’s all fairly affordable here, so as a result, we see children growing up having everything very early on in life, and yet, not having perhaps the most basic things, and that is just their parents and their attention and their patience and their time. That is one of the peculiar and unique angles that we have seen at least vis-à-vis our clients and even personally as through my family and the other parents that we socialize with.
Dr. Samaa Al Abd: It takes me back to knowledge is empowerment because parents might mean really well, thinking that spoiling the children by buying presents and so on is going to make them happy, but we know good quality time is so important with the children, and good quality time, meaning like spending 15 to 20 minutes playing with the child. There are rules, for example – this is about behavior management – about how you play with your child, how you make the child lead, how you praise him and reward him during that playtime. It’s so valuable. We know that if you go and buy your child or the young person 10 books at a bookshop, they’re less likely to read them than if they earned, for example, points to go and buy with their own money a book out of a bookshop. They’re more likely to get it and buy it and read it straightaway. If the parents mean well, I think knowledge about parenting and how to get the best behavior from the child, how to make sure that your child has good confidence and self-esteem, it’s all about having that information and the skills that you as a parent can implement with your child.
Ludmila Yamalova: How about the medical system here and the school network or support network? Does it exist? Is it available to help parents deal with their children if they have these kinds of issues? I’ll give you one example. I had a client who ultimately ended up leaving the country because she was a single parent with her children here. One left and then the other one had the ADHD. The school required her to have a shadow teacher to accompany him to school because he was a bit rowdy, I guess. As a single parent, she just couldn’t afford it. First of all, the school required it from her. Second of all, obviously there were the issues of being a single parent with a single income, so she couldn’t afford it. At the end, she moved to the U.K. where the social system gives this basically for free. The schools are free, and you need the benefits of an additional support for parents is available there as part of the state. Here, it isn’t, so at all if that at all played a factor, but I know my experiences and hearing from some of our clients, this has ultimately resulted in people leaving the country because they just could not enough of a medical and academic support to help them.
Dr. Samaa Al Abd: Right. I think this the support system is developing, and I know that there are individual efforts of parents having developed support systems for themselves, whether it’s Moms in Dubai and they invite specialists to go and talk to them. In fact, I went to some of these organizations and volunteered to go and talk to them. The more awareness is widely spread, people do develop these support systems. Things are happening. They are taking place and the parents request them, and the teachers also request those too and implement some strategies. I am quite impressed of how things are developing quickly in the communities, and usually the parents are drivers in seeking that support.
Ludmila Yamalova: Do you know if the insurance policies here cover psychological help, psychiatric help? Is that covered in the standard provisions of most insurance plans or is this like an add-on?
Dr. Samaa Al Abd: I mean, private insurance is like in other countries, there is a huge variation in what they cover and what they don’t cover. Even in the U.K. some private insurance does not cover mental health. Some do. Some are very picky on the specific areas of mental health they cover. That is a different issue which can be difficult for some.
Tim Elliot: Can I ask you about children feeling different? Children here are very often from mixed marriages, for example, whether that’s in terms of language, education, religion, whatever it might be, but how do children and parents deal with those kinds of issues? Because we live in a society here which is incredibly mixed. We talked regularly about the 200 nationalities that come together and live in the one city of Dubai, the one country of the U.A.E., but it must be hard to kind of stamp your own identity on yourself where there are so many influences.
Dr. Samaa Al Abd: Parents coming from mixed cultures is always an issue. It’s an issue, and couples have different ways of dealing with it. It’s an issue for the couple’s relationship. Then once they have children, it’s about parenting. It depends on the country you’re living in. If you are, for example, living in a European country and you have your doctorate there and you studied and you are of Middle Eastern origin, and then you go back to your home country, without even one’s own knowledge, you change your behavior a little bit – albeit there are changes all the time – you identify maybe more with your original culture, and they come into the way with your partner who has only known you, for example, for the last 10 years when you lived in Europe. Then one is not very knowledgeable about, how do I want to bring up my children?
Now, if you have parents coming from the same culture, even though coming from the same culture it could be quite different, but at least you have more common grounds. If you are coming from a completely different culture, different values, let alone the religious ones, these things evolve as you bring up your children, and sometimes one gets quite surprised about how one does things with one’s own children. I have some parents say, “I always was against how my parents brought me up. They were very autocratic, and then I ended up doing exactly what my parents did to me with my own children.” You just get to learn about your own self when you are bringing up your own children. You say, “Really? Did I do that? I can’t believe I said that. Is it coming from me?” Where there are, sort of, cultural and religious differences, these things suddenly come up to the surface.
Tim Elliot: Then you get to a point where your son stamps his own identity on himself. My wife’s Scottish. I’m English. My son is apparently Scottish. So there you go. It backs up your thesis entirely. But it’s a really interesting point, isn’t it? How children, and you alluded to this earlier as well, and want to bring this back up, how resilient children can be. I think in a place like Dubai where we have so much opportunity and there is so much – let’s not put too fine a point on this – there is so much mollycoddling of children and offering children too much, not withholding anything. That doesn’t help build resilience in children. It can’t be that a child has everything they want. Surely, you have to work for things. You have to earn them, don’t you?
Ludmila Yamalova: Just to give an example from just a few weeks ago with my son. I have to admit, I get to be so busy and I have limited time with my children, so the time I have I just want to be there with them to the fullest extent possible. My son said, “I want a toy.” I go, “Okay. Let me go buy you a toy.” My husband obviously said, “He has to earn.” I stopped that practice now, so my son comes a few weeks ago. He said, “Mom, it’s been so long since I got my last present.” I, as a parent, am learning and evolving and changing and restraining myself. But it’s interesting, to your point, Tim. He’s like, “It’s just been so long!”, like all of three weeks I have not gotten a present.
Tim Elliot: He’s working the angles already.
Ludmila Yamalova: Yes.
Tim Elliot: It’s kind of impressive. There is a life skill to be learned there as well. But it’s a really important point, isn’t it? Children have to understand the difference and to build that resilience, to earn something, that’s got to be important.
Dr. Samaa Al Abd: And it’s good for their self-confidence, for their self-esteem, because you need to feel good about yourself. I think if you earn something, as I mentioned with the book, for example, you are more likely to read it as well. It’s not just about doing some hard work because you feel you’ve put effort into something. You’re more likely to enjoy whatever you get as well. It’s a win/win situation I think when children earn, even if it’s little chores during the holiday or some chores in the house and having a reward system. We all like getting praise, even adults, and I tell parents when you are working in business or in a bank, you get a bonus for the extra work you’ve done if you’ve successfully achieved something, so let alone the children, they have a good sense about themselves.
Ludmila Yamalova: You mentioned a work earlier, the word autocratic. We all know that there are certain cultures that are perhaps more authoritarian in the way they raise children. This is a perfect mix of every possible culture and a mix of culture in the planet. We see it all here. There are a lot of families here from certain cultures that still live or at least are products of that authoritarian culture. Even though, for your purposes, they are not children. For my purposes they are still children because they are the children of somebody else. I see them in the business environment, but yet they are obviously children of their parents, and the way they run a business to this day, I still see that, and they themselves, they acknowledge it. They know, but they can’t really deal with change or do anything with it. The way they behave in business is so much a reflection of how they were raised as part of this culture. Even though they are in their late 30s and 40s, they still feel so beholden and controlled by their parents, and their fathers in particular, because in a lot of these cultures the patriarch is the true patriarch. In their 30s and 40s, they are still afraid. They are sitting with me in business meetings and a call comes from their father, they are shaking, and they know that they’re too controlling, and yet, they cannot break that mold. These are probably not the children that you would see because they’re not of that age, but they are still, in our practice, we see how significantly they are stiff affected by the way they were raised as children. It will be interesting to see how they raise their own children. This is certainly an angle that you don’t see as much perhaps in the U.S. or in other countries where you don’t have as much of fresh mix of cultures. Do you see much of that? Do you know what I’m referring to?
Dr. Samaa Al Abd: Yes, yes, absolutely. We end up doing what we know, to us. For example, you’ve been brought up in a certain way and you become a parent, if you don’t have education as a parent or different ways of doing it, you will just repeat the same pattern and think you’re doing your best. I think that is again another duty of informing parents of better ways of bringing up the children. I do a parenting workshop and we talk about praise, rewards, limit setting, all the criteria in parenting, and I have some parents getting up and saying, “What’s wrong with physical punishment?” Because you stop the behavior. If the child misbehaves and you punish them, they stop the behavior. It’s an important question because you can stop the behavior by following other ways that are actually much more productive in stopping the behavior and building the young person’s self-esteem and confidence. Because my hitting the child you are stopping the behavior, the behavior will stop temporarily, so 10 minutes later it could start again. The second thing is you are teaching the young that hitting is okay. What happens if the parent is hitting them? They go to school and hit their peers. You get that sometimes that the child gets referred by the teacher because of their misbehavior at school. Then you find out actually this is the way of handling the misbehavior at home and the child has learned that method. I find parents are really open to learning new ways of handling their children. They’re always very keen to get better outcomes. Some parents, I dealt with a group of parents in the U.K., for example, who were actually referred by the court for parenting classes. Some of them said, a whole group of friends who were all raised in care themselves, and they said, nobody played with us as children. We don’t know how to play with our own children because we did not get that when we were children ourselves. There is always one first step of teaching somebody and educating them how to do it differently. It’s never too late in my opinion.
Ludmila Yamalova: Do you know, does this country have, I guess you used the word care, so these homes of care or care centers where there are kids without parents, or orphanages you would call them in other countries, do you know if there are orphanages here? If so, do you deal with them much with the children that come out of the orphanages or are there certain orphanages?
Dr. Samaa Al Abd: I’m not very familiar with the system, the whole system. I know there is a place, for example, for battered women and they do provide psychological care and so on. But I don’t have enough knowledge to cover that.
Ludmila Yamalova: Because we have heard. We’ve seen basically reports of abandoned children. There are a lot of abandoned children here that are just being born and abandoned. I wonder if you’ve come across the centers that pick them up. We normally hear that some member of one royal family or another will ultimately create some kind of a care center for them. I was curious whether you’ve had the experience with children that have been abandoned because I can imagine that is a lifelong trauma.
Dr. Samaa Al Abd: I’m only familiar with members of families who have taken these children under their wing and actually brought them up and provided another home for them, which is lovely to see. They grew up and they arranged their weddings. There are very gracious families which actually do take these children under their care.
Ludmila Yamalova: To that point, in fact, there is a specific law that addressed abandoned children. Under the law there is a provision for local families to take these abandoned children into their care, like a long-term fostercare. It’s not an official adoption, but it is just a long-term fostercare and the law sets out exactly under this fostercare framework what these fosterparents can and should do. As you said, they are quite specific and there are a lot of provisions in terms of what these parents can do and should do to provide for these abandoned children. I think that’s a very positive law that actually allows for these members of society to actually create that framework to give homes to these otherwise abandoned children.
Tim Elliot: Plus, recently, Ludmila, we’ve seen changes to the criminal code, the penal code, to help aid in boosting protection of children who are victims of domestic abuse, for example. There have been some dramatic changes in the law very recently.
Ludmila Yamalova: For sure. There is, in fact, a fairly new law against domestic abuse. It is very, very expansive and comprehensive in ways that we were quite surprised and not even sure if similar laws exist in other countries, at least in this kind of form, and that is where ultimately the objective of the law is to criminalize domestic abuse and the definition of domestic goes, I think, up to the 4th or 5th degree of relative, and in terms of abuse, it is no longer just physical abuse. It’s mental abuse, psychological abuse, and even financial abuse, and that is, for example, deprivation of sufficient funds for children or for other family members, mental bullying, and such. The law is there. We have yet to see how it’s going to be applied and enforced, but I know it didn’t exist before, and I’m curious to see if Dr. Samaa has seen anything, that you perhaps would see if anyone has availed themselves of that law. I know that in our practice, we have tried, because it doesn’t just apply to children. It applies to all sorts of adults as well, grandparents, for example. Here if grandparents or parents get bullied and abandoned by their children, all that would qualify, or spousal abuse, but we have yet to see how the authorities actually react to it. But I’m also curious, Dr. Samaa, if you’ve seen anything like this and if you seem much domestic abuse in families here.
Dr. Samaa Al Abd: I have seen it. Again, it’s a difficult issue to talk about because of the shame and guilt. I think confidentiality is such an important one as well. Maybe coming back to the fostercare, because I did work in the U.K. on a fostercare team. It was a mental health team providing service for the children who are being placed with fosterparents and also providing training for fostercare. This is a whole other area that when it is taking place, you need to provide support. You need supervision of the fostercarers, help the children, and look at mental health issues of the children, and they need regular supervision, for example, by social services, and so on. This is another big area to develop.
Ludmila Yamalova: Just going back to all the legislation that has perhaps been introduced in the last few years and continues to be introduced, there is another recent amendment in the penal code, for example, that now criminalizes any kind of sexual intercourse or sexual assault with anybody below the age of 14 with life imprisonment. That is a new law that’s just been effected in the last few months, perhaps a month, and that I think certainly goes to perhaps addressing certain issues that might have existed here before that did not have a legal framework to rely on, but it is ultimately abuse, the various types of sexual abuse that might happen in familial circumstances. Now anything below the age of 14, even if consensual is penalized by life imprisonment. Also, there is a new law in the penal code that criminalize any kind of sexual assault by coercion or manipulation. Also, there is another provision in the law that criminalizes any kind of sexual assault or attempts within certain family dynamics to anybody who is an ascendance or, interestingly enough, guardians, if somebody is being sexually assaulted by a guardian or anybody with authority, that is now criminalized by law. These provisions did not exist before. They are literally hot off the press. I’m very, I guess, that this is going to aid a lot of children and a lot of families moving forward. Certainly, this I would consider to be a fairly groundbreaking rule, perhaps not unexpected given where we are, but with regard to legislation these rules did not exist, and now they are specifically on the books.
Dr. Samaa Al Abd: I agree, they’re groundbreaking rule and the U.A.E. has been leading this, which is fantastic. I’m sure what will follow this is training of different disciplines really of interviewing these children, interviewing the adults, the perpetrators, and looking at therapeutic interventions of how best to tackle these issues as well.
Ludmila Yamalova: Do you work with schools? Does your clinic or your colleagues, do they get approached by schools to do some sort of collaboration with schools? Because I imagine when children are experiencing this, how will they know who to contact except through school somehow? But obviously the children who are suffering these kinds of issues, they won’t voluntarily come up and phrase them or articulate it themselves, so it would have to be someone like the examples you’ve given at the school that notices this and addresses it. Do you know if there is some kind of a centralized effort or initiatives that encourage schools to build relationships or collaborations with psychiatrists and psychologists that help bring these kinds of issues or create a forum or venue for children to air these concerns in school? Do you know?
Dr. Samaa Al Abd: I can’t answer that question. All I can say is from my experience in the U.K. that it’s a multidisciplinary effort when these things come to the surface. Usually the teachers are the ones who notice something and then you have a team of trained social workers as well in the area. You have a child protection pediatrician, for example, in the U.K. who is informed and collaborates with the social worker. It’s a whole team that are specialists in this area. It’s not just one standing psychiatrist who deals with it. Usually they go to the pediatricians first to look at evidence for that, and the pediatrician is in touch with the social worker, and they have a specialist in that too. And training the police as well is really important, how to take information and how to document it. It’s very much a process that involves so many disciplines that are in direct touch with the child and the family and where the abuse is happening.
Ludmila Yamalova: And from your perspective, do you see similar initiatives that are being discussed or implemented here in the U.A.E. as the ones you just mentioned?
Dr. Samaa Al Abd: There are. Yes, there are.
Ludmila Yamalova: Are you involved with them at all?
Dr. Samaa Al Abd: Actually, just last year there was training done here at Rashid Hospital regarding child abuse by specialists. Very positive. We did a workshop this year with Abu Dhabi at the International Mental Health Conference again on child abuse. It was an all-day workshop.
Ludmila Yamalova: So, how do you raise awareness? How do people raise awareness or how do they find out if there are those who want to either attend these workshops or get involved with some of these initiatives? How do they find out?
Dr. Samaa Al Abd: Through the adverts that go about it. Some of them are internal within government hospitals and some through the conference organizers, like the Abu Dhabi one, we had quite a bit of number of attendees as well.
Ludmila Yamalova: Does your clinic or do clinics advertise?
Dr. Samaa Al Abd: No. The clinic itself doesn’t advertise because, as I said, it’s a multidisciplinary effort that goes into this.
Tim Elliot: That’s part 3 in our special series of podcasts on common legal and psychological issues my two guests face this time with regard to children. Our special guest today was Child and Adolescent Consultant/Psychiatrist, Dr. Samaa Al Abd, a Fellow of the Royal College of Psychiatrists in the U.K. Thank you once again for your expertise.
Dr. Samaa Al Abd: Thank you.
Ludmila Yamalova: Thank you, Dr. Samaa. It was very insightful.
Tim Elliot: As always, our legal expert you heard just there, Ludmila Yamalova, the Managing Partner here at HPL Yamalova & Plewka. A huge thank you to you as well.
Ludmila Yamalova: Thank you, Tim.
Tim Elliot: If you have a legal question you need answered in a future episode of Lawgical, we can do that, or if you’d like a consultation with a qualified U.A.E. experienced legal professional, get in touch with us via WhatsApp, 00971 52 525 1611, or you can head to LYLawyers.com and click the Contact button.
