Seeing the Whole Child: Beyond the Diagnosis with Dr. Sudipta Sen

Summary:
Dr. Sudipta Sen, a consultant paediatrician with over 33 years of experience across NHS and private practice, joins Dr. Inyang Takon to unpack what it really means to "see the whole child." Drawing on a career that began at one of Kolkata's busiest hospitals and was shaped by a formative encounter with Mother Teresa, Dr. Sen explains why she pushes back against rigid referral criteria, how she builds trust with a child in the first moments of an appointment, and why a diagnosis should open a roadmap for a child — not define them.

Key Takeaways for Parents and Teachers:

• A diagnosis explains a behaviour; it's the whole-child view that explains the person — don't let a label become the whole story.
• Children shouldn't have to "fit" narrow referral criteria to get support — if something isn't working for a child, it's worth pursuing even without a tidy diagnostic fit.
• Teachers and parents should assume good faith in each other: a child who "looks fine" at school may be dysregulated at home, and vice versa — neither setting invalidates the other.
• Trust-building starts small — Dr. Sen gets down to a child's eye level, shares something personal about herself, and treats the child (not just the parent) as the main person in the room.
• Burnout in this field is real; Dr. Sen's advice to fellow clinicians is to keep learning, find mentors, and hold onto interests outside of medicine.

Resources Mentioned:

• Missionaries of Charity (Mother Teresa's organisation)
• NRS Medical College, Kolkata, India
• ADHD Embrace
• Hounslow ADHD/learning disability pilot clinic

Connect with Dr. Inyang Takon:
Website: www.drtakon.com
General Information for Parents: www.school-doctor.com
Questions? Email: eim@drtakon.com
LinkedIn: Connect with Dr. Takon
Subscribe: Ask a Developmental Paediatrician
Read: Braindiverse Substack
Guest enquiries: podcast@drtakon.com

Transcript

SPEAKER_00 0:03

Welcome back to Early Intervention Matters, the podcast that helps parents, teachers and health professionals understand the diagnosis, treatment, care and support of children with autism, ADHD, threats, and other neurodevelopmental challenges. Your host, Dr. In Yang Takot, is a consultant at neurodevelopment pediatrician, and she will provide insight through interviews, answering questions, and breaking down complicated topics. By sharing stories from parents and professionals in the field, we hope to make sense of what can be an overwhelming topic. Early intervention is crucial for children with developmental difficulties. Yes, early intervention matters. And now, here's your host, Dr. Inyan Tagon.

SPEAKER_04 0:57

A diagnosis tells us what a child has. It doesn't tell us who they are, but that distinction has shaped the entire career of today's guest, and it might just change how you see every child you work with. You're welcome to today's episode of Early Intervention Matters. I'm Dr. Young Takon, the host of I'm really pleased today to have a very experienced guest, Dr. Suddipta Sen. In a short moment, I'm going to get Dr. Sen to introduce herself. But she's got a wealth of experience. She's a consultant pediatrician with over 33 years of experience. She trained in India. She will give us a brief summary of her experience and her journey to this point. Dr. Sen has worked with children in tertiary, secondary, and primary healthcare organizations. She has experience of working with children in the community. And that ethos has driven her passion for the work she does. So I'll get Dr. Sen to introduce herself before we delve into today's episode. You're welcome, Dr. Sen. Thank you for honoring our invitation to appear on the podcast as our guest. I've looked forward so much to discussing this topic. And I know that you're someone who's so passionate about it. I've known Dr. Sen as we, you know, work in similar circles. We've met on professional forums and meetings as well. So we share similar interests. And I've followed her work as well. And you will hear about some of the things that she does. She's a very passionate clinician, pediatrician, and a community organizer and advocate as well. So welcome, Dr. Sen. Thank you very much for joining us.

SPEAKER_05 2:48

Thank you so much, Dr. Takon, because uh I'm truly humbled and honored, and I'm looking forward to having a real fun time with you. In fact, I have to thank you for the topic of discussion. Remember, in our previous conversation, I had picked on your thread of conversation when you said, Can you see the whole child? And it was a turning point for me. I said, Yes, that's what I want to talk about. And you see the whole child. That's the whole point. That's the crux of the matter, isn't it?

SPEAKER_04 3:20

Yeah. No, thank you so much. It was we had this wonderful conversation, and you know, we just shared the same way we think about work and ethos, and that's why I'm so pleased you're here to talk to us.

SPEAKER_05 3:34

Thank you so much. Thank you so much. I'm looking forward to the session.

SPEAKER_04 3:38

Thank you. Now, I can't do justice to all that you've done. You're a very inspiring woman and clinician. So I just want you to tell our audience a bit about yourself in terms of your journey and so that our audience, you know, familiarize themselves with a bit of your because you've done so much and I applaud you for a lot of what you've done. So please share that with our audience.

SPEAKER_05 4:04

It becomes very humbling when somebody who is extremely enriched as a professional like yourself says that, because I have never looked at myself in that light. But however, I must say something that in my journey as a human being or as a professional, I have been extremely lucky to have met with some really passionate people, passionate advocates, whether in this society, whether as teachers, whether as professionals, whether as parents, as patients. And what has been my pillar of strength, that even after being a pediatrician for 33 years, I feel excited every day to go to work. And I feel excited to learn something new. And then don't get me wrong, I'm not like a dura cell bunny that I'm always with a high. It's not possible. But there are good days and bad days. But by and large, what really helps me is that I feel truly happy and honored to be a pediatrician, to do what I do. Not many people get that opportunity, and not many people could have the opportunity to learn from some of the most dedicated people. If I look at my journey, I started in one of the busiest hospitals in in Kolkata, India, which is known as NRS Medical College. It's extremely busy. And in the pediatric department, we literally saw hundreds of children. We were exhausted. We were doing how many hours without food or drink? But what was unbelievable is how we took care of each other, the nursing staff, the other healthcare professionals, how the parents would offer us a meal if, you know, we were working shifts on the ward. You know, all these things shape who you are. And I have been starting volunteering with Mother Teresa's missionaries of charity, very young as medical student and even as a young doctor. And I had the good opportunity to actually work with some of the most dedicated nuns. And before I came to UK in 1997, I went to ask for blessings from Mother Teresa. And she said, Dr. Sen, why don't you come and work for us? And I just got, you know, I for those brief moments, I thought that I have to quit everything. I'm canceling my flight. I have to, I cannot say no. But, you know, then her right-hand person, Sister Shanti, said she managed the situation. She knew my dilemma. She said, Mother, Dr. Sen already does a lot of volunteering for us. So I was able to get her blessing, come to UK. Sadly, she passed away after a few months. But what I took away from my experience is that before even being a clinician, you are a human being. You have to respond to the other child, the young person, the family as humans. And you also have to understand what their lived-in experience is. Never ever come across as a professional with that condescending attitude that I have trained so far, I know everything, I'm an expert. Well, I'm not. The expert is the parent, the expert is the child or the young person who has to lift up experiences. So, you know, that is what I have learned.

SPEAKER_04 7:29

That's amazing. And what an honor and a privilege when I read about the fact that you had had this close, you know, mentorship or experience with Mother Theresa. I felt that was such a great foundation to have. And it then explains to me why you hold that ethos, you know, through your career. And just, you know, the way I have, we've had a chat about this, is that your core values continue to drive you. I felt more energized to do the things that I really wanted to do when I got into medicine. So for us, we are looking after new divergent children. These are a population that even needs more of our input and our voice and our advocacy. So, first of all, what led you into this field? What made you decide to take an interest in this specialty? Two things actually.

SPEAKER_05 8:34

When I was volunteering with missionaries of charity and I had been very closely associated with a lot of children who were in orphanages, and later on as a Rotarian, when I have worked with youth, what I found is that life's experiences, good or bad, shapes the behavior and the background. And it can lead on to further difficulties later in life. And that has made me look at people or young persons or their family or their carers from not only the lens as a professional, but also as somebody who is trying to understand them better, putting myself humbly into their shoes or what works for them and what's not working for them. Second thing is that up until 2015, I have done a lot of acute pediatrics and neonatology as well. So when you are dealing with a lot of extreme premature children, as you know, Dr. Tancorn, during our training period, we have gone back and back and back. At the beginning of my training, somebody surviving 28 weeks was marvelous. But when I left finished my training, we were doing things like 22, 23 weeks. And it led me to have that ethical dilemma. What is happening to a lot of these children growing up? And how are we supporting their needs? How are we following them up? How are we helping them be living their life to the full, blossoming, learning, and what is the lived-in experience of that family? So these are the two things that have actually encouraged me to look more at how does it impact later on in life, not just a cross-section, is the longitudinal aspect and how you can make a society which is really inclusive and supportive of that. And a lot of it is contributed by professionals who made their life's mission, whether it's health visitors, whether it is a social worker, whether it's a nurse, a doctor, a therapist, and a teacher, they have invested in learning more and more so as to work together and support families for more inclusion in the society.

SPEAKER_04 10:52

Thank you so much. And and for the purpose of our audience, what does your day-to-day work entail, your regular work now?

SPEAKER_05 11:00

Yeah, I wear several hats. Of course, uh bulk of my work is in NHS, and I also have my own private healthcare company. So in NHS, I hold, apart from uh being a clinical lead in my community pediatric services, I'm also the name doctor for safeguarding children of my borough. And uh that puts me into uh a certain niche where where a lot I have had to do a lot of training, and I have to be in a lot of very difficult situations where I'm championing young persons. So safeguarding is a big part of my job. Other than that, I do assessments of all children in the NHS. My role is essentially under five for leading the autism service, and in my private capacity, I specialize all the way through transition care up to 19 to 20 for autism, ADHD, dyspraxia, or discoordination difficulties, and specialist sleep support. I also like to teach and train quite a lot and invest in a lot of uh seminars, webinars, and championing some of the causes like ADHD embrace, doing webinars for Senko and teachers, because I find it per perfectly a good role to play where I can work and explain the perspective of this children and young person and support all the way to CP, etc.

SPEAKER_04 12:30

You've got a busy life, but a very varied career, and in all the situations, like you said, you're championing the voice of young people as well in this thing, which is so important. It's so important. So when we look at your career, you feel it around a very child-centered holistic approach to looking at things. Was there a particular moment that you decided to take that approach? Because you and I know that in our regular work, we we're consistently surrounded by strict protocols, strict guidelines, strict, you know. And sometimes you have to make sure that you keep yourself still the doctor that you are in the midst of all these pillars that are around you. And in in the services of today, if you are not taking that human approach, you can become locked into these pillars. So, was there a particular moment that resulted in you saying, no, I have to see things from a holistic view?

SPEAKER_05 13:37

Yes, this is very, very important because one thing I feel is that increasingly we are becoming too focused on forms, on processes, on screening tools. And I feel that these are not always justified because it is becoming increasingly hard because we expect people even to do everything online. People have different levels of education, learning, lived-in experience. It is completely an unnatural situation that we are working for. So, one thing I have done in my career is that to look beyond certain referrals, because to understand, maybe it is a very sketchy referral, maybe I can delay the process by going back and forth, back and forth, back and back and forth to the referral and others, give me more information and then I will decide, so on and so forth. But what we what I'm always trying to do is that what are they trying to say in between the lines? So, where is this concern coming from? Is this somebody who is really failing to thrive in nursery? Is this somebody who is having significant challenging behavior at home which nobody is seeing at school? Is it somebody who is refusing school because of certain kinds of other underlying comorbidities? Is it somebody who is not fitting to a diagnosis? And that is the that is my life's mission. Kids are or young persons or none of us, we were not created on this planet to fit to a diagnosis or our brains be boxed into a diagnosis. And I always feel that if any of us went for a diagnostic pathway, we would come out from one end of one diagnosis, or maybe we would be in some other spectrum. But the fact that we are functional, therefore we don't go and do it. So it becomes important to see the whole child and the whole situation, what's working, what's not working. And it's my life's mission to understand that context, the story of the child, rather than is your child fitting in my referral criteria or not. That is number one. Many times in our workplaces there are constraints about not having funding. So we have to develop special interests. And I can give one example where my colleague and I went out of a way to understand that, you know, there is a gap for children with learning disabilities and no ADHD. So in my borough, we don't have funding for it. So we found out a loophole in another borough where we are, you know, my colleague goes and it belongs to the same trust it used to belong at least. So we found out a way where we started a piloting, a clinic where we would be seeing children with learning disabilities and supporting them, whether they ful uh fulfilled, you know, the criteria for ADHD. And it is tough because there is no rule book about it. Yes. We had to learn about it, we had to do things, and we successfully uh it's still running in Hound Slow. So you see, many things you have to start where nobody encourages you. You have to look beyond, you have to find your passion, and you have to find colleagues to do it. You can't do it all on your own.

SPEAKER_04 16:55

Yes, you are very right. You you are right, and I think they I always say that you know, the gatekeeping that we put before you even allow somebody into the gate, we've already locked the gate. Lock it. But we've stated if you do not fit one, two, three, then sorry, the gate is not open for you. And I think that's the common theme that runs that almost every service puts up a barrier and says, if you don't meet one, two, three, then we can't see you. But that child is still suffering. That child is still, you know, the parents are still going through the same problems. The school is still having, the child is still having difficulties at school, but we've said, no, this is not there, so we can't see. And there was a time that you know, a colleague of mine we were discussing, and she actually said a lot of the children she saw in one of the clinics who had been accepted at that time, but would not have been accepted at this time, would have missed out on criteria of being sane. So again, this brings in what kind of system are we running from the gatekeeping to when we start seeing the child in the service. So we just want to understand from your practice, say you have a child that's come to see you, for example, you know, what what do you spend the first period doing? How do you approach trying to find out about the whole child?

SPEAKER_05 18:30

The whole child means that first showing respect and even in that limited time that you have, showing that the child is the main person in whatever you are doing. It's yes, the parents have a say, yes, the uh professionals have a say. So what I try to do is that, of course, I observe the child at the FOIA. I learn to, I always give a little bit of prep prior to seeing the child to explain how we are going to run that day. And you know, this is something in in the NHS, we have created a fun sheet which goes to the child's family. We have got not only our name, we have got one or two ridiculous hobbies that we we would like to put there. I have got my Indian classical dancing and stuff. You know, already the child or the young person of the family have they have a feeling that this is this is somebody you can trust. In fact, in my private setting, I do the same. So I go down, I depending on the age of the child, I would often kneel down, I would be at eye level, I introduce myself. And if it's a review child, we have a little shared joke about how they are getting taller than the short doctor that I am. You know, they and they they are always very proud every time they come and see that how far they have gone up. And then I try to make them very comfortable and age-appropriate, keeping age-appropriate interest in the clinic. And when it's an older person, somebody who is in the adolescence, I make it very, very clear that they don't have to be on their best behavior, they can be relaxed, they don't have to censor themselves, they don't have to consider that this is a test. And I promise, if not anything else, to be humble, to listen to them, not to judge them, and to hold their confidence. And anything, any information that they give to me, if they don't want to be putting in the report or shared with something, I hold those confidences. And as I said, I'm not going to be judging them and they can themselves as best as they can. And if anytime they want a break, they're happy to do, they can munch, they can walk around in the clinic, they can do whatever. By being a little bit less, you know, rigid, can put people to a kind of a level where they kind of take a breather, breather, and then they can talk a lot about their perspectives, and then we talk about interest. I have got a catch question about, you know, pretend that I'm a fairy godmother. And there's a big laugh because, you know, this short Rolly Poly doctor is certainly not a fairy godmother, but we have a good laugh about it. And then three wishes, and I try to make it as personalized, but I also get a lot of information about if there's some one wish that you want something taken out of your life because you absolutely hate it or don't like it, what would it be? And it's amazing the revelation that I have. Not only about the wishes about maybe flying or having a pet or whatever, it goes down to I don't like school because I find it extremely overwhelming, or I feel anxious, I don't think I'm good at it, I think I d I don't like being bullied. You know? So having that ability to create that bridge very quickly is crucial to get as good an information, also as you You know, Dr. Tacon, for years and years we have been honing our style of interview. So we know how to prioritize, what to go fast, what to do, how to keep the attention when we do an assessment, not to be rigid and prescriptive. It never works. It's not about numbers, it's not about scoring, it's about what is the best quality information. Even if a child who doesn't engage with you, you are able to get stellar information, even how the child has presented. Even if a child is running out of the room and is not able to engage at all, that is telling what is a lived in experience.

SPEAKER_04 22:36

Yeah. Thank you so much for breaking this down really well for our audience because you know, the number of people that are apprehensive, it's just like any of us, if we are going to see a doctor and we don't really know what's going to happen. And we will be apprehensive. What's going to happen there? What are they going to do? Even you and I that are doctors and experience, the not knowing is it can be quite anxiety-provoking. So to think about families or people who have had no exposure to the medical field or a child, oh, they've always seen hospitals as, oh, that's where they do all these things to you, and that's where you go when you're really unwell. The concept of what a hospital is, with nobody really explaining anything to them. And then they get in and sit down and they see this doctor just asking very rigid questions. And at the end of it, the doctor says, No, you don't have this. Okay, no, you are fine. I think sometimes we need to take a step back and just put ourselves in the shoes of what it would be like if I was in their shoes and I took my child to the hospital and this was the experience I had. How would I feel from that experience? I think this is a question that many of us clinicians, professionals, supporting children need to think about. I made it a point, just like you, that every consultation I have, I have to engage the child, no matter what level, I would use their age and you know, talk to them. I would find something fun to, you know, talk to them. So I do a lot of listening into what children are interested in and all that. I bring it up as a topic and stuff. I use something to engage them. And like you said, once children have found a way to trust in you, they will talk to you and they will disclose things and they will tell you something. Sometimes I've had parents say, I didn't know that, you know, when they've heard the child telling you something in the clinic. So beautiful approach that you're using, you know, putting the child at the center, making it about the child. And I think that gesture of spending that first few minutes just making the child comfortable is absolutely great. Because, as you know, we work in a service now where we're driven by protocols, we're driven by so many rigid ways. What's your take on the way our assessments are done for children with neurodevelopmental disorders?

SPEAKER_05 25:19

Personally, I think what I am grateful about is like you, we are always given opportunities and we seek opportunities to continue to learn and grow. We are not just relying on our experience, so-called experience of the last three decades as somebody making assumptions. So I personally say that my take on any protocol, any guideline, protocol sounds so prescriptive or guideline, is that it shouldn't be rigid. It's a fluid thing. It gives a framework and it has to change and revise, and it has to be continuously calibrated based on what is working, what's not working. So that's number one. Number two is that despite coming across as friendly and quite approachable, I also believe in thoroughness, Dr. Takon. We have got limited time, and we as clinicians should use it like, you know, like every senses of ours, our eyes, our mind, our listening, our thing should be always doing something at the time to pick up other things. Because I feel this thoroughness is something that comes from years of also trying to improve your core skills. You can pick up hypermobility, you can you see somebody, you do head-to-toe examination, even if the child has come, because these days people are so enamored by everything is online and it is very easy. I have nothing against online because I do a lot of online, but I do a blended online. I never ever do any diagnosis. It's my preference without actually physically seeing a child, but others might be able to do it. The reason being is that I'm old-fashioned in some ways. I need to check my child and ensure because I feel that that might be the only opportunity the child gets to see a senior clinician. The child might just get a bill. You know, it's not about autism, yes, no. It's not about ADHD, yes, no. It's not about cerebrum palsy, yes, no. It's that's where the umbrella comes in. A child may not have, you know, fit predominantly to one diagnosis, but you should have the clinical curiosity to be able to screen through quickly and ensure that the child doesn't have a heart murmur, that the child doesn't have a squint, the child is able to walk properly, gait is fine, neurology is uh working fairly okay. And all these things can give you indication whether or not you have to do something more. And I have picked up even, you know, a genetic condition association with somebody who had come just for autism. I had picked up, you know, as you very well know, dual diagnosis is very evident. So, you know, while you're looking at one thing, your mind is also working and saying that, hey, I'm seeing this, I'm seeing that. Does it pattern? Or you say that, hey, it's a little bit of this, a little bit of that. And you know, it is you the parents might be heartbroken, oh, is it not autism? Is it not ADHD? You have to have the skills to say that we understand cumulatively how difficult it is for your child. It could be a bit of processing difficulties, maybe not fitting dyslexia, the and that is enhancing the child is not being able to decode information, is increasing the ADHD features because the child is not able to understand and hold attention, or the child is masking exceptionally at school and coming home and throwing a huge emotional dysregulation, whether there is something more going on. And I think that comes from continuously also understanding how to look at guidelines, what are the right questions to ask, how to train your colleagues, and also create those frameworks which are safe and each. I think that is the value of framework, but we shouldn't be rigid about it.

SPEAKER_04 29:19

Absolutely. And I think one of the things, a good example, is the fact that we are increasingly saying that children, especially the females with ADHD, present with a lot of emotional symptoms. Right. And when you look at the guidelines, the guidelines has not made room for those emotional symptoms. But clinically, in the experience, we know and we can understand why they're having these emotional symptoms. So if we're having a child that we're just looking at the protocol, and as you know, and I know, many of those children, if you send a questionnaire to school, they most likely will not score. And the teachers would send a questionnaire and say, no, they're not scoring, and we say, no, they're not scoring for ADHD. But this child is really impaired by their emotional symptoms. Exactly. And and if you were not looking at the whole child, getting the voice of the child in the whole process, seeing how much that child's functioning is impaired, we are going to miss it. And that's why I like your approach a lot, because you have come in with the child at the center having a holistic view. And this is a message for families as well, is that you know, sometimes it can be very difficult for you to articulate this when you're in the clinic room because you think the doctor knows, and therefore the doctor should be able to work out what is wrong with my child. And if it can be very disappointing if you felt, I'm just going there so that they can tell me whether my child's got this or that. I think it's it's a bigger picture than that because we need to understand the functioning of your child. We need to understand, even if it doesn't meet the criteria as written in the books, but there's still things we can do. Exactly. Um advocating for your child at school by understanding your child's needs and whatever parents can do to help support that process in terms of information, you know, is very useful for that process. Great. So one of the things that I really liked about your approach when, or and you talk about this, is the diagnostic tunnel vision. Do you want to tell us a bit more about that? And how do you avoid that when referrals of income? Because these days they're saying, GP saying, I want this child referred for autism, I want me my sex for autism or ADHD. What happens?

SPEAKER_05 31:50

What happens is that whether it's NHS, whether it's a private sector, whether it's parents, nobody's got an unlimited pot of money, and everybody wants to use for something very specific in way of service. So what has happened is that we have got increasingly more descriptive or services that describe only one condition or the other predominantly. So we are talking only about the service that deals with cerebral palsy. We talk of only the service where there is assessment for autism. We are not talking about why a child is struggling. Why, and we are not being able to find out that little tweak that we might be able to offer where the child can suddenly find enough support and actually starts functioning even within what is within the reach of that child? So I have always tried to propose that, say, for example, we in our service don't have DCD as a service. And a child does have coordination difficulties. Does it mean that we will just say that I don't have a service? What if a child has something which others are thinking as dyspraxia, but there is a neurological problem which nobody has seen or ever evaluated because the child has always been under the radar? So what I feel is that it's important to actually not have a tunnel vision, understand from the perspective what are the challenges, which and be very specific, again, articulating those challenges. So it could be say you talked about anxiety and emotional health. So something more specific. How does your Sunday evenings go when you have to go to school on a Monday morning? And or tell me how when do you get up in the morning actually to f to get to school? And how many hours have you been spending just to get yourself ready? And are you still, you know, tell me about it. Talking about things like you tell me about what's going right with your friendship, or even some things that is what is tell me something that you really like doing and you're good at doing. And what something we have to realize is other confounding factors about devices, internet, are there other issues that are mimicking or forcing people or young people to behave more ADHD, more withdrawn, more depressed. And I absolutely ask them that look, I'm not going to judge you. Please tell me per day, is it three hours or four hours you're spending on the device or the thing? And what is the weekend? Is it seven or eight hours? And they give a shy smile and they admit. So you see, it is all, and without being judgmental, and even without judging parents, how difficult it might be for working parents or somebody with challenging behavior or school refusal or not having friends, and parents are very guilty about all these things. So, you know, we it is not our job to tell parents or teachers or children that you're doing something wrong. What we have to understand is that why something is not working for you, and let me kind of and see that if this is an indication for how you can be helped or whether it, you know, whether I can better articulate a condition that explains your presentation. That is my job is to articulate and professionally tell your story so that you get all the support. And I I also encourage you to open up and talk about yourself freely in a way that I can capture your voice. So, you know, this is the role that I believe. It is just not a diagnosis, yes, diagnosis, no, listing, rejecting a diagnosis or saying yes, this is a diagnosis. Yes, that's a that's very important part, but the process is just as important. And having a no-diagnosis doesn't mean that I have not invested in that assessment.

SPEAKER_04 35:54

Thank you so much. And I think that's what that's so important. It's so important because it's a it's a day-to-day we live where people say, Oh, does it look like he's got ADG or does it look like he's got autism? Or, you know, and you can, if you're not careful, you can literally narrow your mind to just thinking in a binary way, is this ADHD or is it autism? And you have to consciously look and say, what brought this family down to see me? What is what is the point that they reached that they thought we need help? Because people don't just get up and go and see a doctor. No, they get to the point where they feel, now, this is beyond us. I think we need help for this. And I think as clinicians, we, you know, we should be able to extract that. And for parents listening in, I think one thing that you can do when you go to see the clinician is also try to articulate some of these things we've been talking about, note it down in a book, write down. Where is little Johnny struggling? What is full-time life? Like Dr. Sen has said, what is the evening before getting up to go to school? Is there a change in the behavior pattern? You know, is there am I noticing a pattern that is on certain days his behavior becomes worse? That he could be happier during school holidays and all that, but there's certain times. And what is that thing that is, you know, making him that way? How much is it affecting him with his family life, friendships, interact? And when he stays after a few days of school, do you see, does he seem happier? So there are things that you can note down to discuss with the clinician because we, as we, as Dr. Sen has said, we're interested in knowing about your child and help your child have a voice. So encourage your child to write down things. What are those things? Some of them don't like talking in front of the doctor, some of them might be shy, but encouraging them, even before that appointment, to write down things and ask their permission if you could share it with the doctor. Because helping them to understand that you're trying to get help for them so that things can, you know, they can enjoy school and enjoy their time there and enjoy time with their friends is really important. So I really love you've mentioned a lot of things about not just sticking rigidly. The GPS referred for ADHD. So we've done, we we've sent out the questionnaires, it's not meeting criteria, so that's the end of the pathway. It's so important. You've mentioned so many things. You mentioned learning difficulties, you've mentioned other things that might be existing with the child. You know, there's so much more that we can't unpick in the way we work, which we have to be careful about. And that brings us to culture. So we're living in a very diverse society. We've all come from diverse backgrounds, we've all had our roots in different backgrounds. And when you were talking about your early days of practice in India, I just translated myself to my early practice in Nigeria, where you would see thousands and thousands of patients coming in all the time, and then you're just working through. But there was always that whole thing about wanting to help them because they were people with needs that had come. So we've learned resilience and dealing with people from different specs of life. So, how does culture shape how neurodevelopmental differences are understood? Because you and I have also worked in these cultures where, you know, people didn't really understand neurodevelopmental differences. And those things don't end up just being back in the culture because we've had movements, migration, people moving in. So, how does how does culture shape that discussion?

SPEAKER_05 40:08

I feel extremely lucky in life that I have had the ability to go between continents and countries. Sometimes I have worked as a professional, sometimes I have accompanied my husband, for example, staying in the Netherlands. So being able to actually interact with different people of diverse culture, even in India, which is so huge, if you just go from one area to another, we don't speak the same language, and everything seems so different. I think the best thing about is about all this is that it not only gives you the ability to be curious and constantly learning, active learning and symbiotic learning. And that is really important. I'll give a simple example that has perhaps made me quite open and approachable because I want to learn from your life's experience rather than me telling you this is the norm here, this is what should be done. For example, even sleeping, as you know, you and I have discussed it before. So, you know, a child is not sleeping, and co-sleeping is quite accepted in many of the cultures from even from the culture that I come from. Here, a lot of the child parents find extreme embarrassment to say that they are co-sleeping, and nobody knows how those parents are suffering day in and day out without any sleep. They are sleep deprived because their child, A, can be quite unsafe to be left alone, B will not fall asleep, C, the child is so anxious that the only way that you can manage sleeping is perhaps the parent. So if I come from the lens, hey, this is not an acceptable thing, it would be an extremely, how shall I say, condescending approach. Similarly, food habits, using cutlery or no cutlery, the way discipline is managed, as long as it is not hurting a child, we have come from boundaries and discipline. So to understand that and expect and understanding expectations or having respect for hierarchy in different cultures, it's something that you have to be an open mind and not critical and judging. Talking to teachers also. They are wonderful. And today's educators or teachers find it extremely hard because they have to manage these children several hours a day. That is the most important part of the child's day-to-day life, and they have to be teaching, managing their moods, their emotions, their anxiety, their reasonable adjustment, and all of it. And at the same time, there is also the question of boundaries. How do you maintain discipline? How do you maintain boundaries? How do you teach children to be resilient when they have a feedback to have? So, you know, all these things, one has to have an openness. And that is, I think, being exposed to so many cultures and coming from a different cultural background myself. I am almost like a sponge. I would like to know more about it. I would like to understand how it works in your home. Tell me about it. I'm all ears. I want to know.

SPEAKER_04 43:22

So it it it's I it's just amazing because whenever I see a family, say, for my part of the world, say from Nigeria, I already know how they're thinking. And I can already see their perspective, and I can, you know, I can relate to what they're thinking about. And I don't dismiss that because I build on that to actually walk through explaining things to them. And I think this is sometimes what is missing in the in the approach where if we're just looking at one size fits all. Not acknowledging that there are differences in the way when I was growing up, there were certain expectations that were expected from us as children. Um, there were certain things that, you know, in the culture there, you know, talking back at an adult or, you know, engaging in a very high-spirited conversation with an adult was very much frowned upon. And if that child goes to another community or comes to the Western world, it might be looked at in a different way. And it's it's we always, always, always have to understand culture. And I like what you said. You said you've worked across continents, you've you've studied the different human behaviors, is something that interests you. We as clinicians should be, I feel as a clinician, we should be uh culturally appropriate in terms of understanding the presentations, you know, understanding you you need to know where people are coming from and why they why they think the way they think, and how you can explain it. And I think that's what we need as clinicians is the ability to break down this complex task. I keep saying this, if I sit in a finance class, it would be like gibberish to me. If I had another accounting class, it would be like, what is this? What are they talking about? So we can't expect people to just readily come and understand our frameworks and and the and the way we do things, except we invest our time in explaining it to them. So culture is really uh very important. So in in, and I'm not sure we do justice to that in actually our developmental histories. I don't know about you know your setting, but what when I think there should be a way that we actually allow that discussion to come in normally, but it's it's all depends on the clinician. I don't know what your experience is with that.

SPEAKER_05 46:08

I think is that in many ways, clinicians have to also really work hard on their communication styles as well as being quite slick in whatever you do. You know, you have to be quite uh sleek and you have to do it very well. The reason why I say this is that sometimes you have to really not pressurize how you break a news to a parent, even to get a consent for further assessment for autism, you have to understand that it might be a taboo coming from a cultural background. You have to understand what is the power dynamics in the family, whether the mother feels that it is her fault. And we have to be very careful about that. It happens, it really, really happens that, you know, and I have had tearful mothers, whatever they experience, maybe it was their antenatal or postnatal, etc. So if you're not careful, and if you feel that this is something that they will feel isolated and they cannot discuss it with their families or extended families, because it is going to become like a real bad label according to them. You have to, it is a clinician's job to be sensitive, understand, not push them hard, work in a way, even however busy your pathway might be, actually not force the person to make a decision then, but factor in. Even if you're not able to give a review, talk to one of the colleagues. Maybe it's a speech and language, maybe it's an occupational therapist who might see the child in the next one or two months. That therapist can actually approach and talk to the mother or the father for that matter. So, you know, you're taking into account that if there is a cultural taboo about certain kind of assessments and they just, if if they're too afraid, they might just go out of the system and there will be an unmet uh health need, one has to be careful about observing these things, gathering those information and being, you know, kind of working out a plan how I can still hold the confidence, how I can still not, you know, be come across as quite harsh as a professional, but ensure that the child is not slipping through the crack because others are afraid of a diagnosis a diagnostic label. You know what I mean?

SPEAKER_04 48:28

Yes, I definitely. And and it I think one thing you have highlighted here is it's not a now or never. No.

SPEAKER_05 48:38

It is never, now or never.

SPEAKER_04 48:40

Yeah, it is it is it's an approach that we have to use by understanding that whole family.

SPEAKER_03 48:47

Yes.

SPEAKER_04 48:48

Understanding why, because they have reasons why, you know, they don't want you have to understand the reasons. Absolutely. And some of them, it just takes a little bit of time for them to come around with the support and then they understand it, you know, then they come on board with you. So just looking at again from there, we know that a lot of the children we see, some of them have additional things wrong with them. So somebody might come into the clinic for one assessment and they then have you pick up that they have a lot more complex profile. How do you deal with that, being able to explain that to the families? What does that mean? That's that question I've asked because there are parents listening who would say, you know, now my child's got like three, four, five things. I don't even know which one is which. Sometimes they're very confused. So, how do you go about explaining all these different aspects to them?

SPEAKER_05 49:49

What I, in my practice, what I try and do is that when I see the child when I've already had a lot of information, I look through the information, I actually work quite hard to build a profile, a matrix of the child. It's like small jigsaw puzzles, okay? And I am also mindful of not throwing the rule book or a whole lot of information overload to the parents because that can be really something that's off-putting. Remember, these are real persons who have a job to do, to do shopping, pick up children, do, and on top of that, you're asking them to look at 200 web links and go for three, four uh training sessions. So you have to be very kind and understand that this is not humanly possible. Be kind to the carers and the parents. So tell them what is a priority. Yes, you you say, and you tell them that look, these are the things available, and we will somebody will check on to you. I will ensure that you can have this if you're having a difficulty. And you know, it's not often, as you very well know, in NHS, we are not able to schedule another review appointment that easily. It's often not possible. Parents can often not come back to the clinicians that easily. And even in the private sector, it is also a paying thing. But so you have to make sure that even whatever system you do, there should be a breathing space where there could be a little bit of follow-up arrangement, somebody as an outreach. It could be a pre- and post-diagnostic support, it could be a very clever occupational therapist who is doing a group with some families and takes that opportunity. And because you have taken the time to communicate with that person and say that you can have this child in your team, would you mind just giving a bit of, you know, talking to mother and also giving a bit of feedback to me as to how it is progressing? You know, even within the system, you have to be conscious, conscious enough to build in some checks and balances, okay? Some ways that there would be some continuity in communication coming back to you or going back and forth. And also not to overload people with too many information. You have to curate what's most important and you and what would make a difference. Don't say that your child needs this, this, this, this, this. Even the school is not able to do all that thing. And when you say that go and ask for this help, parents often feel that just because they've got a diagnosis or whatever, uh, things are going to be magically changing in an education. It doesn't. So you have to also give the reality check and tell them you can get some things perhaps. Somebody who will not get an OT, you look at the profile and say, instead of doing anything that serious, can you just do some fun activities like kneading? Just plain dough. You don't have to make a pizza, also just do that. But put it as a sensory diet, like you use it before the child has, you know, lost temper or something, or build some a little corner in your room where you have got an old cushion where you can actually plummel the cushion and have a play fight regardless, just after when maybe the child comes home. Because there are ways and means that you can support and give strategies which do not sound very ominous. You know, you can actually break it down, use your medical or professional knowledge, translate it in what can be in a real life experience, that they can still do it without, you know, resorting to so many services, essential services like hearing, etc., etc., those can be done. But other things can be done too. And you know, putting them and giving them actually, and many times I would say that, okay, if you're finding it difficult, this three, four information, I'll put it up on my screen. You have a smartphone, do you want to take a picture? Just four of these. And add in your time, when you have a bit of time, look at them. So that way it becomes more personal, you know? And uh they kind of and it sticks the way you curate information and not overwhelm them with too many things. Yes. It's very, very, very, very important. And I'll take one more opportunity to talk something different. Professionals have also got to be clever these days and learn from young persons. I have had young persons who gone onto their web, you know, their Snapchat, etc., to ask the common questions for ADHD and how you can dupe the doctor and then get a medicine that is going to make you score the highest. So you see, you the professionals also have to be on top of their games. So it is just not the questions that matter, really.

SPEAKER_03 54:36

Yes, exactly.

SPEAKER_05 54:37

So that's the reason I said, hey guys, I may not know everything about your web thing, but you know, I know quite a lot about what I'm talking about, and you don't even know what I'm looking for. So, you know, we have this kind of teasing, bantering relationship. So they also kind of respect that this but I cannot do by just going through some motion, yeah, catching answers and not be the magic pill, and then I'm going to just ace acing my exams without opening a single book. So you know it works everywhere. So you have to be very careful and clever how you deal with these things.

SPEAKER_04 55:16

In fact, what you're saying is so important in terms of how much information that we're giving out. So we did an audit recently of the children coming to our ADHD clinic, and we were looking at the children who had emotional and mental health concerns. And the audit had been to see whether the pe whether it, you know, the families had access to the resources of where to go and whether they were using it and whether it was making a difference. Well, a lot of them knew the information. A lot of them were given the information, but many of them were not actually implementing that information. Because, you know, just the fact that we're just sending them, go to it here, go to there, go to there, go to there, does not mean that you have met their needs. And I like your take on saying, what is the priority? How can you simplify it? How can you use day-to-day things within the home that doesn't involve it? It is quite hard. If you've been to work, you've brought your child home, then to start going for X, Y, Z can't really be a lot we're asking for families. So, what is the sinful thing that the families can engage in? And this is why I feel as professionals, we need to start thinking beyond the clinic room. Yes. Beyond those things, you know, the documents and everything on our clinic room or the lovely booklets that have spent time to create, which we just hand over with saying, well, they've we've diagnosed them with ADHD, we've given them the ADHD pack and that. We need to stop, we need to start thinking beyond that because there in today's world, we need to take into consideration what is the priority for this family and what can they do as well. And that brings us to how can early intervention improve outcomes. Because many families are referred late to services. What needs to change?

SPEAKER_05 57:16

Creating a service, I have had the good fortune or whatever, the struggle you may say, even within NHS, because I have been leading my service for quite some time, I had some say in it. And what I really wanted to create was a multifaceted, small, agile team that can easily change direction based on what is the need of the children that we are picking up. And then unclutter the service in a way that if you want to have to meet the parents again, or if you have to take in somebody quickly to see, you create that opportunity in it. So, as I said, one of the most important things that we have been able to do as collectively in our community pediatric services is ITAC Plus, Integrated Team Around Child Plus. And that means that if we find somebody is really, uh we are really concerned about a child or a family or something is not working, we take the consent and then we are able to discuss with relevant interagency professionals to support with intervention. Say the child will not get SLS speech and language in, you know, because the child is older and NHS is not able to support. So we can at least have a key professional from the NHS to talk to the school speech and language and say this is a needy child, is going to you. Can you ensure that this child is in your radar? And next time when you go for your school visits, even though you're not giving individualized program to this child, you know, this child, because the child is in your radar, can you give some extra support to the school teachers who are going to see this child? So I gave you a simple example or somebody who uh the nursery is struggling, and we have picked up that this child needs a lot more support. So we talked to the early years team, they would go back to the nursery and say, This, you know, can we do some? Can I help you to do the early years grant so we can organize some funding for this child because this is a needy child. Somebody needs family support, somebody needs to be seen in a way that we have to work on that family repeatedly until and unless we are all on the same page. So it is not one size fits all. You have to have a very kind of fluid system you have to create, and all of us should be able to create, even within NHS or any other place, that you can have a little bit of regal room to customize the need and do whatever intervention possible. If not, be on the lookout where you can get some freebies and it can be useful. Develop a connection. No point in just saying that call this charity. Maybe the doctor or the professional should call that charity, develop a RAPL, and then you refer and say that, you know, I know a lot of things that can be done there. You don't have to, it doesn't cost money. It becomes a personalized thing because you're talking from your experience, and parents respond to that a lot more. So, you know, there are ways and means. Early intervention is the key. And if somebody is not able to engage with the services, instead of being critical, you have to find out why. Is it a financial thing? Is it a transport? Is it they have not understood the information? Or are we overloading them, asking them too many forms to be filled up and they're terrified? Is the child not in seen by other professionals? Has the child left school and therefore we are not getting a school information? Always ask why, and then you can work out an intervention that is best suited for that child.

SPEAKER_04 1:01:08

Fantastic. What would you, you know, what would you be wanting teachers and Senkus and schoolserv to understand about children with neurodevelopmental conditions in their classroom?

SPEAKER_05 1:01:33

First and foremost, professionals should understand how challenging it is for today's teachers to actually not only ensure that the children are safe, but to look for their education, their emotional health, and in many times physical health, a lot of children can also be on medication and other support. It is not an easy thing. And I have been shaped by educators, and I'm still in touch with my head teacher because she has shaped my life and my relationship with education and teaching. What I would like to say is that one thing perhaps is that teachers and parents should be on the same page because there are a lot of children, boys, girls, neurodivergents especially, can be cloaked with certain kind of behavior. Somebody has got severe anxiety can come on, can come across extreme demand avoidance and may come across as somebody who is completely disruptive and always in detention. Somebody who is an extremely quiet person and is having immense emotional dysregulation at home, teachers should understand just because you can't see something, it doesn't mean it doesn't, it's it doesn't exist. And just because something is existing, not in different settings, but only in home setting, it doesn't mean it is the fault of the family or the parents. That realization should be very important. And also the fact that not to have that notion that some parents are financially well off, can get private diagnosis, and therefore want a lot of demanding attention from the school, which the school is not seeing as a behavior, it puts a lot of, how shall I say, cross-kind of information and puts a lot of confusion on the table between the educators, the parents, the young person, and the healthcare professionals. So we have to work together because you know, training and understanding of conditions, a lot of us have invested not only as clinicians, there are a lot of uh nurse practitioners, there are a lot of clinical psychologists, educational psychologists who have spent years and years. And therefore, if somebody has been, you know, assessed and found to have some condition which is not evident or prevalent in school, while teachers, it would be important for teachers to validate and understand their lived-in experience and professional opinion. Parents should also should come from an understanding is that just because somebody's got a diagnosis, it doesn't magically turn on the tap for a lot of extra support. Because also there are limited cards. The school holds limited cards, even and even then to give that support, it has to be quantified what support is actually available. So having those clarity and having this discussion, at least opening those for those discussions, is rather, rather important so that we are all on the same page, child and young person in the center, and all of us around. And teamwork, multiprofessional teamwork is very, very important and respect for each other's opinion is also very, very important.

SPEAKER_04 1:04:50

Thank you. Thank you so much for putting that very well. Because one of the common things that we see is when the schools send reports and say, Well, we're not seeing any of those problems here. And then, and this always sometimes results in what we are talking about have we seen the whole child? Because schools might say, We're not seeing anything here, and parents might have the information that they are living, you know, what they're experiencing at home, and the clinician might come to the conclusion and say, Well, you know, it's not happening at school, so therefore, you know, it's not happening, not meeting criteria. And that brings us again back to that question: have you seen the whole child?

SPEAKER_03 1:05:32

Have you seen the whole child? Yeah.

SPEAKER_04 1:05:34

Uh what is the basis for reaching that conclusion? We've we've had an amazing conversation. I've enjoyed so much. We've had an amazing conversation. So, as a senior clinician, you are inspiring a generation of younger clinicians, younger doctors, and you're having to mentor or guide or supervise a young pediatrician who is. Or a child health professional, it might be a nurse professional, it might be other professionals as we work in an MDT. What is your advice? What would you be saying to them? What would your advice be?

SPEAKER_05 1:06:13

In NHS and in healthcare sector, there is always that environment where you have to always continuously learn in order to do your appraisal, etc., etc. My take on this is that it is not a tick box exercise. Constantly strive to know and improve yourself. So if you say that today I have got a clinic with five patients, rather, my take on this would be to any of my colleagues is that either at the beginning, if you know something, what am I looking forward to today? And at the end of it, what have I learned from my patients or families or from my ethical question? What have I learned today? And it can, it doesn't always have to be a clinical thing. It can be you found a challenge or gap, even it's as simple as you couldn't order a particular blood investigation. And instead of being frustrated, taking up as some a learning point, because this might have happened again, this might impact your children or your patient care. And to take it up on yourself, lead yourself to understand if this is happening and I want to improve the outcome of this child, how can I link with the right person? What are the things that I can do? How can I simplify the process? Maybe we have to learn a little bit differently how to order the bloods in a particular system. You know, then you take away your frustration and you're constantly resolving situations. So unless and until you have that, it's a long haul, it's a long career. You'll be burnt out. So develop interest. Don't see frustration. Look at gaps and see how you can either learn from it or you can contribute so that that gap is closer. Maybe not the way you liked it. Maybe there is no extra uh 50,000 grand coming in to support you with that service, but maybe you can find like-minded three clinicians and two therapists or that nurse practitioner who would want to join together and create a little bit of a forum where you can resolve some of these issues in a different creative way. So, what I mean to say is that not only learn, have that intellectual curiosity to learn from different ways. Keep yourself always alive, alive, alert, do things that you like. I like my color, my perfume, my lipstick, my dancing. You know, it keeps me happy. And find that module so that you're not just a doctor. You're just not, you know, in the in the larger scheme of life, you have to function in the society. You have to do your shopping, cleaning, cooking, scolding your children, making do making them do their homework, uh, you know, calling the plumber to mend your thing. You cannot always be doing medicine, can you? But at the same time, you must keep yourself healthy, whole. If you're not feeling okay, ask for help. There are lovely mentors. I have always selected, I am quite good at selecting role models. I learned this part from this person, that part from that person, and I've gone out of my way to engage them with them. I've had two very, very gifted senior colleagues. One of them is Dr. Bozina Zorish, one of them is Dr. Daphne King. And even in neonatology, I have had Dr. Otunla, and in my early days, I had Dr. Odeka. You know, I have kept in touch and I have always selected people in different not one person is good at everything. So you select different learning aspects, and you said, Wow, how can I learn from them? Wow, I really like what that mother did to that child to calm him down. You know, there are learning things. Or that colleague said there's a new charity, you know, they do this, this, this. Learn, keep yourself alive, and that is the best way to go forward, and you'll not be a burnt out.

SPEAKER_04 1:10:10

It's very important and remembering the core reason why you chose the profession. That's what's kept me, because we keep going back to that passion we had and reminding ourselves. And we can see from Dr. Sen's earlier years working in that, you know, hospital, working with Mother Theresa. And she's still carrying that same ethos. That same ethos still drives her work because she remembers every time, she reminds herself why she was in this field. We didn't come into this field to be like robots and just doing things. We came in because we're human and it's always good to have that human touch. And lastly, Dr. Sin, it's it's been an amazing conversation. It's almost like I don't want it to end because it's been We joined so many.

SPEAKER_05 1:11:03

Yeah, we can rethink all the things that I like thinking.

SPEAKER_04 1:11:07

No, it's lovely. If there's one message you wanted every listener to remember from today's conversation, what would it be? Because we have audience from all over the world. We have families, we have parents, grandparents, teachers, carers, other therapists. We have people listening. We have people where this message might not be for them, but might be for somebody else that they knew. And they would have been engaging with the conversations that we've had. What is one thing that you want them to remember from this? Because we've we've had lots of conversations, challenges, the barriers, we've talked about different things. What do you want them to remember from this then?

SPEAKER_05 1:11:52

It's coming back to the first germ of idea that you and I had. And I would like to say is that a diagnosis can explain a behavior. A whole child approach explains the person. If we truly learn to see the whole child, we will not only simply improve outcomes, we actually can transform lives. And that is the essence of it. Having the professional curiosity, but the humility to see the whole child, respect somebody else's lived-in experience more than my screening processes, to try and fit the child in a particular box of diagnosis. And even if one has to try and go to the bottom as much as one can, but even though there is no one diagnosis to be had, always try to find out who the child actually is, what could be the strength, what could be the areas that the child can be supported, and try and create a bit of a roadmap instead of saying that yes and no, your child doesn't have ADHD, your child doesn't have autism, or you know, yes, your child has got this condition, and therefore everything has to be explained with this lens. Then we are actually defining a child, a young person, the future of tomorrow, somebody's love of life just by a diagnostic level. Yes. And that is not something we you and I want to do.

SPEAKER_04 1:13:24

No, it's not. And and you know, what you've just said has made me reflect on the very positive stories we've had about some of the guests we've had on the podcast where they're hand-ed a diagnosis and you know they're stunned by what next because or they're not the process of getting the diagnosis has been quite painful for them, or they're even given that diagnosis, and you know, nothing else follows. But the in the the spirit behind those families and how they have worked to actually make those young people achieve their purposes has been something that has been very humbling for me. And I've listened to many of these countless stories and been so amazed about how children who, you know, we just said, okay, no, but because of all the input, and this input have been simple things like music. Yes, families have used music to actually form connections and help that child's development. And there is a beautiful story of a young boy who is non-verbal, but the family's investments have in that child using very simple things, just a bit like what you were talking about when you said, you know, find the priorities, walk with the families around there. I like the analogy of have a little bit of pillow flight before when they come back from school. That's regulating. That's regulating them. You know, do a bit of rough and tumble when they come back. That's regulating them. You know, it doesn't that that bit of thing that you've done doesn't need going to big services, it doesn't need them being 10 sessions of occupational therapies or all those things. But I was just so humbled by this family where this young person today has got a purpose. That young person now has his own business from that music that he learned. Wow. That young person now from learning how to scoot around with his father, now teaches young people to scoot and has a business for skirting. It was just, I was humbled as a pediatrician because I thought this is what life is. This is what purpose is. It's not about a label.

SPEAKER_05 1:15:44

Yes.

SPEAKER_04 1:15:44

It's about nurturing those young people to go through those, you know, rough periods they've had, but actually helping everybody working together to help them achieve their purpose. And, you know, I'm so pleased to have stories like that going out because we need to change our perspectives as, you know, clinicians. We're not just working to assist them to dish out a diagnosis that fits criteria, but we're here as child advocates. And just like all the things you've done, Dr. Sen, which I continue to say I admire so much. Oh, thank you so much. You've just got that voice for the child, and through our conversation this evening, it's just been amazing listening to you because with everything, you've got the child and the family at the heart of the your you know, your work. And I just want to say a big thank you to you. Thank you so much. It's such a pleasure modeling what a a clinician should be and continuing to train the next generation of pediatricians and child health professionals. And we look forward to when systems would would be there to accommodate and actually look and look at the whole child, look at the child's culture, look at the child as a person, look at the family as a person, rather than us just working to diagnostic criteria. So thank you so much for your time on early team. Absolutely.

SPEAKER_05 1:17:14

Thank you for your team also. Thank you, Imei, for supporting in this podcast. I have thoroughly enjoyed and I'm really humbled, and it's it's been such a joy for me. Thank you.

SPEAKER_02 1:17:27

As we always say, early intervention leads to better outcome. And early intervention can only be achieved by early diagnosis. So thank you for listening into the series today. Um, I know some of the things we've talked about today would probably have generated some questions or need to seek clarification. So I'm happy to take questions, and I'll invite you to send your questions to EIM at dracon.com. Thank you for listening.