‘It is most difficult when children feel different from their peers’
Vincent McDarby is a senior paediatric psychologist at Our Lady’s Children’s Hospital, Crumlin
Vincent McDarby, senior clinical health pstchologist at Our Lady’s Hospital, Crumlin. Photograph: Alan Betson
I am a senior clinical health psychologist with Our Lady’s Children’s Hospital, Crumlin and I work primarily with children who have diabetes. I am the sole psychologist specialising in that area.
There are currently about 500 children attending the hospital with the condition. I also see other children referred (to the psychology department) for other reasons. These children would come in through the emergency department or could be in any other area of the hospital.
Research shows that diabetes is one of the most difficult long-term conditions to live with.
The general perception among people who don’t have any direct contact with the condition is that it is pretty straightforward, very treatable and it’s a case of taking insulin injections and not eating sweets. But, in reality, it has a huge impact on day-to-day life.
There is a massive amount of work involved in the management of diabetes in terms of taking injections at certain times, checking blood sugar levels and adhering to a diet, and so on.
With a diagnosis of diabetes, all of a sudden you have to make a significant adjustment to your lifestyle. That’s very difficult and it can have an impact on your psychological wellbeing.
Humans in general are not good at changing behaviour and, from a psychological point of view, people can need a lot of support.
A diabetes diet is a healthy diet and is about eating in moderation. You can’t eat large amounts of sweets and junk food. Some children and young people can adjust to that really easily and some people have huge difficulty.
With diabetes, like most chronic illnesses, there is an increased incidence of anxiety and low mood in the young people affected, and there can be increased stress for parents. Some parents even have symptoms of post-traumatic stress disorder.
The thing children find most difficult about diabetes is when they feel different from peers. This happens when they are playing a football match and they have to go to the sideline to take something to bring their blood sugar up or when they have to leave friends to do injections.
I work with children and their parents and siblings because a diagnosis of chronic illness affects not just the child or adolescent, but the entire family.
Siblings are often overlooked and left out – some kind of chronic illness comes into a family and all the attention is directed towards that one child.
Psychologists are trained in a number of therapeutic approaches, but you always tailor it to the child. With the child who is five or six years of age and under, most of the work is done by the parents, so it is about helping them to support their child.
Some of the work is actually just normalising.
When there has been a significant illness or injury within a family, you are dealing with a whirlwind. Often parents of young people can themselves feel like they are going mad.
They get feelings they have not experienced before – panic or anxiety or depression – and it is about explaining that this is a normal part of adjustment.
Most parents go through a period of mourning when a child is diagnosed with a chronic illness or they have experienced an injury that is going to impact them for the rest of their lives.
Working with teens
With teenagers I tend to work more with individuals – they have generally taken more responsibility for their management.
I don’t necessarily see every new patient diagnosed with type 1 diabetes. At most I just introduce myself, explain what the psychology service is and when they can see me and answer any questions they might have.
Young people and parents have to go through a period of adjustment – that’s normal. After that they might want or need to see me, or maybe not.
There is no typical working week as such for me.
As anyone who works in Crumlin hospital knows, you don’t know who is coming in the door on a day-to-day basis.
On Wednesdays we have a diabetes clinic. It starts at 8am and continues until lunchtime, but it often runs late.
All children with diabetes will attend the hospital every three to four months for a check-up, so they will be seen by a nurse, a doctor and potentially a dietitian or myself, if they need to.
I don’t book in any patients and I have an open-door clinic that day. What happens is families and parents can self-refer when they come in. Most will know that I have an open-door clinic and some of the children will actually self-refer.
The doctors or nurses may also refer and say: “We’ve got a young person or a family here we’d like you to talk to.”
After lunch there’s a review, so the entire diabetes team sits down and everybody who attended the clinic is reviewed. Then it’s time for paperwork.
On Thursdays I am booked up with outpatients. I might see someone at the [diabetes] clinic and tell them that they will need to come back and have a longer session. They would mostly be diabetes patients, but I also see other patients.
Then on Mondays, Tuesdays and Fridays, I do research in the hospital – I have a unique position where half of my time is taken up with research.
In reality I end up seeing clinical cases, going to meetings and giving lectures as well, but it is predominantly research.
One of the primary areas of my research is diabetes, but I’ve a number of other research projects on the go and I work with other psychologists in universities that are doing research within the hospital.
At the moment one of the things we are looking at is how to reduce the anxiety of children who have to give blood samples. One of the things we are looking into is giving them a game to play on an iPad.
I find the job rewarding and it is a great place to work.
There are a lot of sad cases, but everyone here, their goal and their purpose, is to make things better for children and young people.
That’s very rewarding.
After hours . . .
After work I don’t have any difficulty switching off. I’m very active and I think it makes it easier to relax and unwind – I don’t tend to take work home with me.
I cycle to work and I go to the gym beforehand. I play soccer and tag rugby during the summer and I also kite-surf and wake-board.
I enjoy socialising with my friends and I travel a bit.
I’m usually up to something, going somewhere, doing something.