News and media, March 2009

Good childhood inquiry

A psychologist-led inquiry into childhood, published by the Children's Society, has made a series of wide-ranging recommendations to parents, the government and society at large, provoking intense media interest in the process. Chaired by developmental psychologist Professor Judy Dunn and with educational psychologist Professor Kathy Sylva also on its panel, the Good Childhood Inquiry was 18 months in the making and is published in book form, with key findings and recommendations also appearing online: www.childrenssociety.org.uk.

The Children's Society, which has a close partnership with the Church of England, stresses that the experts who conducted the inquiry were given full independence. 

Among the report's recommendations are a call for parents to make a long-term commitment to each other when they have a child; for schools to teach sex education from a social and emotional perspective; for government to introduce a civil birth ceremony and to provide parenting classes; for the media to reflect on the violence in their output; and for society at large to adopt an ethic in which people care more for each other. 'It is a world like this, built on the law of love, that we should create with our children,' the report concludes.

A further specific recommendation relevant to psychologists is for specialist psychological services for children and adolescents to be radically improved over the next five years. '[S]ome 1000 professional child therapists need to be trained in the skills of evidence-based assessment and therapy,' the report says.

Newspaper headlines prompted by the report's publication tended to focus on the idea that 'selfish parents' were being blamed for children's modern-day woes. However, the report itself, while describing our culture as increasingly individualistic, doesn't label parents as selfish. It seems the 'selfish parent' headlines were inspired by the report's observations on the increasing number of women in work and the rise of family breakup, combined with a quote from the Children's Society chief executive that the report shows 'the aggressive pursuit of individual success by adults today is the greatest threat to our children.'

'At no point in the report do we use that [selfish parent] term, and we do not use the language of blame,' Professor Dunn told The Psychologist. 'Our plea is for more support for parents, not for blame.'

Dunn told us that at least two further issues have been misreported in the media: 'At no point do we suggest that mothers ought not to go out to work. We stress the importance of genuine choice for parents of young children. If they decide to work, high-quality childcare should be available. If they decide to work less, more extended parental leave should be available for either parent (even if unpaid), with no loss of seniority. We argue that flexibility of working hours for both mothers and fathers is key.'

'The third issue concerns the suggestion that the report is critical of single mothers. No criticism of single mothers is made or intended. Rather, we propose far better support for all parents: support to help parents stay together if they want that, and support for mothers who are alone. We also show how important it is, if parents split, that harmonious relations between them continue, and that the children go on seeing and communicating with their father.'

This last point in relation to paternal contact, is just one of many of the report's recommendations that are based on research findings, drawn either from evidence gathered as part of the inquiry, or from previously published journal articles. Indeed, 30,000 people contributed evidence to the inquiry, including 20,000 children.

The evidence is gathered under seven themes: family, friends, lifestyle, values, schooling, mental health and inequality. Further highlights include the claim that today, fewer children have best friends who they can trust; that children are targeted more often by advertising; that they are raised in an increasingly individualistic, materialistic culture; that the British schooling system, while largely excellent, is blighted by inequalities; that more children have mental health problems for which they are not receiving expert help; and that Britain has more inequality than any rich nation bar America.

The point about lack of paternal contact leading to increased risk of mental health difficulties was one of a handful of specific claims that prompted media attention. This claim was based on findings from a pair of studies led by Tamsin Ford at the Peninsular Medical School, which looked at the correlates of mental health difficulties in thousands of British Children (www.ncbi.nlm.nih.gov/pubmed/17960315). Importantly,  the second of the two papers was a prospective study that allowed some causal inferences to be made.

Another controversial claim was that more time spent by children on the internet or watching television is associated with a raft of negative outcomes including worse mental health and poorer relationships with parents. The reference cited by the report in support of this claim is a book written by Juliet Schor published in 2004 entitled Born to Buy. A footnote to the citation cautions: 'This suggests rather than demonstrates causality.'

'We are hopeful that the report will contribute to the discussion of the central issue of how we can help children and their parents, and to real policy change,' Professor Dunn said. 'This can happen only if the report itself is read, rather than inaccurate media comments, so we urge the public to read the report itself.'

Autism traits widespread

The social and communicative difficulties experienced by children with autism are also exhibited in milder form among many children without autism. That's according to an investigation of 8094 eight-year-olds by David Skuse and colleagues at the Institute of Child Health, who say their finding supports a dimensional approach to autism (Journal of the American Academy of Child & Adolescent Psychiatry). Rather than autism being a qualitatively distinct category, Skuse's research suggests that autistic-like traits are distributed normally throughout the population, and that the point at which a diagnosis of autism is made is somewhat arbitrary. 

The researchers asked the mothers of children in the Avon area to rate their agreement with 12 statements about their children's social and communication abilities – this was the Social and Communication Disorders Checklist. Examples items included: 'Not aware of other people's feelings' and 'Does not pick up on body language'.

As well as finding that scores on the checklist were distributed normally through the sample, the researchers also found that a higher score was associated with slightly increased behavioural and emotional difficulties at school, as indicated by teacher reports, even for children without a diagnosis of autism.

'Our study suggests that even subthreshold autistic-like traits are associated with a small elevated risk of teacher-reported problems with socialisation, hyperactivity, and conduct problems,' the researchers said. 'This suggests the value of clinicians assessing autistic traits dimensionally and acknowledging the potential impact on function and well-being of even mild autistic difficulties.'

Another key finding was that for girls, but not boys, high verbal IQ appeared to provide protection from the consequences of social and communicative difficulties. This is consistent with the far higher prevalence of Asperger's syndrome – a mild form of autism associated with normal or above-average verbal ability – among boys compared with girls. Boys also scored 30 per cent higher on the Social and Communication Disorders Checklist, on average, which is consistent with the higher prevalence of autism among boys compared with girls.

Tackling reoffending

Reoffending in London remains a massive problem – with both regional and national implications. But the problem will continue to worsen unless better use is made of psychological and criminological research.

These points are made in a British Psychological Society response to a recently published Ministry of Justice (MoJ) consultation document Reducing Re-offending in London. Speaking on behalf of a BPS team that reviewed the document, Professor James McGuire welcomed 'a wide-ranging and thorough document which addresses a complex and challenging task'. However, he added that unless the MoJ takes full advantage of available research on the reduction of criminal recidivism and on offender rehabilitation, an opportunity to have an impact on crime will be wasted and communities may continue to suffer as a result.

One main issue was short-term sentencing. 'Although it is official government policy to reduce the usage of short-term imprisonment,' Professor McGuire said, 'the report reveals that over 60 per cent of those in London's prisons are serving less than 12 months. This achieves little if anything by way of public protection or reduced offending, and may indeed have the reverse effect. Yet the strategies proposed here will continue the same "revolving door" process and even bolster and expand it. This goes against research evidence,
is costly in human terms for prisoners, their families and children, and in financial terms for the public. It does not serve the community well.'

The response instead calls for a net 're-investment' of resources in community rather than custody; reserving prison for those who need to be restrained, and extending community supervision elsewhere. 'Increasing resources for community supervision and improving its quality would enable better monitoring of psychological changes linked to risk of re-offending, as well as providing better opportunities for rehabilitative work,' the report advises.

- Other recent Society responses.

Caffeine and hallucinations  

Students who consume more coffee also tend to report experiencing more hallucination-like experiences, according to a new study by Simon Jones and Charles Fernyhough at Durham University (Personality and Individual Differences; http://tinyurl.com/cpcsqd). For example, high caffeine-using students were three times more likely to say they'd heard a voice when no one was there, than were students who drank less than one coffee a day. One possibility is that caffeine facilitates the pathway from stress to psychosis by increasing cortisol levels. However, this particular explanation is undermined by the fact that no link was found between caffeine intake and persecutory beliefs.

Be a media fellow

The British Science Association Media Fellowships scheme is now open, to allow UK social scientists (with a minimum of two years' postgraduate experience) to spend a summer placement within the media. The aim is to equip fellows with the skills to communicate research to the public and colleagues, and to work within the constraints of the media to produce accurate, well-informed pieces about developments in science.

Work–life award

Society member Professor Cary Cooper (Lancaster University Management School) has been honoured by the charity Working Families for his 'longstanding contribution to work–life research and new thinking and his tireless advocacy'.

He is one of 30 pioneers honoured in a House of Lords ceremony to mark the 30th anniversary of the charity, which supports working parents and carers and helps employers create workplaces that encourage work–life balance.

Social brain project launched

The Royal Society for the encouragement of Arts, Manufacturing and Commerce (RSA) launched its Social Brain project in February with a talk given by leading behavioural economist Professor Colin Camerer of the California Institute of Technology.

The Social Brain project recognises the significance of new findings in behavioural economics showing that traditional economic theories of human choice have profound shortcomings. The project aims to harness these new findings to guide social policy, such as in health and welfare.

Professor Camerer described how the traditional economic assumption was that consumers generally know what is good for them. A simple example would be the idea that regulation isn't needed to keep restaurant quality in check because consumers will do this for themselves – a restaurant packed with patrons is probably enjoying that success because it serves good food, while a restaurant that serves bad food will lose customers and end up closing down.

This is true in some circumstances but research now shows that people are far from rational in many of the decisions they make, and that we're particularly prone to making mistakes when it comes to massively consequential, one-off decisions for which there is little opportunity for trial and error – educational choices, career choices, whether to get married, which house to buy, whether or not to start a family.

A new movement, referred to by some as Libertarian Paternalism, and popularised by books like Nudge, targets the systematic flaws in our thinking and seeks to put policies in place that will help people avoid making big mistakes, yet will not interfere with those people who aren't vulnerable.

Taken to its extreme, Camerer foresees a situation in which people have their brains scanned prior to an important decision, with the activation patterns revealing whether they have fully engaged with the issue at hand. Those people who weren't fully engaged would be warned that they're likely to make a bad decision. The inspiration for this scenario comes from a recent study Camerer conducted in which brain activity was compared when people made real versus hypothetical decisions.

Examples of less radical policies in the mould of Libertarian Paternalism include introducing cooling-off periods for the purchase of expensive products or investments (thus protecting consumers from rash decisions and hard-selling), and setting up employee investment plans that take a default cut from salary rises, so that the investment feels less like a loss.

Camerer said neuroscience findings too are beginning to feed into our understanding of decision making. For example, he cited a recent study showing that 'loss aversion' – our tendency to react disproportionately to losses relative to gains of equal size – is also apparent in the behaviour of Capuchin monkeys.

The monkeys were trained to use plastic tokens to buy bananas from two sellers, one of which gave one banana per token, but occasionally threw in an extra freebie; the other gave two bananas per token, but occasionally stole one back. The net outcome for the monkeys was the same at each seller, yet the monkeys chose to shop from the first seller on 70 per cent of occasions, thus suggesting the monkeys were loss averse. Findings like these raise intriguing questions about the cross-species universality of many of our decision-making biases.

After the talk, RSA chief executive Matthew Taylor, put it to Camerer that an alternative approach could be to inform people of the flaws in their decision making, rather than establishing government policies to protect people from those same flaws. Camerer retorted, however, that attempts at 'debiasing' people have generally proven to be unsuccessful. For example, you can inform people about many of the self-serving biases that affect decision-making and yet, ironically, most people will simply conclude that others may be prone to such foibles, while they themselves are not.

In the audience, psychologist Professor Theresa Marteau of King's College raised some doubts about behavioural economic approaches. For example, Libertarian Paternalism advocates clearer labelling
of fat content on foods, yet Marteau said lab research had shown people tend to eat more of low fat versions of products, relative to standard versions, with the consequence that they actually end up consuming more calories.

'I think there are some very interesting ideas but when one starts to look at trying to shift people's behaviour, actually we've got to think about other factors,' she said. CJ

Vitamin link to cognitive decline

A study has found that levels of vitamin D are lower in older people with cognitive impairment, thus raising the tantalising possibility that vitamin supplements may afford a degree of protection against age-related cognitive decline (Journal of Geriatric Psychiatry and Neurology).

Using data collected as part of Health Survey England, David Llewellyn at Cambridge University and colleagues found that 212 people in a sample of 1766 over-65-year-olds were cognitively impaired. Crucially, those participants who had the very lowest levels of vitamin D (serum 25-hydroxyvitamin D) in their blood were over twice as likely to be cognitively impaired, even after controlling for a raft of possible confounding factors including age, season of testing and medical history.

However, the cross-sectional design of the study means the causal role of vitamin D has not been proven. It's possible, for example, that some other factor(s), such as diet, may affect both blood levels of the vitamin and cognitive functioning.

Kinship care, and body dysmorphia

There's been a policy shift in recent times towards placing children whose parents can't look after them into care with family or friends, where possible, rather than into care with unknown foster parents. This so-called 'kinship care' makes intuitive sense but until recently there's been little research into whether it really is beneficial.

Now a Cochrane Review has combined the results from 62 quasi-experimental studies into this question and concluded that placing vulnerable children into kinship rather than foster care is beneficial across a range of outcomes, including reduced behavioural problems, improved well-being and fewer psychiatric disorders (Cochrane Database of Systematic Reviews). In contrast, there was some evidence that children in foster care may benefit from greater access to the services they need, perhaps because of the training foster parents receive and their connections with community services.

Lead researcher Marc Winokur, at the Social Work Research Center at Colorado State University, said that care was needed in interpreting these results given the low quality of research in the area and the fact that nearly all research to date has been conducted in the US. He also said the value of traditional foster care should not be forgotten. 'Foster care should continue to be an essential out-of-home care option, as children in these placements also experience positive outcomes and appropriate kinship placements are not always available,' he said.

A second recent Cochrane Review has found preliminary evidence for the effectiveness of cognitive behavioural therapy (CBT) and antidepressants in the treatment of body dysmorphic disorder (BDD) – a condition in which people become disabled by what they believe is a defect in their appearance (Cochrane Database of Systematic Reviews). However, the authors of the review warn that their conclusions are founded on a thin evidence base.

Jonathan Ipser at the University of Stellenbosch in South Africa, together with Candice Sander and Dan Stein at the University of Cape Town, identified two trials testing the efficacy of antidepressants, and three that investigated CBT. Two of the three CBT trials found therapy to be superior to a waiting list control and one showed evidence that CBT might help prevent relapse. Drug treatments too were found to be effective. There wasn't enough evidence available to compare the efficacy of psychological treatments against drugs, and many forms of psychotherapy remain untested.

'Given the number of people suffering from BDD and the level of distress caused, it is surprising that so little data is available on treatments,' said Ipser. 'This is certainly a field that deserves additional attention and funding.'

Young people and the media

The accelerating evolution and reach of the mass media means that they play ever more important roles in the lives of young people. Now a special issue of the British Journal of Developmental Psychology has brought together a variety of current perspectives on the ways in which media can form the backdrop to cognitive, linguistic, social and civic development.

Television remains the pre-eminent medium of choice for young people and their caregivers. The special issue contains several papers on the conditions under which children learn and do not learn from television/video; studies led by Elizabeth Zack, Michael Robb, and Sook-Jung Lee show that television viewing and reading habits are formed early in life and reinforced over time, and that infants as young as 15 months old can learn new actions from TV displays.

A large-scale field study conducted by Deborah Linebarger and Jessica Piotrowski shows that television story programmes can support preschoolers' narrative skills. 

Part of the price we pay for media is extensive exposure to advertisements. Avril Nash and colleagues reveal that school-age children turn out to be quite knowledgeable and rather fond of the humour in TV alcohol commercials, perceiving them as effective. Moondore Ali and colleagues report that children in the same age range are less adept at distinguishing what is an advertisement on the internet – only 10-year-olds recognise readily that price tags provide clues. Those interested in counteracting

A memory clinic in every town

The government has revealed plans for a 'memory clinic in every town' in England, to provide early diagnosis and treatment for dementia.

The five-year strategy has earmarked £150 million to set up the clinics, give extra training for GPs to spot dementia warning signs, to provide specialised advisers to help people with dementia and their families navigate the care and support systems, and to improve public awareness and reduce stigma.

Care Services Minister Phil Hope said early diagnosis was key. 'It takes on average three years after the disease begins for people to be diagnosed, partly because of the stigma and also a lot of GPs are not trained to spot the early signs. If you get early diagnosis and early intervention it improves the patient's quality of life, so we are talking about a major roll out of memory clinics.'

The clinics could be housed in hospitals, GP surgeries or in the high street, and patients could refer themselves for expert assessment, support, information and advice.

Dr Sinclair Lough, chair of the Psychology Specialists Working with Older People – part of the Division of Clinical Psychology of the British Psychological Society – felt that the strategy 'fails to bite the bullet and recognise that major service redesign is required. It advocates setting up new memory services in addition to all the existing services. This will simply add to the confusion as to who looks after whom. Our group believes that to improve care, all the existing services should be amalgamated into a single memory service that caters for people from the diagnosis of dementia to their death.'

The group cautioned over an overreliance on memory clinics, arguing that innovative services that address people's changing needs as dementia progresses are equally important. However, the strategy does refer to wider provision of older people's community mental health teams, to assess patients in care homes and to help minimise the use of antipsychotic medication.

Bob Woods, Professor of Clinical Psychology of the Elderly at Bangor University, welcomed the 'person-centred' nature of the document, and the opportunities for psychologists. He told us: 'Clinical psychologists will welcome the way in which the need for timely diagnosis is to be tackled; it would have been tempting to place more emphasis on diagnosis by general practitioners, rather than by specialist memory clinics. However, the assessment of suspected dementia, when any impairment is mild, is complex and requires specialist input. The NICE-SCIE Guideline on dementia recommends that all cases of suspected dementia should receive a neuropsychological assessment, and the Strategy misses the opportunity to address the workforce implications of this specific issue; there will be a need for further development of psychological services for older people to provide this specialist input to the new clinics.'

Professor Woods also said that 'When the research agenda arising from the strategy does emerge at a "summit" to be called by the MRC, it is to be hoped that some attention will be given to developing the evidence base on the benefits of early identification and diagnosis, which have been insufficiently documented to date.'

Wales is also developing a national dementia plan, and Scotland already has national targets for dementia diagnosis and care. 

New CBT register

The British Association for Behavioural and Cognitive Psychotherapies (BABCP) and the Association for Rational and Emotive Behaviour Therapy (AREBT) have joined forces to develop a web-based register of all accredited cognitive behavioural therapy practitioners in the UK, available at http://www.cbtregisteruk.com/.
The registered includes over 1400 therapists, many of whom are psychologists. BABCP President, Professor John Taylor, said 'This is the first and only definitive and complete register of accredited CBT and AREBT therapists in the country.'

The new register went live not long before Health Secretary Alan Johnson made a commitment in a speech at the end of November to increase access to other evidence-based psychological therapies, besides CBT. 'While cognitive behavioural therapy, which has an established evidence base, will remain at the core of the psychological therapies programme, it will not do so at the exclusion of other equally valid forms of therapy,' he said.

Media Section

Harriet Gross on the misrepresentation of Simon Baron-Cohen's research in The Guardian

According to US News on 21 January, one of President Obama's priorities on his medical 'to do' list is to get earlier and better universal screening for autism in the United States. Endorsing this goal, the journalist says that 'early screening is a terrific idea' and 'a huge challenge'.

In the UK, screening for autism hit the headlines on 12 January when the main item on the front page of The Guardian proclaimed 'New research brings autism screening closer to reality' (see http://tinyurl.com/8xjsd4). The article was accompanied by an ultrasound scan picture of a baby, with the caption 'The discovery of a high level of testosterone in prenatal tests is an indicator of autism'. The coverage continued on page 6, under the headline 'Disorder linked to high levels of testosterone in womb' (see http://tinyurl.com/7qzscd). All this was almost certainly the result of a press release by the BPS for a paper by Simon Baron-Cohen and colleagues published
in the British Journal of Psychology.

It is very unusual for a single psychology story to get such a major place in the news pages of a daily newspaper, even a broadsheet like The Guardian, and undoubtedly reflects significant public interest in autism. For this reason, it is perhaps even more disappointing that the headlines and captions appear to misrepresent the research findings. While the details of the actual research are reported reasonably faithfully within the articles, a significant misleading aspect concerns the possibility of using the findings – which link fetal testosterone and later autistic features in typically developing children – to create  a prenatal test for autism. The suggestion is expanded through reported comments from the National Autistic Society about the negative implications of prenatal screening and the spectre of eugenics and from the British Medical Association on the ethical issues concerning prenatal tests and termination.

The coverage also rolled out into other newspapers. The Daily Mail (15 January) ran a story on the 'hormone clue to prenatal screening for autism'; The Independent (13 January) asked 'The Big Question: should mothers be offered screening for autism and what issues would it raise?'; and the Daily Telegraph (12 January) had 'Study finds autism link to womb' and links to their coverage of the original presentation at the British Association in 2007.

Dismayed by the alarmist and inaccurate nature of the coverage and the link to screening, Simon Baron-Cohen wrote a response, which appeared in The Guardian on 20 January (see http://tinyurl.com/a7lgp9).  I then spoke with Simon about what had happened.

As his Guardian response suggested, Simon was 'shocked' by the coverage. Valuable though the research might be, he felt that world events were perhaps of greater import in that week. But he also felt that the information was wrong, misleading and irresponsible. It appears that the issue of screening became conflated with the latest research findings into a more 'newsworthy' story through something Simon had written for the BBC's 'scrubbed up' page, that had by chance appeared on their health website earlier in January. This had briefly mentioned prenatal screening, but it is hardly surprising that a major researcher in autism would have views about screening and its potential value and unlikely that he would be naive about its possible misuse. The point was, for him, that the coverage did not reflect the published research, the press release, or the conversation he had with the Guardian journalist.