1. health and fitness
2. disorders

The Child and Adolescent Mental Health Services
Clinical Academic Group
Child and Adolescent
Mental Health in 2010:
From Basic Research
to Improved Clinical Services
Research Summaries
Institute of
Psychiatry
at The Maudsley
K;
^College
LONDON
^==
South London and Maudsley
NHS Foundation Trust
M I-1 'HI** KING'S HEALTH PARTNERS
Pioneering better health for all
FOREWORD
This year, the biannual Projects Day coincides with the development of the Child and
Adolescent Mental Health Services Clinical Academic Group (CAMHS CAG). The CAMHS
CAG is one of 21 CAGS developing as part of King’s Health Partners (KHP) , the Academic
Health Sciences Centre formed through the partnership of the academic arms, Guy’s,
King’s and St. Thomas Medical and Dental Schools, the Institute of Psychiatry, and
clinical arms, South London and Maudsley, Guy’s and St. Thomas’, and King’s College
Hospital Foundation Trusts. KHP has set the following challenges in clinical practice,
teaching and education, and research:
•
•
•
•
•
•
Drive the integration of research, education and training and, clinical care, for
the benefit of patients through our new Clinical Academic Groups (CAGs).
Consider all aspects of the health needs of our patients when they come to us for
help.
Improve health and well-being across our ethnically and socially diverse
communities and work to reduce inequalities.
Develop an AHSC that draws upon all academic expertise in medical science and
also in basic science, social science, law, and humanities.
Deliver a radical shift in healthcare by identifying ‘at risk’ groups, based on
genotype and lifestyle, and helping them to avoid illness.
Work innovatively with stakeholders in the redesign of care pathways, including
the delivery of care closer to home.
The CAMHS CAG includes the South London and Maudsley clinical services of CAMHS,
the Academic Department of Child and Adolescent Psychiatry and our child and
adolescent mental disorders psychology colleagues in the Academic Department of
Psychology. The CAMHS CAG is well-placed to rise to these challenges. We provide
national leadership in evidence based assessment and treatment of child and adolescent
mental disorders both in our community and national services. We provide training for
many professionals and further education through a number of Masters’ programmes
both to UK and international students. Our research activities are world class in
scientific quality, innovation and productivity.
The work included in this Directory, as well as that presented on Projects Day,
represents the spirit of KHP-integration among clinicians, educators and researchers
providing added value for the benefit of children and young people with mental health
problems and their carers.
Professor Emily A. Simonoff
Head of Department
Child & Adolescent Psychiatry
Institute of Psychiatry, King's College London
VII
TABLE OF CONTENTS
FOREWORD .................................................................................................................................... VI
LIST OF POSTER PRESENTATIONS ................................................................................................... 1
BEHAVIOURAL AND EMOTIONAL DISORDERS
Multi-Family Therapy for Adolescent Anorexia Nervosa: Results Of A Multi-Centre
RCT .............................................................................................................................................................................9
Cognitive Therapy for Generalised Anxiety in Youth: A Preliminary Randomised and
Controlled Trial .................................................................................................................................................. 10
Adolescent Eating Disorders and Related Behaviours: Longitudinal Course and Risk
Factors ................................................................................................................................................................... 11
Therapeutic Assessment for Adolescents Presenting with Self Harm ........................................ 12
The Developmental Psychopathology of Irritable Mood and Its Links to Depression:
Genetic and Environmental Risks, Neuropsychological Mechanisms, and Hormonal
Influences ............................................................................................................................................................. 13
A Pilot Study of Telephone Cognitive-Behavioural Therapy for Obsessive Compulsive
Disorder in Young People .............................................................................................................................. 14
Exploring the Clinical Utility of The Development and Wellbeing Assessment
(DAWBA) as a Diagnostic Tool for Obsessive Compulsive Disorder ........................................... 15
Children with Very Early Onset OCD: Clinical Features and Treatment Outcome ................. 16
Cognitive Behaviour Therapy for Adolescents with Body Dysmorphic Disorder: A Case
Series ...................................................................................................................................................................... 17
Episodic Dyscotrol in Children .................................................................................................................... 18
Empirical Eating Disorder Classification and Validation Using Prospective Studies............ 19
Evaluation of an Adolescent Wellbeing Workshop Intervention .................................................. 20
Suicidality: Treatment Occurring in Paediatrics (STOP) .................................................................. 21
I
NEURODEVELOPEMENTAL AND NEUROPSYCHIATRIC DISORDERS
Biological Embedding of Stress Through Inflammation Processes in Childhood .................. 22
An Investigation into Long-Chain Polyunsaturated Fatty Acids (LC-PUFA), Event
Related Potentials (ERPs) Assessments of Brain Function and Behavioural Measures
in Children and Adolescents with ADHD and Healthy Match Controls....................................... 23
Pharmacological fMRI in ADHD: Comparison Of The Effects Of Atomoxetine and
Methylphenidate on Functional Brain Activation in Medication-Naive Children with
ADHD ...................................................................................................................................................................... 24
Specifity of Brain Abnormalities in Children with ADHD, OCD, and ASD .................................. 25
The Neuroimaging Correlates of Physical Childhood Abuse ........................................................... 26
Investigation of Normal Brain Development Between Childhood and Adulthood and its
Abnormality in Autism Spectrum Disorder............................................................................................ 27
Pharmacological fMRI on the Effects of Fluoxetine on Functions of Impulsiveness,
Cognitive Flexibility and Working Memory in Children with ADHD an in Children with
High Functioning Autism ............................................................................................................................... 28
The Neurocognitive Functioning of Children at Risk of Developing ED Related
Behaviours ........................................................................................................................................................... 29
A Pilot Cognitive Behaviour Therapy Group for Children with ADHD and Their Parents
in a CAMHS Service ........................................................................................................................................... 30
Cognitive Task Performances as Biomarkers and Candidate Endophenotypes in
Childhood Neurodevelopmental Disorders: ADHD and Autism .................................................... 31
Psychoeducation in Families of Children with Attention Deficit Hyperactivity Disorder
(ADHD): Evaluation of the Efficacy in a Randomised Controlled Trial and a Qualitative
Examination (Sunshine Study) (ISRCTN26270684) .......................................................................... 32
Anxiety in Autism Spectrum Disorders: Hypothalamic Pituatary Adrenal (HPA) Axis
and Autonomic Nervous System Function.............................................................................................. 33
Evaluation of Diagnostic Techniques, and Cognitive and Physiological Correlates, of
Anxiety in Young People with Autism Spectrum Disorders. ........................................................... 34
Neuropsychological features in Learning Disabilities with Attention DeficitHyperactivity Disorder (ADHD) .................................................................................................................. 35
Pre-Existing Neurodevelopmental Difficulties in Childhood Brain Tumours –
Implications for Outcome .............................................................................................................................. 36
Cognitive Behavioural Therapy and Social Skills Group Intervention for Families Who
Have Boys with Asperger Syndrome / High Functioning Autism: The Social Detectives
Group ...................................................................................................................................................................... 37
II
Imitation Ability and Reactions to Social Stimuli in Adults with Autism Spectrum
Disorders .............................................................................................................................................................. 38
The Impact on Families of Having a Child with Down Syndrome and Co-morbid Autism . 39
Gender Differences in Neuropsychological Measures of Cognitive Control in a
Normative Sample of 8-11 Year Old Children ....................................................................................... 40
Outcomes in Adulthood for Adults with Autism and their Siblings ............................................. 41
Psychoeducation in Families of Children with Attention Deficit Hyperactivity Disorder
(ADHD): A Qualitative Evaluation of the Programme Using Focus Groups (Sunshine
Study) (ISRCTN26270684) ........................................................................................................................... 42
Genetic Causes of Neurodevelopmental and Psychiatric Disorders in Children:
Translation and Interpretation of Novel Pathogenic Copy Number Variants and Novel
Rare Exonic Mutations into Clinical Practice ......................................................................................... 43
PSYCH-CNVs: Copy Number Variations Conferring Risk of Psychiatric Disorders in
Children ................................................................................................................................................................. 44
The UK10K Project. Rare Genetic Variants in Health and Disease ............................................... 45
Generation of Human Induced Pluripotent Stem Cells (iPSCs) for Drug Discovery
Applications ......................................................................................................................................................... 46
Cytochrome P450 (CYP) Genotype Predicts Steady State Dose in an Open Label Trial of
Atomoxetine in Children with Learning Difficulties Co-Morbid with ADHD ............................ 47
Mental Health of Children with Acquired Brain Injury ..................................................................... 48
Hyperactivity and 22QDS (Velocardiaofacial Syndrome) – Atomoxetine (VCFSAtomoxetine) ..................................................................................................................................................... 49
Hyperactivity and Special Educational Needs-Atomoxetine (HSEN – Atomoxetine) ........... 50
Autism and Complex Needs Intervention Support Team (ACIST) ................................................ 51
PSYCHOTIC DISORDERS
Psychosis and Epilepsy in Young People ................................................................................................. 52
A Pilot Study of the Feasibility of a CBT Manual Aimed at Improving Stress, Coping and
Resilience Among 9-14 Year Olds Displaying Possible Antecedents of Schizophrenia ....... 53
Decision Making in Adolescent Psychosis............................................................................................... 54
III
FAMILIES, PARENTING AND DEVELOPMENT
Helping Children Achieve Study (HCA) .................................................................................................... 55
Study of Adolescents’ Family Experiences (SAFE) .............................................................................. 56
Love, Eye Contact and the Developmental Origins of Empathy Versus Psychopathy .......... 57
Parenting Programme Evaluation Tool (PPET).................................................................................... 58
High Needs Families Projects ....................................................................................................................... 59
Improving Access to Effective Mental Health Care for “Hard to Reach” Families: An
Evaluation of a Peer-Led Parenting Programme.................................................................................. 60
Do Evidence Based Interventions Work when Tested in the Real World? A Systematic
Review and Meta-Analysis of Parent Training for the Treatment of Child Disruptive
Behaviour ............................................................................................................................................................. 61
Meeting the Needs of Families Affected by Parental Mental Illness: An Evidence-Based
Audit of Service Provision in Adult Inpatient Mental Health Services ........................................ 62
Factors Influencing Parenting Groups: Clinicians’ Perspectives ................................................... 63
Disordered Eating Behaviours Among Mothers-To-be: A Study on Eating Disturbances
During Pregnancy.............................................................................................................................................. 64
The Economics of Parenting Programmes.............................................................................................. 65
Understanding how Practitioner Characteristics Influence Family Outcomes Through
the Delivery of Evidence-Based Parenting Groups ............................................................................. 66
Understanding the Effectiveness of Training and Dissemination of Evidence-Based
Parenting Programmes ................................................................................................................................... 67
Evidence Based Measurement of Parenting........................................................................................... 68
GP Universal Perinatal Intervention Promoting Secure Attachment .......................................... 69
Child Health and Development Study (CHADS).................................................................................... 70
LOOKED AFTER CHILDREN
Strengthening Foster Placements for Looked After Children: Development of an
Evidence-Based Tool for Assessment and Care Planning in Local Authority Services ........ 71
Fostering Changes Training Centre ........................................................................................................... 72
Multidimentional Treatment Foster Care – England (MTFCE) ...................................................... 73
A Randomised Control Trial of the Fostering Changes Programme ............................................ 74
Emotional / Mental Health Screening Study – Southwark Looked After Children 0-4
Years ....................................................................................................................................................................... 75
IV
SERVICE USER PERSPECTIVES
A Study Exploring Family Experience of Out-Patient CAMHS Treatment ................................. 76
Child and Adolescent Service Experience (ChASE): Measuring Service Quality and
Process ................................................................................................................................................................... 77
Using the Child and Adolescent Service Experience (ChASE) Questionnaire to Generate
Service Improvements: How do CAMHS Practitioners Engage with Service User
Feedback? ............................................................................................................................................................. 78
Improving Attendance at Child and Adolescent Mental Health Services for Families
from Socially Disadvantaged Communities: A Pilot Evaluation of a Telephone
Engagement Intervention .............................................................................................................................. 79
EDUCATION AND PRACTITIONER DEVELOPMENT
Development and Pilot Evaluation of a Diagnostic Training Workshop for CAMHS
Practitioners ........................................................................................................................................................ 80
Development and Pilot Evaluation of an In-Service Training Programme for CAMHS
Practitioners in Cognitive Behavioural Therapy for Youth Anxiety Problems ....................... 81
An Ethnographic Study of Whiteness in Clinical Practice ................................................................ 82
V
LIST OF POSTERS
Behavioural and Emotional Disorders
Author(s)
Title
Ivan Eisler
Multicentre Evaluation of Family Therapy for Adolescent
Self Harm (SHIFT Trial)
Lauren Herlitz
Measuring Youth Delinquency: Comparing ‘ASSET’ – The
Youth Justice System Assessment Tool - With Other
Evidence-Based Measures of Conduct Problems
Georgina Krebs, Holan
Liang, Kristina Hilton, Fiona
MacDiarmid & Isobel
Heyman
Does the Development and Well-Being Assessment
(DAWBA) Contribute to the Assessment and Diagnosis of
Obsessive-Compulsive Disorder in Young People?
Georgina Krebs, Cynthia
Turner, Isobel Heyman, &
David Mataix-Cols
Cognitive Behaviour Therapy for Adolescents with
Body Dysmorphic Disorder: A Case Series
Saqib Latif
Internet Addiction in Young People: Prevalence
and Impact on Mental Health
Liz Malpass
Household CHAOS and Parental Responsiveness in
Relation to Adolescent Young Offender Behaviour
Charlotte Mawbey
LAMS: The Longitudinal Assessment of Manic Symptoms
Nadia Micali
Adolescent Eating Disorder Behaviours and Relevant Risk
Factors
Argyris Stringaris
From Naughty to Sad: Genetic and Environmental
Pathways from Youth Irritability to Depression
Argyris Stringaris
Measuring Mood: Psychometric and Biomarker
Validation of a New Measure of Mood Variability
Cynthia Turner, Isobel
Heyman, Annabel Futh and
Karina Lovell
A Pilot Study of Telephone Cognitive Behaviour Therapy
(TCBT) for Obsessive Compulsive Disorder (OCD) in
Young People
Matthew Woolgar, Troy
Tranah
Low Mood, Autobiographical Memory Functioning and
Social Problem Solving Biases in Antisocial Youth:
Implications for Social Competence Interventions
Matthew Woolgar, Troy
Tranah
The Impact of Suicidal Ideation on the Cognitive
Vulnerability to Depression in Young1 People Detained in
Secure Accommodation
1
Neurodevelopmental and Neuropsychiatric Disorders
Author(s)
Title
Penny Andreou, Hayley Lee
A Pilot Cognitive Behaviour Therapy Group for Children
with ADHD and Their Parents in a CAMHS Service
Karen Ashwood
A Comparable Analysis of Emotion Recognition in Autism
Spectrum Disorder (ASD) and Attention Deficit
Hyperactivity Disorder (ADHD)
Bahare Azadi
Eye Movement Data in Childhood Neuropsychiatric
Disorders: ADHD and ASD
Fionna Bathgate, Ana
Cubillo, Teresa Lax-Pericall,
David McCormick
Mental Health of Children with Acquired Brain Injury
Maria Bescos
Attention Deficit-Hyperactivity Disorder and Learning
Disability: A Comparison Study of Neuropsychological
Features
Kaylita Chantiluke
Brain Function Abnormalities in Adolescents with
Depression During Sustained Attention and Reward
Kaylita Chantiluke
fMRI of Sustained Attention in Individuals with Autistic
Spectrum Disorder and Attention Deficit Hyperactive
Disorder
Susanna Cole, Nazakat
Wagle
Research Co-Ordination in the SLaM Boroughs
Ana Cubillo, Rozmin Halari,
Anna Smith, Vincent
Giampietro, Eric Taylor,
Katya Rubia
Fronto-Striatal Brain Dysfunction in Adults with
Childhood ADHD and Persistent Hyperactive/Inattentive
Behaviours During Sustained Attention and Reward
Ana Cubillo, Anna Smith,
Nadia Barrett, Vincent
Giampietro, Katya Rubia
Differential Effects of Methylphenidate and Atomoxetine
in Brain Activation During a Time Discrimination Task in
Medication-Naïve Children with ADHD
Amanda Cyriax
Evaluation of the CAMHS ADHD Parenting Group
Andrea Danese
Biological Embedding of Adverse Childhood Experiences
Through Inflammation Processes
2
Author(s)
Title
Rachel V. Gow, Katya Rubia,
Eric Taylor, Michael
Crawford, Kebreab
Ghebremeskel, Allain
Amador-Beuno
Evaluating the Relationship Between Measures of
Depression, Anxiety, Anger, Disruptive Behaviour and
Self-Concept and Blood Levels of Polyunsaturated ω-3/6
Fatty Acids (PUFAs) in Adolescents with ADHD and
Healthy Controls
Matt Hollocks
Anxiety in Autism Spectrum Disorders: HPA Axis and
Autonomic Nervous System Function
Radha Kothari
Risk for Eating Disorders and Neurocognitive
Functioning: Developing Risk Models
Clodagh Murphy, Dr
Anastasia Christakou,
Professor Declan Murphy &
Professor Katya Rubia
fMRI of Sustained Attention and Sensorimotor
Synchronisation in Children and Adults with Autistic
Spectrum Disorder
Anna Smith, Katya Rubia,
R.Patel, Emily Simonoff
Gender Differences in Neuropsychological Measures of
Cognitive Control in a Normative Sample of 8-11 Year Old
Children
Argyris Stringaris
Emotion Dysregulation and ADHD: Testing the
Phenotypic and Genetic Links
Dr Gemma Wilson, Dr Liz
Gill
The Social Detectives Group – A Cognitive Behavioural
and Social Skills Group Intervention for Families Who
Have Boys with Asperger Syndrome, or High Functioning
Autism
Jo Young, Jo Lawrence
Autism and Complex Needs Intervention Support Team
(ACIST)
Psychotic Disorders
Author(s)
Title
Sophie Browning
A Pilot Study of the Feasibility of a CBT Manual Aimed at
Improving Stress, Coping and Resilience Among 9 - 14
Year Olds with Unusual Experiences and Emotional
Problems
Sukhi Shergill, AnneKathrin Fett, Emily Herbert,
Anita Solanki
Decision Making in Adolescent Psychosis
3
Author(s)
Title
Gisela Sugranyes
Error Processing in Children Presenting Putative
Antecedents of Schizophrenia: An Event-Related fMRI
Study
Families, Parenting and Development
Author(s)
Title
Jennifer Allen
Love, Eye Contact, and the Developmental Origins of
Empathy Versus Psychopathy
Understanding How Practitioner Characteristics Impact
Family Outcomes for Parents Participating in EvidenceBased Parenting Programmes
Kirsten Asmussen, Neda
Bebiroglu, Katey Weizel,
Tim Matthews, Hayley
Syrad
Kirsten Asmussen, Maria
Rizzo, Hayley Syrad, Sally
Hudson, Triin Edovald
Commissioning Toolkit and Evaluation of Parenting
Programmes in the UK
Eva-Maria Bonin, Madeleine
Stevens and Jennifer
Beecham, LSE
Parenting Programmes for the Prevention of Persistent
Conduct Disorders: A Model-Based Cost-Effectiveness
Analysis
Crispin Day, Megan Ellis
High Need Families’ Project- Helping Families
Programme: A New Parenting Intervention for Children
with Severe and Persistent Conduct Problems
Abigail Easter
Fertility and Prenatal Attitudes Towards Pregnancy in
Women with Eating Disorders: Results from the Avon
Longitudinal Study of Parents and Children
Shona Falconer, Claire
Powell, Aba Oppon, Clare
Stebbens, Warren Leave
Why Are Observational Techniques Useful in Parenting
Research?
Sean Harry, Novelette
Newell, Sally Cartwright,
Angeliki Kallitsoglou
Are Conduct Problems in 5-7 Year Old Children
Associated with Disadvantage? Preliminary Findings
from the Helping Children Achieve Study
Richard Neil
GP Universal Perinatal Intervention Promoting Secure
Attachment
Milena Stateva, Celia
Beckett, Angeliki
Kallitsoglou
The Helping Children Achieve Trial: Outline of Study
4
Author(s)
Title
Emma Taborelli
Disordered Eating Behaviours Among Mothers-To-Be: A
Study on Eating Disturbances During Pregnancy
Matthew Woolgar, Shona
Falconer
The Impact of Parental Sense of Agency on the
Engagement in Parenting Programs for Antisocial
Behaviour Across Childhood - A New Measure
Looked After Children
Author(s)
Title
Karen Bachmann, Kathy
Blackeby, Kirsty Slack,
Caroline Bengo
Fostering Changes Training Centre
Jackie Briskman
Attachment Patterns in Looked-After Children
Carol Hardy, Lizzie Hackett,
Elizabeth Murphy, Beatrice
Cooper and Sue Conroy
Emotional/Mental Health Screening Study - Southwark
Looked After Children 0-4 Years
Service User Perspectives
Author(s)
Title
Esther Blessitt
MSC Research into Family Experience of Outpatient
CAMHS Assessment Points
5
Project Summaries
Behavioural and Emotional Disorders
Multi –Family Therapy for Adolescent Anorexia Nervosa: Results of a Multi-Centre
RCT
Investigator(s): Professor Ivan Eisler, Dr Mima Simic, Ms Gladys Ellis, Ms Pennie
Fairbairn
Summary
In recent years there has been a growing interest in multiple family therapy (MFT) and
for many it brings with it the excitement of a “new” treatment approach. In fact MFT has
been around for over half a century but what is new are some of the novell formats (e.g.
intensive multiple family day programs) and applications to wider range of problems
including eating disorders. Conceptually MFT builds on existing family therapy
approaches for eating disorders which place a strong emphasis on enhancing family
strengths and resilience. The bringing together of a group of families provides
opportunities for mutual support among families and learning from each other.
The Child and Adolescent Eating Disorders Service at the Maudsley Hospital in London
started developing an intensive MFT day programme over 10 years ago, and over the
past 6 years we have been evaluating its efficacy in a multi-centre RCT. The presentation
will descibe the results of a study in which 170 adolescents aged 13-20 with a diagnosis
of AN or EDNOS (restricting) were randomised to single family therapy or multiple
family therapy. End of treatment and six month follow-up findings will be presented and
their implications discussed.
Funding: Health Foundation
State of Progress: Completed
9
Behavioural and Emotional Disorders
Cognitive Therapy for Generalised Anxiety in Youth: A Preliminary Randomised and
Controlled Trial
Investigator(s): Dr Sean Perrin, Professor Derek Bolton, Dr Crispin Day
Summary
Aims: The primary aim of the project is to evaluate the effect of theory-driven, disorderspecific, and developmentally-sensitive cognitive therapy for children aged 8-18 years
with a primary diagnosis of Generalized Anxiety Disorder (GAD). Children with GAD
suffer from excessive and uncontrollable worries that are accompanied by 2-3 somatic
symptoms, which together cause impairment in one or more aspects of functioning.
Children with GAD worry about the same things as everyone else, they just worry more
frequently and with greater impact on functioning. Comorbidity with other anxiety and
mood disorders is common, and some have suggested that excessive worry is the "base"
anxiety problem from which all anxiety disorders emerge. In contrast to other anxiety
disorders, childhood GAD has proven extremely difficult to treat with standard CBT
approaches. In randomized controlled trials of CBT for anxiety, 40-50% of participants
with GAD (as either a primary or secondary condition) retain this diagnosis after 10-16
sessions of standard CBT, whether delivered alongside medication, in individual, group,
or family formats. The secondary aim of this project is to qualitatively evaluate the
child's experience of the therapy so that it can be further modified in respect of
developmental sensitivity, acceptability, and effect. Participants are randomized to
either 10 sessions of weekly child-focused, individual cognitive therapy or a 10-week
wait-list during which the child self-monitors worry frequency and receives weekly
phone calls from a research worker to remind them of their upcoming appointment
date. Children in the treatment condition receive a 3-month follow-up. Children in the
wait-list who do not recover receive the same protocol cognitive therapy but outside of
the trial. Both treated and wait-listed children participate in qualitative interviews of
their experience of therapy. Recruitment is ongoing and will continue through the end of
2012.
Funding: £220,000 from Research for Patient Benefit Scheme, National Institute for
Health Research
State of Progress: Ongoing
10
Behavioural and Emotional Disorders
Adolescent Eating Disorders and Related Behaviours: Longitudinal Course and Risk
Factors
Investigator(s): Dr Nadia Micali
Summary
Aims: 1) To clarify the longitudinal course and significance of Eating Disorders and
Related Behaviours (EDRB) at 14 and 16 years in a general population cohort; 2) To
build a developmentally sensitive model of (environmental and genetic) risk factors for
adolescent EDRB in: a) a general population sample, and b) a high-risk sub-sample
(children of women with ED).
Methods:This study is a longitudinal prospective study using the ALSPAC sample, based
in Bristol. ALSPAC is a well-characterised longitudinal population-based prospective
study of 14,000 mothers and their children, enrolled in pregnancy and regularly
followed up since. Data on environmental exposures and physical, social, and
psychological outcomes have been prospectively collected from before birth on mothers
(by questionnaire) and children (by questionnaire and from age 7, by 2-yearly objective
assessments). We will collect data on EDRB at age 14 and 16 by postal questionnaires to
children and mothers. The questionnaires include the Channing-Harvard ED screen for
adolescents; the ED section of the Developmental And Well-being Assessment (EDDAWBA) for parents (as informants).
Predictors of Interest (based on risk factors suggested in previous systematic
reviews and meta-analyses): we will investigate the role of parental risk factors:
parental psychopathology (including ED)-measured before pregnancy and at several
time-points during offspring childhood; social factors (socio-economic status, social
support) measured at several time-points during offspring childhood; parental
(maternal in particular) attitudes to food (meals eaten/cooked, choice of foods for
family) and control over the child’s eating (measured at the child’s age of 8 and 10);
parental weight and height. Perinatal factors: maternal depression, anxiety, ED
symptoms, smoking and alcohol use (measured at 18 and 32 weeks in pregnancy); birthweight, gestational age and small for gestational age (obtained from obstetric
records).In regard to individual factors, relevant factors identified in previous studies
include: feeding problems and behaviours: under-eating, picky eating and overeating
amongst others, measured by maternal report at 6 monthly intervals up to 2 years, and
2-yearly thereafter); psychological factors: temperament (measured at 6 months, 2 and
3 years); childhood psychopathology-measured at 7.5, 9, 10 years; self-esteem
(measured at 8 years), depression (measured at 6, 10, 12,13 and 14 years); body image
(10,13 years); and maternal comments on weight and shape (9 years). Other
environmental factors: emotional and sexual abuse (measured at 2 years and at yearly
intervals between 8 and 12); life events (measured at 3, 6 and 8 years); bullying and
teasing (at 10, 11 and 12 years). Physical factors: childhood Body Mass Index (measured
objectively yearly from 7 to 10 and at 13); body composition (measured objectively 2
yearly from age 9); and pubertal status (measured yearly from age 8 onwards).
Implications: Studying the development of EDRB and the relevant prodromes/early
manifestations throughout infancy and childhood into adolescence (the peak time for
their occurrence) is essential to develop evidence based prevention/early intervention
strategies. Identification of modifiable risk factors and the critical timing for the shaping
of behaviours is crucial in order to define how and when prevention programs have to
be put in place to be effective. Associated psychopathology and triggers will also be
studied.
Funding: NIHR
State of Progress: Ongoing
11
Behavioural and Emotional Disorders
Therapeutic Assessment for Adolescents Presenting with Self Harm
Investigator(s): Dr Dennis Ougrin, Dr Tobias Zundel, Dr Audrey Ng
Summary
Aims: To determine whether Therapeutic Assessment (TA) versus assessment as usual
(AAU) improves engagement with follow-up in adolescents presenting with self-harm.
Method: Design: Randomised controlled trial with 3 months naturalistic follow-up.
Setting Child and Adolescent Mental Health Services (CAMHS) in two London NHS
Trusts.
Participants: 26 clinicians were randomised into TA and AAU groups; 70 newly referred
adolescents who self-harmed were assessed.
Interventions: TA, a manualised procedure including a basic psychosocial assessment
and a 30 minute therapeutic intervention; AAU, standard psychosocial assessment.
Main Outcome Measures: Attendance at the first follow-up session; number of the
follow-up sessions attended and changes in Strengths and Difficulties Questionnaire
(SDQ) and Children Global Assessment Scale (CGAS) scores. All measures were adjusted
for clustering, social class, changes of therapist and previous contact with services.
Result: Using the data on all participants (n=70), those in the TA group were
significantly more likely to attend the first follow-up appointment: 29 (83%) vs 17
(49%), OR 5.12, 95% CI [1.49, 17.55] and more likely to attend four or more treatment
sessions: 14 (40%) vs 4 (11%), OR 5.19, 95% CI [2.22, 12.10]. Three months after the
initial assessment there were no statistically significant differences between the groups
on SDQ scores 15.6 vs 16.0, mean difference -0.37, 95% CI [ -3.28, 2.53] or CGAS scores
64.6 vs 60.1, mean difference 4.49, 95% CI [ -0.98, 9.96].
Implications: TA is associated with statistically significant improvement in engagement.
TA could be usefully applied at the point of initial assessment for adolescents with selfharm.
Funding: Psychiatry Research Trust, SLAM Charitable Funds
State of Progress: Completed
12
Behavioural and Emotional Disorders
The Developmental Psychopathology of Irritable Mood and its Links to Depression:
Genetic and Environmental Risks, Neuropsychological Mechanisms, and Hormonal
Influences
Investigators: Dr Argyris Stringaris, Professor Terrie Moffitt, Dr Louise Arseneault,
Professor Barbara Maughan, Professor Adrian Angold
Summary:
Increasing evidence suggests that children who show high levels of irritability are
impaired in their everyday lives and have an increased risk of developing psychiatric
disorders. As yet, however, the reasons underlying this risk remain unclear. We are
investigating how genetic and environmental factors, neuropsychological mechanisms,
and developmental transitions influence irritable mood and its association with
depressive disorders. The research plan is focused on three inter-related questions:
1) What is the influence of genetic and environmental factors on children’s irritability
and on its links with depression?
Using longitudinal quantitative genetic models, we are estimating the amount of
variance in irritability explained by genetic effects and environmental influences
(shared or unique) from age 5 through to 12. Using a longitudinal discordant
monozygotic (MZ) twin design, we are testing the extent to which established
environmental risk factors for psychopathology, such as negative maternal expressed
emotion, contribute to children’s irritability independently of children’s genetic make up
or shared environmental effects (such as poverty and violence in the family).
2) Are individual differences in levels of irritability related to children’s emotion
processing and do deficits in processing emotional cues contribute to poor mental
health outcomes among irritable children?
To address these questions, we will use facial expression data collected in a longitudinal
frame to test which emotion processing difficulties are present in irritable children and
how they may influence inter-individual irritability levels. Using path analytic models
we will estimate the direction of effects between irritability, emotion processing
difficulties, and depression. Using a twin sample, we will estimate the genetic
contributions to these effects.
3) Do puberty-specific factors, such as changes in sex hormone levels, influence
children’s irritability trajectories and can irritability explain some of the effects of
puberty on depression?
Using the longitudinal design of a large epidemiologic sample in which sex hormones
and environmental stressors have been measured annually, we will model individual
trajectories of irritability and estimate the contribution of hormones and environmental
factors. Using serial assessments of irritability and depression ranging from age 9 to 21
years, and hormonal levels assessed serially during puberty, we will test mediation
models of the effects of irritability on depression.
Funding: The E-risk study is funded by the Medical Research Council UK
State of Progress: Ongoing
13
Behavioural and Emotional Disorders
A Pilot Study of Telephone Cognitive-Behavioural Therapy for ObsessiveCompulsive Disorder in Young People
Investigator(s): Dr Cynthia Turner, Dr Isobel Heyman, Dr Annabel Futh, Professor
Karina Lovell
Summary
Background: Cognitive-behaviour therapy (CBT) is the recommended psychological
treatment for obsessive compulsive disorder (OCD) in young people. Access to CBT may
be limited by a number of factors, including lack of trained therapists, and geographic or
financial factors preventing access to a specialised service. Telephone delivery of CBT
represents one way of overcoming some of these accessibility issues. This pilot study
describes outcomes for a telephone-based cognitive-behavioural treatment for
obsessive-compulsive disorder (OCD) in young people.
Method: Ten participants, aged 13 to 17 years, and their parents received up to 16
sessions of telephone CBT (TCBT). Measures of OCD symptoms were obtained using
multiple informants and a repeated measures design. Assessments were conducted at
pre-treatment, post-treatment, and at 6- and 12-month follow-up.
Results: Improvements were found for OCD symptoms across all informants. Family
satisfaction with treatment over the telephone was high.
Conclusions: The findings suggest that TCBT is a clinically effective, feasible and
acceptable means of service delivery that offers the potential to make CBT a more
accessible treatment for young people. TCBT requires further evaluation in randomised,
controlled trials to compare effectiveness with face-to-face CBT, which currently
represents the usual care model.
Funding: SLAM Charitable Trust
State of Progress: Completed
14
Behavioural and Emotional Disorders
Exploring the Clinical Utility of the Development and Wellbeing Assessment
(DAWBA) as a Diagnostic Tool for Obsessive Compulsive Disorder
Investigator(s): Dr Georgina Krebs, Dr Holan Liang, Ms Kristina Hilton, Dr Fiona
McDiarmid, Dr Isobel Heyman.
Summary
Aims: The Development and Wellbeing Assessment (DAWBA) is an interactive, online
questionnaire battery designed to generate ICD-10 and DSM-IV psychiatric diagnoses in
children and adolescents. Provisional diagnoses are produced by the computerised
algorithm, which can then be reviewed by a clinician in conjunction with the original
child/parent responses in order to gain additional diagnostic accuracy. This study aimed
to establish the utility of the DAWBA in predicting obsessive compulsive disorder (OCD)
diagnoses in a clinical sample.
Methods: 51 young people referred to a specialist OCD service completed the DAWBA
prior to full clinical assessment. The positive and negative predictive values of the
DAWBA in detecting OCD were evaluated by comparing the computer-generated
diagnoses (using the ≥15% computer prediction band) and clinician-rated diagnoses
with those made by the specialist multi-disciplinary team (MDT). In cases where there
was disagreement between the DAWBA and specialist MDT diagnoses, cases were
reviewed by senior clinicians to establish patterns in disagreement.
Results and Implications: For the detection of ICD-10 OCD diagnosis, the computergenerated response had a positive predicative value of 85% and negative predictive
value of 44%, and correctly classified 71% of cases. This was in line with the clinicianrated DAWBA, which had positive and negative predicative values of 84% and 54%
respectively, and correctly classified OCD in 77% of cases.
Conclusion: Computer-generated DAWBA responses may be sufficiently accurate to
positively predict an ICD-10 diagnosis of OCD among a secondary care sample of young
people with suspected obsessive-compulsive symptoms. This could potentially expedite
access to tertiary services. Cases that receive a negative prediction of OCD on the
DAWBA may warrant face-to-face clinical assessment. Common reasons for
disagreement between the DAWBA and MDT diagnoses, and the role of the DAWBA in
identifying comorbid disorders are discussed.
Funding: None
State of Progress: Completed
15
Behavioural and Emotional Disorders
Children with Very Early Onset OCD: Clinical Features and Treatment Outcome
Investigator(s): Dr Eriko Nakatani, Dr Georgina Krebs, Dr Nadia Micali, Dr Cynthia
Turner, Dr Isobel Heyman, Dr David Mataix-Cols
Summary
Background: There is emerging evidence that early onset obsessive-compulsive
disorder (OCD) may be a phenomenologically distinct subtype of the disorder. Previous
research has shown that individuals who report an early onset display greater severity
and persistence of symptoms, and there is some suggestion that they may be less
responsive to treatment. To date, this question has been investigated solely in adult
samples. The present study represents the first investigation into the effect of age at
onset of OCD on clinical characteristics and response to cognitive behaviour therapy
(CBT) in a pediatric sample.
Methods: 365 young people referred to a specialist OCD clinic were included in the
study. Clinical records were used to examine whether there were differences in key
clinical characteristics between those who had a very early onset of the disorder (before
10 years) and those who had a later onset (10 years or later). Group differences in
treatment responsiveness were also examined within a subgroup that received CBT
(n=112).
Results: The very early onset group were characterised by a longer duration of illness,
higher rates of comorbid tics, more frequent ordering and repeating compulsions, and
greater parent-reported psychosocial difficulties. There were no differences in
treatment response between the groups, and when age at onset was examined as a
continuous variable, it did not correlate with treatment response.
Conclusions: Very early onset OCD may be associated with different symptoms and
comorbidities compared to later onset OCD. However, these differences do not appear to
impact on responsiveness to CBT and children with very early onset OCD respond
equally well to CBT compared to those with a later onset. These findings indicate the
value in early detection of OCD in childhood, and attempts should be made to reduce the
delays that commonly occur in young children accessing effective treatment.
Funding: N/A
State of Progress: Completed
16
Behavioural and Emotional Disorders
Cognitive Behaviour Therapy for Adolescents with Body Dysmorphic Disorder: A
Case Series
Investigator(s): Dr Georgina Krebs, Dr Cynthia Turner, Dr Isobel Heyman, Dr Daivd
Mataix-Cols
Summary
Background: Body dysmorphic disorder (BDD) has an estimated prevalence of 2.2%
among community samples of adolescents, although it often goes undetected and is
under-diagnosed in clinical practice. The disorder is associated with high levels of
functional impairment and comorbidity, and it is reported that 21-44% of young people
with the disorder will attempt suicide. Despite being relatively common and having
serious negative consequences, the treatment of BDD in young people has received
virtually no empirical attention to date. Although cognitive behaviour therapy (CBT) is
recommended by the National Institute of Health and Clinical Excellence (NICE) as the
first line treatment, the evidence-base for CBT in young people is currently limited to a
small number of single case reports, which have yielded mixed findings.
Aims: To investigate the clinical outcomes obtained by a group of adolescents who
received specialist CBT for BDD.
Methods: Six adolescents with a primary diagnosis of BDD received a course of
developmentally appropriate CBT for BDD with parental involvement. The Yale-Brown
Obsessive Compulsive Scale for BDD (BDD YBOCS) was administered pre-treatment,
post-treatment, and at a three or six month follow-up.
Results and Implications: Scores on the BDD YBOCS indicated a 44% improvement in
BDD symptoms at post-treatment and a 55% improvement at follow-up for the group as
a whole. Considering response as a ≥ 35% reduction in BDD YBOCS score, four of the six
adolescents were classified as treatment responders.
Conclusions: These findings indicate the potential efficacy of CBT for adolescents with
BDD, and highlight the need for further research in this field, which should include a
randomised controlled trial.
Funding: N/A
State of Progress: Completed
17
Behavioural and Emotional Disorders
Episodic Dyscotrol in Children
Investigator(s): Dr E Hughes, Dr T Lax-Pericall
Summary
To review the literature and describe episodic dyscontrol in children
Published in Journal of Paediatric Neurology 8(2010) 119-120
Funding: None
State of Progress: Completed
18
Behavioural and Emotional Disorders
Empirical Eating Disorder Classification and Validation Using Prospective Studies
Investigator(s): Dr Nadia Micali, Miss Francesca Solmi, Professor Janet Treasure, Ms
Alison Field
Summary
Aims: 1)To empirically derive an eating disorder classification scheme based on
comorbidity and outcome during adolescence and young adulthood. 2) To empirically
determine behavioral cut-offs that should be used to demarcate eating disorders in
adolescence and young adulthood.
Study design: This study is a longitudinal prospective study using the ALSPAC sample,
based in Bristol. ALSPAC is a well-characterised longitudinal population-based
prospective study of 14,000 mothers and their children, enrolled in pregnancy and
regularly followed up since. We believe about 7,000 young people and/or parents are
expected to participate at age 18. All young people will be sent a questionnaire on ED
behaviours at age 18.
Methods: Data on ED on the young people at age 18 will be collected by postal
questionnaires to children and mothers. The questionnaires include the ChanningHarvard ED screen for adolescents; the ED section of the Developmental And Well-being
Assessment (ED-DAWBA) for parents (as informants).
Outcomes: ED behaviors will be extracted
Data analyses: We will create classifications for the overall sample, as well as by gender
and within age group (early adolescence, mid to late adolescence, and young adult)
based on questionnaires collected at 18. We will also stratify on treatment and create
eating disorder classifications among those with and without treatment. For those who
have been treated, we will look in more detail at the impact of treatment. Second, we
will assess the associations of each type of eating disorder identified in the various
eating disorder classification systems to weight gain and weight status, comorbid
depression, anxiety, and substance use, and persistence or worsening of symptoms.We
will use latent class analysis to model data obtained. The rich longitudinal dataset will
be utilised to assess transitions between states over time, as a way to understand
persistence of diagnosis.
Funding: NIH, USA
State of Progress: Ongoing
19
Behavioural and Emotional Disorders
Evaluation of an Adolescent Wellbeing Workshop Intervention
Investigator(s): Dr Irene Sclare, Dr Fay Coster, Mr Ilan Ben-Zion
Summary
Aims: The main aims are to construct and evaluate the effectiveness and acceptability of
one-day group workshop interventions for 16-18s with anxiety and depressive
symptoms in Southwark who do not currently access CAMHS. The approach is adapted
from the evidence based Wellbeing workshops for adults, based on CBT principles and
developed by Dr June Brown at IOP, and now delivered by SLAM in community sites. A
key project aim is to adapt workshops to be 'teen-friendly' and acceptable to 16-18s. To
help achieve this, we set up a Teenage Advisory Group (TAG) of local sixth form
students, to advise on participant recruitment, clinical material design and workshop
venues. The TAG will meet at least six times with the team in 2010.
Methods: Clinical manuals for workshops to tackle a) anxiety, and b) low mood will be
piloted in late 2010, and given 'Wellbeing' titles eg 'How to Improve Self Confidence'. To
increase accessibility, community venues in Southwark will be selected and recruitment
will be via a self-referral pathway, using locally based publicity. The research will adhere
to a randomised controlled trial design. Participants will be randomised to two groups
(experimental vs Waiting-List control).Those with more complex problems will be
signposted to Adolescent CAMHS. Project outcome measures will include anxiety,
depression, self esteeem, and adolescent wellbeing scales. Qualitative participant
feedback from TAG members will be obtained by an independent CAMHS practitioner to
evaluate participation.
Results and implications: If the intervention is demonstrated as effective and
acceptable in providing CBT for 16-18s with anxiety and low mood, the approach will be
disseminated to CAMHS colleagues. Next steps will be to further adapt the workshop
approach to meet specific needs of excluded young people. If the TAG is an effective and
viable method of youth participation, this provides a model for recruiting and involving
young people in shaping future children's services.
Funding: Guy's and St Thomas' Charity; South London and Maudsley Charitable Funds
State of Progress: Ongoing
20
Behavioural and Emotional Disorders
Suicidality: Treatment Occurring in Paediatrics (STOP)
Investigators: Dr Parmala Santosh, Dr Sarah Curran, Dr Katherine Aitchison and a
European Network of Investigators
Summary:
The key objectives of this study are; i) to develop a comprehensive assessment of
suicidality and its bio-psycho-social mediators (including medication characteristics,
psychopathology, and biological, psychological and social risk and protective factors) in
children and adolescents; ii) to standardise the newly developed web-based assessment
and monitoring measures using data obtained in three observational trials of children
and adolescents; iii) to address scientific questions about suicidality and its bio-psychosocial mediators (with a focus on medication-related suicidality), through using the new
web-based methodology in three clinical samples; iv) to disseminate the extension of
knowledge acquired by the proposed studies and make available the technology
developed through this proposal to regulatory authorities, researchers, pharmaceutical
companies, and medical and mental health professionals.
Biological Sampling Methods Work Package: This Work package aims to establish a
Biological Sampling Methodology for Investigation of Mediators of Suicidality, including
therapeutic drug monitoring (TDM) and genetic analyses (genomic, epigenetic,
transcriptomic, proteomic, metabonomic). This is an essential piece of work if we are to
look to the future and establish the large collaborative European network that would be
required for paediatric pharmacogenetic studies. All aspects of this work package (for
this large European Collaborative effort) are being undertaken within SGDP laboratory
and we are sub-contracting KCH to undertake TDM.
Funding: EC 7th framework grant for 3 Million Euros.
Progress: Ongoing. The final stages of contract negotiations have been completed and
applicant’s signatures collected. The project is due to start on 1/11/2010 or 1/02/2012
and run for 40 months.
21
Neurodevelopmental and Neuropsychiatric Disorders
Biological Embedding of Stress Through Inflammation Processes in Childhood
Investigator(s): Dr Andrea Danese, Professor Avshalom Caspi, Dr Carmine Pariante,
Professor Terrie E Moffitt, Dr Louise Arseneault
Summary
Aims: Children exposed to adverse psychosocial experiences show elevated disease risk
in adulthood. It is therefore important to better characterise the biological mechanisms
through which children may acquire such lasting vulnerability to disease, namely, the
mechanisms of biological embedding.
Methods: In order to test the effect of childhood maltreatment and depression on
inflammation, we prospectively followed a UK birth cohort, the Environmental Risk (ERisk) Study, during the first decade of the study members' lives. This enabled us to
repeatedly and reliably assess evidence of child maltreatment and depression during
early development. We then employed a recently validated and minimally invasive
method for the assessment of C-reactive protein in dried blood spots levels among 12years old children participating in our study.
Results: We found that children experiencing maltreatment and depression showed
significantly elevated inflammation levels, regardless of their socioeconomic status,
gender, zygosity, body temperature, and waist-hip ratio.
Implications: We report initial evidence that stress-related elevation in a clinicallyrelevant inflammation biomarker is already detectable in childhood, and could therefore
contribute to the biological embedding of adverse childhood experiences.
Funding: Andrea Danese is supported by a NARSAD Young Investigator Award. The ERisk Study is funded by the Medical Research Council (MRC grant G9806489).
State of Progress: Completed
22
Neurodevelopmental and Neuropsychiatric Disorders
An Investigation into Long-Chain Polyunsaturated Fatty Acids (LC-PUFA), Event
Related Potentials (Erps) Assessments of Brain Function and Behavioural Measures
in Children and Adolescents with ADHD and Healthy Matched Controls
Investigator(s): Miss Rachel V. Gow, Professor Katya Rubia, Professor Eric Taylor, Dr
Alexander Sumich, Professor Michael Crawford, Dr Allain Amador Beuno, Dr Kebreab
Ghebremeskel
Summary
Aims: This PhD project aims to investigate the levels of LC-PUFA in ADHD at baseline
and after 3 months of LC-PUFA supplementation and compare it to healthy age and
gender matched controls in relation to 1) disorder-relevant neuropsychological
functions, 2) brain function using EEG/ERPs, and 3) behavioural symptoms. Part of the
PHD includes analysing/write-up of data from The Maudsley Attention Deficit
Hyperactivity Adolescent Fatty Acid (MAAFA) trial, a randomised, placebo controlled,
double-blind study led by Professor Eric Taylor.
Methods: In addition to the MAAFA data, this project recruits age and gender matched
controls to examine; 1) group differences in LC-PUFA status and their relationship to
neuropsychological performance, behaviour and EEG brain function at baseline (for
ADHD); and 2) establish whether LC-PUFA supplementation leads to
normalization/amelioration of these measures in ADHD. In addition, further behavioural
assessments will be collected from the ADHD participants to assess co-morbidities.
Blood sampling (lipidomics and proteomics) will be carried out to investigate potential
abnormalities in the metabolism or synthesis of LC-PUFA in participants with ADHD.
The siblings of the ADHD participants will also be invited to provide a blood sample to
assess genetic markers of LC-PUFA metabolism.
Results and Implications: The overall outcomes of this doctoral project are to (1)
increase the knowledge of the metabolic/genetic pathways involved in the presumably
low levels of PUFA in children, (2) provide a greater understanding of the role of dietary
essential fatty acids in either a) correcting a deficiency, as assessed by comparison of
fatty acid levels between healthy controls and ADHD children or b) to overcome a
metabolic block, investigated by the genetic markers in ADHD group and their nonADHD siblings; and 3) unveil the relationship between key fatty acid indices and
cognitive performance in a neuropsychological task battery and brain function as
assessed using ERP methods in both healthy and ADHD children.
Funding: Vifor Pharma, CH and the Mother and Child Foundation
State of Progress: Ongoing
23
Neurodevelopmental and Neuropsychiatric Disorders
Pharmacological fMRI in ADHD: Comparison of the Effects of Atomoxetine and
Methylphenidate on Functional Brain Activation in Medication-Naive Children with
ADHD
Investigator(s): Professor Katya Rubia, Dr Anna Smith, Ms Ana Cubillo
Summary
Aims: This study explores the differential and drug-specific effects of two different
pharmacological drugs used in clinical practice, a predominantly dopamine transporter
blocker: methylphenidate -MPH; and a predominantly noradrenaline transporter
blocker: Atomoxetine –ATX, on the brain function and functional connectivity using fMRI
in children with Attention Deficit Hyperactivity Disorder (ADHD) compared to healthy
children, during disorder-relevant tasks of motor inhibition, time estimation, sustained
attention and working memory. The project also studies abnormalities in brain
structure, function and functional connectivity in children with ADHD compared to
healthy controls. The aim of this study is to understand drug-specific upregulation
effects and to indirectly shed light on underlying catecholamine neurotransmitter
abnormalities in ADHD.
Methods: 20 children with ADHD are being scanned 3 times under either placebo, or a
clinical dose of MPH or ATX in a placebo-controlled triple-blind randomised controlled
design. The study will identify drug-specific effects on brain activation and functional
connectivity in ADHD by comparing the effects of either MPH or ATX on brain function
within patients. In order to understand potential normalisation effects of either drug on
abnormal brain activation, we will furthermore compare brain activation in 20 children
with ADHD under placebo and after a single dose of Methylphenidate or Atomoxetine to
that observed in 20 healthy controls in fMRI.
Implications: Understanding the medication-specific effects on abnormal brain function
in ADHD may help understanding underlying neurotransmitter abnormalities in ADHD
which will ultimately help to develop more targeted medication for the disorder.
Funding: This study is funded by the Department of Health via the National Institute for
Health Research (NIHR) Specialist Biomedical Research Centre (BRC) for Mental Health
award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of
Psychiatry at King’s College, London, and by an Eli Lilly grant to Prof Katya Rubia.
State of Progress: Ongoing
24
Neurodevelopmental and Neuropsychiatric Disorders
Specificity of Brain Abnormalities in Children with ADHD, OCD, and ASD
Investigator(s): Professor Katya Rubia, Dr Clodagh Murphy, Dr Anastasia Christakou
Summary
Aims: This study compares brain structure and brain function in medication-naïve
patients with ADHD, with OCD, and with ASD as well as healthy controls in order to
investigate specificity of brain abnormalities. We will also investigate effects on age on
normal functional brain development by scanning healthy children and adults.
Methods: 20 male, dextral, age-matched children with ADHD, 20 with OCD, 20 with ASD
and 20 healthy controls are being scanned in structural and functional MRI. In addition
we also scan 20 healthy adults in order to investigate normal developmental effects on
brain function between childhood and adulthood in a healthy population. We use 3 fMRI
paradigms of impulsiveness-related functions, a parametric task of sustained attention,
our version of the IOWA gambling task and a task of temporal discounting.
Implications: Understanding the disorder-specific structural and functional
abnormalities will be important for the development of more objective future
diagnostics and disorder-specific treatment.
Funding: This study is funded by the Medical Research Centre (MRC) Career
establishment grant to Prof K Rubia.
State of Progress: Ongoing
25
Neurodevelopmental and Neuropsychiatric Disorders
The Neuroimaging Correlates of Physical Childhood Abuse
Investigator(s): Professor Katya Rubia, Dr Lena Lim
Summary
Aims: To investigate the effects of childhood maltreatment on brain function, brain
structure and structural and functional interconnectivity, controlling for drug abuse and
psychiatric comorbidity. A secondary aim is to investigate the effects of candidate genes
(MAO-A and SERT) on abnormal brain structure and function in relation to childhood
abuse to test for genetic predisposition.
Methods: Functional and structural (voxel-based morphometry and diffusion tensor
imaging) magnetic resonance imaging will be used to scan young males between 14 and
18 years: 1) 25 young males with childhood abuse and mental health problems, 2) 25
children with no physical abuse but matched for mental health problems, 3) 25 healthy
control children and 4) 25 children with cannabis abuse (common in the first group and
hence a drug abuse control group). The fMRI paradigms will tap into inhibitory and
emotion control. Candidate genes will be assessed via cheek swabs.
Implications: Early maltreatment leads to the development of many behavioural
problems, often leading to psychiatric disorders in childhood or later in adulthood such
as depression, anxiety, conduct disorder and Attention Deficit Hyperactivity Disorder
(ADHD). The better understanding of the effects of early environmental adversities on
brain development will lead to a better understanding of the environmental causes on
the emergence of developmental psychopathology and it may hopefully generate new
and innovative approaches to treatment aimed to normalise or reverse these
experience-induced neurobiological abnormalities.
Funding: Biomedical Research Council
State of Progress: Not yet Started
26
Neurodevelopmental and Neuropsychiatric Disorders
Investigation of Normal Brain Development Between Childhood and
Adulthood and Its Abnormality in Autism Spectrum Disorder
Investigator(s): Professor Katya Rubia, Professor Declan Murphy, Dr Clodagh Murphy,
Professor E Simonoff
Summary
Aims: This study investigates abnormal brain structure and brain function development
between childhood and adulthood and its abnormality in children and adults with
autism spectrum disorder
Methods: Functional magnetic resonance imaging will be used to scan 20 healthy
children and 20 healthy adults as well as 29 children with ASD and 20 adults with ASD
in structural and functional MRI. We use 3 fMRI paradigms of impulsiveness-related
functions, a parametric task of sustained attention, our version of the IOWA gambling
task and a task of temporal discounting.
Implications: Understanding the underlying abnormal structural and functional brain
development of autism spectrum disorder will be important to develop future
interventions.
Funding: MRC CEG grant to Professor K Rubia and MRC grant to Professor Declan
Murphy
State of Progress: Ongoing
27
Neurodevelopmental and Neuropsychiatric Disorders
Pharmacological fMRI on the Effects of Fluoxetine on Functions of Impulsiveness,
Cognitive Flexibility and Working Memory in Children with ADHD and in Children
with High Functioning Autism
Investigator(s): Professor Katya Rubia, Dr Anna Smith, Professor Declan Murphy, Ms
Kaylita Chantiluke
Summary
Aims: The aim of this study is to investigate the differential disorder-specific effects of a
single acute dose of a serotonin agonist, Fluoxetine, on brain function and functional
connectivity during disorder-relevant tasks in children with Attention Deficit
Hyperactive Disorder (ADHD) and in children with high functioning Autism Spectrum
Disorder (ASD).
Methods: Functional magnetic resonance imaging will be used to scan 20 children with
ASD and 20 children with ADHD in a double-blind, randomised controlled design, under
either placebo or one acute clinical dose of Fluoxetine while performing a Stop, Reversal,
Temporal Discounting and a Working Memory task (N-Back). We will also investigate
differences between ADHD and ASD children in brain function and structure under
placebo.
Implications: Genetic and biochemical studies have shown that serotonin dysregulation
may play a pivotal role in both ADHD and ASD. However no previous studies have
investigated the neurofunctional effect of a serotonin agonist in children with either
ADHD or ASD. Therefore this project is highly original and will help to elucidate the
effects of Fluoxetine on brain function in both ADHD and ASD, which may help indirectly
help to uncover the underlying 5-HT abnormalities in these two disorders
Funding: Biomedical Research Council
State of Progress: Ongoing
28
Neurodevelopmental and Neuropsychiatric Disorders
The Neurocognitive Functioning of Children at Risk of Developing ED Related
Behaviours
Investigator(s): Ms Radha Kothari, Dr Nadia Micali, Professor Janet Treasure
Summary
Aim: To investigate the neurocognitive development of children at risk of developing ED
behaviours, due to being born to mothers with a lifetime ED history, so as to examine
whether these symptoms map onto the ED profile of their mothers.
Study One is a detailed investigation into the trajectory of lifetime ED in a general
population sample. We will describe the longitudinal history and symptomatology of
maternal ED in order to map the pattern of symptoms onto cognitive development of
their children. The study is a two-phase cohort design. Phase one was a general
population screening investigating the presence of lifetime ED behaviours, and in phase
two, a subset of this sample is being interviewed in depth about these ED behaviours
and symptoms.
Study Two investigates the neurocognitive functioning of children at risk of developing
ED related behaviours. Firstly we will compare the neurocognitive functioning of a
group of children at risk of developing ED behaviours and a control group. Secondly we
will investigate the relationship between maternal ED (behaviours and traits, chronicity
of ED, and timing of symptoms), and neurocognitive development/functioning of their
offspring.
The Sample: The Avon Longitudinal Study of Parents and Children (ALSPAC) is a
population based study of 14, 541 women enrolled during pregnancy. Women were
eligible if they lived in the study area of Avon at the time of pregnancy, and if their
expected date of delivery was between 1 April 1991 and 31 Dec 1992. Those enrolled
represented approximately 85% of the eligible population, and the 13, 971 children who
were still alive at 12 months old have been followed since, as well as the mothers and
their partners. ALSPAC is a two-generational resource with data collected through
questionnaires, as well as physical, behavioural and psychological tests.
Funding: Wellchild
State of Progress: Ongoing
29
Neurodevelopmental and Neuropsychiatric Disorders
A Pilot Cognitive Behaviour Therapy Group for Children with ADHD and Their Parents in a
CAMHS Service
Investigators: Dr. Penny Andreou, Ms. Hayley Lee
Summary
Aims: The aims of the groups were to: provide psycho-education on ADHD to children
with ADHD and their parents; help children develop a variety of skills that include: I)
listening, II) problem solving, III) dealing with and expressing feelings, IV) anger
management, V) self control, VI) friendship skills, VII) self esteem; help parents
reinforce and support their child’s learning, as well as training in parenting skills and
behaviour management; provide a forum for parents and children to discuss thoughts
and feelings about problems often associated with ADHD such as poor self esteem,
difficulties managing behaviour etc.; improve motor behaviour, inattention, impulsivity
and self esteem as reported by parents and children. The programme followed a
structured curriculum as recommended in the NICE ADHD guidelines.
Method: An 8-week programme which consisted one and a half hour sessions was
delivered to both children with ADHD and their parents. In addition to attending weekly
sessions, children and parents were requested to complete homework tasks. Active
learning strategies were used and rewards were given for achievements. The initial pilot
group was offered to children aged 9 to 12 years old. The initial group size was 4. One
family dropped out of the study due to personal circumstances.
Teachers of the children in the group were informed about the programme. We also
requested that the teachers respond to and reinforce the development of the child’s new
skills. We also provided teachers with a booklet on ‘Managing ADHD in education’ for
more detailed information on classroom management.
Results and Implications: A number of measures were used pre and post the group.
One month follow up measures are due to be collected. At the end of the group children
self reported using the Beck Youth Inventory an improvement in self esteem. Each child
also rated their own individual goals, each demonstrating an improvement by the end of
the group. Parent Conners’ ratings however remained within the clinical range and
parent SDQ scores were mixed. Overall parents and children reported using an
evaluation form that they found all the sessions helpful. This study was a pilot with a
very small sample size and therefore results are difficult to interpret. The timing of the
group, ADHD medication and school involvement are factors to be considered in future
when running the groups.
Funded by: South London and Maudsley NHS Foundation Trust.
State of progress: Ongoing
30
Neurodevelopmental and Neuropsychiatric Disorders
Cognitive Task Performances as Biomarkers & Candidate Endophenotypes in
Childhood Neurodevelopmental Disorders: ADHD & Autism
Investigator(s): Professor Patrick Bolton, Professor Philip Asherson, Dr Ulrich Ettinger,
Mrs Bahare Azadi, Ms Karen Ashwood, Ms Sally Cartwright
Summary
Aims: The overall aim of the study is to see whether there are clinical, or cognitive
assessments that can distinguish between Autism Spectrum Disorder (ASD), Attention
Deficit Hyperactivity Disorder (ADHD) and comorbid ADHD-ASD to aid in diagnosis. The
study also provides a unique opportunity to learn more about the similarities and
differentce between the two coniditons.
Methods: Children and adolescents with a clinical diagnosis of pure ADHD, pure ASD,
and comorbid cases of ADHD-ASD are compared with the age and IQ matched healthy
controls. The participants are all male, between 7 and 16 years of age and IQ level above
70. In order to identify putative biomarkers of ASD and ADHD, we decided to focus on
measures which have already been validated in previous studies by showing casecontrol differences for ADHD and autism. Promising Executive Function (EF) measures,
a series of central coherence (CC) tasks and Theory of Mind (ToM) tasks are included in
the cogntive battery. In addition, novel eye tracking and emotion paradigms have also
been developed. We also aim to study cognitive profiles of siblings within each of the
three clinical groups in order to examine whether biomarkers included in the study can
represent putative intermediate phenotypes which show specificity for sub threshold
/dimensional traits observed in siblings and related to each condition.
Results andImplications: Biomarkers for the assessment and diagnosis of childhood
onset neurodevelopmental disorders have been little studied, but emerging evidence
suggests they may have utility in various clinical settings (e.g. as early pre-symptomatic
diagnostic tools; and also as diagnostic tools in complex and borderline cases).
Funding: National Institute of Health Research Specialist Mental Health Biomedical
Research Centre (BRC)
State of Progress: Ongoing
31
Neurodevelopmental and Neuropsychiatric Disorders
Psychoeducation in Families of Children with Attention Deficit Hyperactivity
Disorder (ADHD): Evaluation of the Efficacy in a Randomised Controlled Trial and a
Qualitative Examination (Sunshine Study) (ISRCTN26270684)
Investigator(s): Ms Anthea Martin, Dr Maite Ferrin, Mr Aidan Cooney, Dr Samaa El Abd,
Miss Viviana Perez, Miss Martina Schneiderova, Miss Ginevra Drinka
Summary
Aims: 1. Structured psychoeducation program in families of ADHD children/adolescents
will lead to a significant reduction of ADHD symptoms in these children in comparison
with a control group; 2. Psychoeducation program in families of ADHD
children/adolescents will lead to improvement of treatment adherence rates and quality
of life in these children in comparison with a control group.
Methods: Inclusion criteria:1. Diagnosis of ADHD (DSM-IV), most of their co-morbidity
represented (except for the exclusion criteria), and any treatment prescribed; 2. Age of
child between 4 and 19 years, either sex. Excusion criteria:1. Severe ASD; 2. Severe
learning disabilities; 3. Earlier or current participation in other intervention trials that
might interfere with the current study.
Psychoeducation intervention (experimental group): Families of ADHD
children/adolescents attending psychoeducation sessions. Psychoeducation consisting
of 6 weekly sessions, 120 minutes length, groups of 8 - 10 families. Posterior qualitative
approach using Focus Group techniques to explore perceived efficacy of the
psychoeducation program. Control group: Routine medical care.
Primary outcome: ADHD-symptoms by Conners Scale. Secondary outcomes: 1. Attitudes
Towards Treatment by QATT ; 2. Adherence levels by direct questioning and BARS; 3.
Psychiatric conditions by SDQ ; 4. C-GAS ;5. CGI; 6. Quality of life by PedsQL™ ; 7.
Satisfaction with psychoeducation by CSQ; 8. Parents Stress Index (PSI). Assessments on
all measures pre-treatment and post-treatment, follow-up assessment on all measures
after 6 months
Results might allow clinicians/health care providers to make evidence based choices
about how suitable this particular programme may be to improve specific outcomes for
ADHD children/adolescents and their families.
Funding: South London and Maudsley Charitable Funds
State of Progress: Ongoing
32
Neurodevelopmental and Neuropsychiatric Disorders
Anxiety in Autism Spectrum Disorders: Hypothalamic Pituatary Adrenal (HPA) Axis
and Autonomic Nervous System Function
Investigator(s): Mr Matthew Hollocks, Professor Emily Simonoff, Professor Pat Howlin,
Dr. Lois Grayson, Ms Katherine Wood, Mr Lewis Whittingham
Summary
Recent epidemiological and clinical studies have suggested a high prevalence of anxiety
disorders in those with an autism spectrum disorder (ASD), the most common of which
appears to be social phobia (Simonoff et al, 2008). This project is one element of a larger
research project examining the presence of co-morbid anxiety disorder in children and
adolescents with ASD. The hypothalamic-pituitary-adrenal (HPA) axis and the
autonomic nervous system (ANS) are two interrelated biological systems modulating
the body’s response to threat. Both systems are regulated by neural sites associated
with ASD and anxiety disorder such as the Amygdala. We are studying the HPA axis and
autonomic response to psychosocial stress using an adapted version of the wellvalidated Trier Social Stress Test. Our sample will include 10-16 year old boys with
ASD, with and without co-morbid anxiety disorders (separation anxiety, generalised
anxiety and social anxiety disorder), typically developing children with anxiety
disorders and a healthy control group. All need to be of normal intellectual ability.
Participants are being recruited via clinics (both within and outside of SlaM) and
through public recruitment. By measuring group differences in salivary cortisol and
heart rate, we aim to identify potential biological correlates of anxiety in ASD.
Funding: BRC
State of Progress: Ongoing
33
Neurodevelopmental and Neuropsychiatric Disorders
Evaluation of Diagnostic Techniques, and Cognitive and Physiological
Correlates, of Anxiety in Young People with Autism Spectrum Disorders
Investigator(s): Professor Emily Simonoff, Dr Lois Grayson, Mr Andrew Papadopolous,
Mr Matthew Hollocks, Miss Katherine Wood, Mr Lewis Whittingham
Summary
Aims: Epidemiological research suggests that as many as 40% of children with autism
spectrum disorder (ASD) have an anxiety disorder.Typically, the assessment of anxiety
in children relies heavily on self- and parental report of symptoms. In ASD this report
may be compromised both by characteristic difficulties in communication and
introspective thought, and also by misinterpretation of ASD behaviours. Our objectives
are: 1. To evaluate the accuracy of extant diagnostic and screening instruments for
identifying anxiety disorders within this population. 2. To explore alternative
approaches to anxiety disorder diagnosis in young people with ASD. Ultimately it is our
goal to describe a ‘gold standard’ diagnostic protocol for assessing anxiety disorders in
ASD, one that integrates behavioural, cognitive and physiological methods.
Methods: Our participants are four groups of boys aged 10 to 16 years (i) with ASD; (ii)
with ASD and anxiety; (iii) with anxiety alone; and (iv) with no history of either
condition. We are including separation anxiety, generalised anxiety, and social anxiety
disorders. Data are obtained from both parents and the boys themselves. In relation to
symptoms measures, we are contrasting diagnostic categorisations using each of two
widely-used paediatric anxiety screening tools (the Spence Child Anxiety Scale and the
Screen for Child Anxiety Related Disorders), with results obtained from using the Child
and Adolescent Psychiatric Assesment (CAPA) both across and within groups. With
respect to cognitive correlates of anxiety, and associative learning,
attentional/interpretative bias paradigms are being evaluated as potential anxietyspecific cognitive marker tasks. Physiological measures (e.g., salivary cortisol volume,
heart rate and heart rate variability) provide us with endocrinological data in response
to psychosocial challenge. We aim to see whether the features that differentiate boys
with ASD and anxiety disorders from those with ASD alone are the same features that
differentiate boys with anxiety from those with no mental health problems.
Experimentation both substantiates and explicates results obtained from the diagnostic
components of this research in terms of underlying mechanisms. Additionally it
facilitates novel investigation of the aetiology and maintenance of anxiety in young
people with ASD, through comparison with data obtained from young people with
anxiety, and from young people drawn from the general population.
Funding: Biomedical Research Centre for Mental Health
State of Progress: Ongoing
34
Neurodevelopmental and Neuropsychiatric Disorders
Neuropsychological Features in Learning Disabilities with Attention DeficitHyperactivity Disorder (ADHD)
Investigator(s): Dr Maria-Jose Bescos, Dr Anna Smith, Professor Emily Simonoff
Summary
Attention deficit hyperactivity disorder (ADHD) is characterised by abnormalities in
activity, attention and impulse control that are inappropriate for a child’s developmental
level. Rates of ADHD are increased in children with intellectual disability (ID). The
diagnosis of ADHD is often missed in this group and clinicians report difficulties in
determining whether behaviour is out of keeping with developmental level. Although
children with ADHD and ID respond to stimulant medication, they do so to a lesser
extent than children of average ability and the reasons for this diminished response are
unclear. Furthermore, there is little understanding of why this is so and whether the
neurocognitive processes underlying ADHD in ID are the same as in children with ADHD
alone. There is little research investigating the cognitive features of a sample of children
with comorbid intellectual disabilities (ID) and attention deficit hyperactivity disorder
(ADHD). Numerous studies of children with ADHD and average intellectual ability have
demonstrated a range of neuropsychological deficits associated with sustained and
selective attention, response inhibition, working memory, and ability to delay reward.
The aim of this study is to examine several of these characteristics and determine
whether the same pattern of deficits applies to children with ADHD and ID, compared to
children with ID alone.
We are comparing the performance of 3 groups of children: one with ADHD and mild
learning disabilities, the second with only ADHD and average ability and the third with
learning disabilities alone. All participants complete five cognitive tasks found to be
affected in ADHD: choice impulsivity, response inhibition, time perception, rewarded
sustained attention, and spatial working memory.
Participants, who are identified from previous studies or clinical settings, all have a
diagnosis of hyperkinetic disorder (ICD-10) or ADHD-combined type (DSM-IV) by an
expert clinician. We also ensure there is a standard measure of IQ, on either the
Wechsler scales or Raven’s Matrices and measures of ADHD symptom severity on either
the Strengths and Difficulties Questionnaire or the Conners Rating Scale (short form).
We exclude children with significant autistic features (assessed on the Social
Communication Questionnaire).
The performance in the different tasks will be compared in the three groups by using a
MANOVA procedure. The comparisons will help us to identify which cognitive deficits or
strengths are typical of the group with both learning disabilities and hyperactivity. Our
aim is to find the neuropsychological profile that characterises this combined group and
check if the current theories that explain cognitive difficulties in hyperactivity could also
apply to these dual diagnoses. We are matching our groups on mental age.
The results will contribute to our understanding of the causes of ADHD in children with
ID. In the longer term, this may help with improved assessment and management.
Funding: Alicia Koplowitz Foundation
State of Progress: Ongoing
35
Neurodevelopmental and Neuropsychiatric Disorders
Pre-Existing Neurodevelopmental Difficulties in Childhood Brain Tumours Implications for Outcome
Investigator(s): Dr D Lumsden, Ms C Woodthorpe, Dr D Hargrave, Dr T Lax-Pericall, Mr
C Chandler, Dr T Hadderley
Summary
The incidence and significance of pre-existing neuro-developmental problems in
children presenting with brain tumours is yet to be determined. It is often unclear
whether these problems are secondary to the tumour itself or instead are due to
primary disorders predisposing to tumour development. Coexistent neurodevelopmental problems have a profound impact on patient management, as well as
huge implications for studies on outcome post-treatment. Our aim was to establish the
prevalence and highlight the range of pre-existing neuro-developmental difficulties in
children at diagnosis of brain tumour.
Methods: In our busy tertiary neurosurgical unit all children are seen at presentation by
a multidisciplinary team encompassing a neurologist, oncologist, neurosurgeon, nurse
specialist, and when appropriate neuro-psychiatrist. Clinical experience has highlighted
high numbers of children diagnosed with brain tumours who also have particular neurodevelopmental difficulties detectable at the time of presentation. The authors reviewed
case notes of all children (n=131) admitted to our neurosurgical unit between July 2006
and November 2009 with a new diagnosis of brain tumour.
Results: 12/131 (9.2%) patients had documented neuro-developmental problems prior
to diagnosis or treatment. These included anxiety disorders such as school refusal and
specific phobias, tic disorder, social communication difficulties, language disorder,
cognitive, and neuro-psychiatric difficulties. These problems could not be attributed
either directly to the tumour or to a primary syndromic diagnosis (eg, tuberous sclerosis
or neurofibromatosis) in every patient. Some children were receiving management for
these disorders, and in some there were family members with similar difficulties
without brain tumour.
Conclusion: Long-term outcome studies in paediatric brain tumours are limited to date.
Where available, they have considered the effect of different treatment modalities on
cognitive outcome and survival. To our knowledge, the importance of premorbid factors
when considering long-term outcome has not been studied. This important area must be
addressed if intervention is to be targeted appropriately. The authors recommend
prospective collection of data on all children diagnosed with brain tumours, enquiring
specifically about the neurodevelopmental features and neuropsychiatric comorbidity,
so these important issues can be managed appropriately.
Lumsden, D., Woodthorpe, C., Hargrave, D., Lax-Pericall, T., Chandler, C., Hedderly, T.
(2010). Pre-Existing Neuro-Developmental Difficulties in Childhood Brain Tumours-Implications for Outcome. Archives in Disease in Childhood, 95(Suppl 1), A10-A11.
Funding: None
State of Progress: Completed
36
Neurodevelopmental and Neuropsychiatric Disorders
Cognitive Behavioural Therapy and Social Skills Group Intervention for Families
who have Boys with Asperger Syndrome/High Functioning Autism: The Social
Detectives Group.
Investigator(s): Dr Gemma Wilson, Dr Liz Gill
Summary
Aims: The aim of the project was to investigate the clinical effectiveness of a pilot CBT
and social skills group intervention for children with Asperger syndrome (AS), or High
Functioning Autism (HFA), and their parents. The project drew on 'The multi component
Social Skills intervention - The Junior Detective Training Programme', (Beaumont and
Sofronoff 2008), and RCTs of group CBT interventions for anxiety in children with
Asperger syndrome, (Sofronoff et al 2005, and Chalfant et al 2007). The eight week
programme we developed included small group sessions, concurrent parent training
sessions and teacher handouts. Group sessions were designed to teach children skills in
emotion recognition, emotion regulation, and social interaction.
Methods: Four boys with AS, and one boy with HFA, aged 9-11 and their parents were
recruited. For all children the presence of anxiety symptoms was accepted from parental
report via the assessment interview. Parent and child measures of anxiety, social
worries, social skills, emotion recognition and regulation were used before and after the
group, and at six weeks follow up. Parent and child goal attainment measures were also
used before and after the group.
Results and implications: Parental report indicated that the children's anxiety had
decreased, social worries remained the same, and social and emotional regulation skills
had increased. The parent's ratings of their child's strengths and difficulties remained
the same. However parent's ratings the impact of their child's difficulties to have
decreased, and parents reported feeling more confident and in control in managing
these difficulties. These gains were maintained at follow up. Results from the children's
measures showed that total anxiety and social worries had decreased, the number of
facial and posture cues to emotional states identified had increased and the children
generated more strategies for managing anger and anxiety.
Overall, the intervention was endorsed by parents as a useful programme for children
diagnosed with AS or HFA exhibiting anxiety symptoms, and active parental
involvement enhanced the usefulness of the programme. Limitations of this small pilot
study and implications for future clinical work and research will be discussed.
Funding: None
State of Progress: Completed
37
Neurodevelopmental and Neuropsychiatric Disorders
Imitation Ability and Reactions to Social Stimuli in Adults with Autism Spectrum
Disorders
Investigator(s): Professor Patrick Bolton, Professor Francesca Happé, Professor
Patricia Howlin, Dr Fiona McEwen and Dr Rhonda Booth
Summary
Background: The ability of children to imitate others is thought to play an essential role
in the way that we learn about other people, and seems to rely on recently discovered
'mirror areas' in the brain. Children with Autism Spectrum Disorders (ASD) have
problems imitating and an imitation deficit might lie at the core of ASD. However, there
are still uncertainties about the role of imitation in social development and how it may
manifest in later life. The significance of different types of imitation (e.g., hand vs face,
intentional vs automatic), for example, is not clear. Imitation of goal-directed actions
and automatic imitation of hand movements seem to be intact in ASD, but imitation of
meaningless actions are impaired and automatic face imitation has not been studied.
Aims: The aim of this study is to map the different types of imitation ability and
impairment in individuals with ASD. Two main hypotheses are being tested: (i) that
automatic imitation of hand and mouth movements will be preserved but that eye
region imitation will be reduced in ASD compared to typically developing (TD) controls;
(ii) that performance will be reduced when more complex social stimuli are used in the
contagious yawning and ‘chameleon effect’ task despite the focus on the body and
mouth.
Methods: We have developed novel measurements of goal-directed imitation, automatic
hand and face imitation, and contagious yawning. These measures are been assessed on
the same sample of individuals with ASD (N = 30) and TD (N = 30) to see how they relate
to each other and to measures of social understanding.
Results and implications: A clearer understanding of the precise nature and
development of imitation problems in ASD will help describe the cognitive mechanisms
involved in ASD and could help define subgroups for the purpose of genetic studies. This
information will also be of use to those developing intervention strategies and to those
who work with people with ASD.
Funding: Autism Speaks
State of Progress: Ongoing
38
Neurodevelopmental and Neuropsychiatric Disorders
The Impact on Families of Having a Child with Down Syndrome and Co-Morbid
Autism
Investigator(s): Professor Patricia Howlin , Dr Jo Moss
Summary
Recent research indicates that a significant minority of children with Down syndrome
(DS) also meet diagnostic criteria for an autism spectrum disorder (ASD). These children
tend to have much greater difficulties, both cognitively, socially and behaviourally than
children with ASD or DS alone.The goal of the present study is to provide an estimate of
rates of ASD symptoms amongst children with DS and to explore how the problems of
children with the dual diagnosis differ from those of children with DS alone
Aims: 1. To obtain an estimate of the frequency of autistic type disorders amongst
children with DS in the UK using a postal questionnaire. 2. To conduct a systematic study
of the differences between children with a confirmed diagnosis of ASD+DS and those
with a diagnosis of DS only. 3. To assess in detail the impact on families of raising a child
with the dual diagnosise
Participants & Design: Study 1: postal survey of all families with a child with Down
Syndrome age between 5 & 15 years registered with the UK Down Syndrome
Association (n=>3,500). Study 2: A comparative study of children with DS who also meet
criteria for ASD with those who do not show symptoms of ASD (n=30 in each group).
Funding: Bailey Thomas Charitable Trust
State of Progress: Not Yet Started
39
Neurodevelopmental and Neuropsychiatric Disorders
Gender Differences in Neuropsychological Measures of Cognitive Control in a
Normative Sample of 8-11 Year Old Children
Investigator(s): Dr A. Smith, Professor K.Rubia, Miss R.Patel, Mr S. Nestler
Summary
Aims: To obtain normal data from typically developing children using a set of cognitive
tasks entitled the Maudsley Attention and Response Suppression (MARS) battery which
is designed to test for deficits in children with Attention Deficit/Hyperactivity Disorder
(ADHD). Children with ADHD are characterised by their poor inhibition and inattentive
performances on tasks, correlating with their impulsive behavioural style. While
cognitive tasks in child psychiatry are usually adapted from adult tests, the MARS is a
cognitive task battery suitable for children. We also aim to collect DNA samples from
children in order to detect associations between performance measures and genetic
markers of ADHD.
Methods: Typically developing children without learning disabilities, from age 8 to 14,
were recruited from primary schools across South East UK. Childen completed a battery
of tasks, consisting of eight short tests measuring motor response inhibition (Gonogo
and Stop), cognitive flexibility (switch task), sustained attention (CPT), interference
inhibition (Simon), reward-related decision making (temporal discounting & gambling),
and time discrimination. The neural correlates of all tasks have been mapped in healthy
children and adults and have been associated with task-specific neural networks; they
are sensitive to the performance deficits of children with ADHD and are associated with
brain dysfunction in ADHD. Parents are asked to complete a Strength and Difficulty
Questionnaire (SDQ) as well as providing demographic data. Children also undergo an
IQ test and provide a sample of DNA via a saliva swab which will enable us to establish
associations between genetic markers and task performance so that we may obtain an
objective biomarker to be associated with typical hyperactive performance. Results: A
sub-sample of these children have been analysed for gender differences in different
inhibition functions and are currently being prepared for publication: Findings
demonstrate that boys show significantly faster response inhibition (Stop Task) but are
no different than girls in interference inhibition (Motor Stroop Task), or cognitive
flexibility (Switch Task). Boys do however, demonstrate a generally faster response
style with fewer errors. Ultimately this data will allow us to develop this battery for
assessment in clinical and non-clinical settings such as schools and research
environments.
Funding: Biomedical Research Centre
State of Progress: Ongoing
40
Neurodevelopmental and Neuropsychiatric Disorders
Outcomes in Adulthood for Adults with Autism and Their Siblings
Investigator(s): Professor Patricia Howlin, Miss Philippa Moss, Miss Sarah Savage
Summary
Aims: The primary aim of this project is to investigate outcomes (living status,
employment, friendships, and relationships) and mental health difficulties amongst
individuals in mid-late adulthood who were diagnosed as having autism in childhood. As
children all had a non-verbal IQ ≥ 70. We are also investigating the predictors and
correlates of outcome. In addition, we are exploring outcome in adulthood amongst
siblings of individuals with autism, both those who, as children, were thought to be
'unaffected' by autism and those considered to exhibit the broader autism phenotype
(BAP).
Methods: To date 59 individuals with autism, 58 'unaffected' and 19 BAP siblings have
been assessed. The average age of the autism group is 44 years 2 months (range = 29 64 years), of the 'unaffected' siblings is 40 years 5 months (range = 21 – 57 years), and
of the BAP siblings is 39 years 6 months (range = 23 – 54 years). Measures include the
Autism Diagnostic Interview - Revised (ADI-R) and the Family History Schedule (FHS).
Cognitive and language abilities are assessed using standard psychometric tests, and
data on mental health difficulties have also been collected.
Results and Implications: Preliminary analysis indicates that, despite having an IQ in
the normal range as children, most individulas in the autism group have a very poor
outcome in adulthood. Few are in long-term relationships, and independence and
employment levels are low. However, rates of mental health problems are less than
predicted on the basis of earlier research with clinical samples. Siblings designated as
"unaffected" as children appear to be achieving relatively well as adults, although rates
of mental health problems (especially anxiety, affective disorders and OCD) are higher
than in the general population. Outcome in the "broader phenotype" group is very
mixed, with some individuals doing well and showing few residual signs of an autism
spectrum disorder. Others are highly dependent as adults, and some now have
diagnoses of autism. A number of siblings (both "unaffected" and BAP) and some
individuals in the autism group have children of their own, some of whom have been
diagnosed with autism-related problems.
Funding: Nuffield Foundation
State of Progress: Ongoing
41
Neurodevelopmental and Neuropsychiatric Disorders
Psychoeducation in Families of Children with Attention Deficit Hyperactivity
Disorder (ADHD): A Qualitative Evaluation of the Programme Using Focus Groups
(Sunshine Study) (ISRCTN26270684)
Investigator(s): Ms Anthea Martin, Dr Maite Ferrin, Mr Aidan Cooney, Dr Samaa El Abd,
Miss Viviana Perez, Miss Martina Schneiderova, Miss Ginevra Drinka.
Summary
Aims: The aims of this aspect of the project are: 1. To elicit parents' experiences and
views of the organisation, operation, and efficacy of the psychoeducation programme for
families of children with ADHD; and 2. To use these findings to inform the development
of the programme.
Methods: To achieve these aims we are undertaking a series of qualitative focus groups
with the parents of children with ADHD who have participated in the psychoeducation
programme. All parents who attend the programme are invited to take part in the focus
group immediately following the end of the programme. To date we have conducted n=3
groups with a total of n=8 participants. We expect to run a further two to four groups.
Each of the groups to date has been held at Sunshine House, between June and
September 2010. The focus groups are semi-structured and directed by a topic guide
drawn up to include the key concerns of the broader project. The guide is used only to
faciliate discussion; participants are encouraged to introduce their own concerns to the
discussion and to elaborate on these. All focus groups are audio recorded with the
informed consent of the participants. In two of the three groups to date the order of
speech has been noted by a second facilitator. Each audio recording is transcribed by an
independent transcriber then checked for accuracy and corrected where necessary by a
member of the psychoeducation research team. The focus group transcripts will be
coded with the assistance of the qualitative data management software NVivo 8. Using
NVivo, coding frameworks will be constructed which allocate codes to themes and
issues emerging from the data, thereby facilitating the identification and organisation of
emergent themes and issues. Using these coding frameworks, data will be classified,
indexed and subject to thematic analyses. The framework will facilitate the
identification and organisation of key themes which will inform steering group
discussion about the development and improvement of the psychoeducation
programme.
Funding: South London and Maudsley Charitable Funds
State of Progress: Ongoing
42
Neurodevelopmental and Neuropsychiatric Disorders
Genetic Causes of Neurodevelopmental and Psychiatric Disorders in Children:
Translation and Interpretation of Novel Pathogenic Copy Number Variants and
Novel Rare Exonic Mutations into Clinical Practice.
Investigators: Dr Sarah Curran, Dr Simon Holden, Dr Caroline Ogilvie, Professor David
Collier, Professor Paul Gringras, Professor Patrick Bolton, Dr Richard Dobson, Dr Simon
Furney.
Summary and aims are: 1)To establish a framework for the development of a King’s
Health Partner (KHP) Brain & Behaviour Genetics Resource Exchange (BB-GRE) that
supports research linking clinical child health data with genetic data and ensures that
families of all children with neurodevelopmental +/- behavioural disorders; (i) referred
for assessment to KHP clinics; and (ii) referred by secondary care clinicians for genetic
testing to the South East Thames Regional Cytogenetics Laboratory at Guy’s hospital, can
participate in the joint BRC cutting-edge research programmes. 2)To capture relevant
clinical information in a standardised format at the point of referral for genetic testing in
order to facilitate; (i) research linking clinical and laboratory data; and (ii) to enhance
clinical interpretation of genetic test results. 3)To develop bespoke software solutions;
(i) to develop an off-line, secure BB-GRE database that stores, links, and manages clinical
and genetic data; and (ii) to interrogate and interpret the data, in order to identify
genotype-phenotype correlations and the gene-gene interactions/biological pathways
that underpin these common disorders. 4) To set the stage for future research, for
example large scale whole genome sequencing for the identification of rare pathogenic
mutations, in a large, under-researched population.
Funding: Joint NIHR Strategic Project Award.
State of progress: Ongoing. We have established the BB-GRE strategy group and have
developed a new, scannable clinical referral sheet for Clinical Cytogenetics and have
obtained the agreement of Guy’s Clinical Geneticists, St Thomas’ Paediatricians and
SLaM child psychiatrists to implement this. We have discussed bioinformatics strategy
and have agreed on data capture and storage procedures. An ethics application is being
drafted taking account of established projects and approvals. A job advert has been
completed and approved and a post-doctoral RA will be employed from November 2010
for 1 year. 6 applicants have been shortlisted for interview.
43
Neurodevelopmental and Neuropsychiatric Disorders
PSYCH-CNVs: Copy Number Variations Conferring Risk of Psychiatric Disorders in
Children.
Investigator(s): Professor David Collier, Professor Patrick Bolton, Dr Sarah Curran, Dr
Simon Surgaleze, Dr Sophia Frangou, Professor Hreinn Stefansson, Dr Hannes Petursson,
Dr Vera Golimbet, Dr Igor Martsenkovsky, Dr Teimuraz Silagadze, Dr Marija Raleva, Dr
Milica Pejovic Milovancevic
Summary:
The objective of this study is to generate new knowledge on genetic variants conferring
risk of psychiatric disorders in children and adolescents. The main objective is to study
ASD (autism spectrum disorder) and psychosis, (schizophrenia and bipolar disorder).
More details of the project can be found at http://www.psych-cnv.eu/aims.php.
Funding: This project is supported the European Community FP7. The consortium
includes several Eastern European Centres (Russian, Ukraine, Georgia, Serbia, and
Macedonia) as well as Iceland and the UK (London).
State of Progress: Ongoing. 321 UK ASD cases (537 in total) and 435 schizophrenia
cases have been enrolled. Genotyping and CNV analysis is being undertaken at decode
and the preliminary findings will be presented and discussed at the World Congress
Psychiatric Genetics, in Athens, October 2010. In addition, within this project, I have
taken the lead in establishing a Western Europe ASD Case-Control Consortium:
colleagues from UCL, Italy, Belgium, Germany, Finland and Holland have contributed
samples and phenotypic data on >2,000 cases with ASD. We are currently trying to
replicate common variants that have reached/ nearly reached significance in GWAS.
44
Neurodevelopmental and Neuropsychiatric Disorders
The UK10K Project. Rare Genetic Variants in Health and Disease
Investigator(s): Professor David Collier, Professor Patrick Bolton, Dr Sarah Curran.
Other collaborating institutions are Cardiff University, University of Edinburgh, and
University College London. My role is as a collaborator providing cases of ASD from
SLaM/IoP collections and in phenotypic work-up and analysis of genotype-phenotype
correlations.
Summary:
The UK10K project is a major collaboration among several leading academic and
research institutions including Bristol University, King's College London, the Medical
Research Council, UK Department of Health, and the Wellcome Trust Sanger Institute.
The primary funding for the project is from the Wellcome Trust. The aim of the project is
to undertake whole genome sequencing of 10 thousand individuals drawn from general
population longitudinal cohorts (ALSPAC, KCL Twins) and cases with various physical
and neurodevelopmental disorders. The project will provide a definitive picture on the
frequency of rare variants in the aetiology of the various clinical conditions. It has been
agreed that 1,000 -1,500 cases with Autism Spectrum Disorders and 1,500
schizophrenia cases will be selected for exonic sequencing.
Funding: Wellcome Trust
State of Progress: Ongoing. Ethical issues have been reviewed and approvals are,
where necessary being amended. Details of the methods of sample collection have been
clarified, and existing stocks of DNA have been audited. It is planned that sequencing
will begin within the next few weeks and will run over the next two years.
45
Neurodevelopmental and Neuropsychiatric Disorders
Generation of Human Induced Pluripotent Stem Cells (iPSCs) For Drug Discovery
Applications
Investigators: Professor Jack Price, Dr Thomas Steckler, Dr Graham Cocks, Dr Caroline
Ogilvie, Dr Sarah Curran.
Summary:
The aim is to develop a robust technology for generating iPS cell lines from a variety of
patients with neuropsychiatric disorders, especially autism and schizophrenia. We
expect this technology to provide a major innovative step in target
identification/validation and screening efforts and can be expected to lead to new
targets of high relevance for psychiatric disorders and to assays that have high
predictive validity for the therapeutic effects of psychoactive drugs.
Sarah Curran taking the lead on a component called: ‘Induced Pluripotent Stem (iPS)
Cells from Keratinocytes: a Neuronal Model of Autism Spectrum Disorders (ASD)’.
Summary 2: This study aims to overcome the problem of lack of viable human neural
tissue in the study of autism spectrum disorders. Firstly, we are culturing keratinocytes
derived from plucked hair cells of affected individuals. Next these cells are induced to
regain pluripotency by delivering four or five reprogramming factors into the cells.
These pluripotent cells (iPS cells) will then be validated and the final step will involve
directing them to develop into neurons. This will allow us to directly study development
in human nerve cells from individuals with ASD, in particular the cellular and molecular
basis of neurogenesis, synaptogenesis, and neurite outgrowth.
Funding: Johnson & Johnson
State of Progress: Ongoing. Ethics approval is in place. We have already obtained
consent from the parents of a 4 year old boy with autism and a specific genetic
abnormality as detected on array CGH. Hair samples have been taken and we have
successfully cultured keratinocytes from these. Detailed phenotyping has been
completed.
46
Neurodevelopmental and Neuropsychiatric Disorders
Cytochrome P450 (CYP) Genotype Predicts Steady State Dose in an Open Label Trial
of Atomoxetine in Children with Learning Difficulties Co-Morbid with ADHD.
Investigators: Dr Sarah Curran, Dr Katherine Aitchison, Professor Ian Craig, Professor
Emily Simonoff.
Summary:
Aims and objectives of this study are; 1) To compare CYP genotyping on DNA extracted
from buccal swabs vs. whole blood DNA, 2) To conduct CYP genotyping on appropriate
samples from the atomoxetine trial, and 3) To analyse CYP genotype as a predictor of
steady state atomoxetine dose
Funding: BRC Biotechnologies
State of Progress: We have established that DNA extracted from buccal swabs is as
good a substrate as that from whole blood for the long PCRs necessary in CYP
genotyping. Therefore we have prepared buccal kits and have initiated the sample
collection from the children enrolled in the trial.
47
Neurodevelopmental and Neuropsychiatric Disorders
Mental Health of Children with Acquired Brain Injury
Investigator(s): Dr Fionna Bathgate, Ms Ana Cubillo, Dr. Teresa Lax-Pericall, Dr David
McCormick
Summary
Aim: This is a pilot project to explore the variables that influence a referral to Child &
Adolescent Mental Services (CAMHS) for children with Acquired Brain Injury (ABI). Our
first step was to compare the scores on the parent version of the Strengths and
Difficulties Questionnaire (SDQ, Goodman, 1999) for children with ABI referred and not
referred to CAMHS with those of a CAMHS clinic sample. The second step was to
examine the ABI children’s medical files to try and identify which factors influenced a
referral to a CAMHS.
Introduction: As many as 2.5% of children in the UK may have sustained a head injury
resulting in a visit to A & E (Middleton, 2001). The prevalence of emotional, behavioural
and cognitive difficulties following a head injury is high, particularly for moderate and
severe head injury (Rutter et al., 1983). Such children and their families may benefit
from a referral to CAMHS, but not all are referred. It is important to know what factors
influence a referral to CAMHS, e.g. severity of the physical, emotional, behavioural, or
cognitive sequelae, their perceived impact, or other factors (priority as perceived by the
referrer, complexity, parents demands, waiting lists, etc).
Methods: The SDQ is routinely used as an initial screening tool in CAMHS and is also
used in the Paediatric ABI Clinic at King’s College Hospital. Children attending the ABI
clinic were divided into two groups—referred (N=21) and non-referred to CAMHS
(N=21) and matched by age and gender. SDQ scores were compared to a matched
sample of children referred to CAMHS without neurological problems (N = 21).
Results: Kruskal Wallis analysis revealed no significant differences between the three
groups on any of the SDQ scores or category groupings. Similar numbers of children
were rated as having high levels of difficulties in all three groups across the SDQ
subscales. However, there was a trend for significant difference in the impact scale of the
SDQ, with ABI children referred to CAMHS having higher impact scores than those not
referred. From the data in the clinical notes children with ABI referred to CAMHS were
more likely to live with a lone parent and present with more behavioural problems at
follow-up than children with ABI not referred.
Discussion: This sample of children with ABI referred and non-referred to CAMHS has
similar levels of emotional and behavioural difficulties as children referred to CAMHS
without neurological problems, according to a screening questionnaire completed by
their parents—the SDQ. Many of the scores in the SDQ subscales are higher than would
be expected from the usual population, in all three groups, including impact scores.
This project suggests that reasons other than the level of emotional & behavioural
difficulties and their perceived impact influence a referral to CAMHS in ABI children.
Examination of the medical records in the ABI children has highlighted the influence of
psychosocial factors which may have a direct or indirect impact on a family’s ability to
cope with high levels of behavioural difficulties. Further exploration of the level of
parental distress would be a useful next step.
The findings may also highlight the fact that the SDQ is not sensitive enough in this
population to adequately discriminate between families who are coping with high levels
of difficulty and those who are not. This study is limited by the small sample size.
Funding: No funding was received for this project
State of progress: Completed
48
Neurodevelopmental and Neuropsychiatric Disorders
Hyperactivity and 22qDS (Velocardiaofacial Syndrome)- Atomoxetine (VCFSAtomoxetine)
Investigator(s): Professor Emily Simonoff, Professor Declan Murphy, Dr Eleni
Paliokosta, Dr Clodagh Murphy
Summary
Aims: The trial aims to examine if atomoxetine is associated with improvement in
attention, hyperactivity, and impulsivity in children with ADHD and VCFS and to
evaluate the rates and the types of adverse effects. This will help to determine whether
atomoxetine represents a second-line treatment option in this population.
Methods: This is an open label trial of atomoxetine lasting 16 weeks. Children are
randomised either to receive medication immediately or after 8 weeks. Atomoxetine is
commenced at a dose of 0.5 mg/kg every morning and gradually increased to 1.2
mg/kg/day provided adverse effects allow. Children who do not show an adequate
behavioural response at 8 weeks and where adverse effects are acceptable may try a
further dose of 1.4 mg/kg/day. Behavioural improvement will be evaluated by Conner’s
questionnaires to parents and teachers as well as the Clinical Global Impressions Scale.
Adverse effects will be monitored by questionnaires to parents, direct enquiry and
examination of the child.
Results and implications: The study is currently in the preparation stage. Patients
should benefit from the regular careful monitoring during the trial. Evidence of the
efficacy of atomoxetine and side effect profile is important to guide safe practice
regarding atomoxetine in this group.
Funding: The trial is funded by the Department of Health, under the project ‘crossing
the divide. Effective treatments for people with neurodevelopmental disorders across
the life span and intellectual ability’. There is no commercial interest.
State of Progress: Not Yet Started
49
Neurodevelopmental and Neuropsychiatric Disorders
Hyperactivity and Special Educational Needs-Atomoxetine (HSEN-Atomoxetine)
Investigator(s): Professor Emily Simonoff, Professor Declan Murphy, Dr Eleni
Paliokosta
Summary
Aims: The trial aims to examine if atomoxetine is associated with improvement in
attention, hyperactivity, and impulsivity in children with ADHD and intellectual
disability and to evaluate the rates and the types of adverse effects. This will help to
determine whether atomoxetine represents a second-line treatment option in this
population.
Methods: This is an open-label trial of atomoxetine lasting 16 weeks. Children who have
previously had a poor response to methylphenidate (including because of adverse
effects) are candidates for this trial and can be referred either by their current clinicians
or through review of children who previously participated in a trial of methylphenidate
for children with ADHD and intellectual disability (HSEN).
Children are randomised either to receive medication immediately or after 8 weeks.
Atomoxetine is commenced at a dose of 0.5 mg/kg every morning and gradually
increased to 1.2 mg/kg/day provided adverse effects allow. Children who do not show
an adequate behavioural response at 8 weeks and where adverse effects are acceptable
may try a further dose of 1.4 mg/kg/day. Behavioural improvement will be evaluated
by Conners questionnaires to parents and teachers as well as the Clinical Global
Impressions Scale. Adverse effects will be monitored by questionnaires to parents,
direct enquiry and examination of the child.
Results and implications: The study is currently ongoing. Patients should benefit from
regular careful monitoring during the trial. Evidence of the efficacy of atomoxetine and
side effect profile is important to guide safe practice regarding atomoxetine in this
group.
Funding: The trial is funded by the Department of Health, under the project ‘crossing
the divide. Effective treatments for people with neurodevelopmental disorders across
the life span and intellectual ability’. There is no commercial interest.
State of Progress: Ongoing
50
Neurodevelopmental and Neuropsychiatric Disorders
Autism and Complex Needs Intervention Support Team (ACIST)
Investigator(s): Dr Jo Young, Miss Jo Lawrence
Summary
The ACIST pilot project was established in May 2007 and ran until October 2008 to
assess the viability and effectiveness of a skilled team that would provide intensive
interventions to the families of young people with autism and SLD at home so that their
access to the community resources could improve. One of the main objectives was to
increase the success of local educational placements and reduce the need for out of
borough residential schools.
Aims: 1)To help parents/carers to understand and manage positively the young
persons challenging behaviour, in the context of autism, through functional assessment
of the behaviour carried out together with them and other involved professionals; 2) To
use shared, practical and consistent approaches across all settings within the support
system involved with the child; 3) For the young person to show sufficiently appropriate
behaviours to enable access to wider community facilities.
Outcome measures: A range of measures were used to gather baseline and post
intervention data, these were: The Challenging Behaviour Interview (CBI), Parents
Rating of (Behavioural ) Progress, Frequency and intensity of challenging behaviours,
Pre and post outcome scale, Parental Stress Index (PSI), The Strengths and Difficulties
Questionnaire (SDQ), The Parent/carer Satisfaction Questionnaire, and the Professional
Satisfaction Questionnaire.
Results: 1) There were no referrals for out-of-area residential placements from the
group compared to those who were not included in the project; 2) All of the young
people remained at home; 3) All of the young people remained in school and
experienced no exclusions; 4) All students were supported successfully into secondary
school; 5) Reduction of classroom support from 2:1 to 1:1 in one student; 6) One student
who had originally withdrawn himself from lessons and taken himself out of the
classroom, was able to return to the class and become fully included in all class
activities. A full copy of the evaluation is available on request.
The current ACIST service has been developed from the pilot project and evaluation and
is now established as a service for Lambeth children up to the age of 14 years. Key
performance indicators and activity data are reviewed on a monthly basis and this
information is provided to the steering group and to the Joint Commissioning Group.
Funding: £180,000 per annum
State of Progress: Ongoing
51
Psychotic Disorders
Psychosis and Epilepsy in Young People
Investigator(s): Dr M. T. Lax-Pericall, Professor Eric Taylor
Summary
Aims: To describe the characteristics of young people under 18 suffering from epilepsy
and psychosis.
To compare the characteristics of these children with children suffering from
schizophrenia
Results and Implications: 17 cases identified suffering from epilspy and psychosis.
Compared with the group suffering from schizophrenia the children with epilepsy and
psychosis had other neuropsychiatric conditions like learning disability and autism.
Psychosis and epilepsy in this group was not associated with mesial temporal sclerosis
nor with focal epilepsy.
Lax-Pericall, M.T., Taylor, E. (2010). Psychosis and epilepsy in young people. Epilepsy &
Behavior, 18 (4), 450-454.
Funding: None
State of Progress: Completed
52
Psychotic Disorders
A Pilot Study of the Feasibility of a CBT Manual Aimed at Improving Stress, Coping
and Resilience among 9 – 14 Year Olds Displaying Possible Antecedents of
Schizophrenia
Investigator(s): Dr Sophie Browning, Ms Karen Bracegirdle, Professor Sheilagh
Hodgins, Dr Kristin Laurens, Ms Suzanne Jolley, Dr Colette Hirsch, Professor Elizabeth
Kuipers, Dr Louisa Bravery
Summary
Aims: To develop and pilot a manualised CBT intervention designed to address
emotional difficulties and peer relationships, alongside improving skills for coping with
stress and unusual psychotic-like-experiences among 9-14 year old children displaying
the putative antecedents of schizophrenia (ASz).
Methods: The families of children identified at screening in earlier studies (Laurens et
al., 2007) as meeting criteria for ASz were contacted. Consenting children were screened
for current difficulties on the Strength and Difficulties Questionnaire (SDQ, Goodman et
al., 2001) and the Psychotic-Like-Experiences questionnaire (PLE, Laurens et al., 2007).
Those scoring in the clinical or borderline range on the SDQ emotional problems subscale were offered the intervention.
The intervention is a manualised CBT focusing on emotional and social difficulties and
on understanding and coping with psychotic experiences. The package draws on CBT
approaches demonstrated to be effective in children with anxiety, and incorporates
techniques for dealing with mood and peer relationships. Each session is customised
with age and task appropriate games and activities, with prizes. A designer and
illustrator (Andy Gault) was commissioned to develop visually appealing graphics and
handouts. An additional section ‘Top brain training’ has been adapted from similar
packages for adults, building on the work of Moritz and colleagues, and developments of
this by Garety and colleagues (Moritz & Woodward, 2006). It is designed to help
children understand and deal with unusual perceptual experiences or thoughts,
reasoning and problem solving biases, core beliefs and unhelpful thinking. The aim of
these sessions is to raise the child’s awareness of these possible distortions and help
them to reflect upon and alter them and improve their problem-solving. The children
completed up to 15 sessions, lasting 45 minutes each, with a clinical psychologist or CBT
therapist. The therapist and child completed measures of feasibility and acceptability
pre and post each session. The SDQ and PLE were also repeated at a mid point and at the
end of therapy.
Results and implications The manual has been developed and piloting begun. Three
children have so far completed the treatment sessions. Feedback from children and their
families has been very positive, and the therapy seems to be helpful (assessed by SDQ
and PLE). Next we aim to evaluate the intervention in a clinical setting (Tier 2 CAMHS).
Funding: BRC
State of Progress: Ongoing
53
Psychotic Disorders
Decision Making in Adolescent Psychosis
Investigator(s): Dr. Sukhi Shergill, Anne-Kathrin Fett
Summary
Background: Psychosis is associated with severe social dysfunction. Its core symptoms,
such as paranoia, are characterised by hostility and a fundamental loss of trust in others.
The impairment of basic trust has long been regarded as a primary deficit of the illness.
This may be especially important in adolescence, a critical period in the evolution of
social interactions and also peak age for the onset of psychosis. However, there has been
little research into the social interactive quality of psychotic symptoms.
Aim: To investigate the underlying mechanisms of disturbed interpersonal trust and
reciprocity in psychosis in adolescence.
Method: The project is comprised of two studies. Both studies (each N = 50) include
adolescent patients (13-18 yrs) with psychosis and healthy controls. The studies involve
the completion questionnaires, two subtests of the WISC, a detailled assessment of
symptoms and the completion of two computerised mentalising tasks. A multi-round
trust game is used to investigate the cognitive and neural mechanisms underlying
disturbed social cognition. Participants of the fMRI study play the trust game while
being scanned. The behavioural study involves playing the trust game on a laptop.
Results: Psychosis will be associated with reduced trust (lower investments), and a
reduced reciprocity (lack of increase in investment in response to cooperative
behaviour) at a behavioral level. At the neural level a reduced brain reward response
(lower sensitivity to social reward) in reaction to cooperative behavior will be visible
within the striatal and orbitofrontal cortex and the anterior insula.
Implications: This study will provide a better understanding of the symptom formation
and instantiation in adolescent psychosis. The findings may help to identify social
cognitive dysfunctions as risk markers for psychosis. Identifying the underlying
mechanisms of social dysfunction in early psychosis may pinpoint new treatment
targets for early intervention in order to prevent functional impairment.
Funding: Netherlands Organisation for Scientific Research
State of Progress: Ongoing
54
Families, Parenting and Development
Helping Children Achieve Study (HCA)
Investigator(s): Professor S. Scott, Professor K. Sylva, Professor M. Dadds, Dr C. Beckett,
Dr T. Ford, Dr M. Doolan, Dr A. Kallitsoglou, Dr J. Beecham, Dr M. Stateva, Miss A. Oppon,
Mrs A. Kember, Miss N. Newell, Mr S. Harry, Miss C. Powell, Miss S. Cartwright, Miss L.
Brownhill, Miss L. Hansford, Miss L. Hodge, Miss A. Lynes , Miss J. Minton, Miss H Eke
Summary
Behavioural and learning disorders in children tend to go hand-in-hand, however, little
is known about how treatments for behavioural difficulties affect children’s literacy, and
vice versa. This study is planned to disentangle possible effects by a four arm trial
comparing a behavioural programme, a reading programme, both combined, or neither.
The research evaluates the effectiveness of the interventions in two sites: one a
disadvantaged, multi-ethnic inner city population and the second a large military town
based in the south west of England.
Methods: Children at risk for long-term antisocial behaviour, and thus, for poor
academic outcomes and social exclusion are identified using school screens,
nominations from schools and self-referrals via newspaper advert. Detailed assessments
are repeated at three time points: before starting intervention, within 9-11 months of
pre-assessment and another a year later. There are also two additional reduced
assessments made during and immediately after the intervention to assess the factors
that change first.
Results and implications: In terms of policy and service development, the study utilises
a family-based approach to achieve aims , by finding out what works best, for whom,
how and why. The HCA trial has the potential to inform future provision of
comprehensive interventions for children with concurrent behavioural and literacy
problems across the country and internationally. The HCA study focuses on early
intervention to improve the life chances and opportunities of the most disadvantaged
and hard-to-reach in society.
Funding: Department for Education
State of Progress: Ongoing
55
Families, Parenting and Development
Study of Adolescents' Family Experiences (SAFE)
Investigator(s): Dr Sajid Humayun, Ms Melanie Chesnokov, Miss Lauren Herlitz, Miss
Amy Li, Miss Elizabeth Malpass, Miss Carrie Nakan
Summary
Aim: The Study of Adolescents' Family Experiences (SAFE) is the first randomised
controlled trial of Functional Family Therapy (FFT) within the UK. SAFE aims to
compare the effectiveness of FFT in reducing recidivism against the usual services
offered to young people in Brighton and Hove and West Sussex.
SAFE is a longitudinal study using a multi-method, multi-informant approach to assess
antisocial young people and their families. SAFE will identify how to work effectively
and cost-effectively with teenage antisocial behaviour and delinquency.
FFT is a family based intervention which is supported by over 30 years of clinical
research. There is strong evidence from the US that FFT can successfully reduce
recidivism rates, reduce out of home placements and the times spent by juvenile
offenders in institutions, and reduce offending in siblings of referred youth. FFT aims to
assist young people and their families to make meaningful changes in their functioning.
This is achieved by reducing negativity in the family and focusing on significant yet
obtainable behavioural changes that will have a lasting impact on the family.
Method: 100 families are being recruited through Brighton and Hove and West Sussex
Youth Offending Services, and other services in Brighton including Targeted Youth
Support Services, Family Intervention Project and Antisocial Behaviour and Parenting
Teams.
SAFE will obtain rich information on family relationships, parenting and adolescent
behaviour through accounts taken from both parents and young people, as well as
official records from school, offending services and other service provision. Measures
are taken at 4 time points: pre-randomisation, and 3, 6 and 18 months post
randomisation.
Different research techniques – including questionnaires, direct observations and
interviews – are used to assess a range of different factors including: antisocial
behaviour, parenting, family relationships, caregivers and young people’s mental heath,
young people’s behavioural development and the genetic underpinnings of conduct
problems. In addition to investigating re-offending in young people, the RCT will provide
a detailed health economics analysis in order to determine the cost-benefits of intensive
interventionists versus existing service provision.
Results and implications: Data collection is ongoing and preliminary results will begin
to be published in late 2010.
Funding: Department of Education
State of Progress: Ongoing
56
Families, Parenting and Development
Love, Eye Contact and the Developmental Origins of Empathy Versus Psychopathy
Investigator(s): Professor Mark Dadds, Dr Jennifer Allen, Mr Nathan Faulkner, Miss Kat
Legge, Miss Caroline Moul, Dr Bonamy Oliver, Miss Clare Chivers, Miss Charlotte
Wormald
Summary
Aims: A natural propensity to pay attention to and be interested in other people’s
emotions is a necessary condition for the development of empathy. We hypothesise that
a failure of this propensity is a core feature of psychopathy that begins early in life as a
failure to attend to core emotional features (viz., the eyes) of attachment figures. This
study used a novel ‘love’ scenario to test whether impaired eye contact and related
deficits in affection are characteristic of young children with oppositional-defiant
disorder (ODD) and callous-unemotional (CU) traits when sharing love with their
mothers.
Methods: ODD children, assessed on levels of CU traits, and a healthy control sample,
were observed in a love interaction with their mothers. Eye contact, and verbal and
physical affection levels were measured for each dyad (child to mother, mother to child).
Results: There were no differences in levels of verbal and physical affection and eye
contact expressed by mothers of healthy, ODD and ODD + CU traits children. Compared
to healthy controls, ODD children expressed lower levels of physical and verbal affection
back to their mothers; ODD children with high CU traits showed significantly lower
levels than ODD children with low CU traits. As predicted, ODD children with high CU
traits showed uniquely low levels of eye contact made toward mothers during the love
interaction.
Implications: The findings indicate that impairments in eye contact are uniquely
characteristic of young children with putative psychopathic traits, and these
impairments are independent of maternal behaviour.
Keywords: Psychopathy; conduct problems; eye contact; parent-child interactions
Funding: Department of Children, Schools and Families
State of Progress: Completed
57
Families, Parenting and Development
Parenting Programme Evaluation Tool (PPET)
Investigator(s): Dr Kirsten Asmussen, Dr Triin Edovald, Miss Maria Rizzo, Miss Hayley
Syrad, Ms Sally Hudson
Summary
Aims: The aim of the project is to evaluate the quality and effectiveness of parenting
programmes using the Parenting Programme Evaluation Tool (PPET). The quality
ratings based on the PPET are published on the Commissioning Toolkit that is a
searchable online database of parenting programmes, which aims to provide
commissioners with detailed information about the quality and content of parenting
programmes delivered in England. Developed by the Department for Education (DfE),
the Commissioning Toolkit responded to the needs identified by commissioners and
stakeholders for parents to be offered high quality interventions that have been
demonstrated to work and for a system to be in place that enables commissioners to
justify why they are spending money on one programme and not another.
Methods: On behalf of the Department for Education (DfE), King’s College has developed
an evaluation tool (PPET) using objective criteria for evaluating the quality of parenting
programmes. The tool allows evaluation to take place against best practice standards
demonstrated by well-known international programmes that have proven positive
outcomes. The evaluation tool considers four independent elements: 1. the specificity of
the target population and recruitment processes; 2. the quality of the programme’s
content, format and activities; 3. the quality of the programme’s training and
implementation support; and 4. evidence that the programme works. The PPET
provides a rating for each of the four elements using a scale of quality ratings ranging
from 4 to 0, with 4 meaning the programme meets all criteria within each element and a
0 meaning that no criteria were met.
Results and implications: The Commissioning Toolkit currently includes over 150
programmes of which over 100 have been evaluated by the PPET team since December
2008. The Commissioning Toolkit allows commissioners to make informed choices
about how suitable a particular programme may be in meeting the needs of specific
parents and improving specific outcomes for children. It also provides parents with
high-quality interventions which have been proven to work.
Funding: Department for Education
State of Progress: Ongoing
58
Families, Parenting and Development
High Need Families Project
Investigator(s): Dr Crispin Day, Dr Megan Ellis, Dr Lucy Harris, Dr Juan Moreno, Dr
Naina Gupta
Summary
Aim: To develop and test an innovative manualised parenting intervention (The Helping
Families Programme) for complex multi-stressed families with primary school aged
children who have severe and persistent conduct problems including frequent and
serious non-compliance, aggression, destructiveness and violation of social rules such as
lying and bullying.
Method: Initially, on behalf of the Department of Education (DfE), the National Academy
for Parenting Research (NAPR), Kings College, UK, has led an international research
collaboration involving the University of Queensland and Griffith University, Brisbane,
Australia to develop an innovative manualised parenting intervention for severly
marginalised families who have multiple risk factors across several domains including:
harmful substance use, interpersonal conflict with their child, partner, close family,
and/or school, inability to maintain a tolerant, stable, and regulated mood, lack of
supportive family/social networks and frequent family crises and events. The Helping
Families manual describes and guides the practitioner through core processes and
strategies. There are guidance notes’ detailing the processes used, including; Practice
Tools, Practice Fidelity Tools, Parent Tools and Session Tools. These are used by
practitioners to plan, implement, review, and assess the use and outcomes of the
Helping Families Programme.
A quasi-experimental case series with a small number of multi-stressed, complex, hard
to reach families using self report measures, was undertaken to test and develop the
manual and programme.
Following this initial development phase, the project has undertaken a quasiexperimental design in which outcomes of a group of children whose parents are
receiving the Helping Families Programme will be compared with those of a group of
similar children whose parents are receiving routine intervention and care. Parents
complete a Demographics Questionaire, Strengths and Difficulties Questionnaire (SDQ) –
Parent Report Version, Behaviour for Learning Questionaire at the beginning in the
middle and at the end of the intervention, Client Service Receipt Inventory- Adapted
(2009) at the beginning and the end, and a number of sessional measures (Goal
Attainment Scale, Outcome Rating Scale and Session rating Scale at six points
throughout the intervention. The target child's school complete a School Attendance
questionaire, Strengths and Difficulties Questionnaire – Teacher−Report Version and
Behaviour for Learning Questionnaire (BfLQ). Qualitative interviews with clients,
practitioners and service managers will be completed at completion of the 20 session
intervention.
Implications: This manualised programme aims to offer practitioners a clear, structured
but flexible method to work as effectively as possible with multi-stressed families who
have children with severe conduct problems and are at risk of being excluded or have
been excluded from their primary school. The Helping Families Programme manual is
based on a clear set of values, and on an explicit model of the intervention process and
uses a clear range of strategies for helping families to achieve their desired goals that
will reduce frequency and severity of child conduct problems, improve school
attendance and improve parenting behaviour, emotional regulation and attributions.
Funding: Department of Education
State of Progress: Ongoing
59
Families, Parenting and Development
Improving Access to Effective Mental Health Care for “Hard To Reach” Families: An
Evaluation of a Peer-Led Parenting Programme
Investigator(s): Dr Crispin Day, Dr Stacey Thomson, Dr Daniel Michelson
Summary
The efficacy of parent training approaches for the treatment of childhood behaviour
problems has been demonstrated in a large number of studies. However, such
interventions may be under-utilised in mainstream mental health services due to
difficulties in the recruitment, engagement, and retention of parents, particularly from
socially marginalised and excluded families. The Empowering Parents, Empowering
Communities (EPEC) programme was developed by SLaM clinicians in order to increase
access to effective parenting support by training parents as “peer facilitators” to deliver
high-quality parenting courses in their own communities.
Aim: To systematically evaluate the training and clinical outcomes of the EPEC
programme.
Method: Following an extensive pilot evaluation (Day et al., in preparation), a controlled
clinical trial (N=240) with nested RCT is currently underway in Southwark to examine
the effectiveness of the EPEC peer-led parenting intervention in improving child
behaviour, parental stress, and parenting skills. A qualitative arm of the research is also
looking at the processes, experiences, and outcomes of the programme for parents who
have been trained and supervised as peer facilitators (N=20).
Results: Interim results from the controlled trial suggest that parents who take part in
EPEC's "Being a Parent" groups report a significant reduction in the severity of childbehaviour problems, as well as reduced levels of parental stress and increased use of
positive parenting skills. Parents have also reported a very high level of satisfaction
with the groups, with high rates of retention (>80%) over the eight-week programme.
Implications: By the end of the research in March 2011, outcome data will have been
collected from more than 200 families. This will allow for robust analysis of outcomes
for parents and children from diverse backgrounds and with a range of needs. The
results will help to determine the feasibility of EPEC as a core component of provision
and support to families in Southwark, with further implications for the provision of
effective and acceptable parenting interventions nationally and internationally.
Funding: Guy's and St Thomas' Charitable Foundation
State of Progress: Ongoing
60
Families, Parenting and Development
Do Evidence-Based Interventions Work When Tested in the Real World? A
Systematic Review and Meta-Analysis of Parent Training for the Treatment of Child
Disruptive Behaviour
Investigator(s): Dr Daniel Michelson, Dr Crispin Day
Summary
Psychotherapy research involving youth populations has developed rapidly in recent
years, providing empirical support for a range of psychological treatments. However,
evidence-based interventions (EBIs) are typically unavailable in everyday clinical
settings. A key reason for this implementation gap may be the reluctance of
practitioners to adopt an EBI on the assumption that the evidence base does not reflect
real-world conditions.
Aim: To assess the clinical effectiveness of parent training interventions for the
treatment of children’s disruptive behaviour problems across different real-world
practice contexts.
Method: Randomised controlled trials were identified from a systematic search of
electronic bibliographic databases. A quantitative synthesis of child-behaviour outcomes
across trials was undertaken using meta-analysis. Planned subgroup analyses involved
comparisons between studies grouped according to individual real-world practice
criterion and total real-world practice criteria scores, reflecting the extent to which
parent training was delivered by non-specialist therapists, to a clinic-referred
population, in a routine setting, and as part of a routine service.
Results: 17 studies satisfied all inclusion criteria and reported comparable childbehaviour outcome data. Meta-analysis revealed significant trends across all studies
towards effectiveness of parent training programs compared with waitlist control
conditions. Subgroup analyses did not demonstrate significant differences in effect size
estimates according to the total number of real-world practice criteria met by studies or
by specific practice criterion score.
Implications: Parent training appears to be an effective treatment for children with
disruptive behaviour problems. There was no evidence that conducting parent training
in real-world practice contexts is a deterrent to achieving effective child outcomes.
Practitioners must carefully consider the specific applicability of parent training to a
given case, and not dismiss the results of research evidence due to presumed lack of
generalisability.
Funding: Guy's and St Thomas' Charitable Foundation
State of Progress: Completed
61
Families, Parenting and Development
Meeting the Needs of Families Affected By Parental Mental Illness: An EvidenceBased Audit of Service Provision in Adult Inpatient Mental Health Services
Investigator(s): Dr Stacey Thomson, Dr Daniel Michelson, Dr Crispin Day
Summary
While the negative impacts of parental mental illness on child outcomes have been
widely investigated, much less is known about effective healthcare strategies for
meeting the needs of affected families. Where guidance does exist, such as the recently
published "Think Child, Think Parent, Think Family: A Guide to Parental Mental Health
and Child Welfare" (Social Care Institute for Excellence, 2009), recommendations have
primarily focused on improving interagency working rather than specific clinical
interventions or assessment procedures. Hence, there is a pressing need for quality
standards to evaluate and inform more effective clinical care for families affected by
parental mental health problems.
Aim: To develop and pilot an evidence-based audit tool for use in examining current
practice in adult mental health services for inpatients with dependent children
Method: A systematic review and narrative synthesis were undertaken for intervention
outcome studies specifically focused on the emotional and practical needs of children
with mentally ill parents, and/or the needs of a mentally ill parent in relation to his/her
parenting role. Following from this review and synthesis, an audit tool was constructed
to determine the extent to which evidence-based approaches had been used to support
dependent children and their parents in adult inpatient mental health services.
Results: The systematic review provided evidence for six broad categories of
intervention, including those focused on: (1) mental health care needs of children; (2)
social care needs of children; (3) parenting skills and competencies; (4) strengthening
other family relationships; (5) crisis management; and (6) coping and resilience of
children. A subsequent audit revealed inconsistent care planning around these domains,
with support primarily focused on children's social care needs.
Implications: Additional work is needed to ensure that the needs of families affected by
mental illness are considered and met. This requires more structured and systematic
assessment of family needs by adult mental health staff, which may be supported by
interagency working with professionals in CAMHS and social services.
Funding: CAMHS Directorate, SLaM NHS Foundation Trust
State of Progress: Completed
62
Families, Parenting and Development
Factors Influencing Parenting Groups: Clinicians’ Perspectives
Investigator: Professor Ivan Eisler, Ms Margaret Kirkum
Summary:
This study explores the experiences and perceptions of clinicians co-facilitating
parenting groups in a CAMHS (Child & Adolescent Mental Health Service) setting and
what they consider to be the most influencing factors in the outcomes of the groups.
Nine semi-structured interviews were conducted, paying attention to process and
practice. The study employed a qualitative design and used Thematic Analysis. The
results show that CAMHS clinicians view their role as an expansive one, highlighting
what a complex process it can be to run the groups and the need for this to be
recognised by colleagues and management alike. Working in the groups can be an
extremely effective way in developing collaborative solutions and new understandings,
with parents, clinicians, co-workers and referrers.
Four main themes were identified: Context, Role of the Clinician, Referral Process, and
Collaborative Working. From the themes, it was evident how the clinicians paid
attention to the multi layered contextual influences surrounding the parents who attend
the groups, their children, and referrers. They showed how they can work across
systems with multiple relationships, from management, to the referrer, to the referred,
to the wider systems, including the family, other professionals involved, as well as the
school and community. In this, they demonstrated a truly “circular” process. The
constraints of working in this way were also discussed by participants, including
balancing the time for the groups with the pressures of day to day clinical work.
The study concludes with recommendations for clinical practice including a suggestion
for a lead role within the service, which would mean taking overall responsibility of coordinating the groups, as well as keeping up to date with research and current evidence
and thinking; then being able to translate this into practice through offering training and
work-shops.
Funding: N/A. Researcher carried out the interviews in her own time and as part of her
MSc in Systemic Therapy.
State of Progress: Completed
63
Families, Parenting and Development
Disordered Eating Behaviours among Mothers-To-Be: A Study on Eating
Disturbances during Pregnancy
Investigator(s): Dr Emma Taborelli, Ms Abigale Easter, Dr Nadia Micali
Summary
Although Anorexia Nervosa (AN) and Bulimia Nervosa (AN) incidence is rather low
(from 1-3% for BN, 0.3% for AN) compared to other psychiatric disorders, recent
studies have highlighted how sub-clinical disordered eating behaviours can be found in
many individuals. Partial eating disorder (ED) syndromes have been reported to occur
between 3% and 5% in the normal population. Although some studies reported that ED
symptoms tend to decrease during pregnancy, only few studies have been focused on
detecting how disturbed eating patterns can modify during pregnancy.
Aims: to investigate disordered eating behaviours in pregnant women, given the
importance of nutritive factors on the pregnancy’s outcomes.
Methods: a modified version of Eating Disorder Diagnostic Scale (EDDS) has been
administered to 212 pregnant women due to perform their first scan at 12 weeks.
Results: None of the participants met the criteria of AN or BN. Despite of that, looking at
the previous 6 months, 27 women ( 12.7 % ) had recognised that weight influenced their
way to perceive themselves, while 21 (9 %) reported that their shape had a great
importance in their self-esteem. 47 women (22.16 % ) referred having binging
behaviours in the last 6 months. Looking at the last 3 months, 3 women (1.4%) admitted
having vomited to prevent weight gain or counteract the effects of eating, one (0.47%)
used diuretics, 2 (0.94%) fasted, one (0.47%) engaged in excessive exercise.
Conclusion: the findings seem to indicate that disordered eating behaviours and
concern for shape and weight persist during pregnancy, although modified. Clinical and
theoretical implications will be discussed.
Funding: National Institute for Health Research
State of Progress: Ongoing
64
Families, Parenting and Development
The Economics of Parenting Programmes
Investigator(s): Professor Jeni Beecham, Ms Madeleine Stevens, Ms Annette Bauer, Ms
Ruth Puig-Peiro
Summary
The Economics component of the NAPR programme is being carried out by researchers
at the Personal Social Services Research Unit at the London School of Economics and
Political Science http://www.lse.ac.uk/collections/PSSRU/
Aims:
1. Assess cost-effectiveness of the interventions evaluated by NAPR in the Helping
Children Achieve (HCA) and Study of Adolescents’ Experiences (SAFE) trials.
2. Review existing research relating to the economics of parenting programmes and
develop models of the possible longer-term outcomes and costs of these programmes.
3. Using the descriptions in the Commissioning Toolkit of Parenting Programmes,
estimate the costs of more than 100 programmes and explore the variation in costs.
4. Feed into other aspects of the NAPR research programme, including exploring the cost
and cost-effectiveness of parenting programmes for foster carers or families with high
needs and assessing the extent to which a cost-effectiveness analysis can be added to
existing follow-up studies.
5. Consider ways in which the above UK-based information can help commissioners take
decisions about the most suitable suite of programmes given the needs of their
population and their resource constraints.
Methods:
1. Development of instruments and methods for use in cost-effectiveness evaluations of
parenting programmes.
2. Literature reviews on different aspects of the economics of parenting programmes.
3. Estimation of costs and statistical modelling of the cost variations
4. Decision modelling to arrive at improved UK-based estimates of the longer-term
outcomes and costs of parenting programmes.
Outputs: Reports and papers on the above components. These will contribute to the UK
evidence base on the economics of parenting programmes, providing information on the
costs and benefits of investment in parenting interventions, and of different approaches,
for government and local commissioners.
Funding: Department for Education
State of progress: Ongoing
65
Families, Parenting and Development
Understanding How Practitioner Characteristics Influence Family Outcomes
Through The Delivery Of Evidence-Based Parenting Groups
Investigator(s): Dr Kirsten Asmussen, Dr Moira Doolan, Dr Neda Bebiroglu, Miss Katey
Weizel, Mr Timothy Matthews, Miss Hayley Syrad
Summary
This study will investigate two related research questions: 1) to what extent do
practitioners' knowledge of parenting practice and their qualifications interact with
programme models to improve family-level outcomes?; and 2) to what extent does
practitioner skill in the delivery of parenting groups impact parent and child outcomes?
In order to investigate the first question, we will compare the parent and child outcomes
of families attending one of four evidence-based parenting programmes: Incredible
Years (IY), Triple P, Strengthening Families/Strengthening Communities (SFSC) and
Strengthening Families (SF) 10-14. IY and Triple P assume a bachelor's qualification in a
helping profession for program delivery, whereas SF 10 - 14 and SFSC do not. Data
collected from the National Academy for Parenting Practitioners training offer suggests
that less than a third of those delivering Triple P or IY has a bachelor's qualification or
higher in a helping profession. A key aim of this study is to understand the extent to
which professional qualifications influence the outcomes of parents attending these
parent training programs. The study will also consider the extent to which child
outcomes are linked to practitioner qualifications in the SFSC and SF 10- 14 models. 400
practitioners (100 from each programme model) will be recruited to the study. Parents
will be recruited on the basis of their participation in a parenting course run by each of
the recruited practitioners, with the aim of reaching 3200 parents. Practitioners will be
asked to complete questionnaires involving their knowledge of child development and
the program fidelity. Parent participents will provide demographic information, and
complete the Strengths and Difficulties Questionnaire (Goodman et al, 2000) and the
Alabama Parenting Questionnaire (Elgar et al, 2007). Multivariate analyses will be used
to consider the extent to which practitioner qualifications, knowledge, and fidelity
intereact to predict improved outcomes for parents and children. To investigate the
second question, the research team will code video-tapes of practitioners delivering the
IY program, which are required as part of the IY certification process. 100 practitioners
with a target of 800 parents will be recruited to participate in this segment of the study.
Videos of practitioners will be coded with the Leader Observation Tool (Eames et al,
2008). Multi-level analytic strategies will be used to consider the extent to which
practitioner skill and other characteristics (qualifications, knowledge and programme
fidelity) interact with agency-level variables, programme model, and family
demographics to predict improved parent and child outcomes.
Funding: Department for Education through the National Academy for Parenting
Research
State of Progress: Not Yet Started
66
Families, Parenting and Development
Understanding The Effectiveness of Training and Dissemination of Evidence-Based
Parenting Programmes
Investigator(s): Dr Kirsten Asmussen, Dr Neda Bebiroglu, Miss Katey Weizel, Mr Tim
Matthews
Summary
Research consistently suggests that evidence-based parenting support, delivered by
appropriately trained and supervised practitioners, reliably improves developmental
outcomes for children. Research also suggests that when implemented properly,
evidence-based parenting programmes can achieve community-wide cost-benefits in
terms of reductions in anti-social behaviour and substance misuse, as well as increases
in school achievement. Proper implementation is contingent upon a number of factors,
however, including practitioner qualifications and agency-level support. The National
Academy for Parenting Practitioners (NAPP) was established in 2007 to transform the
size and quality of the parenting workforce so that evidence-based parenting
programmes could be made available to families who need them across England. This
study considers how practitioner-level and agency-level factors contribute to the
successful implementation of a parenting group within six months of training through
the NAPP evidence-based training offer.
The primary aim of NAPP’s training evaluation was to understand factors affecting the
impact of the evidence-based training programme as it was rolled out so that
improvements could be made on an ongoing basis. Practitioners attending NAPP
training were tracked by a web-based monitoring system developed to provide ‘realtime’ information on the progress of the training offer. Information gathered included
the numbers trained, their qualifications and skills, whether or not they implemented a
group, the numbers of parents attending their groups and barriers to successful group
implementation.
Evaluation findings are available for the first three phases of training roll-out (December
2008- August 2009). Of 1473 practitioners contacted to take part in the follow-up
evaluation, 1075, or 73%, completed the questionnaire. Take-up of training was
significantly related to Local Authorities having a Parenting Expert in post. The majority
of practitioners (92%) attending training were highly satisfied with the experience.
Results show that 39% of those attending training implemented a parenting group
within 6 months and 52% believed that the training had influenced their work with
families regardless of whether they had delivered a programme or not. Findings also
show that those employed as a Parenting Expert were signficantly more likely to deliver
a parenting group than those in other practitioner roles. Also, high agency support,
including time to set up and deliver groups, significantly improved the likelihood of
parent group implementation.
The evaluation of NAPP training is ongoing and future assessments will consider the last
phase of training as well as 12-month follow-up results from all training phases.
Funding: Department for Education through the National Academy for Parenting
Research
State of Progress: Ongoing
67
Families, Parenting and Development
Evidence Based Measurement of Parenting
Investigator(s): Dr Matt Woolgar, Dr Shona Falconer, Ms Claire Powell, Mr Warren
Leaver, Ms Lauren Herlitz
Summary
Aims: We have various ways of assessing children’s problems but there is a lack of wellvalidated measures for assessing the quality of parenting. This is a problem as
interventions for improving children’s behaviour work by improving parenting. This
project aims to translate evidence from the latest research on parenting quality into
formats that can be readily used by practitioners, and then to make these measures
available. The aim is to ensure that they are user-friendly, relevant, brief, easy to use
with minimal training, and that they are entirely evidence based. In this way,
practitioners will be able to assess the impact of parenting interventions upon parenting
quality directly, i.e., not simply inferring their impact from changes in children’s
behaviour. These measures will assess the mechanism of change that lie behind
successful interventions and will also provide practitioners with information about the
possible barriers to effective change, offering the opportunity to identify and address
these barriers.
Methods: This project has designed two news measures for key mechanisms previously
shown to drive improvements in parenting behaviour but which may also act as barriers
to effective engagement in, and response to, parenting programs. The first of these,
parental agency, assesses parents’ beliefs that they have the capacity to bring about
change in their child’s behaviour. This construct is being measured using a new five item
self-report questionnaire. The second construct, parental attributions, assesses parents’
beliefs about the causes of their children’s behaviour. This construct is being assessed
using a brief semi-structured interview with the parents, which takes no more than 10
minutes to complete. These measures are being validated across four studies
investigating parenting programs for children and young people, spanning an age range
from 4 years to late teens.
Results: Data on these measures has now been collected for approximately 200 families,
at the pre-treatment stage. This information is being used to validate the new measures
in clinical samples from primary school-age to late teens. Both measures have been
shown to correlate well with existing measures of similar constructs and there is further
evidence of discriminant validity for both measures. The use of treatment studies
permits the exploration of whether these two dimensions of parenting can be thought of
as mediators or moderators of child behavioural outcomes, and the analysis of this is
currently on-going within the distinct programs.
Funding: Department for Education
State of Progress: Ongoing
68
Families, Parenting and Development
GP Universal Perinatal Intervention Promoting Secure Attachment
Investigator(s): Dr Richard Neal, Ms Sue Conroy
Summary
Aims: The aim of the project is to develop and evaluate much needed neonatal
interventions that promote child mental health using attachment as a model.
Interventions are aimed to be deliverable during routine perinatal contacts by primary
care workers with minimal extra resources.
Methods: Currently evaluating an ongoing innovative intervention during GP contacts
with new mothers at 2 and 6 weeks. A cognitive approach promoting knowledge of
outcomes of different care patterns, infant carrying, sensitive parenting, and tackling
common "spoiling" reservations.
a) Survey of practice of, and attitudes to infant carrying aids
b) Collection of contemporaneous data on carrying and spoiling attitudes
c) Retrospective survey of infant care practices, including carrying aids,
matched with socio-economic data
Results: a) Infant carriers available and commonly owned. Usage mostly for journeys
outside home in early weeks. Possession, ownership and use related to
socio-economic and ethnic status.
b) Significant increase by 2nd visit in reported infant carrying and decrease in
spoiling concerns - across all subgroups.
c) Retrospective recall of infant carrier use shows sharp divide. The mature,
educated and financially secure showed significant change in practice
compared to informal controls. The young, poor and of lower educational
achievement did not show a change.
Implications: This provisional data is insufficient to judge the value of the intervention.
It supports the view that the intervention is of value, but does highlight that those most
in need of intervention may be more difficult to help. A more complete assessment
would include:- objective measure of any shift in parenting attitudes; parenting
sensitivity measured at age one year (correlating with infant attachment outcomes); use
of better matched controls; longer term assessment of child and parent outcomes;
consideration of alternative evidence based interventions to compare. These are the
subjects of a bid in preparation.
Funding: Currently unfunded
State of Progress: Ongoing
69
Families, Parenting and Development
Child Health and Development Study (CHADS)
Investigator(s): Dr Kristin R. Laurens, Miss Hannah Dickson, Miss Alexis E. Cullen, Dr
Gisela Sugranyes, Professor Eric A. Taylor, Professor Sheilagh Hodgins, Professor
Barbara Maughan, Professor Robin M. Murray, and the CHADS research team
Summary
Aims: To determine biological and psychosocial mechanisms operating during
childhood and adolescence that give rise to mental health or illness among children who
present different levels of risk for developing schizophrenia. The longitudinal phase of
the study aims to differentiate distinct developmental trajectories to schizophrenia in
at-risk children.
Methods: The project includes children aged 9-12 years at baseline assessment,
recruited from primary schools located within the Greater London area. Children
complete questionnaires in class, and caregivers complete questionnaires at home and
return them by mail. A subsample of these participants undergo a comprehensive
assessment including psychosocial and biological measures (structural and functional
neuroimaging, event related potential techniques, assessment of hypothalamo-pituitaryadrenal axis, and buccal swab/blood samples, etc.), and are followed-up biennially.
Children are classified into three groups according to symptomatology and family
history. The Antecedent High Risk group includes children presenting a triad of putative
antecedents of schizophrenia, namely: (i) psychotic-like experiences [PLEs]; (ii) a
speech/motor development delay or abnormality; and (iii) a social, emotional, or
behavioural problem. The Genetic High Risk group encompasses children who have at
least one first degree relative or two second degree relatives with a psychotic disorder.
The Low Risk group is composed by typically developing children presenting none of the
above features.
Results: Data from 1,347 child and caregiver dyads in the community indicate that 9.5%
(13.2% boys, 6.1% girls) present the antecedent triad. Among these, 69% report
experiencing distress or impairment associated with PLEs. Based on cross-sectional data
from baseline assessments (comparing AHR and LR children), we have established that
AHR children already present clinical and epidemiological features that characterise
patients with schizophrenia.
Implications: These children may constitute a new population to which target
preventive interventions for schizophrenia. Longitudinal follow-up of the sample will
allow us to determine the stability of the current findings, and to determine the extent to
which these represent general vulnerability to psychopathology or confer specific risk
for schizophrenia.
Funding: National Institute for Health Research (Career Development and Postdoctoral
Fellowships), BIAL Foundation, British Medical Association, NARSAD, Psychiatry
Research Trust, NIHR Specialist Biomedical Research Centre in Mental Health at
KCL/SLaM. Dr Gisela Sugranyes is funded by an Alicia Koplowitz Foundation Grant.
State of Progress: Ongoing
70
Looked After Children
Strengthening Foster Placements for Looked After Children: Development of an
Evidence-Based Tool for Assessment and Care Planning in Local Authority Services
Investigator(s): Mr Stephen Rock, Dr Stacey Thomson, Dr Daniel Michelson, Dr Crispin
Day
Summary
Ensuring the stability of foster placements for looked after children (LACs) is a high
priority for mental health and social services. While a number of previous research
studies have highlighted the deleterious psychological, social and educational
consequences of placement breakdown for fostered children, far less is known about
how services can promote more stable placements as part of routine practice.
Aim: To develop an evidence-based tool for use in assessment and care planning with
LACs in local authority services.
Method: (1) Systematic review and narrative synthesis of factors affecting the stability
of foster placements. Qualitative studies were included alongside quantitative research
in order to gain further insights into the processes that facilitate and impede placement
stability. (2) Following from this review and synthesis, an audit tool was constructed to
examine the extent to which putative stability factors were assessed and acted upon by
social workers. (3) A focus group and individual consultations were carried out with
social workers and mental health staff in order to validate findings from the review and
audit, and generate ideas for how to use this information to improve practice.
Results: The systematic review provided evidence for six broad categories of
risk/protective factors for foster placement stability (child, birth parent, social worker,
carer, relationship, placement). A subsequent audit of local authority case files revealed
inconsistent identification and care planning around key stability factors in routine
practice with LACs. Consultations with professional stakeholders led to the development
of a checklist and accompanying guidance notes to enable more structured,
comprehensive and evidence-based assessments of foster placement stability at critical
points in the care process.
Implications: After successfully piloting the checklist and guidance with a team of social
workers in Lambeth, senior local authority managers are considering routine
implementation. Though its effectiveness has yet to be established, the checklist
provides social workers with a systematic method for assessing and enhancing the
stability of foster placements, bridging a significant gap between policy and frontline
practice. An outcome-orientated evaluation of the checklist's effectiveness would be a
logical next step.
Funding: CAMHS Directorate, SLaM NHS Foundation Trust
State of Progress: Completed
71
Looked After Children
Fostering Changes Training Centre
Investigator(s): Ms Karen Bachmann, Ms Kathy Blackeby, Ms Kirsty Slack, Mrs Caroline
Bengo
Summary
Aims: The aim of this project is to deliver a national rollout of the Fostering Changes
Programme via the delivery of a Facilitators Course. 155 Local Authorities in England
will be trained to deliver their own Fostering Changes Programme.
The Fostering Changes Programme is behaviourally based and derives from research
into parenting skills, attachment; educational attainment and the academic progression
of looked after children who are in foster care.
The project targets Social Workers, Psychiatrists, and Psychologists who work with
looked after children in foster care to attend the Facilitators Course. A total of 20
courses and 6 consultations sessions are to be delivered across the regions.
Methods: A customised project methodology derived from Prince2 was devised and
utilised which defined the project according to five phases: planning and research,
design and development, publicity and promotion, training delivery and evaluation. The
project commenced in January 2009 and is due for completion in March 2011.
The recruitment strategy reflected the highly relationship based nature of the industry
utilising direct telephone contact with the 155 LA's with follow up emails and brochures
containing course information along with a dedicated website.
Results and Implications: To August 2010, 46% of the 155 LA's have been trained, and
53% of these have gone on to deliver their own Fostering Changes Programme. An
additional 32% have indicated that they will deliver the Fostering Changes Programme,
but have no set date. The project is on track to train over 80% of the 155 LA's by March
2011.
The overall evaluation of the course by participants is good to excellent. The majority of
participants indicate that they have good levels of confidence to deliver the programme
and that the course would benefit the way in which they work with carers.
Carers indicate that the Fostering Changes Programme assists them enormously with
practical skills to manage their placements. It has been shown to improve the behaviour
of looked after children and reduce stress levels of carers.
An RCT is currently being conducted across 4 LA's to determine the full impact and
benefits to carers. Results are due in 2011.
Funding: DfE
State of Progress: Ongoing
72
Looked After Children
Multidimensional Treatment Foster Care -England (MTFCE)
Investigator(s): Ms Rosemarie Roberts, Ms Megan Jones, MS Cath Connolly, Ms Diana
Cooke, Ms Alison Nash
Summary
Aims: The MTFC model, developed at the Oregon Social Learning Center (OSLC) in the
USA, has a strong evidence base including a number of randomised trials in the US and
europe. The MTFCE National Implementation team was set up by the Department for
Education (DfE) in 2003 to support the development of the government pilots of the
MTFC models for children in the care system between the ages of 3 and 16+ years with
complex needs. The national team, under a network partnership agreement with OSLC,
provides consultancy, training and support to local social services teams across the UK,
in partnership with their local CAMHS and education departments, to set up and run the
MTFC programmes. The team also monitors the quality and fidelity of the intervention
and outcomes for children and young people.
Methods: Comprehensive audit data is collected on each child or young person coming
into MTFC, including standardised measures (e.g. SDQ, WISC/WPPSI, CBCL), high risk
behaviours, family and abuse history, developmental and educational difficulties, and
placement breakdowns. Data is collected pre-placement and at 12 months or on leaving
the programme. Data is also being collected on foster carers experience of MTFC and
research is being conducted into what makes a good MTFC carer.
Results and implications: An annual report is produced for the DfE which reports on
progress and outcomes of the different programmes and the lessons learned from the
national pilot sites. The MTFCE programmes have been found to be helpful in reducing
risk behaviours for adolescents and improving conduct problems, social and emotional
functioning and placement stability for all ages. Significant improvements in functioning
and reductions in severity of behavioural difficulties have been noted. For the younger
children placement stability (i.e return home to birth or extended family, adoption or
remaining with their MTFC carers) has been increased. Programme sites adherence and
fidelity to the model has been shown to be significantly related to positive outcomes.
Consideration is currently being given to the possibility of a wider national roll out of
the programmes.
Funding: Department for Education (DfE)
State of Progress: Ongoing
73
Looked After Children
A Randomised Controlled Trial of the Fostering Changes Programme
Investigators: Ms Jackie Briskman, Mrs Caroline Bengo, Miss Kathy Blackeby, Mrs
Kirsty Slack, Mrs Jenny Castle, Miss Clare Stebbens, Mr Warren Leaver, Miss Karin
Kuhlmann
Summary
Aims: The aim of the project is to evaluate the quality and effectiveness of a group
programme for foster carers. The Fostering Changes programme was set up in 1999 in
response to an urgent need to provide carers with practical advice and strategies for
managing difficult and challenging behaviour, using a cognitive behavioural approach to
help them to develop their skills. The first manual for the course was published by the
British Agencies for Adopting and Fostering (BAAF) in 2005, entitled “Fostering
changes: How to Improve Relationships and Manage Difficult Behaviour. A Training
Programme for Foster Carers. (Pallett et al 2005).
Methods: On behalf of the Department for Education (DfE), King’s College has
undertaken a major revision of the programme in order to address additional needs that
had emerged in previous trials. The revised programme places greater emphasis on
empowering carers to access better educational opportunities for looked-after children,
and on recognising and coping with the impact that attachment problems have on
behaviour. The manual has now been re-written and is in the final stages of editing. It
will be published in 2011 by BAAF (British Association for Adoption and Fostering).
The Fostering Changes team are currently running a randomised controlled trial of the
revised programme, involving four local authorities in and around London.
Implications for the future: The result of the Fostering Changes RCT will show the
extent to which short-term outcomes for fostered children can be improved by groupbased training. Improvements in the behaviour of looked after children and in the
relationships between carers and children have been found to be strong predictors of
placement stability which in turn predict improved outcomes for looked-after children
(Pecora 2010). Potential cost savings to society from secure foster placements far
outweigh the costs of providing effective evidence-based support and training to meet
the needs of foster carers.
Funding: Department for Education
State of Progress: Ongoing
74
Looked After Children
Emotional / Mental Health Screening Study - Southwark Looked After Children 0-4
Years
Investigator(s): Ms Carol Hardy, Ms Lizzie Hackett.
Summary
Aims: The aim of this study is to identify early social and emotional difficulties in young
children, aged 0-4 years, who become looked after by Southwark Children’s Services.
There is strong evidence that 70-80 % of children entering care have extensive needs
that require skilled professional help (Ward 2008). The project plans to screen all young
children entering care within a 12 month period. We are asking foster carers and birth
parents to complete a standardised screening questionnaire at the child’s initial health
assessment, and will consider the information in the context of the child’s general
development. (SEGC;Greenspan,2004 or ASQ-SE;Squires,2003). The second part of the
screening involves carrying out a home observation of the child’s interaction and play
with their carer.
We will formulate a profile of the child’s social-emotional development and share
information from the screening with professionals across the network of health and
social care, with the aim of positively informing and influencing the care planning for the
child. In addition we will deliver a short intervention of foster carer support/advice to
focus on the children highlighted as having specific needs. We also want to improve
access to CAMHS for children with more significant mental health difficulties who
remain looked after and signpost children to appropriate community services if they are
returning home to their birth family.
We will evaluate the uptake of the screening and utility of the service by collating
feedback from foster carers, paediatricians and social workers from Cla, Adoption and
Fostering, Assessment and Safeguarding, and Family Support teams.
In addition the project will provide specific data on the number and types of social and
emotional difficulties among children under 5 who are looked after in Southwark which
could be used to inform future staff training programmes and service development.
Funding: Guys and St Thomas's Charity
State of Progress: Ongoing
75
Looked After Children
A Study Exploring Family Experience of Out-Patient CAMHS Treatment
Investigator(s): Ms Esther Blessitt
Summary
Aims: How adolescents experience the processes of assessment and treatment in
CAMHS when a parent is involved in these processes.
The corresponding experience of parents of adolescents referred to the CAMHS service
when they are involved in these processes.
The competing or complimentary concerns arising from this whole family approach.
What can be learned from these clients’ experiences that might be helpful for CAMHS
clinicians and trainees of all associated disciplines; the implications for practice?
Methods: 4 focus group discussions were held; 2 focus groups of adolescents and 2 of
parents of young people in treatment in the CAMHS clinic.
Focus group discussions were transcribed verbatim and the resulting data was analysed
using a thematic analysis.
Over arching themes were identified and grouped into categories for further analysis.
Results and implications: The results suggest that adolescents in the study felt well
supported in their treatment by CAMHS clinicians, who were perceived by the young
people as collaborative and responsive to their individual needs. Adolescents also felt
that, whilst they had some reservations about the involvement of their parents in the
treatment, this was nevertheless an important part of the process. Parents, despite
regular inclusion in treatment sessions, perceived CAMHS as an organisation focused on
the individual needs of the child, rather than parents. Parental involvement in treatment
sessions was experienced by parent participants as “sitting in on”, rather than being a
part of, the treatment process. Furthermore, parents suggest that they are not
sufficiently supported by CAMHS clinicians; they feel that they lack general advice
regarding mental illness in adolescents and lack individual information relating
specifically to their child.
This study might highlight the need for systemic training for CAMHS staff and for
psychoeducation to be offered more frequently to families attending the service. This
may result in parents and carers feeling better equipped to manage their unwell child
which, in turn is likely to have a positive impact on recovery. This hypothesis could be
tested by similar research being carried out in CAMHS clinics where patients and
parents have experienced a systemic intervention and/or formal psychoeducation.
Funding: Completed as part of the Masters in Family Therapy at KCL/IOP
State of Progress: Completed
76
Looked After Children
Child and Adolescent Service Experience (ChASE): Measuring Service Quality and
Process
Investigator(s): Dr Crispin Day, Dr Daniel Michelson
Summary
Dissatisfaction with health services is associated with patient/clinician disagreements
over the nature of health needs, reasons for referral, intervention goals, early treatment
termination and poorer outcomes.
Aim: To develop a straightforward, reliable and accurate method of eliciting service
experiences within child and adolescent mental health care.
Method: This project has used a mixed-method, participative design. An initial
qualitative study was undertaken to identify children and young people's priorities in
relation to their mental health service experience (Day et al., 2006). CAMHS service
users were then involved in working with the research team to develop the ChASE, a
tool to measure children and young people’s service experience. A subsequent study
using a non-experimental, cross-sectional design has examined the psychometric
properties of the tool.The participants were 132 mental health service users aged 9-17.
The participants and their main carer completed the ChASE, Parent Satisfaction
Questionnaire and SDQ Impact Supplement. Clinicians completed the SDQ Impact
Supplement and provided clinical activity data. A subsample of participants completed
the ChASE on a second occasion, six weeks after the completion of the first
questionnaire. Scrutiny of ChASE data indicated high levels of completion. Principal axis
factoring identified three factors within the ChASE: Relationship, Privacy and Session
Activity. A factor structure that has been verified in a subsequent study. The ChASE has
good internal consistency and test-retest reliability. Significant correlations were found
between the ChASE and carer satisfaction, service use and youth clinical outcomes.
Implication: The ChASE is a short, psychometrically robust tool for routine
measurement of children and young people’s experience of mental health services which
users can complete easily. The results underline the importance of alliance factors to
children and young people and their association with clinical improvement, as well as
the potential for the ChASE to be used a measure of children’s therapeutic progress and
alliance. The ChASE is now being used routinely in SLaM CAMHS services as well as
other Trusts across the UK. Further research is planned to develop methods for
benchmarking ChASE to improve service experience in CAMHS and an in-patient version
of the tool.
Funding: Guy's and St Thomas' Charitable Foundation
State of Progress: Completed
77
Looked After Children
Using the Children and Adolescent Service Experience (ChASE) Questionnaire to
Generate Service Improvements: How do CAMHS Practitioners Engage with Service
User Feedback?
Investigator(s): Dr Crispin Day, Dr Daniel Michelson
Summary
Aim: To investigate the effects of user feedback on clinical practice and service
provision.
Method: A qualitative study examined how feedback from the ChASE may be used by
individual practitioners and services. Anonymised scores from the ChASE were provided
to 13 CAMHS practitioners, who were then interviewed about their views on receiving
this feedback and the implications for their own practice and wider clinical services.
Interviews were transcribed and subjected to thematic analysis.
Results: Five main themes were identified: (1) emotional responses, where clinicians
variously expressed pleasure, reassurance, and anxiety in response to receiving ChASE
feedback; (2) attempts made by clinicians to contextualise feedback in terms of child,
family and service characteristics outside their direct control; (3) implications of
feedback for clinicians’ own practice; (4) implications of feedback for services; and (5)
potential advantages and limitations of the ChASE in routine use.
Implications: The ChASE can provide meaningful and clinically useful information to
clinicians. In general, feedback helped clinicans to reflect on service provision and the
support necessary for effective practice. For some respondents, the process of receiving
feedback was more problematic, with the potential for defensiveness and self-blame.
With the ChASE now in routine use within the Trust’s CAMHS Directorate, it is important
for managers and supervisors to consider how best to support individual practitioners
in responding to service users’ feedback, as well as optimising conditions for
implementing feedback within services.
Funding: Guy's and St Thomas' Charitable Foundation
State of Progress: Completed
78
Looked After Children
Improving Attendance at Child and Adolescent Mental Health Services for Families
from Socially Disadvantaged Communities: A Pilot Evaluation of a Telephone
Engagement Intervention
Investigator(s): Dr Daniel Michelson, Dr Crispin Day
Summary
As well as being a major cause of wasted resources and increased waiting times in
CAMHS, non-attendance of families at initial appointments increases risks for poor
continuity of care and unmet needs for treatment. Local and national surveys indicate
that rates of non-attendance in outpatient CAMHS in SLaM and other UK Trusts are
substantially higher than the DoH's (2002) target of ≤ 11.3%.
Aim: To develop, pilot, and evaluate an intervention aimed at improving early
engagement of families at Tier II CAMHS in Lambeth.
The intervention format was informed by an empirically-supported approach from the
USA (McKay et al., 1996, 1998, 2004), which was adapted to meet local needs following
a series of stakeholder consultations with service users and clinicians. In practice, this
involved a 20-30 minute telephone conversation between an allocated keyworker and
carer prior to the child/family's first scheduled appointment. The objective was to
facilitate engagement with families by: (1) clarifying the need for help from CAMHS; (2)
maximising the carer’s investment and efficacy in relation to help-seeking; (3)
identifying and addressing attitudes and previous experiences with statutory services
that could dissuade the carer from bringing their child to CAMHS; and (4) developing
strategies to overcome concrete obstacles to attendance, such as lack of time,
transportation, and child care issues.
Method: Rates of early discharge, cancellations, missed and attended appointments
were examined for cases referred over a six-month implementation phase (Cohort 2,
n=170) and in the six months prior to implementation (Cohort 1, n=163).
Results: Significantly lower rates of non-attendance were found within Cohort 2 for
families that received the intervention, as compared with those that could not be
reached by telephone (10% vs. 55%). However, service outcomes did not significantly
differ between Cohorts 1 and 2, with the effects of the intervention possibly confounded
by differences in referral pathways and waiting times. Further analyses are planned to
examine the effects of the intervention for families from different ethnic groups and
living in areas of varying socioeconomic deprivation.
Implications: Engaging with families by telephone prior to scheduling face-to-face
appointments allows clinicians to identify and address salient factors affecting
willingness and practical ability to attend CAMHS. Although this method of engagement
may not be possible for all referred cases, it may offer important advantages over
standard opt-out and opt-in letters. Further work is needed in order to evaluate the
effects of the intervention under more rigorously controlled conditions.
Funding: Guy's and St Thomas' Charitable Foundation
State of Progress: Ongoing
79
Education and Practitioner Development
Development and Pilot Evaluation of a Diagnostic Training Workshop for CAMHS
Practitioners
Investigator(s): Dr Daniel Michelson, Dr Crispin Day, Mr Stephen Rock
Summary
Accurate diagnosis is associated with improved outcomes for mental health service
users and is important in matching services and funding to areas of greatest clinical
need. However, previous audits conducted in local CAMHS have revealed large
inconsistencies in the recording and overall quality of routine diagnostic assessments.
Aim: To develop, pilot and evaluate a new training workshop in diagnosis for CAMHS
practitioners.
Method: A training workshop was developed and delivered to practitioners (N=63) in
all clinical teams within Southwark CAMHS during March 2010. This comprised one full
day of teaching, including basics of ICD-10 multiaxial diagnosis, use of screening tools
and role-play with simulated patients. Participants were also provided with an
accompanying Handbook and portfolio of screening measures. The project evaluation is
examining the extent to which training: (1) is acceptable to practitioners; (2) leads to
improved personal effectiveness of practitioners in their understanding and use of
diagnostic methods; and (3) impacts on provision and accuracy of diagnostic
assessments in routine practice.
Results: Preliminary analyses indicate a high level of satisfaction with training, as well
as significant improvements in particpants' self-reported confidence in diagnostic
assessment skills. An ongoing audit of clinical case files is comparing rates and accuracy
of diagnoses made before and after the training period.
Implications: This project is intended to lead to improvements in the availability and
quality of diagnostic assessments in routine practice, which may in turn contribute to
more efficient and effective care for service users in CAMHS. There is scope for the
training workshop and accompanying diagnostic Handbook to be extended and adapted
for other CAMHS in the Trust and elsewhere.
Funding: CAMHS Directorate, SLaM NHS Foundation Trust
State of Progress: Ongoing
80
Education and Practitioner Development
Development and Pilot Evaluation of an In-Service Training Programme for CAMHS
Practitioners in Cognitive Behavioural Therapy for Youth Anxiety Problems
Investigator(s): Dr Daniel Michelson, Professor Derek Bolton, Dr Crispin Day, Dr
Eleanor Leigh, Dr Susanna Payne, Dr Sean Perrin
Summary
A large body of evidence indicates that methods of cognitive behavioural therapy (CBT)
are effective in the treatment of child anxiety difficulties. However, national and local
surveys suggest that CBT is not routinely available for clients presenting at CAMHS. One
major barrier to widespread dissemination of CBT is the relative lack of training
programmes aimed at building and maintaining relevant competencies in the CAMHS
workforce.
Aim: To develop, pilot and evaluate a new training programme in CBT for youth anxiety
problems.
This programme was developed and run by experts at the National and Specialist
CAMHS Anxiety Clinic, SLaM, during 2009-2010. It comprised: four introductory
workshops (two sets of two days); supervision over nine months (group face-to-face
supervision offered monthly; email and phone supervision as required); a course
guidebook; assessment of participants’ competencies via written case studies and
videotapes; and research evaluation of the training programme.
Method: The training was evaluated across four broad domains: (1) learners’ reactions
to training; (2) learners’ acquisition of knowledge and skills; (3) the routine
implementation of this learning; and (4) clinical outcomes.
Results: 24 clinicians attended the introductory workshops and at least one group
supervision. Workshop attendance was associated with significant improvements in
knowledge of anxiety disorders and CBT concepts. Skills in case formulation also
increased significantly after the workshops, with further improvements reported over
the course of training. However, use of CBT techniques did not appear to generalise
beyond specific training cases, and a number of organisational barriers to routine use of
CBT remained constant. Systematic evaluation of clinical outcomes for training cases
was limited by the availability of follow-up measures, but rates of caseness tended to
improve. Although participants reported a high level of satisfaction with training, there
was a high level of attrition due to job changes (n=6), lack of time (n=2), maternity leave
(n=2) and difficulties finding suitable cases (n=2). By the end of the programme, 12
participants submitted final case materials for appraisal and nine achieved the overall
learning objective (“Level 2a: Formal Psychological Therapy Practice in training/CPD”)
based on the Trust's Psychological Therapies Competencies Framework.
Implications: Although training in CBT may lead to increased knowledge and skills,
other methods are required to ensure that such learning can be implemented as part of
routine practice. More work is needed to develop and evaluate methods for improving
the sustainability of CAMHS workforce development activities.
Funding: CAMHS Directorate, SLaM NHS Foundation Trust
State of Progress: Completed
81
Education and Practitioner Development
An Ethnographic Study of Whiteness in Clinical Practice
Investigator(s): Ms Claire Dempster
Summary
The focus of this research is an exploration of white experience and its application to the
process of research and clinical, therapeutic practice. My experience from presenting on
this topic has had great interest from both white and black practitioners in thinking
more about whiteness. Whiteness often seems hard to pin down, but then equally hard
to ignore. There’s a range of thinking about what might be captured by the term
whiteness and for some, questions about its relevance.
Most research about race and ethnicity in psychotherapy focuses on the experience of
black or other similarly `marked’ participants. There is little attention to the experience
of white ethnicity or identity. This perpetuates whiteness as an `absent norm’ by which
other or different experiences are measured (Hardy & Laszloffy 1995). One consequence
is that by neglecting whiteness, we end up perpetuating a focus on black/minority
ethnic experience as being `the problem’.
I anchored this research about whiteness with ideas about the history of racism and
colonialism. This was not to trick any one nor foreclose debates about how whiteness is
understood or even if you regard it as relevant. Neither is it to suggest that all
experiences of whiteness are the same. My approach has been to use a qualitative
methodology to explore whiteness and more specifically, an ethnographic approach. I
contacted CAMHS teams who might be interested in taking part and asked individual
team members / potential participants for consent to take part. Taking part was
voluntary and so people were free to withdraw without giving a reason at any time.
The research involved me observing a team's clinical team meetings on six occasions. At
the end of each meeting, I met with them to think about how we did or did not notice
whiteness in the thinking and discussion. Prior to the start of the research I asked the
white participants to complete a semi structured interview about whiteness with me. I
am currently in the process of analysing the field data.
My hope is that this small scale research makes a positive contribution to good practice.
There is very little research of this kind done in the UK and even less, in the NHS. The
participants / team joining me made a huge contribution as without them, this research
would not have gone ahead.
Funding: Self funded with contribution from SLAM
State of Progress: Ongoing
83