New treatment guidelines for conduct disorder in children were published in March by the government’s independent health advisory body NICE, in collaboration with the Social Care Institute for Excellence.
According to the new recommendations, conduct disorders are the most common reason for a child’s referral to mental health services and they are ‘characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviour that amounts to significant and persistent violations of age-appropriate social expectations’. A child diagnosed with conduct disorder is at increased risk of poorer educational outcomes, criminality and mental health problems later in life.
According to the guidelines, existing interventions have in common a strong focus on working with parents, recognition of the importance of the wider social system, and a focus on prevention. The guidelines specifically recommend preventative in-school emotional learning programmes for children who are in a class with a high number of pupils at particular risk for conduct disorder. Risk factors include harsh parenting styles, abuse, mental health problems, being in care, and poverty. The guideline points out that nearly half of all boys with a conduct disorder diagnosis also have a diagnosis of ADHD. Contact with the criminal justice system is also common among children with a conduct disorder diagnosis.
For children aged 3 to 11 with suspected or confirmed conduct disorder, the guidelines recommend group parental training programmes. For children aged 9 to 14 with a conduct disorder, group social and cognitive problem-solving training is recommended for the child. The drug Ritalin is recommended for children with conduct disorder who also have a diagnosis of ADHD, and it is advised that the anti-psychotic (and sedative) risperidone be considered for ‘the short-term management of severely aggressive behaviour in young people’ who have not responded to psychosocial interventions.
Professor Stephen Pilling, a Chartered Psychologist and Director of the National Collaborating Centre for Mental Health (of which the BPS is a partner member), said: ‘The new guideline highlights the importance of supporting the child’s parents or guardians in the treatment of the condition – recommending training programmes tailored specifically for them – as aspects of parenting have been repeatedly found to have a long-term association with antisocial behaviour.
‘Many parents do an excellent job in caring for a child with a conduct disorder,’ he added, ‘but it can be incredibly challenging. Parent training programmes provide them with strategies for dealing with difficult children and how to better handle them going forward.’
Other psychologists involved in the new guidelines were Chartered Psychologist Peter Fonagy, Professor of Psychoanalysis at UCL and Chief Executive of the Anna Freud Centre; and Chartered Psychologist and former Chair of the Division of Clinical Psychology Jenny Taylor.
The new guidelines were not welcomed by all. Chartered Psychologist Gordon Milson, a clinical psychologist and Head of Children and Young People’s Services in Bury, took to his blog (tinyurl.com/cj6g3al) to criticise the guidelines’ adherence to the medical model of mental illness and its use of terms like ‘condition’ and ‘disorder’, as if the behavioural problems lie within the child.
‘My admittedly crude illustration of this is that if someone punched me in the face would it be right to label me with “Punched in the Face Disorder?” That sounds ridiculous, doesn’t it?’ he wrote. ‘This has to stop,’ he added. ‘This systematic labelling of children as disordered when they are simply trying to get by in the world is inhumane and extremely unhelpful and potentially damaging.’
- Christian Jarrett (cj)
Access the new guidance Antisocial Behaviour and Conduct Disorders in Children and Young People: Recognition, Intervention and Management:
Little harm from TV
The debate over the possible harms to children of spending too much time watching TV took another twist in March, with publication of a new study that assessed thousands of British children when they were aged five, and then again two years later (Archives of Disease in Childhood). Controlling for a range of family and child factors, Alison Parkes and her colleagues at the University of Glasgow found that watching more than three hours TV or DVDs a day at age five was associated with a small increase in conduct problems at age seven, but was unrelated to other emotional problems, hyperactivity or relationships. Time spent playing video games at age five was unrelated to any outcomes at age seven.
Most previous research on this issue has been conducted in North America, and while excessive time watching TV has been linked to negative outcomes, results tend to be inconsistent. ‘Our findings do not demonstrate that interventions to reduce screen exposure will improve psychosocial adjustment,’ the researchers concluded. ‘Indeed, they suggest that interventions in respect of family and child characteristics, rather than a narrow focus on screen exposure, are more likely to improve outcomes.’ cj
Findings from a new brain-imaging study have raised the spectre of a dystopian future where people’s freedom is curtailed on the basis of crimes they have yet to commit (PNAS: tinyurl.com/cny8yy9).
Kent Kiehl at the Mind Research Network, New Mexico, plus his colleagues, among them lead author Eyal Aharoni and neuroscience luminary Michael Gazzaniga, scanned the brains of 96 male prisoners just prior to their release. While in the scanner, the prisoners completed a version of the well-known Go/No Go task, which tests impulsivity and inhibitory control.
Those prisoners who showed less activity in a frontal brain region – the anterior cingulate cortex (ACC) – during the task were about twice as likely to reoffend over the next four years, as compared with prisoners who showed more activity in this brain region. Focusing on non-violent crimes alone, the increased risk was almost doubled again.
‘These findings have incredibly significant ramifications for the future of how our society deals with criminal justice and offenders,’ said Kiehl. Co-author Walter Sinnott-Armstrong added: ‘Much more work needs to be done, but this line of research could help to make our criminal justice system more effective.’
In their journal report, the researchers adopted a cautious tone, admitting that the diagnostic relevance of the findings to individuals had yet to be established. ‘We are skeptical that emerging neurobiological markers could ever independently outperform… existing [risk assessment] tools in sensitivity and specificity,’ they wrote, ‘but they could potentially improve overall risk estimates in combination with known psychosocial risk factors.’
The Neurocritic blog pointed out that a basic application of the high and low ACC activity criterion to prisoners in the current study would have wrongly identified 40 per cent of those with low ACC activity as future offenders, while missing the 46 per cent of high activity ACC prisoners who did commit future crimes. ‘It’s not all that impressive and completely inadmissible as evidence for decision-making purposes,’ said Neurocritic. cj
Autism research priorities
Adults on the autistic spectrum would like earlier diagnosis to be made a research priority. That’s according to a survey published in April by Autistica, one of the UK’s largest autism research charities. The charity’s One in a Hundred report included a survey of hundreds of parents of autistic children, 187 adults with the condition, plus face-to-face focus groups held in English cities with 33 mothers and 10 fathers of children with autism or an autism spectrum condition.
Ninety-four per cent of parents said they were worried about their children’s future. ‘It’s scary that they’ll be on their own,’ said a mother about her non-verbal autistic children. ‘Who is going to listen to them? I don’t want them to be shoved in a corner and forgotten about.’ Many parents reported frustrations with the NHS, especially the lack of information and support made available after a diagnosis.
Attitudes to autism research were largely positive, with 82 per cent of parents and 57 per cent of autistic adults agreeing that more medical research into autism would be of benefit to their lives. These figures could be positively biased because much of the sample was sourced from research registers.
Whereas early diagnosis was the favoured research priority for adults with autism, parents prioritised research into interventions for the months after a diagnosis, and interventions for the problems that often exist alongside autism, including sleep problems and epilepsy. Worryingly, around a third of parents, and a third of adults with autism, said they had resorted to interventions that they knew had no evidence base.
The report was authored by Alison Hardy, director of Headstrong Thinking, Simon Wallace, a former psychological researcher into autism who now works as Autistica’s research director, and Jeremy Parr, a consultant in paediatric neurodisability. ‘Autism research continues to be poorly funded in the UK, despite the significant social and economic costs associated with the condition,’ they concluded. ‘Families have communicated clearly what their research priorities are, and these will shape Autistica’s future research strategy.’ cj
Get the One in a Hundred report as a PDF at tinyurl.com/d29e6du
APS rising star
Esha Massand, a researcher at the Centre on Brain and Cognitive Development, Birkbeck, University of London has been named as a ‘rising star’ by the Association for Psychological Science based in Washington, DC. Dr Massand works with Professor Annette Karmiloff-Smith CBE, an Honorary Fellow of the BPS, investigating developmental brain processes in children on the autistic spectrum and with Down’s syndrome.
In March, Louis Hoffman, President of the Society for Humanistic Psychology, and Professor Peter Kinderman, Professor of Clinical Psychology at University of Liverpool and former Chair of the BPS Division of Clinical Psychology, joined with other psychologists to launch a campaign against the latest version of psychiatry’s diagnostic code – the DSM-5. At the time of writing in early April, their petition had attracted over two and a half thousand signatures.
See the petition at http://dsm5response.com
Brain research app
Researchers at the Wellcome Trust Centre for Neuroimaging at UCL launched a new experimental app in March as part of Brain Awareness Week. Featuring four games designed to tap memory, attention, mood and executive control, the designers of The Great Brain Experiment have bold ambitions. ‘[This] is one of a new generation of neuroscience experiments that “gamify” data collection and crowdsource it to gain a wider audience,’ said PhD student Harriet Brown, adding that it ‘has the potential to be the largest neuroscience experiment ever conducted.’
Get the app: tinyurl.com/cc8fhrs
Ed psych shortage
The Highland Council Psychological Service is suffering from an ongoing shortage of educational psychologists with four positions remaining unfilled as of March 2013. Retired psychologists and a trainee have been drafted in to help plug the shortfall. With the imminent retirement of more psychologists, a report issued by the Council’s Director of Health and Social Care proposes recruiting four local psychology graduates as Assistant Educational Psychologists. cj
Read the report: tinyurl.com/c2rn52g
Frontiers of brain research
After all the rumours, speculation and commentary (see April news), the Obama administration’s multi-million dollar project to map the brain finally received its official launch early in April. Speaking to an assembled audience of eminent neuroscientists, Obama struck a patriotic tone, saying this would be the ‘next great American project’. He also revealed its name: The BRAIN Initiative, which stands for ‘Brain Research through Advancing Innovative Neurotechnologies’, and said he hoped it would change the lives of billions of people by facilitating cures for Parkinson’s, epilepsy, PTSD and more.
Coinciding with Obama’s speech, a new project website appeared – nih.gov/science/brain – where it was made clear that the emphasis is on developing new technologies with which to better visualise the brain in action, ‘for the first time, show[ing] how individual cells and complex neural circuits interact in both time and space’.
Obama didn’t mention the pan-European Human Brain Project which launched earlier this year with over one billion euros of funding: humanbrainproject.eu. Whereas the American initiative is focused on visualisation technologies, the aim of the European project is to model the brain, but each claims their work will lead to better diagnosis and treatment of brain diseases. Although it’s tempting to see the projects as rivals, in reality the progress made by both will be complementary in furthering our understanding of the brain. cj
The Academy of Social Sciences
The Academy of Social Sciences has welcomed 35 eminent social scientists into membership as Academicians, including several psychologists. Receiving the accolade were Professor Judy Edworthy (University of Plymouth), Professor George Gaskell (London School of Economics and Political Science), Professor Mark Griffiths (Nottingham Trent University), Professor Sarah Grogan (Professor of Health Psychology), Professor Michael Lamb (University of Cambridge), Professor William Lindsay (University of Abertay), and Professor Kim Plunkett (University of Oxford) – all were nominated by the Society’s Research Board. Also welcomed in was Professor Constantine Sedikides (University of Southampton). js
He’s in the army now
Captain Duncan Precious has become the first-ever clinical psychologist to be commissioned into the British Army at a ceremony held at the Royal Military Academy Sandhurst in April. Jamie Hacker Hughes, Society Fellow and Visiting Professor of Military Psychological Therapies at Anglia Ruskin University, has been lobbying for a uniformed role for clinical psychologists in the Army since the late 1970s. In his role as Defence Consultant Advisor on Clinical Psychology to the MoD, he initiated discussions with the Director General Army Medical Services and the British Psychological Society on the establishment of posts, drafting of terms and conditions of service and the initial planning of recruitment. These have been taken forward by his successor, Dr Rachel Norris.
Dr Precious told us: ‘Our profession has a lot to offer the armed forces and by being better integrated into the army, I hope that we can achieve a great deal. The Sandhurst course challenged me mentally, physically and emotionally and now, I am very keen to crack on with my job.’ js
Psychologist appointed Vice-Chancellor
The University of York has appointed cognitive psychologist Professor Koen Lamberts as its new Vice-Chancellor.
Born in Hasselt, Belgium, Professor Lamberts undertook both his undergraduate and postgraduate studies at the University of Leuven, culminating in the award of his PhD in psychology in 1992. He has developed an extensive track record in experimental and theoretical research on human perception and memory (for which he has won prizes from the Experimental Psychology Society and the British Psychological Society’s Cognitive Psychology Section), and is currently Deputy Vice-Chancellor and Provost of Warwick University. He will take up his new post on 1 January 2014.
Professor Lamberts said: ‘I am enormously proud to be chosen to lead this great University. In only 50 years, York has forged a reputation in the UK and internationally for its outstanding teaching and world-class research. I look forward to the challenge of making sure that the University continues to make a difference in the world in the years ahead.’ js
Jon Sutton reports from a talk at Goldsmiths, University of London
If Professor Elizabeth Loftus had her way, the solemn oath taken before witnesses take the stand would be ‘Do you swear to tell the truth, the whole truth, or whatever it is you think you remember?’ So far, she said with a wry smile, it hasn’t caught on.
Professor Loftus – who has been voted the most influential female psychologist of all time – was speaking at this special event presented by the Anomalistic Psychology Research Unit, Goldsmiths, and the Centre for Inquiry UK. Her wit and creativity shone through as she rattled through real-life stories, wrongful convictions and ingenious research that all illuminate the faulty nature of memory.
Beginning with some classic cases of political figures reporting memories that can’t be true – such as Mitt Romney’s account of the Golden Jubilee that occurred nine months before he was born – Loftus showed that ‘all that Yale school or Harvard training doesn’t stop you having false memories’. And this has implications way beyond goofing politicians: DNA exoneration studies suggest that faulty memory is responsible for wrongful conviction in more than 75 per cent of cases.
In case the assembled audience thought they were somehow immune to this, Loftus showed otherwise with a fascinating paradigm involving photos of faces. A post-event activity that induced us to pick a wrong person led to around half of the audience subsequently picking the wrong person in the test phase. ‘You’re wrong because I made you wrong,’ said Loftus, ‘right here in the middle of a lecture on false memory’.
But that’s somewhat artificial, say the critics (and Loftus says she has had a fair few, who do not like the message of her research). OK, says Loftus, what about our new study looking at military personnel taking part in a mock prisoner phase of survival school training? Here, the provision of misinformation following four days of evasion and half an hour of interrogation led even highly trained soliders to make false IDs with high confidence.
Loftus admitted to ‘nagging concerns’ around the ethics of such findings. ‘Aren’t we putting a recipe out there that could help bad people do bad things?’ On balance, she and her collaborators feel that it’s best to get the research out there in the hope that awareness could lead to ways to overcome the problem. And there is a lot to counter: Loftus’ research has shown that false memories can be induced in a variety of ways, including the use of imagination, dream interpretation, hypnosis, the provision of false information or doctored photos, and even simple exposure to other people’s memories.
It’s a research journey that has taken some tremendous turns. I love how the way the ‘lost in the mall’ analogue – convincing participants that they got lost in the shopping mall as a child – evolved in response to the repeated insistence of reviewers that ‘maybe that really happened’. When that accusation was even levelled at a study that persuaded people that they had been licked by Pluto at Disneyland – ‘disturbingly and persistently’ – Loftus and her team simply switched to Bugs Bunny, a Warner Brothers character!
Loftus had provided ample demonstration of the repercussions of false memories, in accounts of repressed memory accusations. (‘There is no credible scientific support for the notion that memories can be massively suppressed in this way’, she concluded). But what about positive effects? If psychologists can convince adults that they got sick eating a particular food as a child, could this technique be used to help people avoid fattening foods? Yes, and others have now found that this effect lasts, and affects actual eating behaviour. Welcome to the mental diet!
Can these false memories be distinguished from true ones? Not by rated emotion, and neuroimaging reveals only small differences, with true memories showing more activity in the visual cortex and false memories showing more in the auditory. But, said Loftus, ‘we are a long long way from taking a memory, examining it in the brain scanner and saying whether it is true or not.’ Memory is malleable, concluded Loftus, and if there was one take-home message from her life’s research it was this: ‘Just because memory is expressed with confidence, detail and emotion, doesn’t mean it’s true.’
After the talk, I had the pleasure of sitting next to Professor Loftus at dinner. I very much enjoyed our chat about a potential revolution in memory, as wearable devices and large, cheap storage bring ‘memory prosthetics’ to the masses. If we all have ‘personal CCTV’, like the dashboard cam footage of the Russian meteor strike, do our own memory failings become less of an issue? The professor quickly reminded me that such footage could be doctored, potentially leading to an arms race for the truth. One thing seems undeniable: whatever the future brings for memory research and practice, Professor Loftus will be at the forefront of it for many years to come.
Mixed results for anti-stigma campaign
The impact of the long-running Time to Change mental health anti-stigma campaign has been assessed comprehensively in a series of open-access articles published in the British Journal of Psychiatry (tinyurl.com/bmhx9ws). Results were mixed for the multi-million pound advertising and events-based campaign, which was launched in 2007 by Mind and Rethink Mental Illness with funding from the National Lottery and Comic Relief.
A survey of mental health service users suffered from an extremely low response rate, but there was an overall reduction in experienced discrimination of 11.5 per cent, and a particular reduction in stigma when dealing with friends and family. There was no evidence of reduced discrimination when dealing with health professionals.
A survey of thousands of members of the English general public found a trend towards more positive attitudes and intended behaviour towards people with mental illness, but no improvements in knowledge about mental health or in actual behaviour.
Newspaper reports showed an increase in anti-stigmatising articles, but no reduction in stigmatising articles, and a reduction in neutral articles. Employers showed an improved awareness of mental health problems, but still believed in disclosure of problems when applying for jobs.
Unfortunately, there were signs that some of the documented anti-stigma gains were regressing in 2011, perhaps due to the effects of the recession. In their editorial, two researchers involved in the evaluation, Claire Henderson and Graham Thornicroft of the Institute of Psychiatry, concluded that ‘stigma and discrimination against people with mental illness are global challenges, and the evidence of our evaluation of phase 1 of Time to Change is that they can be successfully tackled with a focused, determined and long-term approach’. The campaign is now entering phase 2, which runs to 2015 with funding from the Department of Health and Comic Relief. cj
Face blindness – recognition sought
The specific inability to recognise other people by their faces – prosopagnosia – was first documented in the 1940s in brain-damaged patients, and for decades it was considered a rare condition that only arose after injury. In recent years, however, it’s become clear that many more people have a developmental form of ‘face blindness’. Now Sarah Bate, a psychologist who leads the Centre for Face Processing Disorders at Bournemouth University, has launched an awareness campaign for all forms of the condition.
‘I imagine there is such low awareness of prosopagnosia because it has traditionally been thought of as a rare disorder, and only recently has it become clear that it affects many people,’ said Bate, who estimates that one in 50 people may be affected. She’s started a petition to get prosopagnosia discussed in Parliament. For this, Bate needs 100,000 signatures, although she’d collected only 314 at the time of writing. cj
The EPSRC Technology Strategy Board is inviting applications for participation in a sandpit workshop to undertake novel thinking about institutional long-term care. The aim of the sandpit is to bring together a varied group of participants from industry and academia to develop radical, risky and novel ideas that can then be developed into proposals for industry led Small Business Research Initiative projects. Full details of the sandpit are available on the website. Interest in the competition must be registered by 5 June and the closing date for applications is 12 June 2013. tinyurl.com/cf5p7bc
The NHS National Institute for Health Research under the Health Technology Assessment Programme has the following commissioning briefs that may be of interest to psychologists:
13/17 Feasibility of psychosocial interventions for preventing blood-borne virus infection in people who inject drugs
13/18 Peer support for breastfeeding maintenance (feasibility study)
13/25 Interventions to enhance engagement in exercise referral schemes
13/27 Non-neuroleptic mood-stabilising medication for challenging behaviour in adults with intellectual disability
The deadline for applications for all the calls is 29 August 2013.
Children in Need have Main Grants (grants over £10,000) and Small Grants (under £10,000) available for projects that support children and young people of 18 years and under experiencing disadvantage through illness, distress, abuse or neglect; any kind of disability; behavioural or psychological difficulties; or living in situations of deprivation. Not-for-profit organisations can apply. Details of the kinds of activities that do not receive funding are given on the website. Closing dates are 15 September and 15 January.
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