Written by Beth Barker

​This week, members of the pPOD team were fortunate enough to attend the 8th International Attachment Conference, held at the Institute of Education in London. With nine key note speakers to hear from, almost fifty symposia to attend, and two hundred posters to browse, we have been truly spoilt for choice over the last three days. Reflecting on the event as a whole now, I think I could quite happily go back to the beginning of the conference and take countless different routes through the networks offered by the programme, and still feel like I hadn’t had the chance to experience it all! Hopefully as a group we will spend the next few weeks drawing on what was learnt, the new areas of interest sparked, and the connections we’ve made, but for now a brief (or as brief as I could manage!) summary of the first day of talks will have to do.

The IAC key note speakers were of a fantastic standard and the knowledge gained from each of their presentations could fill an entire blog post in its own right. In lieu of a thesis-sized blog though, I thought I’d attempt to summarise what I found most interesting from Day 1.   

Dr Edward Barker - King's College London
​First up was Dr Edward Barker, who was presenting on the role of DNA methylation in the link between early adversity and child and adolescent psychopathology. In amongst a fantastic overview of the twists and turns that epigenetic research has taken through the field of child and adolescent mental health in recent years, a highlight was hearing about the recent work from the research group at King’s, including studies led by Charlotte Cecil and Esther Walton. The group have been using ALSPAC data to look at DNA methylation at birth and age 7, and the trajectories of ADHD symptoms in the kids up until age 15. The stand-out part for me was that, due to the novel (and large!) sample offered by the ALSPAC study, the group have been able to conduct methylome-wide analysis of ADHD symptomology in this sample from birth to adolescence. In amongst a number of epigenetic studies which are cross-sectional in design and generally focus on a handful of candidate genes, this approach makes their findings really unique! Following the talk, papers from Ted’s research group, which have been published in the last year-or-so, were quickly added to my ‘must read soon’ list (a list which only continued to grow throughout the conference!).   

Prof. Edmund Sonuga-Barke - King's College London
Next up was Prof. Edmund Sonuga-Barke who presented on the follow-up data from the English and Romanian Adoptees Study, now that the participants are in their early 20s. The exceptional circumstances of this sample provides us with a unique understanding of the long-term effects of early exposure to adverse experiences, and specifically institutional deprivation. By splitting the sample into UK adoptees who did not experience deprivation, Romanian adoptees who experienced less than 6 months in an institution, and Romanian adoptees exposed to more than 6 months in an institution, Prof. Sonuga-Barke and his colleagues found that, compared to UK controls, Romanian adoptees with >6 months in an institution had persistently higher rates of autism spectrum disorder, disinhibited social engagement, and inattention and over-activity, as well as lower educational achievement, and higher unemployment. By comparison, the Romanian group who had spent less than six months in institutional care had similar low levels of symptomology across most ages and outcomes when compared to the UK controls. At the very beginning of an event aiming to draw together research outlining just how fundamental early nurturance is in determining the life course of today’s children, the presentation of these findings couldn’t have been more timely.  

Prof. Mary Dozier (University of Delaware)
​The final key note of the day came from Prof. Mary Dozier who gave a highly comprehensive insight into the work of the Attachment and Biobehavioural Catch-up (ABC) intervention, which aims to help caregivers provide nurturing care to their infants. This talk of course felt especially relevant given the nature of the Healthy Start, Happy Start study. The intervention involves weekly one-hour home-visits across 10 weeks. Most interesting for me was the concept of “in the moment” feedback on parent-child interactions, which involves the ‘parent coach’ offering comments every minute-or-so throughout the hour-long interaction. Specifically, Prof. Dozier talked us through an RCT designed to assess the implementation and effectiveness of ABC, compared to a control intervention, with families who were considered to be at-risk by child protective services. In terms of child outcomes, differences in attachment security (52% secure classification in ABC vs. 33% in control), normative diurnal patterns of cortisol production, inhibitory control, and emotion regulation, were seen between the ABC and control group. Significant differences were also seen in parental delight, sensitivity, and intrusiveness in parent-child interactions, as well as neural activity. The highlight of Mary’s talk was a montage of videos from a family’s 10 weeks on the ABC programme. Statistically significant results can tell you a lot, but there’s something really quite moving about seeing for yourself the dynamics of an entire family shift over just a couple of months, to remind you of the true power of parenting.   

​So that’s Day 1 of the key note speakers' work briefly touched upon – I haven’t even got to the fantastic fifteen symposia that the first day brought with it, nor the array of posters on display. Hopefully I’ll do a better job of squeezing in a symposium-shaped summary into the thoughts from Day 2 tomorrow! 

For the last of our videos from Noclor (North Central London Research Consortium) and Healthy Start Happy Starts “Attachment Master Class” back in 2016, Stephen Scott thinks about how to alleviate the effects of poor parenting.

Here at Imperial college we are trialling one of the many early parenting inventions available. VIPP-SD (Video Intervention to Promote Positive Parenting- Sensitive discipline) aims to increase a parent’s sensitivity to their child’s cues as well as to appropriately reward and criticise their child. These are not one in the same, says Professor Stephen Scott.

His research on parenting as a whole has suggested that this distinction taps in to two different aspects of parenting and predicts different aspects of a child’s behavioural and emotional functioning.

In one of his own studies he found that a parent’s sensitive responding predicted their child’s attachment security over and above positive and negative parenting however a parent’s level of criticism towards the child predicted conduct problems over and above sensitive responding.

The effects of parenting as a whole therefore may contribute to different aspects of child functioning as a whole. What we can say is that both aspects are important contributors to a child’s future. Marinus van IJzendoorn, Marian Bakermans-Kranenburg, Pasco Fearon and Stephen Scott are paving the way in early interventions to allow children to have a brighter one.

As the second International Fathers’ Mental Health Day comes around, Mark Williams asked us if we’d write a blog. We’re delighted to, and thought we’d muse a bit on dads and depression, and talk about a couple of papers that the pPOD team (www.ppod.org.uk) have been involved with which have come out in recent weeks.  

It’s now much better known and accepted that men can also have mental health problems in the postnatal period and when their children are young, and that this can (can, but doesn’t always) affect their ability to work, look after their children and build and maintain a supportive relationship with their partner.  Many men continue to manage brilliantly in the face of depression, anxiety and other mental health difficulties, but it can be a struggle.  More men are speaking out about their experiences, and that is empowering and helpful.  As well as this though it’s important to know what research tells us about the mental health of men who are fathers.

We recently wrote a review article for the journal Current Opinion in Psychology, which appeared in a special issue about parenting (reference 1 below).  For this article we studied as much of the available research as we could, to draw together the key views on the importance of the different dimensions of fathering, to understand how these can shape the father-child relationship, as well as child outcomes.  The key conclusions we arrived at from this were:

• Increased sensitivity and engagement seen in interactions between dads and their children, as well as secure father-child attachment, have been associated with reduced levels of child psychopathology, including reductions in child internalising and externalising behaviours.
• Paternal depression, which is one of the most studied problems affecting fathers, can impact upon the way in which dads interact with their children, and this negative impact has been linked to the development of child behavioural and emotional problems. Interestingly, it seems from some studies that girls and boys may be affected in different ways, dependent on the mental health problem their dad is experiencing (e.g. anxiety, depression, alcohol dependence).
• Key aspects of fathering, commonly affected by paternal mental health difficulties, can be positively influenced through parenting interventions. We think newer, innovative approaches to engage dads in parenting interventions are needed, to maximise beneficial outcomes for both the father and child.  

The other paper we’ve been working on recently has also just come out (see reference 2 below).  This isn’t related specifically to the mental health of fathers, but does look at the potential importance of fathers from very early in children’s lives.  In this study we met with men and women who had new babies and visited them at home when the baby was 3 months old, and again when the baby was 2 years.  We were able to video the parents playing with their children, and also do interviews with the parents about themselves and their children. Finally, when the children were 2 years old, one of the research team sat down with each child to do a standard cognitive test with them (a bit like an IQ test, but obviously changed quite a lot to be suitable for young children – it’s called the Bayley Scales).

So, what did we find?  Well the nub of it was that the children of fathers who were more engaged when we saw them at age 3 months, did better on the Bayley Scale assessment at age 2 years. That is they had higher scores for their cognitive development (a bit like IQ). Child development is complex, and this study can’t tell us for sure that fathers being more engaged was what led to the children having higher cognitive development scores, but it fits with some other studies and so a pattern is forming which suggests that father engagement, even in the earliest days of a child’s life, can have an important positive influence on that child’s cognitive development.
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So, what to take away for this International Fathers’ Mental Health Day.  Well two papers on their own don’t change much, but they add to a growing body of research evidence which shows two things. First, that fathers roles in their children’s lives can be important, right from the very earliest days of that child’s life. Second, that mental health problems commonly affect fathers, they can affect not only dads, but also their partners and children, and efforts to recognise this, and provide effective and accessible help for families (both mums and dads) is important. 

Attachment is important and is associated with many of children's mental health and behavioural outcomes. If you aren't convinced I invite you to watch our other clips from our "Attachment Masterclass" available on the pPOD website!

However if we aim to improve children's  outcomes as a whole there may be other influences to consider. Professor Stephen Scott points us to other possible enduring consequences of poor parenting including ill-adaptive habits such as poor diet and low exercise that will have an obviously adverse effect on children.