​We were extremely fortunate to attend part of this brilliant conference in Geneva. The overarching theme was transition in a world of change and the content more than met our expectations. 
 
The keynote speakers included Professor Tony Charman from King's College, London and Professor Johannes Hebebrand from Germany.
 
Professor Tony Charman's talk was on tracking the emergence of early autism symptoms in at-risk infants, looking at possibilities for prodromal intervention.  Until recently, most of what we knew about the emergence of autism in infancy relied on retrospective accounts. A new approach, the study of infants at familial risk (younger siblings of autistic children), aims to identify the earliest “pure” manifestations of autism, before subsequent years of atypical development exacerbate, or compensate for, initial atypical development. He explained that there are some studies suggesting that in children from 12 months old, it is possible to detect signs (measured with EEG, ERP, visual fixation and attention) which could be related to ASD development.

He presented data from a prospective longitudinal study (J. Green et al, J Child Psychol Psychiatry 2017) based on using VIPP as a pre-emptive intervention in the prodrome of autism. Specifically, it is a RCT comparing a 12-session parent-mediated social communication intervention delivered in infants at familial risk of autism but not otherwise selected for developmental atypicality, between 9 and 14 months of age (Intervention in the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting), against no intervention. The results were that very early VIPP for infants at familial risk of developing autism has shown a treatment effect, to reduce the overall severity of autism prodromal symptoms and enhance parent-child dyadic social communication over this period.   

More information about the European project based on siblings of ASD children can be found here www.eurosibs.eu
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Professor Johannes Hebebrand presented on pre- and post- natal screening in the context of CAP.  Should we proactively be screening pre and postnatally for mental disorders? He covered the WHO criteria for a screen, the potential biases, the ethical issues around non-invasive prenatal screening, the modified checklist for autism risk in toddlers (M-CHAT-R/F) and highlighted the demand for better integration of CAP services with increased focus on evidence based screening with improved interdisciplinary collaboration with Paediatricians GPs and Gynaecologists.

Other keynote speakers included:
 
* Jörg Fegert (Germany) discussing the Care of traumatized children in youth welfare systems.
* Patrick McGorry (Australia) talking about Transitioning to 21st century mental health care: early intervention for young people with emerging mental disorders.
* Paul Hoff (Switzerland) on Conceptual transitions: what will happen to the concept of mental disorders in the 21st century?
* Patrick Luyten (Belgium/UK) on A radical shift in the treatment of child and adolescent depression: Perhaps the time is ripe?​​* Maria Melchior (France) on Social inequalities in children's mental health – from observation to prevention.
* Dieter Wolke (UK) on Peers and siblings matter for mental health: long term consequences of bullying.

The symposiums included tracks covering an incredibly broad range of subjects. From presentations on early findings from Professor David Coghill's ADDUCE project to transgenerational effects of childhood adversity, including early detection of personality disorders to the treatment of eating disorders, to the use of neuroimaging and treatment of psychosis to more highly emotionally charged topics relating to the world's response to political crisis in relation to refugees with examples from Syria, Iraq, Serbia & Croatia and a presentation on the child psychiatric care in Nice following the terrorist attack in July 2016. 
There was something in there for absolutely everyone to engage with. We have all learnt a huge amount and come away feeling inspired to collaborate with our colleagues from across the world in future research and clinical practice. 

We are very much looking forward to the next meeting in Vienna in July 2019.
 


Author: Marina Fabrega Ribera and Rebecca Lancaster

Written by Beth Barker

Following the close of the first day of IAC 2017, I found my head buzzing with fresh ideas for future research, collaborations and papers. Part of me wondered how Day 2 could come even come close to the bar set so high by Day 1 but wonderfully the second day just pushed that bar even higher. The day was kicked off by three insightful and thought-provoking talks from the key notes, and rounded off by a fantastic fifteen symposia.  

Prof. Marian Bakermans-Kranenburg - Leiden University 
To begin, Prof. Marian Bakermans-Kranenburg provided a captivating insight into the world of infant crying. We already know that crying plays a really important role in how infants develop attachments with their caregivers, but key to this attachment forming is the response that their crying is met with. Crying often evokes a sensitive and positive response from parents to ensure that the needs of the infant are met. However, infant crying can also result in anger, fear, or aversion from the parent, particularly if the baby is crying for 5+ hours a day. Prof. Bakermans-Kranenburg’s group have been working to examine why some parents are able to respond in a sensitive way to their crying infants, whilst others respond in an abusive manner. The fact that incidences of Shaken Baby Syndrome peak around eight weeks of age, around the same time that rates of infant crying peaks, really drove home why research of this kind is so important. 

A range of biological and psychological factors appear to play a part in individual responses to infant crying, including maternal oxytocin levels and attachment representations. Findings from Marian’s work indicate that intranasal oxytocin administration can not only increase overt sensitive maternal behaviours when exposed to infant crying, but also result in a decrease in amygdala reactivity and handgrip force, from those with insecure attachment representations. Prof. Bakermans-Kranenburg stressed that, despite the encouraging results of these findings, the answer isn’t quite as simple as administering oxytocin to all in an effort to induce solely positive responses to infant crying, as effectiveness differed between groups. Nonetheless, the findings were highly interesting and the papers from the research were quickly added to my growing to-read list! 

​Prof. Jonathan Hill – University of Reading
Next up was Jonathan Hill who was presenting findings looking at sex differences in adaptation and pathways to psychopathology. One set of interesting findings Prof. Hill presented outlined differences in the ways in which boys and girls are affected by low birth weight and prenatal maternal anxiety, and how this might influence later psychopathology, using a sample from the Wirral Child Health and Development Study. What they found was that low birth weight predicted higher vagal reactivity at 29 weeks only in girls, whilst prenatal maternal anxiety predicted lower vagal reactivity only in boys. Further studies have now followed these children up to 5 years of age and from these findings, it has been hypothesised that increases in vagal reactivity is associated with an increase in ODD symptoms in girls and a reduction of ODD symptoms in boys. From an early intervention stand-point, these findings are really interesting as it indicates that early markers of risk (such as low birth weight or prenatal maternal anxiety) may need to be considerate of slightly different processes in males and females. 

​Prof. Miriam Steele – The New School for Social Research
The final talk of the day came from Miriam Steele, presenting on the work of the Group Attachment-Based Intervention (GABI) which looks to prevent the intergenerational transmission of child maltreatment in families that have already experienced trauma. GABI, developed by Dr. Anne Murphy and inspired by the work of John Bowlby and Mary Ainsworth, is designed for families who have histories of adverse childhood experiences (ACEs) with the aim of enhancing parent coping and resilience, in turn promoting secure parent-child attachment and preventing disorganised attachment relationships. The intervention works under a framework called R.E.A.R.I.N.G and involves parents with 0-3 year olds attending GABI up to three times a week for two hours, where families can learn parenting skills, share experiences, and meet with a range of therapists. It seems that purely based on the frequency of contact provided by the intervention, GABI can act as a secure base for families in amongst what’s, frequently, an otherwise chaotic life. Building on Mary Dozier’s talk from yesterday, the power of video was displayed once again when Prof. Steele showed us a moving clip of a mother’s response to seeing videos for the first time of her and her infant daughter interacting. We saw that the mother didn’t look solely to the therapists during feedback but also to the other mums taking part, which really highlighted the unique forms of support offered by interventions which have a group-based element. 

​I appear to have got a little carried away again in trying to “summarise” each the captivating array of studies which came through in the three talks of Day 2 – it was all just a little too interesting and noteworthy if you ask me! Tomorrow I aim to get on to Day 3 and not only touch on the key notes but also the highlights from the many symposia we were lucky enough to attend too! 

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.