The Psychologist October 2014

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psychologist vol 27 no 10

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Autism: Myth and reality Uta Frith introduces the issue

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news 730 eye on fiction 768 careers 786 looking back 796

big picture centre interview: with Francesca Happé 762 looking in: my son’s not Rainman 766 one on one: with Simon Baron-Cohen 800

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Autism – are we any closer to explaining the enigma?

Uta Frith introduces the special issue

tinyurl.com/thepsychomag @psychmag

Autism – myth and reality 746 Christian Jarrett talks to researchers, people with autism and their relatives

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Combining the old and the new Jon Brock looks at Bayesian and predictive coding accounts of autistic cognition

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Cover ‘My bad day’: self-portrait by a 13-year-old with autism, Angus Lacey, Create Art for Autism 2014 Winner 2D category.

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New voices: What is autism anyway?

Eilidh Cage with the latest in our series for budding writers

special issue

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Risk and resilience in the developing brain 754 Mayada Elsabbagh looks at lessons from autism

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...reports news 730 policing tactics; reporting suicide; child protection; faith-based organisations; and more society 770 President’s column; Lifetime Achievement Award; understanding psychosis; Society hubs; autism and the criminal justice system; and more

The Psychologist is the monthly publication of The British Psychological Society. It provides a forum for communication, discussion and controversy among all members of the Society, and aims to fulfil the main object of the Royal Charter, ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied’.

Managing Editor Jon Sutton Assistant Editor Peter Dillon-Hooper Production Mike Thompson

Journalist Ella Rhodes Editorial Assistant Debbie Gordon Research Digest Christian Jarrett (editor), Alex Fradera

Associate Editors Articles Michael Burnett, Paul Curran, Harriet Gross, Marc Jones, Rebecca Knibb, Charlie Lewis, Wendy Morgan, Paul Redford, Mark Wetherell, Jill Wilkinson Conferences Alana James History of Psychology Nathalie Chernoff Interviews Gail Kinman, Mark Sergeant Reviews Emma Norris Viewpoints Catherine Loveday International panel Vaughan Bell, Uta Frith, Alex Haslam, Elizabeth Loftus

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psychologist vol 27 no 10

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the issue ...debates letters the assisted dying debate; expertise and being a woman; memory; dyslexia; EMDR; practitioner titles; sex offenders; obituaries; and more

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...digests autistic traits and altruism; Google Glass; media reports of terrorism; and much more from our free Research Digest (see www.researchdigest.org.uk/blog) 738

...meets interview our editor Jon Sutton talks to Francesca Happé about autism, DSM-5, women in science and more

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careers 786 we meet Stella Acquarone as part of our autism special issue; Aidan Horner on his ‘negative CV’; and Nick Hatton on an unusual PhD setting looking in 766 ‘my son’s not Rainman’: John Williams on being a parent of ‘The Boy’ with autism one on one 800 with Simon Baron-Cohen, Director of the Autism Research Centre in Cambridge

...reviews Eye on fiction: Generic images of autism 768 Douwe Draaisma on stereotypes in novels, films and real life also The Man with His Head in the Clouds; We are All Completely Beside Ourselves; should research fraud be a criminal offence?; and more, in our ‘Reviews’ section

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Over the years, I suspect I have heard far more about autism than about any other developmental disorder, even those that affect greater numbers. Hundreds of press releases that end with ‘such research may lead to early diagnosis of conditions such as autism’; countless conference presentations; dozens of broadsheet articles from parents of a child with the condition.

But do I have a true picture of the person, the realities behind the myths?

Although some people with autism fight against labelling it a ‘puzzle’ (see www.unpuzzled.net), for many psychologists that is surely what it remains. Across this special issue (taking in all our regular formats as well as a set of articles), we consider how scientific approaches to autism have changed, and we get to meet people with autism and their relatives. As Uta Frith (p.744) says, ‘Only by putting together many different viewpoints will we eventually know what autism is really like’.

As ever, please share your views via psychologist@bps.org.uk.

Dr Jon Sutton Managing Editor @psychmag

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...looks back A continuing journey 796 Patricia Howlin considers where more than 70 years of research and intervention has left us in understanding autism

The Psychologist and Digest Editorial Advisory Committee Catherine Loveday (Chair), Phil Banyard, Olivia Craig, Helen Galliard, Rowena Hill, Victoria Mason, Stephen McGlynn, Tony Wainwright, Peter Wright

Nine years ago Go to www.thepsychologist.org.uk for our archive, including Sergio Della Sala on ‘the anarchic hand’

read discuss contribute at www.thepsychologist.org.uk

Big picture centre-page pull-out an image by William Tipple, a 15-year-old with autism.

Comment from Uta Frith

LETTERS

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Turning our backs on the dying?

One reason for supporting the Assisted Dying Bill is that the alternative to a relatively quick and painless ‘assisted death’ is not eternal life – certainly not for those terminally ill people who fall under the remit of the proposed legislation.

Instead it is what the person themselves (and those who love them) may experience as a protracted, distressing, and undignified dying process.

Advances in medical technologies have increased our lifespan but sometimes with what people consider a severely reduced quality of life (Sears & Stanton, 2001). A life with little or no consciousness (maintained by ventilators or feeding tubes) is commonly viewed as a life not worth living (Demertzi et al., 2011).

In response, many countries, including England and Wales, have given statutory force to ‘Advance Decisions’ which allow people to specify, while they still have the capacity to do so, which treatments they want to refuse

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is an uncompassionate response to the significant minority of dying people whose symptoms cannot be relieved by palliative care. The wishes of such people should be heard and respected within a legal framework. Secondly, suffering at the end of life is a much broader concept than simply pain, and only the dying patient has the right to determine how much suffering they can endure.

Dr Brett Smith is wrong to equate assisted dying and disability. Lord Falconer’s bill makes no reference to disabled people or to the quality of a person’s life. The bill addresses a

in the event that they lose the mental capacity to make the relevant decisions at the time. It is perfectly legal to refuse any and all lifeprolonging treatments as long as you have mental capacity to do so – and this is legally defined as the ability to understand the decision you are making, to remember and weigh up the relevant information, and to communicate your decision (Mental Capacity Act 2005).

According to the UK charity Compassion in Dying

fundamental issue with the quality of a person’s death. To that end it is strictly limited to terminally ill, mentally competent adults. Furthermore, and in contrast to Dr Smith’s claims, the voices of ‘“ordinary” disabled people’ are present in this debate – according to a 2013 YouGov survey, 79 per cent of people with disabilities support assisted dying.

Professor Scott Murray wants people to be able to discuss their end-of-life concerns. An assisted dying law would encourage this much more than the current law does by providing terminally

TIM SANDERS

In the news article ‘We should bring death back to life, into the open’ (September 2014), your journalist claimed they were unable to find psychologists who support assisted dying, hypothesising that ‘[p]erhaps there is a desire in the community to address and resolve issues rather than using this quicker means to an end’.

We write as psychologists who do support the right for terminally ill, mentally competent adults to have the choice of an assisted death. We do so precisely because we want to address and resolve the issues that are currently faced by dying people, rather than turn our backs on their suffering.

In the article Professor Owen Hughes asserts that he ‘certainly wouldn’t support assisted dying for people who have pain’. This

(www.compassionindying.org. uk), only around 4 per cent of people in England and Wales have completed Advance Decisions – in part because of a persistent myth that ‘next of kin’ are able to make medical decisions on behalf of loved ones (Kitzinger, 2014).

Advance Decisions (along with other well-established principles requiring the withholding of ‘futile’ or ‘burdensome’ treatment) mean that it is lawful – and indeed, can be required by law – for doctors to withhold or

withdraw life-prolonging treatments even if this results in your death (so-called ‘passive euthanasia’). However, it is not lawful for doctors to give you medication with the intention of causing your death (so-called ‘active euthanasia’ or ‘assisted dying’).

This is what the proposed legislation in England and Wales seeks to change – but only for a very limited category of patients who meet three strict criteria: they must have mental capacity, no more than six months left to live

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ill patients with transparent choices.

Patients would no longer fear criminally implicating their care professionals by raising their concerns, and this would lead to clarity on what treatments are available to them. In Oregon (where assisted dying is legal, under strict safeguards) only 1 in 10 who discuss assisted dying with their doctor go on to have an assisted death.

Currently, around 300 terminally ill people take their own lives every year in England and every two weeks somebody from the UK travels to the Dignitas clinic in Switzerland to die. These problems will not go away until the law on assisted dying changes. Parliament must act on this issue, as the Supreme Court has recently acknowledged. Healthcare professionals should contribute constructively to the debate. Outright opposition, as expressed by the professionals your journalist consulted, is comparable to turning our backs on the suffering of dying people.

Under The Assisted Dying Bill, those healthcare professionals who object in principle to assisting a terminally ill patient to die would be protected by a conscientious objection clause. They

and be able to self-administer the medicine.

My own research is with families of patients who will not be helped by the proposed legislation – people in longterm coma-like conditions.

Following the court decision in the case of Tony Bland, the young man left in a vegetative state after the Hillsborough disaster, it is lawful to withdraw treatments from patients in a ‘permanent vegetative state’ (PVS), including (if authorised by the Court of Protection) withdrawing a feeding tube.

A recent court case (United Lincolnshire Hospitals NHS Trust v. N) also set a precedent for withdrawal of a feeding tube from a patient in a ‘minimally conscious state’ (MCS). Once a feeding tube is withdrawn from a patient who cannot otherwise obtain food or hydration, death is inevitable and organ failure will result within two weeks.

Many families of PVS and MCS patients contemplating this process consider it barbaric (‘You wouldn’t do it to

should not stand in the way of those healthcare professionals who are willing to respect their patient’s informed choices.

Dr John Marzillier Clinical Psychologist, Oxford Professor Elizabeth Peel University of Worcester Professor Sue Wilkinson Loughborough University

Editor’s note: I would like to take the opportunity to apologise for the editorial slip in the penultimate paragraph, which questioned why we were unable to find psychologists ‘to speak against the bill’: this clearly should have read ‘in favour of the bill’. Also, I should reiterate – as implied in that penultimate paragraph – that we were aware that the piece was unlikely to be representative of the voice of our membership, but that we decided to include it as a prompt for discussion and debate. I am glad to see it has served that function.

Finally, it might have been useful for us to refer to ongoing work within the Society on the issue, notably the End of Life Care Working Party, chaired by Dr Elaine McWilliams.

a dog’), and there is a widespread perception that lethal injections would be more humane, compassionate and dignified than ‘death by neglect’. Many of the 65 family members interviewed had considered ‘mercy killing’ – using a quicker method that (they believe) would result in less suffering for the patient, and for other family members (sometimes including children) witnessing the death (Kitzinger & Kitzinger, 2014).

These patients (and their families) are not helped by the bill’s proposals. Since patients in PVS and MCS can now be maintained for many years or even decades they are not ‘reasonably expected to die within six months’, and as they are severely brain damaged and not fully conscious, they do not have ‘the capacity to make the decision to end their own life’.

For these profoundly disabled patients, the alternative to assisted dying is death from untreated infections and diseases (several interviewees’ relatives eventually died of

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I write as a retired GP and a supporter of assisted dying. I have read the Hansard account of the House of Lords debate and while the majority of contributions were helpful, a number of speeches from the noble and learned Lords did not address the provisions of the Bill. Professor Hughes and Dr Smith do the same.

There is no proposal to offer assisted dying to anyone who has chronic pain or disability unless he or she has a terminal illness. In addition, the patient must be of sound mind and settled intention. The four stages that Professor Murray finds that psychological distress occurs can presumably be identified and ameliorated by treatment.

In Oregon, where assisted dying has been available for 16 or 17 years, people described as vulnerable, those with disability, chronic illness, psychological illness and low socioeconomic status, are underrepresented in the people who have assistance to die.

Iain C. Kerr Glasgow

pneumonia; one died of untreated gangrene) or death following court-authorised withdrawal of a feeding tube (see ‘Family experiences of vegetative and minimally conscious at healthtalk.org).

Likewise, the bill does not help profoundly disabled people like Tony Nicklinson, paralysed from the neck down after a stroke (see tinyurl.com/cttg9zo). He wanted the ‘right to die’, yet was physically unable to take his own life. He would have needed to be killed by someone else, which under current law would constitute murder. Since Nicklinson did not have a terminal illness and also was unable ‘to selfadminister the medicine’ he, and people like him, are excluded from the provisions of the bill.

In sum, the bill opens up the possibility of an assisted death to only a very restricted group of people. It leaves those who do not qualify for assistance and fear an ‘undignified’ or protracted death with the alternatives of

death resulting from withholding or withdrawing treatment or alternatively – as ‘Dignity in Dying’ (www.dignityindying.org.uk) campaigners point out – an early pre-emptive suicide while still having the mental capacity and physical ability to do it.

Professor Celia Kitzinger CPsychol, FBPsS University of York References Demertzi, A. et al. (2011). Attitudes towards end-of-life issues in disorders of consciousness: A European Survey. Journal of Neurology, 258, 1058–1065.

Kitzinger, C. (2014). Advance Decisions: Do they work in practice? Elder Law Journal, 4(2), 123–238.

Kitzinger, C. & Kitzinger, J. (2014).

Withdrawing artificial nutrition and hydration from minimally conscious and vegetative patients: Family perspectives. Journal of Medical Ethics [Advance online publication]. doi:10.1136/medethics-2013-101799 Sears, S.R. & Stanton, A.L. (2001).

Physician-assisted dying: Review of issues and roles for health psychologists. Health Psychology, 20, 302–310.

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contribute

It was with great interest that I read the article on the Assisted Dying Bill in the September issue of The Psychologist. I took an active part in contributing to the role of psychologists in assisted dying (AD) during my career in the NHS, having acted as an expert witness to the original proposal by Lord Joffe in 2004, and offered a response to legislators in the subsequent years. I also chaired the BPS working party on the role of psychologists in end-of-life care , which produced a report (BPS, 2008) that is currently being updated, and acted as an expert witness to the Demos Commission on Assisted Dying when the current iteration of the Assisted Dying Bill was being reconsidered.

I find the article in The Psychologist deeply disappointing from a number of perspectives. Firstly, and most importantly, while it informs the reader that the current bill refers to making AD available only to those people with a terminal illness and in the last six months of their lives, it fails to mention that there would be a rigorous assessment process, which involves considerable investment of time, knowledge and skill on the part of the healthcare (and potentially other) professionals involved. It is an entirely voluntary process, and the safeguards to ensure the person requesting assisted dying has full mental capacity are robust.

I would urge anyone who has a serious interest in the bill to read it. The bill most closely follows the Oregon Death With Dignity Act (DWDA), and thus readers might also look at the research from the US, predominantly Oregon, which legislated for the DWDA in 1997, and who have been collecting robust data since that time (see tinyurl.com/nfq8uqa).

There is also a body of independent research looking at factors such as doctors’ attitudes to AD, the nature of the people who request a lethal prescription, and the effects on the palliative care

services (Battin et al., 2007). It is also helpful to look at the websites of Dignity in Dying (www.dignityindying.org.uk) and Care not Killing (www.carenotkilling.org.uk), which offer two very different perspectives on the potential impact of the bill.

A further disappointment is the inclusion of two clinicians who are not involved in services for people with a lifelimiting illness. The bill is very clear that it refers only to people with a life-limiting illness, therefore people with chronic pain, or a specific disability would, by definition, be disbarred from requesting AD. The final contributor, who works in primary palliative care cites his own work, which while offering interesting data, provides neither new information (we have known about the critical stages in the experience of having cancer since the work of Jimmie Holland in the early 1970s: see Holland et al., 2010), nor is it relevant to the issue of AD, because, as stated above, a request for AD can only be made in the last six months of life (so far as it is possible to prognosticate), thus other critical periods for significant psychological distress can, and should be managed by other means, whether through medication and/or psychological therapies (Brennan, 2004; Sage et al., 2010).

There is a strong implication in the article that pressure groups for people with disabilities are anxious that a change in the law would put individuals with disabilities under implicit pressure to volunteer themselves for AD, were the bill to become law –the ‘slippery slope’ argument. While not wanting to dismiss the anxieties of such groups, it is not possible for this to happen within the remit of the bill. It is very specific, and as stated above, most closely matches the DWDA, and not that of the models that many of the Benelux countries have adopted, which often incorporate

THE PSYCHOLOGIST NEEDS YOU! Letters These pages are central to The Psychologist’s role as a forum for communication, discussion and controversy among all members of the Society, and we welcome your contributions.

Send e-mails marked ‘Letter for publication’ to psychologist@bps.org.uk; or write to the Leicester office.

Letters over 500 words are less likely to be published.

The editor reserves the right to edit or publish extracts from letters. Letters to the editor are not normally acknowledged, and space does not permit the publication of every letter received.

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euthanasia, in which a person is helped to die through a physician administering a lethal drug, and AD, in which a physician prescribes lethal drugs, and the patient themselves taking them if /when they believe right time has come.

Evidence from Oregon suggests that while the numbers of people with lifelimiting disease requesting a lethal prescription have risen steadily since 1997: a total of 1173 people have had assisted-dying prescriptions written and 752 patients have died from ingesting medications prescribed under the law, the proportion of people who take the drugs, as opposed to having them in a safe place at home, remains between 50 and 60 per cent year on year. This means that from 40 to 50 per cent do not take the lethal drugs, and die from other causes.

However, they have the peace of mind of knowing the option is there for them if they need it (see tinyurl.com/nfq8uqa).

From a clinical perspective, having worked in specialist palliative care for 20 years, and having a consultancy in the field now, I found the patients who talked about wanting to commit suicide, or having help to die were many, and the number of people who took their own lives very low.

In summary, while it is laudable that The Psychologist has chosen to consider this issue, it is disappointing that the opportunity to engender well-informed and open debate seems to have been missed. Perhaps the BPS should consider developing a debate with interested parties, including representatives from faith groups, relevant pressure groups, the Royal Colleges, etc., particularly given that the issue is ‘live’ at the moment, while the bill progresses through the parliamentary process.

Finally, and perhaps of most importance, we need to ensure that the profession is at the forefront of the important conversations that individuals

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and families want or need to have when faced with the deeply important issue of discussing how we die.

I support the Assisted Dying Bill, to give the terminally ill the right to choose to be assisted to die, which was the subject of the article ‘We should bring death back to life, into the open’ in the September issue of The Psychologist.

I fully support the aims put forward by the specialists in relation to their areas of Christine Kalus expertise, but none of them makes any mention of an individual’s right to make their Consultant Clinical Psychologist in own assessment of whether or not their life is worth living. independent practice Professor Hughes wants ‘greater availability of pain management’; Dr Old Portsmouth Smith wants better support and more suitable accommodation for disabled Hants ‘We people and the promotion of a more positive view of the potential for a s disabled person to have a good quality of life; Professor Murray wants better References nto t hould br he o palliative care, particularly better psychological support for the terminally Battin, M., van der pen’ ing deat h ill; all of these are important points which would undoubtedly make life Heide, A., Ganzini, L. better for many terminally ill people. But that is not the issue here. It is not et al. (2007). Legal for any specialist to judge whether the application of the best techniques physician-assisted available will make life worth living for a particular individual. dying in Oregon and I believe the Assisted Dying Bill will enhance the wellbeing of all the Netherlands: terminally ill people, by giving back to each individual some of the control Evidence concerning that they have lost – the ability to choose to terminate their own life should the impact on they judge that it has become intolerable. (There are safeguards in the bill patients in to prevent such decisions being implemented on a whim.) ‘vulnerable’ groups.

This choice is particularly important for those suffering deteriorating Journal of Medical health. Without that reassurance, some feel they must take their own life Ethics. 33, 591–597. while they are still able to do so. They fear that if they live (happily) a few Brennan, J. (2004). more months, even years, they could become unable to die without Cancer in context. assistance should their life become intolerable. At that point they would be Oxford: Oxford forced to suffer months of an intolerable life, or to ask a friend or relative to risk University Press. imprisonment by helping them to die. Neither is acceptable, so they must choose to end British Psychological Society (2008). The role of their life while they can do it alone. That is the only way they can retain control – and psychologists in end of life care. Leicester: Author. lack of control over one’s fate is psychologically debilitating.

Holland, J., Breitbart, W., Jacobsen, P. et al. (Eds.) The knowledge that there would be the choice to be helped to die if life were to (2010). Psycho-oncology (2nd edn). New York: become unbearable would give many the confidence to enjoy life despite their declining Oxford University Press. abilities.

Sage, N., Sowden, M., Chorlton, E. & Edeleanu, A. ospec uld alt of havin r ow low peo g a law n in ple recen lives has to get place rs bac t month caused help to U ying ked Lords after H K-wide o B nine- ill at its Falconeruse of se h ore th our deb cond re ’s ad at the P an 130 p e of its ing mak rivate M eers spo e k given it legal foembers’ e at B – it w assistan r termin ill, ce x mo ould ap to end ally ply n ous ths to live to peop et le that hical an . th d it to is bill w beco o from me la uld ke to a psych w, but ologi spec ca ia lliati ve ca lists in l re fo r thei r More

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eers ‘Unfo spok wen have rtunatel e at the ycho Hughes, endin lost con y, people deb lo ate anag gist and abou g their trol of th can feel on th e Pri d, doement, do h t it) can life (or at eir life an that they vate M desp es not som ave one give them least th d that repo eo it mysel ne wh option o a senseinking ditio e cent rted low o n it ca f I have has a chpen to th that th elpin of th of them n g you take ove firsthan ronic p em. As ey em h h nic p w le ai d ad ere ai year t it. I w r your experie n prob hat th n. be in worried tol s befo of pract as lucky consciou nce of hlem ey kept a men re for th assist hand. I ising the in that s mind ow wasn these if they e I w ed dyin certainl techni I had 15 ’t th

(2010). CBT for chronic illness and palliative care.

Chichester: Wiley.

In the service where I work as a clinical psychologist, many of our clients are drawn from well-off, educated backgrounds, having had successful careers and often placing great value on cognitive ability and academic endeavour. Though not common, I have come across a number of clients who express a desire to end their lives following a diagnosis of dementia. I think particularly of one very intelligent man in his 80s who is extremely cognisant of the decline in his cognitive faculties, monitors these changes constantly, and is well informed about the prognosis for his cognitive future. Since his diagnosis he has expressed an unwavering wish to take his life. His family, realising that he is likely to do so in a less controlled way, have offered to take him to Dignitas in Switzerland. This is difficult

Richard Mobbs Kingston upon Thames

and expensive for a family to undertake. However they are endeavouring to respect their father’s desire to hold his fate in his hands as they have always done. This while having to overcome their own conflicting feelings.

In my role I have supported this gentleman for eight months. We have considered the impact of euthanasia on his family, as well as exploring his feelings around the changes that he is experiencing (physical, emotional and cognitive).

The gentleman does not appear depressed on either objective or subjective measures and any negative appraisals are directly related to his diagnosis of dementia.

He has been assessed to have capacity. Therapy has been successful in challenging his belief that his cognitive decline will be rapid and sudden and that life with a diagnosis of

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Alzheimer’s disease is not worth living. He has agreed to postpone his suicide, but is adamant that it is the way in which he wishes to end a very independent life. He is anxious that by postponing his suicide he will pass the point where he is able to commit it.

As you can imagine, this has been a challenging road for a new psychologist to tread. While ensuring that I am not perceived to support his desire to end his life, I need to respect my client’s wish to live (and yes, die) as he chooses. I have had to consider how to give him sufficient support so as to engender trust and prevent him from disengaging from therapy, while not actually encouraging his actions. I have explored this complex ethical dilemma within supervision and considered our profession’s responsibility with regard to safeguarding.

Perhaps it is understandable therefore that it has been difficult for psychologists to speak up in favour of the Assisted Dying Bill. As a profession, we are committed to prolonging life and well-being, but as therapists we are also acutely aware of the suffering that clients experience as a result of the difficult lives they lead. We might believe that the client is the expert on themselves, but in a case such as this, do we hesitate when giving their (legitimate) wishes credence?

Our BPS Code of Ethics and Conduct highlights respect for clients’ self -determination.

Would it be ethical to dismiss this man’s considered wishes for the end of his life or to give tacit (or even explicit) support to his plan to end it while he still can in a manner of his own choosing?

Name and address supplied

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‘Creative’ (and non-creative?) industry Creative Britain is certainly a phenomenon, if it exists, which we and our descendants will have to nurture if we want to thrive. But what is this; and as your correspondent David Wood writes in (Letters, September 2014), exactly where is it?

Stephanie Taylor (‘Creative Britain, August 2014) gives much useful information about what the Department for Culture Media and Sport designate as creative industries, comprising ‘advertising, architecture, the art and antiques market, crafts, design, designer fashion, film and video, interactive leisure software, music, the performing arts, publishing, software and computer services, television and radio’ which evidently contributed (in 2010) £59 billion to the national economy.

Before examining (social) psychological aspects of the above industries it would be useful to set the economic size of all this activity alongside that contributed by other industries.

A Wikipedia article (citing the UK Office

for National Statistics) reports that in 2011 the construction industry contributed £87 billion to the UK economy, its largest component being the London Crossrail project; aerospace has an ‘annual turnover of £20 billion’ with British Aerospace the largest component, being the world’s second largest defence contractor.

By composing the list above the DCMS might imply that other industries are not so (or not at all?) creative. Some critics will judge by the utility of the output and would argue that the defence (armaments) manufacturers are not creative but destructive; I have read similar arguments about large sections of the drug industries. Leading from this it is also easy to find critics and analysts who argue that much of advertising and screen products (including video games) arbitrarily designated ‘creative’ by the DCMS is destructive.

Taylor turns to those who challenge a focus on individual creativity. An expert

is cited who proposes that ‘creative behaviour is the outcome of favourable circumstances’ (and how might they arise?). Ah! Creative behaviour is what we (informed and influential people) say it is. ‘Social psychological studies [all of them?] challenge the conventional association of creativity with individual genius or special talents’ (Taylor, p.592); please count me out of this view. We need to notice how G.F. Handel powered his way, from a very early age, against his parents’ designs for him, to establish himself as performer and creator of music – and, then, agreeing with the ‘social’ gurus, to become a builder in an existing industry (opera) and the creator of a new one (oratorio).

There is no doubt much to be said about

‘I’m no expert’, says female psychologist…

I love psychology. I have monopolised many a dinner party talking about it. By chance/serendipity/fate I met someone who was researching for a book that interweaves the story of James Sadler, the first Brit to fly, with the author’s own journey to conquer their lifelong fear of heights. Crucially, he wanted to recreate Sadler’s hot-air balloon flight – horribly incompatible with his height phobia. A perfect excuse to chat about psychology for hours.

Long story short, the book has been published [see review on p.792]. I am so proud – like a kid with a show and tell – that some of my comments made it into the story. We’ve also done a couple of local radio appearances to promote the book and contribute to the public dialogue about mental health.

The very odd thing is that my appearance in the book and on the radio is consistently prefaced with the phrase ‘phobia expert’. I am at the start of my career as a psychologist, seemingly surrounded by people more experienced, skilled, and deserving of that status. It feels a very odd title for me. I was trained to consider power relations; the inherent inequality of the title ‘Dr’. In fact, I’d go so

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far as to say that if I were given feedback that ‘Hannah took the expert position’, I would consider it rather an indictment.

So at first, I was taken aback.

Always the dutiful psychologist, I consulted my supervisor, who suggested that I may never think of myself as an ‘expert’, but I know a lot more than the average person and therefore have a valuable contribution. A peer suggested that public engagement is one of the most useful things a psychologist can do – and in common parlance ‘expert’ is probably a reasonable title. A friend looked at me quizzically and said, ‘Hannah, you’ve been training for the best part of the last decade…?’

And then comes a seemingly unrelated intersection. Women, we hear, still occupy only 24 per cent of the most senior posts in the country. We earn less, we take longer to progress up the career ladder.

Why? Well, apparently women wait longer to apply for promotions, they are less likely to describe themselves as experts, they promote themselves less aggressively. When looking for contributors for Channel 4 news, Jon Snow noticed that when he asked women to appear as an ‘expert’, they would say,

‘It’s not exactly my expertise, I ought not do it’. Men would say ‘It’s not exactly my area of expertise, when do you want me?’.

In a roundtable discussion at the British Association for Behavioural & Cognitive Psychotherapies conference recently, a quick headcount suggested 13 of 75–80 attendees were men. But... of six panelists and one chair at the front of the room, only one was a woman. Toward the end the panellists began to mention the conferences/books they were currently promoting. When her turn came the one woman said ‘Oh I don’t have anything to promote’, and the panel moved on.

Someone else jumped in: ‘You have a book out! [to the audience] It’s excellent – buy it!’ It seemed to encapsulate in 15 seconds the facts and figures and dissections of culture that we read about.

I feel so passionate about redressing this imbalance. The Every Sexism Project, founded by Laura Bates, has examples and statistics that leave us in no doubt that sexism is alive and well: it ranges from quietly being sidelined or subtly patronised (‘Calm down, dear’ from the lips of our very own PM), to outright vitriolic abuse (such as that received, and responded to in such a dignified manner,

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The end of prosopagnosia? social facilitation (or frustration) of individual attributes and their operation, but to rule them out of this particular discussion (and in general) is to make a hole in the most important unit in the ‘equation’.

I trace the problem back to the 1960s when educational psychologists teased out and labelled two constructs, of divergent and of convergent ability.

The first, by itself, (mistakenly) became identified with ‘creative’ thinking, and action and was fostered in school curricula. It also became associated with certain subjects and dissociated from others. A different view, that creative performance would most likely spring from a combination of three things – both high divergent and high convergent personal ability and of course encouraging contextual conditions – was not developed. It would be more creative of us now to return to a more rounded account.

J. Mallory Wober PhD London NW3

My eye was caught by two articles in the August issue. The first of these was Elliott and Grigorenko’s ‘The end of dyslexia?’. They noted that some children selfevidently find it more difficult than others to learn how to read and write, but that the concept of dyslexia had not really contributed much to our understanding of this, nor to our ability to intervene usefully. They also noted the way in which the term ‘dyslexia’ has come to be used for political and campaigning purposes, which has arguably confused an already confused situation further: ‘the label is a cultural meme that remains unscientific and conceptually problematic’.

The second article (‘Getting engaged with the public’, Society) was partly about prosopagnosia – ‘face blindness’ – and it struck me that many of the points made in the dyslexia article might equally apply to the suggestions in the prosopagnosia piece. For example, it was claimed that 1 in 50 suffer from face blindness, without the term being adequately defined (i.e. are we talking about the ‘I don’t recognize my wife’ variety, or the ‘I’m not very good at remembering new faces’ variety?). There were also suggestions that a national charity should be established, that health and education professionals should be made more aware of the

condition, and even that ‘a set of guidance notes’ should be developed.

I am reluctant to take all this at face value. Severe prosopagnosia is without doubt a difficult condition to live with, but I worry that – as with dyslexia – people may self-diagnose then seek a formal assessment (I’m freeing up my diary in anticipation) in order to get a formal diagnosis, which is unlikely to result in any useful intervention. Could it be that the ability to ‘learn’ and recognise a face, like many other cognitive abilities, is simply a skill which is more-or-less normally distributed in the general population?

John Higgon Clinical neuropsychologist Dumfries

Memory – from zeal to fantasy by both Mary Beard and Sarah Millican).

Such treatment arguably contributes to the significantly higher prevalence of (almost all) mental health problems in women than in men. Daniel Freeman’s recent book cites that in the last year 25 per cent of adult men had significant psychological difficulties, but for women the figure was a whopping 37 per cent.

As a young woman, I want to play my part. Women should be more assertive about their abilities. We should take ownership of our sphere of knowledge.

This feels alarmingly incompatible with my suffocating pressure to be modest; to reject the ‘expert’ title… but when the two stances feel incompatible we mustn’t be discouraged. We’ve got to start navigating our way toward a compromise.

All of a sudden, I hear an imagined fragment of voice… ‘“I’m no expert”, says female psychologist.’ Well, no wonder then if everyone stops listening. Since the knowledge I already have is useful for other people, particularly in the public arena, why not share it?

Hannah Stratford Research Clinical Psychologist Oxford Centre for Anxiety Disorders and Trauma

Over many years of acting as memory expert witnesses we have identified four groups of people who are happy to stand up in court and give ‘expert’ memory advice, whether or not they are ‘memory’ expert witnesses: bona-fide memory researchers, the Zealots, the Old Guard, and the Fantasists. When we wrote our article (‘Beliefs about autobiographical memory’, July 2014) we confidently expected to hear from these last three groups, and we were not disappointed (see Letters, September 2014).

The Zealots have a fundamentalist belief that memory is accurate, particularly so when it is of emotionally negative or traumatic events. This group place great emphasis on any findings that selectively give support to their single central belief. This is why the modern view of human memory, outlined in our article and based upon a full review of the scientific findings, is so troubling to them: the vast amount of data on autobiographical memory shows the notion of ‘accuracy’, and indeed of ‘confidence’, to be highly complex. Even worse, no memory is accurate in being a complete or literal copy of an experience (the core of their belief).

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Members of this group would benefit from studying the important and influential 2008 report Memory and the Law from the British Psychological Society’s Research Board (download via tinyurl.com/oydxy3x). A team of national and international memory researchers provided advice on memory distilled from a wide and representative range of memory research. The modern view of human memory is based on about 35 years of research into many different aspects of memory, including beliefs about memory, extensively reviewed in this report (as well as in the recent volume by Nadel & Sinnott-Armstrong, 2012, and a forthcoming volume, Conway et al., in press).

The Old Guard is represented here by Professor Michael Kopelman, a colleague of ours and one of the country’s leading psychiatrists, a bona-fide memory expert, and a leading expert witness in our courts for several decades. Kopelman is clearly right to note that psychologists give expert advice in many areas and not just in cases that prominently feature memory.

Our interest is, however, in those cases where memory is the only or main evidence. In such cases the Court of

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Appeal and virtually all judges take the view that as jurors have their own memories, which they can reflect upon, there is no need for any memory expert advice. Our article shows them to be wrong.

Finally, there are the Fantasists. There is not a shred of credible scientific evidence in support of their creative thoughts about memory. These beliefs can

only be viewed as what they are, an enjoyable flight of fancy. What is troubling to us, and what might trouble you too, is that the distance between the Zealots and Fantasists is much less than one might suppose.

Martin A. Conway City University Catriona M. Morrison Lucy V. Justice

References British Psychological Society, Research Board (2008).

Guidelines on memory and the law: Recommendations from the scientific study of human memory. Leicester: Author.

Conway, M.A., Howe, M.L. & Knott, L. (in press). When memory serves as evidence. Hove: Taylor & Francis.

Nadel, L. & Sinnott-Armstrong, W. (Eds.) (2012).

Memory and law. New York: Oxford University Press.

Dyslexia – the issue is outcomes I read the continued articles and letters on dyslexia with a depressing sense of déjà vu.

It has always puzzled me why educational psychologists have a problem with the term – clinical and occupational psychologists have no issues it seems (e.g. Psychological Assessment of Adults with Specific Performance Difficulties at Work, guidance produced by a working group of the BPS Division of Occupational Psychology). Indeed until the late 1970s we had the then Department of Employment recognising dyslexia and the

Department of Education refusing to.

I should have picked up a clue as a young Research Fellow at the University of Aston in the mid-1970s. I was addressing a group of educational psychologists who had requested a seminar on our research showing differential neuropsychological processing and individual differences in cognitive skills in dyslexics (aka contemporary research!). I was showing the atypical reading and spelling errors shown by children in our research

MALE PSYCHOLOGY Alongside the June special issue on men’s psychological health, the first Male Psychology Conference was held at UCL in the same month. It was such a success that we have extended the programme for next year’s conference an extra day in order to include more presentations and include workshops. We had excellent keynote speeches this year (on modern masculinity, government policy and even a Jungian take on sexuality) and presentations (mostly clinical psychology), posters and dynamic renditions of poetry exploring PTSD and being a male victim of domestic violence.

We hope by next year that sufficient numbers of BPS members will have voted for the creation of a Male Psychology Section of the BPS in order to focus research and discussion on the important topics in this field – vote at http://response.questback.com/ britishpsychologicalsociety/malepsychsection.

In the meantime, we invite presentations and workshop proposals for 2015 (see www.malepsychology.org.uk).

John Barry UCL Medical School Luke Sullivan Barnet, Enfield and Haringey Mental Health Trust Martin Seager Central London Samaritans

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cohort/assessment centre. The Principal Psychologist interrupted me saying ,‘We don’t want to see the children’s work, but to talk about the politics of dyslexia.’ Sadly, an attitude that seems to have persisted.

Yet terms like autism, ADD, ADHD, MLD, SLI, dyspraxia, dyscalculia are not the subject of condemnation and ‘doesn’t exist’ polemic. Perhaps they should. Take autism for example – well accepted as a diagnostic descriptor by local authorities some of whose psychologists, despite the SEN Code of Practice from 1982 to now, the BPS report of 1999 and the Rose report of 2009, still baulk at ‘dyslexia’. Autism is much vaguer – is it a ‘spectrum’, where does Asperger’s finish and autism begin, should one include all the ‘triad’, what level of social communication dysfunction are we talking about, how is it measured?

For me, having run a school for dyslexic children for 27 years, the issue is outcomes. If you are identified as ‘dyslexic’ (or indeed another SEN) you are more likely to get the help you need. I don’t accept that this means less support for others, we should support all SENs fully. Importantly, being dyslexic implies a particular kind of teaching programme (different from e.g. MLD, comprehension impairment, etc.), without which they will not make progress.

Of course, children do vary but descriptors are a convenient overarching shorthand. So, one could say (without entering into the discrepancy or ability/achievement model debate!) that the child has: ‘A specific learning difficulty characterised by a severe delay (despite conventional literacy teaching) on a standardised psychometric assessment (i.e. more than 1 SD from the mean) in reading decoding (with better reading comprehension if decoding was supported), spelling, writing and phonological skills, sometimes associated with poor (on a standardised test) working memory, processing speed, non-word reading, rapid automatic naming; the implied etiology being neural pathway processing leading to the underlying cognitive skills resulting in the behavioural observations describe above.’

Hmm… seems a clear diagnostic descriptor, but rather a mouthful, how about a shorthand description?

I know – dyslexia.

Dr Michael Thomson AFBPsS Ramsgate, Kent

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EMDR – time will tell Regarding EMDR, my observation – in the light of 10 years’ practice and supervision – is that if anything, Dr Robin Logie understates the case for the therapy (July 2014). While EMDR may look similar to other treatments from the outside, the inside view (Kahneman, 2012) gives a rather different picture.

Beyond the numerous RCTs in its favour, EMDR has striking and novel features that stand out clinically. For one thing, actual trauma processing can, at best, be extraordinarily fast in EMDR. I personally have had various cases in which the traumatic memory was resolved in 10 minutes or under of actual processing – to the astonishment of all concerned. In such cases, it seems as if a bubble of consciousness, temporarily problematic due to trauma and often with significant somatic links to the memory, has been burst. This type of experience is not so unusual: I estimate that I hear a jaw-dropping EMDR story of rapid and/or deep symptomatic relief at least once a month.

My prediction – and only time will tell if it is correct – is that EMDR will turn out to be the first in a new class of psychotherapies that work differently from conventional talking therapies, perhaps via different neural and somatic pathways, and at deeper levels.

As one instance of this possibility, bear in mind that nightmares (often emerging as the royal road to the underlying issues via association) are frequently targeted for successful processing. At another, it is possible to process traumatic memories swiftly and successfully in virtual silence with EMDR. This not only can protect the service user (and clinician) in cases of extreme trauma since a full and painful verbal account is often redundant, but it is also hard to explain via the paradigm of conventional talking therapies.

In short, given the view from the clinic, there is reason to think that – for those service users stable enough to undertake it – EMDR may be the quickest, and most powerful psychological tool currently at our disposal. This could explain why EMDR is gaining ground among psychological therapists of all stripes who know a good thing when they see (or rather hear about) one. I think something different is going on here. Time will tell, as I say.

Dr Roger Kingerlee Principal Clinical Psychologist, Norfolk and Suffolk NHS Trust Reference Kahneman, D. (2012). Thinking, fast and slow. London: Penguin.

Practitioner psychologist – a title without division I have read with interest the recent letters regarding parity between clinical and counselling psychologists within the NHS and feel there is a wider issue.

I am a forensic psychologist who has completed all of my training and postqualification employment within the NHS, and as such have often had to work to have my training, qualification and, in some cases, even professional judgement considered on a par with clinical psychologists. My understanding is that, as June Richards (August) points out, there is an agreed level of parity between clinical and counselling psychology within the NHS at all grades, and posts that do not require the ‘essential competencies’ of either one will be advertised as Clinical/Counselling, while this is not true of clinical and forensic psychology.

The long-standing relationship between the NHS and clinical psychology training, and the associated financial commitment this has involved, lends itself towards clinical psychologists being favoured for many NHS jobs. However, increasingly, the NHS is providing services to other agencies, such as criminal justice, therefore individual specialism has to be recognised.

I understand and accept that many jobs within the NHS require the specific skills and training of a clinical psychologist; however, we should not limit applications to posts where other

modes of training have equal relevance.

The HCPC title of ‘Practitioner Psychologist’, I believe, helps to promote parity between disciplines and this should be embraced by the NHS. Why not advertise a post for a ‘Practitioner Psychologist’ and let the individual skills and experience of the applicant inform the recruiting panel whether they are suitable for the job?

Bryony Crisp CPsychol Leeds

We can echo Carolyne Keenan’s (Letters, July) experience of being ruled out for NHS posts purely on the basis of adjectival title or (mis)perceptions of what that title represents. In our own cases, we have faced this dispiriting and frustrating experience more often than not when seeking promotion in our local area, despite having already proven ourselves in NHS psychologist posts.

The various applied Divisions within the BPS (Divisions being an unfortunate term), have done a great deal of good collaborative work at the national levels.

However, there still appear to be pockets of the NHS where a mutually respectful attitude and recognition of shared competences has yet to filter through. In the context of NHS changes, particularly in relation to the commissioning of services and the delivery of psychological therapies by a wide range of professionals, it seems all the more important that we

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are psychologists first and foremost, and the specialisms are secondary. Politicians, commissioners and managers are generally uninterested in our internal differences, and indeed will be dismayed if such a small profession cannot present a united front and a common expression of the strengths we can bring to the NHS. As counselling psychologists, we simply want to do the valuable work we have been well trained to do, and see enormous value in working closely with clinical psychologists and a wide range of other professions. We try to help our clients to recognise and modify outdated or unrealistic perceptions – can we psychologists do the same?

Lewis Blair Rachel MacLeod Glasgow

Editor’s note: The Society has previously written to NHS trusts (most recently in September 2011) advising them that ‘advertisements for psychology posts should seek applications from Applied Psychologists who meet the required competencies for the post. Where specific essential competences are needed this must be clearly specified and consideration must be given to whether an applicant, through CPD and post qualification experience may have acquired these competences, despite adjectival title, and so be eligible for the post.’

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Sex offenders - time to step outside the anger?

In recent years revered public figures popularised by their achievements and good standing in the community have been revealed as child sex offenders, triggering shock waves across social consciousness. Once a totem of the better side of human nature, they proved to be otherwise. What happens next? The public feel betrayed and deceived and so redefine, demonise and dismiss ‘him’ as ever being like ‘us’. Public resentment and rage follow, fuelled by sensational stories from the media. The response is understandable – no one condones abuse; but it will alienate the offender whist promoting the myth that sex offenders are isolates and psychopaths. Some are of course, but most are not.

This myth is created by media reporting that fuels public anger towards offenders and inhibits the potential for safe reintegration. The reality is, most men who sexually offend do so within the family home or are known to the family and have many socially acceptable, even admirable qualities.

Research proposes that the first sexual experience sets the pattern of expectations for the future. If it has been deviant, the possibility of that affecting sexual behaviour as an adult increases. However, without empathic insight into these issues, an aggressive public attitude is not tempered and maintains the fear of reprisals, deviancies are secreted and a covert life evolves alongside mainstream cultural beliefs, behaviours and values. Thus, he is enabled to live, work and achieve as an accepted member of the community: a celebrity, bank manager, clergyman, accountant, policeman, judge, psychologist, plumber, window cleaner, sportsman, politician, student, teacher, soldier, sailor, social worker, and more.

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The problem exists across the whole of society, within all religions, cultures and professions, and across all levels of educational achievement; this is not an isolated population. Yet as a society we appear startled when it makes front-page news. Feeling betrayed, we separate ‘him’ from ‘us’, demoting him to a stereotyped deviant set apart from ‘normal’ people. But by doing this, we deny ownership of a sexually destructive undercurrent in the culture, reverting to blame and attack, which fail to explore the origins of a problem created within a society whose lack of ownership drives it underground.

For those whose deviant thoughts are in the ‘contemplative stage’ or where a short sentence did not enable prison treatment, probation treatment is also unavailable. Unfortunately, there is little community treatment apart from the costly private sector. Where then do offenders or potential offenders go for help? With the current availability and cultural attitude to sexoffender rehabilitation, the answer is likely to be nowhere! Disclosure has

become too much of a risk. In an ideal world, a non-punitive supportive attitude from the public and available community treatment services prior to abuse would be the way forward.

The issue raised here is contentious as it suggests reduced risk requires a change in public attitude and media

reporting, which without political back up is a ‘big ask’.

But new ways of thinking are required as the old way is failing: offenders are still alienated, psychological damage to victims continues, the financial cost of processing sexual offending increase – arrest, legal processing, prison, probation and finally long-term monitoring in the community.

Arguably, the biggest inhibitor of change is media myths that generalise negative characteristics of all sex offenders and inflame societal attitude. Meanwhile, as we reel from revelations about public figures, society’s attitude inhibits offenders requesting help. For this to be different a change in media reporting and public attitude is required.

The question remains: Is it possible to affect a change in public attitude through insight?

Alex Hossack Consultant Clinical Psychologist Liverpool

obituary

Conrad Graham (1929–2014) Conrad Graham who died on 7 August after a long illness, was a key figure in the early history of the Association of Educational Psychologists. He had a long career in the profession in London, first in Ealing and then as Senior Educational Psychologist in what was at that time the Borough of Willesden. He steered the educational psychology service there through the combination of Willesden with Wembley to form the London Borough of Brent, where he was Chief Educational Psychologist for 17 years.

He helped to shape Brent’s response to rapid changes in the school population and to complex challenges from the vicissitudes of the 11+ examination. His contributions to the latter were informed by a longstanding interest in the psychometric underpinning of the test regime and its illunderstood complexities.

Conrad described himself to friends and colleagues as an ‘inveterate joiner’, and a good number of the many societies and

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obituary

David Smail (1938–2014) Aged 76, David Smail died on Sunday 3 August this year. As coordinating editor of Clinical Psychology Forum, I put together only three special issues specifically dedicated to individuals whilst still alive – one to Dorothy Rowe, one to John Clements, the other to David. Clinical psychologists queued up to write for all three. David, ever modest, was taken aback when his copy came through the letterbox. By then he knew how much his work had influenced my roles as writer, editor and Director of Psychological Therapies. Over a whisky in Nottingham we talked a little of how ironic it was that we both emphasised the individual in context but when it came to putting those we admired on pedestals there was no room for all the other factors involved in that elevation. (To add to the irony I had succeeded him as Chair of the Psychotherapy Section of the BPS.) Fluent in French with a rich understanding of philosophers like Sartre and Merleau-Ponty, David would have been admirable if he had never entered clinical psychology.

He trained at Horton Hospital in Epsom and then at Claybury Hospital in Essex and entered my life when he came to speak at Leicester University in the late 1970s. He had been the first editor of the Psychology and Psychotherapy Association Newsletter after co-founding the PPA with Miller Mair and Don Bannister. The Newsletter became Changes, which I was asked to edit in 1988, and a few years on changed again to the Journal of Critical Psychology, Counselling and Psychotherapy. Ten years earlier Dorothy had recommended David’s Psychotherapy – A Personal Approach and some of us in her department became immediate converts. One reading of PAPA was that therapists might attend more to what patients were actually saying about their lives, a commitment that required months or years of regular meetings rather than quick-fire behavioural or

psychodynamic constructions. There was something both alarming and humbling about discovering just how many challenges were faced by those in the mental health system. These weren’t challenges that therapy could possibly fix.

David was head of clinical psychology services in Nottingham until 1993 and retired from the NHS in 1998. He held the honorary post of Special Professor in Clinical Psychology, University of Nottingham, from 1979 to 2000. One role at the university was as part of the student counselling service, a position he likened to being an encouraging dad to young people struggling with being away from home and crushed by the expectation to succeed. He gave up his counselling role when he found himself being kept awake on Sunday nights ahead of counselling sessions on Mondays. It was typical, I think, of David that his caring should lead to sleeplessness. Not content with a life of full retirement he continued to write and was a founder member of the Midlands Psychology Group.

Curiously, in Forum and JCPCP, I have reviewed all of David’s books with the exception of his last – Power, Interest and Psychology: Elements of a Social Materialist Understanding of Distress (PCCS Books, 2005). Guy Holmes and I were commissioning editors for the latter. David had left us with pretty much nothing to do. As in public talks, the text was precise, the humour sardonic and the sources broad: Tolstoy and Jung get three references, Foucault six and Skinner and Thatcher one each (the same number as Hitler, Christ and Toscanini).

The September issue of JCPCP is a tribute to David. This time he won’t be around to read it but I shall raise a glass anyway.

organisations he joined were eager to elect him to honorary posts where his organisational skills made things happen. At one point in the early 1960s he held five concurrent secretaryships, and that may not have been the peak of his activity. The most farreaching of his professional initiatives was as originator and joint founder of the Association of Educational Psychologists. Conrad was its first National General Secretary and later a successful President. He played an important role in ensuring that its services to members extended beyond those of a trades union to the provision of focused professional support and consultation.

In 1976 he left Brent and joined a number of other educational psychologists in the small team of Inspectors of Special Education in the Inner London Education Authority.

He had responsibility for special education matters in all schools in a large division covering two boroughs. He also had specialist responsibility for work across Inner London with pupils who had emotional and behavioural difficulties. Colleagues had always turned to Conrad for advice and for practical support. Now more than ever his calm approach to knotty problems, his clear-sighted analysis of any situation and his firm, confident judgement were in great demand. He was close to the schools and the teachers and supportive of them but also able to look at their needs from

outside dispassionately. He retired in 1988 after 40 years’ service in education.

One of his own favourite anecdotes from his days as a psychologist illustrates some of those qualities of perspicacity and determination that characterised Conrad’s whole career. He was asked to interview an intelligent, 15-year-old boy who had an obsessive interest in poisons. There was no direct evidence, but on the basis of the interview Conrad became convinced that he was administering poisons to others in small quantities. His immediate superior in the local authority hierarchy was loath to take action. So Conrad ensured police involvement through his own local network, leading to the boy’s conviction. Sadly after release from Broadmoor some years later Graham Young killed three workmates with poison and was sent to prison for life.

The episode illustrates some of the qualities that professional colleagues valued highly in Conrad. He was able to see past the surface of things, was always willing to face difficult facts and was ready to do whatever was needed to achieve the objectives he thought were required. He is survived by his wife Kay, their two children and four grandchildren.

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Craig Newnes Shropshire

Tony Cline University College London

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NEWS

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A study in

Recent riots in Ferguson, Missouri, which began following the fatal shooting of Michael Brown by authorities, have raised concerns over the militarisation of police in dealing with conflict and protest.

Psychologists have developed useful theories about crowd control and implemented these in practice, but how far has the message spread? And what can be done to promote more progressive thinking in police forces worldwide?

Professor Steve Reicher (University of St Andrews) and his colleagues developed the Elaborated Social Identity Model of crowds, which, in its coverage of Ferguson, Newsweek described as the ‘leading scientific theory on crowds’ (see tinyurl.com/k45ajyf). The theory, which examines how crowd police interactions produce conflict, spells out the implications for public order practices designed to limit conflict.

Professor Reicher explained: ‘The four principles are: education, to understand the nature of the various social groups in the crowd, their norms and values, aims and intentions, notions of legitimacy and illegitimacy; facilitation, don’t simply act to stop things that are deemed unlawful, start by facilitating lawful aims and intentions; communication, talk to crowds, explain how you are trying to facilitate them and why you are acting as you do; and differentiation, always use measures –

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tactics, technologies, et cetera – which are targeted and which distinguish between those acting lawfully and unlawfully.’

These principles have been used in major football tournaments and have led to the development of ‘dialogue policing’ which applies to all public order policing, not just football crowds, and has been adopted in Denmark and Sweden. In recent years they have been accepted as the basis for reforming UK public order policing and are enshrined in an official report of Her Majesty’s Inspectorate of the Constabulary (see tinyurl.com/k89ujvl).

Regarding the police response in Ferguson, Professor Reicher said: ‘From what I can see – and most commentators seem to agree – it was pretty woeful. After the initial killing, they didn’t listen to the family, they showed no respect to the community, they certainly didn’t seek to facilitate lawful protest, there was little attempt to communicate, and they applied indiscriminate force against everyone present. In short, they violated every single one of our principles of non-conflictual policing. And they reaped the results.

‘But perhaps the short-term errors reflected a longer-term problem. The police did not reflect the community and had little legitimacy in Ferguson. They were an outgroup who were seen as imposing themselves on the community rather than looking after the community. Any solution

failure?

must deal with the broader context as well as the specific dynamics which led to violence.’

While Professor Reicher led on developing the underlying models of crowd psychology and the general principles of policing, Dr Clifford Stott’s (University of Leeds) work in developing concrete models of policing and applying them bagged him a prestigious ESRC Celebrating Impact Prize this year. Dr Stott’s ideas, among other things, inspired the introduction of Police Liaison Teams who open up a dialogue between police and protestors.

Promising results have been seen in their use during the Occupy protests of 2011 and in Obelisk, the South Yorkshire Police operation surrounding the 2011 Liberal Party Spring Conference in Sheffield.

Dr Stott said the evidence that has come out suggests that the disproportionate way the situation was handled in Ferguson amplifies the general feeling of police illegitimacy. ‘There’s a background tension which grows out of day-to-day interactions with the police.’ After Michael Brown’s death crowds began to gather around the area he was killed to protest, and Dr Stott said the police response to this was clamping down. He told us: ‘The paramilitarised response wasn’t sensitive to people’s rights of assembly and free expression… it would appear the police were much more focused on trying to

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control the potential for aggression.

That feeds into the sense of antagonism towards the police, and confirms a view of the police as an organisation that denies the black community their rights.

‘Ferguson was interesting because we saw a period of escalation followed by de-escalation followed by further escalation. What’s interesting is that this de-escalation came when a police captain came in and walked along with protestors through Ferguson. In other words the deescalation was consistent with our theory – that policing should be oriented towards facilitation based on dialogue and communication. People want the capability to express their protest and the police should work with them to facilitate that.’

Although the media spotlight will inevitably fall upon the paramilitary side of some of America’s police forces, Dr Stott said the real picture is not so well defined. He said: ‘There are some very progressive forms of policing in the USA, for example in Boise, Idaho, where the police have adopted an approach very similar to the one we talk about. There’s also considerable variability in Europe, and even in this country. We’re in a place where, despite the progress that has been made, the assertion of this kind of progressive policing is always vulnerable to going back into the past.’ ER

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Treating depression in cancer Three papers published in The Lancet Psychiatry, The Lancet, and The Lancet Oncology have revealed that around three quarters of cancer patients who have major depression are not receiving treatment for it, and that a new integrated treatment programme is more effective at reducing depression and improving quality of life than current care.

Researchers at the University of Oxford and University of Edinburgh analysed data from more than 21,000 patients attending cancer clinics in Scotland and found that major depression is more common in cancer patients than in the general population and was most common in those with lung cancer, affecting 13 per cent of patients.

Moreover, 73 per cent of depressed cancer patients were not receiving treatment.

To address the problem of inadequate treatment the SMaRT Oncology-2 randomised trial evaluated the effectiveness of a new treatment programme called ‘Depression Care for People with Cancer’ (DCPC). The programme is delivered by a team of specially trained cancer nurses and psychiatrists, working in collaboration with the patient’s cancer team and GP, and is given as part of cancer care. It is a systematic treatment that includes

both antidepressants and psychological therapy.

The trial, involving 500 adults with major depression and a cancer with a good prognosis (predicted survival more than 12 months) compared DCPC with usual care. DCPC was more effective at reducing depression. At six months, 62 per cent of the patients who received DCPC responded to treatment (at least a 50 per cent reduction in the severity of their depression) compared with only 17 per cent of those who received usual care. This benefit was sustained at 12 months. DCPC also improved anxiety, pain, fatigue, functioning and overall quality of life.

To see whether patients with a poor prognosis cancer could also benefit from this approach, the SMaRT Oncology-3 randomised trial, published in The Lancet Oncology, tested a version of DCPC adapted for patients with a typically poor prognosis cancer (lung cancer). The trial, involving 142 patients with lung cancer and major depression, found that those who received the lung cancer version of DCPC had a significantly greater improvement in depression than those who received usual care during 32 weeks of follow-up. The lung cancer-specific version of DCPC also improved anxiety, functioning and quality of life. ER

Police morale Psychologists working for the Police Federation of England and Wales (PFEW) have been carrying out a large survey in which the views of over 32,000 officers have been assessed, as the way that officers’ pay and conditions are set is moving from a face-to-face system of negotiation to a pay review body similar to that used for teachers and NHS workers. This will require an evidenced case to be provided demonstrating how officers’ morale and retention are affected by their conditions.

The PFEW, a staff

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association representing all 124,000 police officers up to the rank of Chief Inspector, has asked how the Police Service can help to retain experienced and well-motivated officers in the face of the stresses of the job. Its survey found that 94 per cent of respondents believe morale in the Police Service as a whole is low, and that there is a statistical relationship between personal experience of recent changes (such as changes to overtime pay, and access to pay for particular roles) and morale.

Although this survey was primarily designed to provide data for evidencebased policy decisions, this information will also allow PFEW researchers an insight into the interaction between factors that affect the psychological wellbeing of officers. The work will form a part of the case being put to the newly formed Police Remuneration Review Body in the autumn. In addition, the researchers are also looking to have their results published in a research journal in the near future. ER

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IoP name change Historic boost The Institute of Psychiatry at King’s College London has been renamed the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) after almost 100 years with the same name. From September 2015 the Institute will also be offering a newly created BSc Psychology programme.

The Institute will comprise 300 academic staff, with an annual turnover of nearly £100 million and a research turnover of nearly £50 million and will take on a new structure comprising three academic divisions. These are the Division of Neuroscience, headed by Professor Mark Richardson, the Division of Psychology and Systems Sciences, headed by Professor Til Wykes, and the Division of Academic Psychiatry.

Professor Til Wykes, also Vice Dean of Psychology and System Sciences in the Institute, explained why the change was a significant one.

She said: ‘Psychology has always been an independent presence at the Institute of Psychiatry with its own department, prestigious clinical psychology course as well as centres for training in professional qualifications. We have never offered an undergraduate degree but will be Professor Wykes said the change of name was adding one next to recognise the importance of psychology to year. This is a very resolving issues that surround mental health exciting evolution as our clinical and applied work will also have an expansion with access to psychological expertise from new areas.’

She told The Psychologist: ‘The IoPPN has three divisions and this brings together four departments – Psychology, Health Service and Population Research, Biostatistics and the MRC Centre for Social Genetic and Developmental Psychiatry. The departments without psychology in the title have psychologists working within them so we will have a large contingent at the IoPPN, more than just a critical mass.’

Professor Wykes said the change of name was to recognise the importance of psychology to resolving issues that surround mental health – the theoretical as well as the applied. She added: ‘We need psychology to help us understand the basic mental and brain mechanisms, to develop individual treatments and care, to work out the best ways to implement those treatments, to understand the social impact and discrimination that surrounds mental health disorders as well as to combat stigma. At the end of this research pathway there are always interesting issues that can only be resolved through experimental studies within psychology, and so the scientific cycle starts again.’ ER

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The Center for the History of Psychology at the University of Akron, Ohio, has received a $3.5 million donation from Nicholas and Dorothy Cummings. The Center will be renamed after the couple who have previously donated $1.5 million. With the funds the Cummings Center is planning to expand its museum and build a dedicated research space and offices for visiting scholars and staff, and to fund an endowment to support a full-time associate director position.

Peter Dillon-Hooper, who manages the British Psychological Society’s own History of Psychology Centre said: ‘This is great news for historians of psychology.

The University of Akron is a renowned centre for studying the history of psychology,

and this generous donation will allow it to expand its activities and cement its leading position.

‘In the UK, research on history of psychology and teaching on the topic are not so well established in our universities. The BPS History of Psychology Centre does what it can with limited resources, and the Society’s History & Philosophy of Psychology Section has a dedicated core membership but remains a minority interest. This is a shame. An understanding of the history of psychological ideas and their impact is surely fundamental to being a modern psychologist. Perhaps some deep-pocketed benefactor this side of the Atlantic might want to help with a donation to our Centre?’ ER

White Water Writers A project, designed by psychologists, which gives groups of young people the chance to write and publish their own full-length novel in a week, has been given extra funding to expand. The White Water Writers project was developed at Royal Holloway, University of London by Joseph Reddington, Yvonne Skipper, Patrick Leman and Douglas Cowie.

Dr Reddington said: ‘White Water Writers evolved out of a science experiment – to see if you could use software engineering approaches to create narrative. What led us into being a literacy project was watching the students develop. Over the week they developed as fast as the narrative did – and not just in terms of their creative skills.’

The young people take part in a week-long camp, at their schools, led by university students. They develop a novel, write it and eventually have it published. Dr Skipper has recently received a grant from the HEFCE to develop the project in Keele University and has worked with children with special educational needs and looked after children.

Dr Skipper said the camps also seem to help with the young people’s self esteem, she added: ‘Before they participate we measure their current perceptions of their skills, self-esteem and locus of control. We then repeat these measures at the end of the project.

In some camps we also hold focus groups before and after to learn about how the participants feel about the project. Results suggest that participating in White Water Writers leads young people to feel more positive about their skills, themselves and more in control of their lives.’ ER I For more information about the project see tinyurl.com/lbt3o2g

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‘Responsible reporting can save lives’ In the wake of Robin Williams’s death, Ella Rhodes spoke to Professor Rory O’Connor about the way the media report suicide thinking), so even if they have had director of the Suicidal Behaviour thoughts of suicide, they may not have Research Laboratory in Glasgow, said formed a detailed plan of how they would there was clear evidence that some media translate their suicidal thoughts into reporting of suicide can have an impact on vulnerable people – making them more action. Our concern is that detailed descriptions of methods of suicide may likely to attempt suicide. He told The facilitate this transition. Robin Williams’ Psychologist: ‘We know talking about death was very badly suicide doesn’t plant handled; in too many the idea in people’s instances the media reporting heads, the issue is that guidelines were ignored if someone is already completely, which was thinking of suicide, irresponsible. It is important the reporting of to remember that the suicide may increase responsible reporting of the likelihood that suicide can save lives. Talking they’ll attempt suicide. in detail about the method Although we need to may prime its use, making it better understand more salient to people who precisely how media are already vulnerable.’ reporting increases the But what can risk of suicide, there is psychologists do to make the clear evidence that media more aware of the sensationalist, explicit ‘People who die by suicide dangers of insensitive reports reporting of suicide is come from all walks of life’ of suicides? Professor especially risky.’

O’Connor said: ‘A few months ago, I took When asked why the media should part in a fruitful meeting, organised by keep details of the method of suicide Samaritans, with journalists in Scotland. scant, he said: ‘Vulnerable people often We discussed the concerns about the show cognitive constriction (tunnel reporting of suicide and the implementation of the guidelines. It was a really helpful discussion – and psychologists should have a role in such discussions. In addition, we should be conducting more research into how the The amount of people travelling to Switzerland for assisted suicide has doubled in media reporting affects vulnerable people. four years according to a study published in the Journal of Medical Ethics. The main We can also have a positive impact by reasons for turning to assisted suicide include paralysis, motor neurone disease, improving how the media guidelines are Parkinson’s and multiple sclerosis; and people from Germany and Britain are the communicated, disseminated and main groups choosing to travel to Switzerland to die. implemented. Part of the challenge is that Including Dignitas, there are six right-to-die organisations in Switzerland, four we don’t want to censor the media, it’s of which allow those from other countries to use their services. The researchers very important that suicide is reported to analysed 611 cases of individuals from outside Switzerland who had undertaken minimise the stigma around discussing it; assisted suicide, and found they came from 31 different countries. Germany had the it’s about promoting safe and responsible highest number of so-called suicide tourists, at 268, followed by the UK, at 126. The reporting. Psychologists, among others, researchers conclude their study by writing that the ‘unique phenomenon of suicide also have an important role in tourism in Switzerland may indeed result in the amendment or supplementary destigmatising mental health.’ guidelines to existing regulations in foreign countries’.

The media have also been criticised Meanwhile, the World Health Organisation (WHO) released a report last month for presenting Williams as something of calling for a coordinated effort to reduce suicides worldwide. The report points out a ‘sad clown’ character in reports of his that, globally, more than 800,000 people die from suicide each year. The report, death. Professor O’Connor said: ‘I don’t which is the first of its kind released by WHO, draws on evidence from Australia, find such descriptions helpful. Suicide Canada, Japan, New Zealand, the United States and a number of European countries can, and does, affect anyone, so it’s not which has revealed that limiting access to the most commonly used methods for helpful to caricature individuals into these suicide can help prevent people dying from that method. The report also states that subtypes. Although I can see why the another key to reducing deaths by suicide is a commitment by governments to media were describing him as such as establish a coordinated plan of action for suicide prevention. The report can be there is evidence that there’s a link found here: http://tinyurl.com/ose3ser ER between suicide risk and creativity, my I For a psychological exploration of the UK’s Assisted Dying Bill, see September’s message is that people who die by suicide issue of The Psychologist, and this month’s ‘Letters’ come from all walks of life.’

Comedian and actor Robin Williams’ death attracted media coverage across the world, and many questions have been raised about the reporting of his suicide.

Print and broadcast journalists have access to guidelines recommending that they do not reveal too much detail about the method used in any suicide, do not oversimplify the causes, and do not overly focus on celebrity suicide or provide sensationalist coverage.

Concerned organisations (including Samaritans – see tinyurl.com/sammgrs) have developed these guidelines for journalists reporting suicides, and rules also exist in the Press Complaints Commission Editors’ Code of Practice and Ofcom’s Code of Practice. However, there was widespread criticism that some newspapers revealed too many details about the method that Williams used to take his own life. There was also consternation over a tweet sent out by The Academy which some commentators felt could glorify the act or suggest to others that suicide is a means to end suffering.

Professor Rory O’Connor (University of Glasgow), president of the International Academy for Suicide Research and

‘SUICIDE TOURISM’ INCREASING

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Dialogue across the disciplines Kate Johnstone, a postgraduate at University College London, reports from a Memory Network event overcome with an uncontrollable urge to walk as far as he could, On 6 September University College London hosted an event wherever he could, and no matter how exhausted he was. He organised by the Memory Network, a multidisciplinary walked in a fugue state, returning home days or weeks later with enterprise that brings together researchers, authors, artists no memory of his journey. Author Anna Stothard (The Pink and organisations to fuel original thinking about memory Hotel, The Art of Leaving) had a thoughtful discussion with (see http://thememorynetwork.net). academic and neuro-literary critic Jason Tougaw (Department of Dr Hugo Spiers (Department of Experimental Psychology, English, The City University of New York) UCL) helped found the Network with Dr on the role of physical objects in memory Sebastian Groes (Department of English and storytelling. Neuro-literary criticism is and Creative Writing, University of a relatively new field, where academics Roehampton). Dr Spiers said: ‘Many from the arts and science explore the psychologists and writers share a biological processes behind reading, fascination with memory. The Memory creating and processing fiction.

Network has done a fantastic job of The highlights of the event were bringing them together and allowing them several truly big names in psychology to challenge each other’s preconceptions. and literature. Suzanne Corkin (Emerita There will be several publications arising Professor of Neuroscience, MIT) gave her from the current interactions, and we unique perspective on Henry Molaison, hope many further events to encourage whom she studied for nearly five decades further dialogue.’ up to his death in 2008. Experiments The event was a Science and Literature involving ‘patient HM’, as we all knew Festival entitled ‘The Story of Memory’. him, were crucial in understanding the It featured 10 speakers with literary or Ian McEwan (left) and Professor Paul functioning of short-term and long-term psychological backgrounds, who shared Bloom, Yale (right) memory. Corkin played an extract from their thoughts on aspects of memory and an interview between herself and Henry storytelling. On the literary side, author from 1992 which demonstrated his memory deficiencies. For Maud Casey talked about her new novel, The Man Who Walked example, Henry could correctly identify the date of the Second Away. This is a fictionalised account of Jean-Albert Dadas, a World War and the then American President, but was unsure French gas-fitter in the mid-19th century. Dadas was regularly

Faith in well-being A report by the faith organisation network FaithAction has been released which brings together evidence of the usefulness of faith in a public health setting by examining the work of faith-based organisations (FBOs). The report, among other things, recommends that faith organisations should be proactive in promoting their services and that public health bodies should work alongside them.

The report, Faith-Based Organisations on Public Health and Social Capital, has been reviewed by Chartered Psychologist and Director of Public Health at Hertfordshire County Council Jim McManus. He said: ‘I would say this report is important because it is an attempt to summarise scientific evidence and actual case studies in a way that enables policy makers to understand there is a good evidence base for the impact of faith on health and well-being, and the impact of faith communities on it. The report also identifies some good practice

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principles for faith communities and policy makers to get benefit from working together, and also avoid any potential problems, since we know faith can be both protective of health and resilience, as well as being implicated in psychopathology and poor coping.’

The report points out that the work of FBOs in health settings is in danger of not being fully recognised by the groups themselves and by policy makers, often because there is a lack of evidence around what is taking place and its effectiveness.

The authors point out several issues, first, that although FBOs do not have universal reach, they do reach communities that do not always benefit from public services.

They suggest faith groups need to recognise that this access gives them a role to play in improving health and well-being. Second, there is uneven recognition in policy circles that the faith sector has the potential to be a force for change and a partner in the delivery of services. And third, that there is a lack of

evidence as to the kind of interventions that may be effective and how these could be delivered with and through FBOs. Mr McManus writes in the report: ‘The role of faith in people’s health is being elucidated, with recent research suggesting that faith can be a protective factor in health behaviours and outcomes as well as a vulnerability factor. Faith communities are potentially important settings for public health interventions because cultural and faith assumptions and conventions are intimately linked with understandings of health, the behaviours and conventions around maintaining good health, and dealing with poor health. This report, while not an exhaustive summary of all this, importantly summarises key evidence, identifies key themes for action by public health agencies and faith communities respectively and together, and provides some important case studies and examples of good practice.’ ER I www.faithaction.net

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about whether he had grey hair, and where or when he might have met Corkin before (who by that point had been working with him for 30 years). Corkin’s book about patient HM (Permanent Present Tense: The Man with no Memory and What He Taught the World) has just come out in paperback, and must be essential reading for any psychologist interested in memory.

The festival culminated in a lively discussion between Paul Bloom (Professor of Psychology and Cognitive Science, Yale University) and Ian McEwan, undoubtedly one of Britain’s foremost living authors. McEwan is on the advisory panel of the Memory Network, and has long been interested in the intersection between art and science. The protagonist in Saturday, for example, is a neurosurgeon, and in Solar, a Nobel prize-winning physicist. It seems that in another life, and with superior mathematical skills, McEwan would have been a physicist himself.

McEwan and Bloom’s conversation ranged over a number of topics, straying from the original brief of storytelling and memory. McEwan is clearly well versed in psychological theories, and is particularly fascinated by cognitive biases and the impossibility of rationality. His latest book, The Children Act, centres not on a scientist but another apparent bastion of rationality, a High Court judge. McEwan was at his most animated when talking about the tragic miscarriage of justice inflicted on Sally Clark, wrongly convicted for murdering her two sons due to judicial misunderstanding of statistical probabilities. McEwan indicated that the Royal Society is planning a conference for senior judges to improve their understanding of probability, cognitive biases and how memory actually works, surely a long-overdue move. All was not serious, though, and we also learnt that bonobos don’t like novels, and ants would be really bad at writing them.

Overall a fascinating and enjoyable day which demonstrated how important it is to maintain cross-disciplinary dialogues.

FUNDING NEWS The Association of Commonwealth Universities invites applications for the Canada Memorial Foundation Scholarships. Established to honour the one million Canadians who served with Great Britain during the First and Second World Wars, the scholarships are open to British students or graduates who wish to pursue a postgraduate course at a higher education institution in Canada. Candidates must be UK citizens and hold, or expect to achieve, a minimum of a second class degree by September 2015. The scholarships last for one year and allow for airfares and living expenses. Deadline: 30 November 2014.

I tinyurl.com/knyr3u2 The International Social Science Council and Foundation Mattei Dogan invite nominations for their Prize for Excellence in Interdisciplinary Research. The prize is awarded to a social scientist, or team of scholars, with advanced scientific knowledge in social sciences by crossing disciplinary boundaries. Nominations can be made by ISCC members or other professional associations, as well as by universities and academic institutions. The closing date for nominations is 14 December 2014.

I tinyurl.com/kgnnfsd The Leverhulme Trust also invites applications for its Study Abroad Studentships. The studentships support an extended period of advanced study or research at a centre of learning overseas for between 12 and 24 months. Applicants must have been resident in the UK for at least five years and hold an undergraduate degree from a UK institution, or have been registered as a student within the last eight years. Studentships are for up to £18,000 and the closing date is 12 January 2015.

I tinyurl.com/m6ts3jv The British Academy invites applications for its Quantitative Skills Acquisition Awards, to develop and enhance the quantitative skills of early-career scholars. Applicants must be within 10 years of receiving their doctorate and be in an established academic post at a UK university. The maximum award is up to £10,000 over 12 months.

Around 20 awards are available. Closing date 29 October.

I tinyurl.com/cykapu3

Psychologist and gambling researcher Dr Amanda Roberts will lead a new research centre

Dr Amanda Roberts

at the University of Lincoln devoted to studying gambling.

Dr Roberts has joined the School of Psychology from the University of East London.

The new research centre will focus on understanding the psychological causes and effects of gambling, including addictive gambling, risk-taking behaviour, treatment programmes and the impact of new technologies such as betting smartphone apps. Dr Roberts will also bring with her an ongoing research project evaluating 40 years of data

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info

New gambling research centre

For BPS awards and grant schemes, see www.bps.org.uk/awards&grants Funding bodies should e-mail news to Emma Smith on emma.smith@bps.org.uk for possible inclusion

on treatment offered by the Gordon Moody Foundation, a UK charity that offers residential treatment programmes to addicted gamblers, which will assess how different length treatment programmes affect behaviour.

Dr Roberts said: ‘My move to the University of Lincoln is an exciting one. The launch of the research centre will give us the opportunity to better explore the reasons why

people gamble. There is no consensus on the most effective way to treat gambling, largely because treatment research is so scarce.

Additionally, treatment facilities which primarily rehabilitate problem gamblers are very limited; in the UK the NHS does not provide treatment facilities, unless the individual has other disorders they might need treatment for.’ ER

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Child protection and the Rotherham abuse scandal

August saw the horrific revelation that at least 1400 children had been the victims of sexual exploitation in Rotherham between 1997 and 2013. A scathing report

by Professor Alexis Jay (see tinyurl.com/m6enadz) revealed failings by police and council officers over the years when confronted with these reports.

But what makes these historical cases of sexual abuse so difficult to uncover? Is it likely similar large-scale cases of sexual exploitation by gangs will have taken place? Is there a danger that the psychological community’s focus on false memory could act as a barrier in investigating or prosecuting such cases?

We spoke to experts in child abuse, gender, sexual violence and memory for their views.

Reporting exploitation and abuse Debbie Allnock, NSPCC Research Consultant and lecturer in child and adolescent studies (University of Bedfordshire), said that the emergence of widespread sexual exploitation in Rotherham, and previously in Rochdale, suggested that child sexual exploitation was likely to be occurring elsewhere. She added that it was important to recognise that the specific patterns and dynamics of

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abuse, and the profile of perpetrators, may vary. ‘It is difficult to know with great certainty, however, because of a number of systemic barriers.

According to Allnock, the recent inquiry into child sexual exploitation carried out by the Office of the Children’s Commissioner identified nine specific failings or barriers in the system.

‘Included in this is significant variability in recording and monitoring practices, which means that many local authorities do not know how many victims had been identified in the year of the inquiry. Other barriers include a lack of leadership and strategic planning, and low levels of awareness among professionals about sexual exploitation and how to engage with children and young people at risk.

The inquiry identified a culture in some areas which blames victims, evidenced in the use of phrases to describe these children and young people such as “promiscuous” and “putting themselves at risk”. Thus, children and young people are seen as “troublesome” rather than as victims in need of safeguarding.’

When asked what makes it particularly difficult for victims of sexual abuse or exploitation to report these crimes, Allnock said: ‘There are intertwining and complex factors which

act as barriers to disclosure of child sexual abuse more broadly and sexual exploitation more specifically. Children and young people are often groomed by their perpetrator or perpetrators, in order to carry out the abuse and gain children’s silence. Young people who have participated in my own, and in others’, research say that perpetrators threatened them verbally or physically, or threatened that they would harm others close to them. Child sexual exploitation is also often tied up with some form of gain, for example access to drugs and/or alcohol.

Children and young people may not tell because they feel guilty or complicit in the abuse. Research has also found that young people who are being sexually exploited may not realise it for a number of reasons.

This may be because they think they are making a choice, because of confusion around sexual activity and the issue of consent or because of a normalisation of sexual violence.’

Outside observers may sometimes be surprised that historic cases of sexual abuse have taken so long to come to light, but Allnock explained that coming forward may be easier for some people if the perpetrator is no longer alive or no longer in their lives. She added: ‘Disclosure in these cases usually refers to

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sharing their experiences in confidence with friends, partners, family members or in a therapeutic setting rather than formal sources of disclosure such as the police.

While some people may wish to seek justice for what happened to them as children or to protect other children who may be in contact with the perpetrator, others may lack confidence in the police or social services, they may worry that too much time has passed, that there is no evidence of their abuse or they may have ongoing anxieties about the impact of their disclosure on others.’

What sort of culture leads to the widespread, underreported, exploitation of children? Allnock said the question must be examined ecologically. ‘Societal acceptance of sexual violence results in a “normalisation” of violence and abuse.

In this sort of context, children and young people may not realise there is anything to report. A societal acceptance of violence also facilitates a culture of victim-blaming, which prevents adequate response. At the community level, weak community and/or institutional sanctions against perpetrators of sexual violence mean that victims find it hard or impossible to report what is happening.

More and better educational and preventive work in communities is needed, not only with young people but with professionals working with them and members of the wider community.’

Gender and media reports Dr Jemma Tosh, researcher and author of Perverse Psychology: The Pathologization of Sexual Violence and Transgenderism, said it was a sad reality that reports of the failure to investigate, convict or take seriously crimes related to sexual violence are a common occurrence. She said: ‘It is extremely disappointing that, as a researcher of the psychology of sexual violence, I am not surprised when I see such reports. When I come across a headline of this kind, it is amongst a wealth of similar headlines, tweets, blogs, articles, books and conversations. They create an overwhelming noise of victim blaming, slut shaming, and disbelief in the experiences of rape victims – what has been described as a “rape culture”.’

Dr Tosh said that it was this context that contributed to the interpretation of victims’ behaviours and statements in ways that were more likely to result in them not being taken seriously, or not being reported at all. She told us: ‘The media’s terrible treatment of rape survivors and victims, in addition to negative reporting of female bodies and sexuality more generally, can make it very

difficult for people to come forward. This is through a fear of attracting negative attention, such as not being believed or being blamed for their victimisation.

Gender plays an important role – women’s sexuality and victimisation are reported differently both in media contexts as well as within academia.

There has been much research into how female adolescent victims are framed as ‘seductive’ and judged as sexually active, which contrasts with the stereotype of a rape victim. This can make it very difficult for young women to seek justice for their abuse.’

Dr Tosh said there was a way to change this pessimistic situation. ‘We need to reconsider the stereotype of an innocent victim to one that is more inclusive of a range of social categories, such as class. We also need to change the way we view and report female sexuality so that it no longer becomes a way to humiliate or discredit a woman, much like we see with images and videos being released without people’s consent – like the recent Jennifer Lawrence hacking reports. The non-consensual distribution of sexual images is gaining further consideration by legal perspectives, such as the UK Ministry of Justice’s consultation on “revenge porn”.’

Memory – not fundamentally unreliable?

Professor Chris Brewin (University College London) told us that he was concerned the explosion of research into false memories over the past 20 years may be leading to a cultural shift, causing the public and juries to believe that memory is largely unreliable. He said: ‘It’s almost as if we’ve lost sight of the idea that memory, most of the time, is accurate, even though in some circumstances it can mislead people. Of course people can have the experience of remembering things inaccurately, and they are vulnerable to misinformation. But the rather one-sided focus on false memories in the research literature has led to media articles implying that memory is fundamentally unreliable. In the past some of the Rotherham victims experienced great difficulties in being believed, while others were believed but ignored. I am concerned that in similar cases, particularly where there is less corroborative evidence, jurors might bring these assumptions into court, perpetuating the culture of disbelief.’

Professor Brewin said psychologists needed to make people more aware that the community may use a shorthand when talking about memory. ‘There’s

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a more balanced context to the research which scientists might not always spell out… We have collected most autobiographical memory data in laboratory settings or under controlled conditions and almost all of what we know is about single events, we know very little about memory for something which occurred more than once – a situation relevant to many crimes involving physical and sexual violence.

We must be very cautious and make sure that both the data and the conditions in which they have been collected are relevant to cases we have been asked to comment on.’

I The Society’s Child Protection Working Party has produced a position paper, Safeguarding and Promoting the Welfare of Children, which is available to download from tinyurl.com/bpssafeg

CONSULTING ON DOMESTIC ABUSE LAW Home Secretary Theresa May has opened a consultation on strengthening domestic abuse law to create a specific offence for controlling and coercive behaviour in intimate relationships. Currently stalking and harassment legislation covers coercive and controlling behaviour but it does not explicitly apply to intimate relationships.

The consultation documents point out that 30 per cent of women and 16.3 per cent of men will experience domestic abuse in their lifetimes, and the government has called on the public and other interested parties to have their say on the proposals until Wednesday 15 October.

Mrs May said, on opening the consultation: ‘There is now a widespread understanding that domestic abuse is not just about violence. Coercive and controlling behaviour can be harder to recognise but can have an equally devastating impact on its victims. In recognition of this, in March 2013 we expanded the government definition of domestic abuse to capture nonviolent behaviour. This consultation now asks for views on whether the law needs to be strengthened to keep pace with these developments. I know that there is a wide range of strongly held views on this issue.

This consultation does not prejudge the outcome or next steps. We want to hear the views of victims and those who work in this field to understand how we can offer the best possible protection against domestic abuse.’ ER

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Students with more autistic traits make fewer altruistic choices Most people with autism have difficulties socialising and connecting with others. It’s generally agreed that part of this has to do with an impairment in taking other people’s perspective. More specifically, an emerging consensus suggests that autism is associated with having normal feelings for other people, but an impaired understanding of them. Little explored before now is how this affects the behaviour of people with autism towards others who need help.

Leila Jameel and her colleagues surveyed 573 students using the 50-item Autism-Spectrum Quotient, which is a questionnaire designed to tap key traits associated with autism spectrum disorder. Then they asked 27 of the top 10 per cent of scorers and 24 of the bottom 10 per cent to complete a new test of prosocial behaviour known as the Above and Beyond Task.

The participants read scenarios that conflicted another person’s needs with their own. They first stated how they would act in this scenario, and then they chose from three fixed alternatives, ranging from selfish, to medium prosocial, to high prosocial (or ‘above and beyond’). For example, one scenario involved seeing a man fall in the street while the participant was rushing to work for a meeting.

After giving their own response as to how they would react, the three fixed options were: carry on walking; help him up and carry on walking; help him up and offer to take him to sit down on a nearby bench.

High scorers on the Autism-Spectrum Quotient more often chose the selfish, low prosocial options and less often chose the high prosocial options, as compared with low scorers on the questionnaire.

The high scorers also gave more selfish openended answers when first asked how they would respond to each scenario.

In the Journal of Autism and Developmental Another measure was how satisfied the Disorders participants thought they would be with their chosen course of action, and how satisfied the needy person in the scenario would be. The high and low scorers on the Autism-Spectrum Quotient did not differ in their ratings of the needy person’s satisfaction with the different response options.

However, the high scorers tended to say they personally would be more satisfied after making more selfish choices, and less satisfied after more altruistic choices.

This is a sensitive topic. If misinterpreted or oversimplified the findings risk bolstering the stigmatisation of people with autism. It’s important to realise that the study did not involve people diagnosed with autism, but rather a ‘sub-clinical population’ (in the researchers’ words) who scored highly on a self-report measure of autistic traits. Moreover, the study did not involve realworld helping behaviour. It was based on hypothetical scenarios, which raises problems of interpretation. For example, perhaps people with more autistic traits are simply more honest about how they would behave. Perhaps they find it difficult to, or choose not to, treat the fictional character as they would a real person.

With these caveats in mind, these results hint tentatively at how autistic traits could affect people’s helping behaviour in the real world. The researchers also said their new Above and Beyond Task could be used to measure the outcomes of training programmes designed to help people with autism. ‘Despite considerable attention to social skills training in people with Autism Spectrum Disorder,’ write Jameel and colleagues, ‘relatively little is known about the efficacy of such programmes or the key ingredients for success.’ CJ

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Your angry face makes you look stronger In Evolution and Human Behavior No matter where you travel, you are likely to have no problem recognising when someone is angry with you. From the plains of Russia to the beaches of Brazil, anger shows itself in a tell-tale facial display involving lowered brow, snarled nose, raised chin and thinned lips.

A popular view has it that, besides reliably conveying anger, this particular constellation of facial movements is arbitrary and serves no other function.

A team of evolutionary psychologists led by Aaron Sell disagree. They think the anger face also makes the angry person look stronger. This fits their ‘recalibration theory of anger’ that sees the emotion as an aggressive threat. An angry animal or person is communicating the costs that they will inflict on others if they do not get what they want. By making an angry person look stronger, so the theory goes, the facial expression gives weight to the threat of aggression, likely influencing the target’s judgment about the seriousness of the threat.

To test this, Sell and his colleagues created pairs of faces using a computer programme. They began with a 20-year-old male face, morphed from averages of many faces, and then calibrated it so that for each of the seven distinguishing features of anger (lowered brow, raised lips, raised mouth, widened nose, enlarged chin, lips thinned, lips pushed forward), they created a pair of

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contrasting faces. One face in each pair displayed one angry feature, the other face showed the opposite feature (e.g. one with lowered brows, one raised).

Thirty-five student participants then looked at the facial pairs and indicated in each case which face they thought looked stronger. The key finding? Each anger-related facial feature when displayed on its own attracted higher ratings of perceived strength. This implies each element of the anger expression contributes to making a person appear stronger.

Further experiments ruled out an alternative explanation – perhaps angry faces actually serve to make a person look older, and this leads to ratings of greater strength because observers assume a slightly older man is stronger than a 20-year-old. One way the researchers tested this was to show participants pairs of morphed faces of a 60-year-old man, in which case looking older presumably wouldn’t be associated with greater strength. Three of the angry facial features actually led him to being rated as younger, with only two prompting ratings of being older. Moreover, participants rated the man as stronger when he displayed six of the seven angry facial features.

‘The current study is the first systematic test of the individual components of the anger expression,’ the researchers said. ‘And in so doing it confirms that these features are improbably well designed to solve the adaptive problem of bargaining with threats of force.’ CJ

The simple piece of information that could dramatically increase your muscular endurance In Psychology of Sport and Exercise How most of us choose to behave is shaped powerfully by the behaviour of others (or, more specifically, our perception of their behaviour).

Psychologists call this the influence of ‘social norms’, and its potency has been investigated extensively in the context of environmentally friendly behaviours like recycling, and health behaviours, such as binge drinking and frequency of exercise.

What if this same psychological lever could be exploited, not to encourage people to take up more physical activity, but to boost their athletic performance? A pair of researchers, Carly Priebe and Kevin Spink, have tested this idea for the first time.

Sixty-eight regulars (average age 40, nine men) at a pilates studio were asked to perform two plank exercises, and to hold each for as long as they possibly could. As a cover story, they were told that the purpose of the challenge was to help find out the average performance level for this exercise.

The plank is a physically demanding exercise that involves adopting a face-down prone position, then raising the body on forearms and toes, and holding this position rigid, parallel to the ground. It was emphasised to participants that they should hold the position for as long as possible on both attempts, and that their times would be averaged.

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The participants were given a three-minute rest between each attempt. The key intervention is that between planks, half the participants were given the ‘social norms’ message that 80 per cent of people similar to them (in terms of age, gender and pilates level) had achieved a 20 per cent longer time on their second effort. The other participants were told nothing of this kind, or anything else (this is a potential weakness of the study, which I’ll return to).

The researchers had hoped their intervention, if successful, would lead merely to sustained performance on the second attempt. The rather dramatic result is that participants given the social norms message achieved a 5 per cent increase on their second attempt (first attempt average time was 95.82 seconds; second attempt average was 99.79 seconds).

This is dramatic because after performing a first plank to exhaustion, one would typically expect participants’ second attempt to be shorter. The control participants, as expected, achieved a significantly shorter time on their second plank attempt (76.38 seconds vs. 90.09 seconds on their first attempt – a drop of 18 per cent).

Priebe and Spink said their findings ‘hint at the potency of the descriptive norm information and the potential effects of social influence on physical activity tasks’.

Participants in the social norms

condition reported higher ‘selfefficacy’ (belief in their own ability) than control participants, so this hints at a possible mechanism for the effect of the intervention.

A strength of this research is that the researchers gauged participants’ beliefs about other people’s performance before presenting them with the social norms message. The majority of participants assumed that most others would decline in performance on their second attempt. This was important to check because past research has shown that social norms interventions can backfire if people hold initial beliefs that exceed the reality of the normative message.

As hinted at earlier, a weakness of the study is the lack of a control condition that communicated a different message to the participants.

This means we can’t tell how much of the apparent effect of the current intervention was specific to its social norms content. It’s possible receiving any kind of motivational message between exercises would have had a galvanising effect. Another problem, of course, is that the social norms message was a fabrication – the participants were effectively fed a lie. It’s also not clear how long this kind of intervention could sustain its effects. News of other people’s performance might be motivating at first, but could quickly lose its potency, or even become counterproductive. CJ

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PHILIP WOLMUTH/REPORTDIGITAL.COM

Reader reactions to news of terrorism In the Journal of Applied Social Psychology How readers’ emotions are affected by media reports of terrorist attacks depends on the photos used to accompany the story. That’s according to an analysis by Aarti Iyer and colleagues, who say these different emotional reactions in turn lead to support for different government policies.

Over 200 British adults (aged 18 to 68; 92 women), many based in London, read a news summary of the London terrorist bombings that occurred on 7 July 2005.

Afterwards, the participants were split into two groups – one group was shown photographs that displayed the terrorist attackers, including head-shots and security camera footage.

The other group was shown photographs displaying victims of the attacks, including wounded people and distressed bystanders.

Participants who viewed the images of terrorists subsequently reported feeling a stronger sense of injustice (than those who saw the victims), and felt more of a sense that the terrorists were dangerous and threatening. In terms of emotions, viewing the images of the terrorists was associated with higher levels of fear and anger. In contrast, participants who saw the images of the victims were afterwards more conscious of people suffering, and they tended to report feeling more sympathy.

Although a direct comparison found no difference between the two participant groups, in terms of their subsequent support for various government terrorism policies, Iyer and her team claim there

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were indirect effects of the two image conditions. According to the researchers’ analysis, viewing images of the terrorists increased levels of anger and fear, and in turn these emotions were associated with more support for aggressive counterterrorism and more negotiation, respectively. In contrast, seeing images of victims increased feelings of sympathy, which was associated with more support for policies aimed at helping victims.

‘Given that images of terrorism may be easily used (and abused) to manipulate public opinion, it is ... vital that media editors and policy makers better understand the psychological processes underlying the phenomenon,’ the researchers said. They admitted that much more research is needed, and they acknowledged that in reality readers and viewers are often exposed to a mixture of images.

But despite this caution, Iyer and her team also wrote that their findings demonstrate ‘the powerful impact of media images in shaping individuals’ emotional and political responses to terrorism...’

Readers of a sceptical persuasion may not be so convinced. The path analysis used in this research can only demonstrate correlations between factors, not causality.

Ultimately, the two groups of participants did not differ in their support for different government policies. This research was also unable to explain why some people responded to images of the terrorists with anger, and others with fear. CJ

The psychology of wearable computing - does Google Glass affect where people look?

In the British Journal of Psychology Computing eyewear such as Google Glass can record information far more discreetly than a handheld camera. As a result, privacy concerns have been raised: are users of this tech likely to use their new toys responsibly? Early research was promising, suggesting that the very act of recording our gaze may lead us to be extra considerate in where we look.

Unfortunately, a new study finds that while wearing gazemonitoring devices may initially encourage more socially acceptable looking behaviours, the effect doesn’t last.

In this experiment 82 participants (aged 18 to 51; 59 women) were secretly monitored as they waited alone after finishing the six-minute computer task they believed to be the purpose of the study.

The researchers led by Eleni Nasiopoulos were interested in how much time during the wait the participants spent glancing at the racy pin-up calendar hanging on the wall.

A control set of participants who were not wearing special eye-tracking glasses spent around 80 per cent of the available minute ogling the calendar. Another group were earlier fitted with eye-tracking glasses and knew that their gaze was being tracked by the device. In line with past research, this group used their

gaze in a more socially acceptable manner, glancing at the calendar less than half the time. So far, so good.

But the experiment had another preliminary task at the very beginning, in which participants spent five minutes walking the building searching for coloured squares stuck on walls. Some of the participants in the later eye-tracking condition were actually set up with eye-trackers before this initial task, so they had been wearing the glasses for a longer amount of time than the others.

Focusing on just these participants, the researchers found their eyes lingered on the calendar for as much time as those in the no-device control group. The longer passage of time and different context appeared to eliminate the social acceptability effect of gazemonitoring equipment.

Interestingly, those participants who had eyetrackers fitted at the start of the experiment, but who were subjected to a brief equipment recalibration once they had entered the calendar room, did show an effect of the glasses: their calendar perusal was back down to about 45 per cent. This suggests that rather than users habituating to the eye-trackers – meaning that the experience matters less and less until it becomes passé – it’s more

The material in this section is taken from the Society’s Research Digest blog at www.researchdigest.org.uk/blog, and is written by its editor Dr Christian Jarrett and contributor Dr Alex Fradera. Visit the blog for full coverage including references and links, additional current reports, an archive, comment and more.

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about people forgetting that they are in use.

Eye-tracking researchers have argued that users of wearable computing are actually taking along a chaperone, and although it can be a discreet one (putting aside the spectre of hacking hanging over all digital data), the appeal of resharing recorded experiences to social media renders every use as potentially public. This feeling of our gaze being recorded should make us self-conscious and influence our looking behaviour – just as we engage in more approval-seeking behaviours when filmed by a

security camera, despite not knowing if the film will ever be watched, or by whom. But wearable computing isn’t ‘Out There’ - like cameras or the human beings who have evaluated our social behaviour since childhood - it’s ‘On Us’, and this phenomenon may be too unfamiliar to trigger a sense of being observed.

Of course, this is good news for researchers keen to use eyetrackers to evaluate realistic behaviours, who now also learn the benefit of an acclimatisation period in their set-ups.

Meanwhile, if we want to deter Google Glass users from recording things they shouldn’t, another lesson from this research is that socially conscious app designers could insert reminders into recording software to keep users aware that their gaze has a witness. AF

LINK FEAST Uta and Chris Frith: A partnership of the mind Mo Costandi profiles the cognitive neuroscience pioneers. tinyurl.com/od66shc A neuroscientist’s study of how technology is affecting our brains and everyday lives Cordelia Fine reviews Mind Change, a new book by Susan Greenfield. tinyurl.com/lkquxx9 Brand New Brain Myths to Keep neurobloggers in work Dean Burnett spreads some amusing new neurononsense. tinyurl.com/o84p2du Asking for advice makes you seem more competent, not less Yet most participants in this research thought the opposite would be so, reports Melissa Dahl. tinyurl.com/lnww7vo Finding a good therapist Jules Evans’ (author of Philosophy for Life and Other Dangerous Situations) recent encounter with a ‘somatic therapist’ didn’t go too well. http://tinyurl.com/ouaexcg All you need to know about the 10 percent brain myth, in 60 seconds ‘The average person uses 10% of their brain capacity’ says the promotional poster for the film Lucy, which opened across the UK this summer. tinyurl.com/ounnrya

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DIGEST DIGESTED Full reports are available at www.researchdigest.org.uk/blog Overselling the power of science could encourage people to neglect environmental concerns.

Students who read a hyped news story about scientific progress were less likely, than those who read a more pessimistic article, to make green choices afterwards.

European Journal of Social Psychology Participants diagnosed with schizophrenia described how they avoided seeking help for fear of receiving the diagnosis. Others said it was a ‘dirty word’ and they hid their diagnosis from others for fear of stigma. Psychiatric Bulletin Psychopathic traits are higher among people in managerial positions, self-identified conservatives and the non-religious.

That’s according to an online survey conducted in the USA and Europe. Frontiers in Psychology Low doses of alcohol can boost people’s sense of smell – both their detection of odours and their ability to discriminate odours. The effect seems to occur by a process of disinhibition. Higher doses had no effect or reduced performance. Behavioural Brain Research People who are more focused on the past tend to think of it as being located in front of them, even if the convention of their language is to see it as being located behind. Researchers made the finding by studying speakers of Moroccan Arabic, who mostly see the past in front, and comparing them with Spanish speakers, who usually see it as behind. Psychological Science.

Anxious interviewees perform better when interviewers are mean to them. The researchers think this is because anxious people are distracted by positive feedback that doesn’t gel with their self-concept.

Anxiety, Stress and Coping

Most people think they will be happier if they ignore strangers, but research conducted on public transport and in a waiting room found that people enjoyed themselves more when they were encouraged to strike up conversation with people they didn’t know. Journal of Experimental Psychology: General

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Psychology in the Pub

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For more information or to notify us that you will be attending visit www.bps.org.uk/southwest-events

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similarly struck by these individuals, and the result was a book on autism and Asperger syndrome. I never anticipated how dramatic the impact of the concept of Asperger syndrome would be in the brief history of autism. Many psychologists and psychiatrists had only just become aware of autism, and now they had to embrace a whole autism spectrum (Wing, 1996).

I believe the impact is still felt even if the label Asperger syndrome no longer appears in the 5th edition of the Diagnostic and Statistical Manual of the American t this time about 25 years ago I was Psychiatric Association. nervously awaiting readers’ reactions One of the positive effects of the to my book. Having been persuaded interest in Asperger syndrome is that we to go with the title Autism – Explaining the now know that autism can occur at all Enigma, I knew for certain that I hadn’t levels of intellectual ability, including very explained it. I had laboured on it for years superior levels. On the negative side, this and years, and most of the time I felt makes us sometimes forget that about half ‘Who am I to even try and write such a the cases diagnosed with an autism book?’ The main antidote for this feeling spectrum disorder suffer also from a came from fellow psychologist John marked degree of intellectual disability.

Morton, who egged me on from draft to It is this substantial group that presents draft with words like ‘you have something the most challenging behaviour and the to say, so say it’. most difficult problems of management.

In those days, books on autism were However, problems in managing life a rarity, and people were just beginning to cannot be blamed on intellectual disability. ask what autism was. The film Rain Man, Instead they are the consequence of the starring Dustin Hoffman and Tom Cruise, profound social communication problems was a milestone in the rise of public that are at the core of autism. In a truly awareness of autism. I remember how epic study that reported a 40-year followdifficult it was for bookshops to decide up of 45 autistic individuals with an IQ which of their sections was suitable for the >70, Howlin and colleagues (2013) found book. Mostly, it was placed with psychiatry that 83 per cent were unable to live texts, and ironically Frith was placed next independently. Here is a plea for to Freud. I would have much preferred to psychologists to take up their cause. be placed with books on experimental Now I stick my neck out to mention psychology, because I believe that another unforeseen psychology provides the side-effect of stretching space where the enigma the diagnostic might eventually be “people with autism really boundaries. With more solved. I could not have a very different mind lenient criteria and imagine then that there and different brain” heightened awareness would be a time when of autism, the diagnostic books on autism fill their process will inevitably own section, and when produce false positives. Thus, there are there would be this special issue of individuals with problems in social The Psychologist. relationships and other features that are Almost as soon as I had finished reminiscent of autism, who have either the Enigma book, I became hopelessly claimed or been given the label Asperger attracted to Asperger syndrome. With syndrome, but actually belong to a time I met an increasing number of different category. Sadly, this category is unusual adults with a provisional diagnosis as yet undefined and may even be part of autism, who amazed me because they of neurotypical individual variation. were far more able to converse than the Meanwhile these people have changed now grown-up children whom I had first the perception of what the syndrome is seen when I started doing research on like. This perception is currently geared autism in the 1960s. What struck me to emphasise the continuity between was their ability to provide insightful neurotypical and autistic development. observations about their experiences. That While I like the idea of neurodiversity, opened up completely new possibilities to I am not so sure that this necessarily investigate the autistic mind. Adults like means that there are only quantitative this had been mentioned by Hans Asperger differences between people. The argument in his landmark paper from 1944. I set is also geared to deny that the nature of about translating this paper and got in autism can be explained by cognitive touch with other researchers who were

Autism – are we any closer to explaining the enigma?

Uta Frith introduces a special issue

questions

Autism is a developmental disorder characterised by impairments in social interaction and both verbal and non-verbal communication, along with restricted, repetitive or stereotyped behaviour. Following more than a quarter of a century of extensive research from psychologists, are we any closer to explaining the enigma? Has stretching the diagnostic boundaries helped or hindered scientific and practical progress?

A critical step in ‘solving the puzzle’ of autism is to consider the myths and realities surrounding autism, both for those living with it and their relatives. This issue gathers a variety of perspectives from those people and from leading researchers in the field.

Is it better to look at autistic and neurotypical people as being on one and the same continuum, or as falling into two distinct categories?

resources

Frith, U. (2003). Autism: Explaining the Enigma (2nd ed). Oxford: Wiley.

Frith, U. (2012). Why we need cognitive explanations of autism. Quarterly Journal of Experimental Psychology, 65(11), 2073-92. https://sites.google.com/site/utafrith/ recent-publications

references

Notwithstanding DSM-5, is the label Asperger Syndrome still useful?

Howlin, P., Savage, S., Moss, P. et al.

(2013). Cognitive and language skills in adults with autism: A 40-year follow-up. Journal of Child Psychology and Psychiatry, 55(1), 49–58.

Wing, L. (1996) The autism spectrum: A guide for parents and professionals.

London: Constable.

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and failure is common. It is very desirable to be able to explain such difficulties without blame for the individual. They are indeed often outside the individual’s control. This is true for many medical conditions. Now if autism is a medical

cases of Asperger syndromes. Perhaps these individuals should be classified as having ‘autistic-like personalities’ rather than an autism spectrum disorder.

Everyone agrees that there is an enormous variety in all our individual experience and histories, just as there is in our personalities and temperaments. Not everyone is an extravert and happy only with other people. Some display little emotional warmth and some are narcissists that do not care very much about others and often don’t pay much attention to other people. There are also perfectly neurotypical tendencies that tend to make life difficult: pursuing a specialised interest, being obsessive, enjoying strict routines, dithering over decision, and so on.

It seems to me entirely plausible that combinations of these social and nonsocial features can occur in one and the same person and can then present an autistic-like picture. Human social relationships are extremely complex,

condition it can provide a ‘no-blame’ explanation. This would explain why perfectly neurotypical people like the idea that they – or one of their neurotypical friends – may be a ‘little bit autistic’.

However, there is a conundrum. If you follow the argument above, these individuals do not have a medical condition. They may feel different from other people, but aren’t we all different and don’t we all have our problems?

And this is how I understand the campaign for neurodiversity. It would make perfect sense, for some people, to argue for abandoning the idea of autism as a separate and pathological condition. After all, these individuals do not suffer from any ‘condition’, and it is indeed wrong to say that they have cognitive or emotional ‘deficits’. They just have problems that might be a little bit worse than those of many other people. However, although I am entirely on the side of the neurodiversity campaign, I draw a line at

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deficits. I find this problematic – but, given that I have thought and written about cognitive deficits in autism all my life, I would say that, wouldn’t I? My deliberately provocative suggestion is to reconsider the mildest of the mild

read discuss contribute at www.thepsychologist.org.uk

including the whole of the autism spectrum. I am very well aware that this argument is still running and that it will take a lot of discussion and also empirical research to find out whether the line I want to draw can really be drawn.

But here is the line I would like to draw: people with autism really have a very different mind and different brain.

To me this has always been what attracted me most to autism. It is very rare and a precious gift to get a glimpse into another mind that operates on different assumptions and with different premises. However, there need to be other voices in this discussion. Should we believe only in continua and quantitative differences, or by contrast, in categorical and qualitative differences?

This is an enigma that is tantalisingly hard to resolve. I know which side I am on, but I am prepared to change my mind if the weight of the evidence convinces me.

Are we getting any closer to solving the puzzle? A critical step in this journey is to bust myths that have accumulated and to listen to voices from all parts of the community and from all those who are directly touched by autism. Myths and truths about autism have been intertwined in the many representations of autism in literature and film and our attitudes are often conflicted. We like to see autism as an interesting personality variant with potential for creative genius.

This is what films and fiction mostly portray. We can also see that autism can be a terrible obstacle to living an ordinary life. We find it easy to be sympathetic to young children with autism, but often hard in relation to some adults, let alone old people. If the voices of people with autism are also heard they will give an important counterbalance to researchers’ and professionals’ pronouncements. Only by putting together many different viewpoints will we eventually know what autism is really like.

The sheer quantity of publications and its presence on many dedicated web pages confirms that autism research has thrived in the last 25 years. It has flourished in particular in the UK, and some of our most talented psychologists are represented in this issue. It is thrilling to me to think that the UK still has a head start in the psychology of autism.

Uta Frith is Emeritus Professor at University College London u.frith@ucl.ac.uk

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Autism – myth and reality Christian Jarrett talks to researchers, people with autism and their relatives, to find out what autism is really like

research assistant at the University of Connecticut and was diagnosed with autism at age three. ‘We have interests and talents like many people,’ she says, ‘but to say that we are superior in any way, it’s like we’re trying to justify our existence alongside other people, as if we have to keep up this myth, or nobody will want us.’

People with autism can be friendly and caring ublic awareness of autism has grown immensely in recent decades, thanks in large part to the 1988 multi-Oscar-winning film Rain Man. But so too has the spread of myth and misconception. Today few terms are hurled about with as much hype and abandon as ‘autism’ and ‘autistic’: worryingly, it even appears to have some currency as an insult (tinyurl.com/q5t8mdb). Thankfully the pernicious idea of autism being caused by ‘refrigerator mothers’ has been virtually eradicated. Instead we’re fed a near-daily diet of inaccurate autistic stereotypes, vaccine scare stories, and claims of autism epidemics and miracle cures.

This article attempts to set the record straight. From the idea that everyone with autism has a hidden talent, to the notion that all autistics are unfriendly, I’ll debunk popular myths about the condition.

At the same time, and with help from researchers, people with autism and their relatives, my aim is to convey a sense of what autism is really like.

P

Not everyone with autism is a genius

references

There’s an iconic moment in Rain Man, in which Dustin Hoffman’s autistic character counts in an instant the exact number of cocktail sticks dropped on the floor by a waitress. In other scenes he demonstrates incredible powers of memory and calendar calculation (identifying the day of the week for any given date). The success of

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Bishop, D.V., Whitehouse, A.J., Watt, H.J., & Line, E.A. (2008). Autism and diagnostic substitution: Evidence from a study of adults with a history of developmental language disorder.

Developmental Medicine & Child Neurology, 50(5), 341–345.

Ramachandran, V.S. & Oberman, L.M. (2006). Broken mirrors: A theory of autism. Scientific American, 295(5), 62–69.

the film has helped spread the mistaken idea that all or most people with autism are savants, with these and other exceptional talents.

This myth has also been helped along by popular books about autistic savants (including a chapter in Oliver Sacks’s 1985 classic The Man Who Mistook His Wife for a Hat and Other Clinical Tales) and by frequent media reports on gifted people with autism. Examples include the animal welfare expert Temple Grandin, whose life story was turned into an HBO film in 2010; and the creator of photorealistic cityscapes Stephen Wiltshire, who has appeared in numerous TV documentaries.

Although many people with autism have islands of relative or impressive strength – for example, superb maths skills or attention to detail – the reality is that approximately .05 per cent of the autistic population has an extreme talent or genius-level gift (no one knows the precise figure, but this estimate is from the National Autistic Society). The idea that everyone with autism has a gift may seem like a positive misconception, but it can create difficulties for autistic people and their parents.

‘It can be really discouraging for parents of children who are less able,’ says Dr Liz Pellicano, an autism expert at the Institute of Education in London. ‘It can be damaging because there’s an immediate perception that their child must be good at something, and they might not be.’

Allison Shefcyk agrees. She’s a

Hamilton, A.F.D.C. (2013). Reflecting on the mirror neuron system in autism.

Developmental Cognitive Neuroscience, 3, 91–105.

Happé, F. & Frith, U. (2009). The beautiful otherness of the autistic mind.

Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1522), 1345–1350.

Howlin, P., Savage, S., Moss, P. et al.

(2014). Cognitive and language skills

Perhaps the most hurtful of the myths about autism is the idea that people with the condition are, by nature, asocial and selfish. It’s true that social difficulties are a hallmark of the condition, and there is plenty of research showing that people with autism struggle with ‘theory of mind’ (ToM) tasks that involve putting themselves in other people’s shoes.

However, it’s important to realise that ToM involves two elements – a cognitive component and an emotional component.

Although people with autism often struggle with the cognitive challenge of taking another person’s perspective, there is not necessarily anything lacking in their feelings for other people’s joy and pain.

Michelle Duncan is the mother of a nine-year-old boy with autism, and was diagnosed as being on the autism spectrum herself just 18 months ago. She can understand why people might get the wrong impression that autistic people are uncaring. ‘I’m not an outwardly emotional person, and there are times when I don’t feel like mixing in a group,’ she says.

But she adds, ‘I help other people to the extent that it’s a detriment to myself. And actually one of the most common features of autistic people is that they have an innate sense of justice – they can’t stand to see injustice around them, even if it’s not directed at them.’

Kim Southall can also understand how the uncaring/asocial myth has spread. Kim is the mother of a seven-yearold boy with autism and she co-founded the Autism Aware UK charity (autismaware.co.uk) with her husband

in adults with autism. Journal of Child Psychology and Psychiatry, 55(1), 49–58.

Senju, A., Maeda, M., Kikuchi, Y. et al.

(2007). Absence of contagious yawning in children with autism spectrum disorder. Biology Letters, 3(6), 706–708.

Taylor, B., Jick, H. & MacLaughlin, D. (2013). Prevalence and incidence rates of autism in the UK: Time trend

from 2004–2010 in children aged 8 years. BMJ Open, 3(10), e003219.

Usui, S., Senju, A., Kikuchi, Y. et al (2013).

Presence of contagious yawning in children with autism spectrum disorder. Autism Research and Treatment. doi:10.1155/2013/971686 Volk, H.E., Lurmann, F., Penfold, B. et al.

(2013). Traffic-related air pollution, particulate matter, and autism. JAMA Psychiatry, 70(1), 71–77.

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The MMR vaccine does not cause autism In 1998 the British paediatrician Andrew Wakefield and his colleagues published a small study in the respected Lancet medical journal that implied the MMR vaccine (for measles, mumps and rubella) plays a causal role in autism. The world’s media sensed a scare story and they fed parental fears with years of sensational headlines. In fact, many large-scale studies have failed to find a link between the MMR vaccine and autism. The Lancet paper was retracted in 2010, judged to be flawed and fraudulent. The same year Wakefield was struck off the doctors’ register after being found guilty of dishonesty and professional misconduct.

The MMR/autism myth continues to cost lives, as vaccine rates struggle to reach pre-scare levels.

Jon. ‘People with autism tend to be quite aloof and they don’t know how to be in certain social situations,’ she says. ‘Some of them also don’t like to be held close because they have a sensitivity to touch, but it’s absolute rubbish to say that they’re not loving or capable of love. Our son is really lovely and all the people I’ve ever met with autism, they’ve all been very loving.’

The myth of the unfeeling autistic person has also been given oxygen thanks to studies suggesting that, compared with ‘normal people’, those with autism are less prone to contagious yawning – interpreted by some researchers as an automatic marker of empathy. For example, in 2007 a team led by Atsushi Senju at Birkbeck College reported that 25 neurotypical children yawned more while watching yawning videos, whereas 24 children with autism did not.

Far less publicised, however, was a failed replication of that finding, published by the same group (Usui et al., 2013). This time the children with autism were prompted to look at faces in the yawning videos and they now displayed just as much contagious yawning as controls. This result ‘corroborates previous findings that individuals with ASD can demonstrate behavioural contagion,’ the researchers said.

People with autism do not have a broken mirror neuron system A related autism myth concerns mirror neurons, one of the most hyped concepts in neuroscience (see my piece at tinyurl.com/qbupkco). Although the majority of research into the existence and function of mirror neurons has been performed in monkeys, this hasn’t stopped

evangelists proposing that these cells do not have an imitation problem per se, are the neural source of human empathy, Dr Hamilton explains, but rather they human culture and basic social skills such struggle to decide when and how much as imitation. Suggestions have followed to imitate – a subtle social skill that most from University of California of us take for granted. neuroscientist Vilayanur S. Ramachandran, Of course, some people with autism and others, that the reason people with are unfriendly or uncaring, just as some autism have social difficulties is because neurotypical people are. But it’s time to they have a broken mirror neuron system. abandon the broken mirror theory and In a cover article for Scientific the related hurtful myth that lack of American in 2006 feeling and emotion is Ramachandran and an inherent part of the his colleague condition. In fact, it is “it’s absolute rubbish to Lindsay Oberman arguably the rest of us say that people with explained their who need to show more autism are not loving or reasoning: ‘Because understanding of what capable of love” these [mirror] the world is like from the neurons appeared perspective of a person with to be involved in autism. abilities such as empathy and the Allison, the University of Connecticut perception of another individual’s researcher with autism, provides a clue. intentions, it seemed logical to She likens life with the condition to hypothesize that a dysfunction of the visiting a foreign land. ‘It’s like taking mirror neuron system could result in somebody who talks a foreign language some of the symptoms of autism. Over to a country whose customs and language the past decade, several studies have they’re not familiar with,’ she says, ‘and provided evidence for this theory.’ yet they’re still expected to know the However, this early support for rules, and they get in a lot of trouble for the broken mirror theory has not been not knowing them.’ sustained. In 2013, in a fatal development for the theory, Dr Antonia Hamilton at Celebrating strengths, UCL, an expert on mimicry and imitation in autism, published a systematic review recognising difficulties of 25 relevant studies including brain Central to a better understanding of imaging and eye-tracking research. autism is striking a balance – recognising Overall, she found little evidence to the advantages of the condition, but also support the broken mirror theory. acknowledging the difficulties it can ‘I don’t think it explains anything,’ impose on people with the disorder and she says. ‘It doesn’t tell us anything that’s their relatives. Related to this is specific to autism because we’ve got so appreciating the huge variety on the many indications that children can autistic spectrum. At one end are those imitate when they’re getting the right with severe autism, who may be noninputs.’ Contrary to the predictions of the verbal and unable to care for themselves. broken mirror theory, people with autism At the other, are those with Asperger’s, for

read discuss contribute at www.thepsychologist.org.uk

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whom the effects of the condition may be far more subtle (note that changes to US psychiatry’s diagnostic code in 2013 mean Asperger’s is no longer classified as a separate condition).

‘People who are waiting for a diagnosis, all they tend to hear about are the negatives,’ says Kim. When she first learned that her son could be autistic, she had a sense that ‘I’m going to raise this child who won’t do well at school, probably won’t get a job, and will need care for the rest of his life.’ Being a parent of a child with autism has been a challenge – no question. Kim’s son couldn’t speak until he was four, has full time one-to-one support at school, and needs medication to get to sleep at night.

But now, aged seven, his reading, writing and numeracy are ahead of his peers. ‘He’s proved to us that no matter what people’s perceptions are, or what you read, they are individuals, and they’ll go at their own pace, and they can achieve anything,’ says Kim. ‘It isn’t all doom and gloom.’

This is the message backed by groups like the Autism Friends Movement (AFM), whose aim is ‘to educate the

public that the autism spectrum is not always a disability’. AFM and other elements of what’s become known as the ‘autism pride movement’ also aim to give people on the autism spectrum their own voice. Everyone I spoke to welcomed this aspect of the pride movement.

‘Much of current research is developed under what professionals believe parents need and want, but rarely ask us [people with autism] directly for our opinions; even when formulating research and policy that has a direct impact on our lives,’ says Allison. ‘Call it pride, call it perseverance, call it what you may; but speaking for yourself and others with the hope that they can have a better tomorrow is a wonderful thing that must be cultivated for people with autism.’

Controversy Where things get more contentious is with the campaign by AFM and others against the development of ‘cures’ for the condition. ‘We don’t want to lose who we are and have future autistics wiped through genetic screening,’ says the AFM

website. But not everyone touched by autism agrees with this approach.

‘I understand why some people are offended by the term “disorder”, says Kim, ‘but if somebody was to give me a cure, I would take it because I know how difficult life is for my son.’

Part of this controversy is about how to characterise autism – as a disorder or simply a different way of being. AFM state that autism is a ‘difference to be valued’. In an article published by the Royal Society in 2009, the leading autism experts Professors Francesca Happé and Uta Frith refer to ‘the beautiful otherness of the autistic mind’. Others go further.

Michelle suggests ‘exaggerated excellence’ as a moniker for the condition. ‘I think that when you’re autistic anything you set out to achieve, you go that bit further – more into the detail,’ she says.

But while these attempts to romanticise and celebrate the condition are laudable, they clash with many people’s everyday experiences. Take, for example, the perspective of Dr Carl Walker, a psychologist and mental health expert at Brighton University. He

Creativity I’ve heard it said I’m some quaint, programmed husk Who cannot think beyond a rigid box.

Cold facts, harsh figures, dance at my fingertips While sweet imagination slips me by.

But I can spot the spondee in a verse And signpost trochees, dactyls, and iambs; Uproot acrostics in a pyrrhic rush, Uncover the choree and the dibrach.

The anapaest and amphibrach are clear As colours in a painting, to my mind.

The cog-wheels of each line keep churning round As dative clauses latch onto the vine.

And I can spot grand theories spinning round And sit back as they crash, crumble, and die.

And then I pick the pieces up, and form Afresh, new truths from old malignant lies.

And what about the beauty of the box?

Why ever would I want to think outside?

When I can grasp its roots and functions, and Gain a creative angle you’re denied?

My world’s not yours.

I spy what you cannot And yet am blind to what you clearly see.

We’re different, yes.

But don’t infer from that That my brain lacks your creativity.

By Jonathan Andrews, a 20-year-old with autism, for the Create Art for Autism competition – see www.createartforautism.com. For more of Jonathan’s work, see tinyurl.com/omz9vcu and tinyurl.com/ppf3n6h

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remembers the troubled school days of his older brother, who has a diagnosis of Asperger’s and is unemployed. ‘I like the idea of celebrating otherness,’ Dr Walker says, ‘so there’s something very attractive and seductive about [Happé and Frith’s] description, but unfortunately 16-, 15and 14-year-old angry young men at school don’t have the capacity to see and understand beautiful otherness.’

For people with less severe autism or Asperger’s, who attend mainstream schools, Dr Walker’s assessment is blunt: ‘It can be a fucking horror show,’ he says.

‘It’s dreadful. Much of the legacy that people with autistic spectrum disorder have comes from the exclusion, the marginalisation, the abuse, the difficulties they have at school, trying to fit into a world that doesn’t make sense to them.’

For a further sense of the reality of autism for many, it’s perhaps also worth heeding the findings from a recent study that investigated the current status of 60 people first diagnosed with autism as children between 1950 and 1979 (Howlin et al., 2014). Although they all have intelligence in the ‘average range’ (i.e. an IQ of over 70), Patricia Howlin and her colleagues found that only 27 per cent of them were now living independently or semi-independently – the others were being cared for at home or in a residential facility.

Looking ahead Unfortunately, the desire persists among the media, and some experts, to encapsulate autism in a single unifying theory. Last year, for example, an article about the new ‘intense world’ theory of autism (tinyurl.com/p5o6879) attracted great interest. Developed by the head of the EU’s ambitious Human Brain Project, Henry Markram (who has an autistic son), and his wife Kamila (a neuroscientist and autism researcher), the theory proposes that the strengths and impairments of autism are caused by oversensitive sensory and emotional systems in the brain.

Although well-intentioned, this new theory, and others like it, risks falling into the old traps of oversimplification and romanticisation. Like the broken mirror theory it could also be plain wrong and, when promoted too rapidly, lead to misguided treatments, such as the withdrawal of stimulation. Writing for the Simons Foundation Autism Research Initiative (see tinyurl.com/k25kteo), Professors Anna Remington and Uta Frith pointed out that there is in fact huge variation in sensory sensitivity among people with autism, and they fear that the deliberate, routine

Is there really an autism epidemic?

It’s true the number of children being diagnosed with autism has increased hugely over recent decades. There was a five-fold increase in the UK during the 1990s alone, although there’s evidence this rise had plateaued by the early 2000s (Taylor et al., 2013). According to the National Autistic Society, the prevalence in the UK is now around 1 in 100, although they warn that this is an approximation. In March 2014 the Centers for Disease Control and Prevention in the US declared that the prevalence in that country is now 1 in 68 (this compares to a prevalence estimate of 1 in 150 in 2002).

The dramatic increase in rates of autism has led to scare stories about possible causes (see box on MMR vaccine), and research into possible environmental causes, such as air pollution (Volk et al., 2013). However, the reasons for the rise are currently subject to debate, and many experts think it is probably almost entirely due to a mix of broadened diagnostic criteria and greater awareness of the condition.

Such an argument was supported by a study published in 2008 by Dorothy Bishop and her colleagues. They studied 38 adults diagnosed with a developmental language disorder (but specifically not autism) in their childhood, and found that 12 of them would meet contemporary diagnostic criteria for autism or autism spectrum disorder.

withdrawal of stimulation could be a harmful approach.

The pair are also concerned about the Markrams’ claim that this minimisation of environmental stimulation could be a way for parents to unleash their autistic children’s inner genius. In an interview with the Huffington Post (tinyurl.com/lot68ec), for example, the Markrams stated that ‘We actually think if you could develop a filtered environment in the early phase of life you could end up with an incredible genius child without many of the sensory challenges.’

Sadly, this kind of talk risks sending the message that autistic children’s worth is tied to their having some hidden super ability (the very sentiment that we heard earlier is resented by Allison and other people with autism).

Final thoughts The reality is that the simple term ‘autism’ conceals a world of complexity.

A recurring theme to emerge from my

read discuss contribute at www.thepsychologist.org.uk

conversations with parents, researchers and people with autism was the diversity of autism experiences. For some people, autism may truly seem like a gift. For others, it has made life intolerably difficult.

And there are acres of ground between these poles. We need to respect these differences and avoid the temptation to simplify the autism story.

We must also be careful with the language we use – talk of disorder and cures can be offensive to people who feel their autistic nature is a fundamental part of who they are. That doesn’t mean they don’t want help. It does mean recognising that people with autism have feelings, giving them a voice, and being sensitive to the way we discuss the challenges they face in world that’s dominated by ‘neurotypicals’.

I Dr Christian Jarrett is editor of the British Psychological Society Research Digest and author of Great Myths of the Brain, published by Wiley-Blackwell this month. christianjarrett@gmail.com

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Combining the old and the new Jon Brock looks at Bayesian and predictive coding accounts of autistic cognition

question

Bernard Rimland’s classic text, Infantile Autism (1964), marked the beginning of research on autism as a disorder of cognition. Rimland’s hypothesis – that autistic individuals have difficulty relating new and old experiences – has recently been updated in the form of Bayesian and predictive coding accounts of the condition. These new approaches have the potential to explain a wide range of symptoms associated with autism, linking differences in cognition to their underlying neurobiology. But as with all contemporary theories of autism, the challenge will be to address the huge variability that exists within the autism spectrum and the overlap with other supposedly distinct conditions.

M

How might researchers differentiate between alternative accounts of Bayesian and predictive coding?

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How does autism research move forward if there are in fact many different autisms all lumped together?

Clark, A. (2013). Whatever next?

Predictive brains, situated agents, and the future of cognitive science.

Behavioral and Brain Sciences, 36, 181–204.

‘How did Nate Silver predict the US election?’ www.theguardian.com/ science/grrlscientist/2012/nov/08/ nate-sliver-predict-us-election

Adams, R.A., Stephan, K.E., Brown, H.R. et al. (2013). The computational anatomy of psychosis. Frontiers in Psychiatry, 4, 47.

Brock, J., Norbury, C., Einav, S. & Nation, K. (2008). Do individuals with autism process words in context? Cognition, 108, 896–904.

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Revisiting the relationship between autism and schizophrenia. Annual

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ark Rimland was not like other babies. As his father, Bernard, later recalled, ‘Mark was a screaming, implacable infant who resisted being cuddled and struggled against being picked up’. The paediatricians were baffled, and it was only after his mother, Gloria, remembered reading about Leo Kanner’s description of ‘autism’ in a psychology textbook that a diagnosis was eventually made.

Today, autism is considered to be a neurodevelopmental disorder arising from the complex interplay of genetics and environmental factors during preand early post-natal development.

However, in 1958, when Mark was first diagnosed, it was generally regarded as the child’s reaction to a lack of maternal affection – the infamous ‘refrigerator mother’ hypothesis. Bernard knew that this was nonsense and set out to determine the real cause of his son’s difficulties. His literature search led in 1964 to the publication of a book, Infantile Autism, that was to become a landmark in autism research. Not only did he conclusively debunk the refrigerator mother hypothesis, Rimland also set out his own revolutionary theory.

Autism, he argued, was a cognitive dysfunction. The ‘diversity of symptoms and manifestations’ could be traced to ‘a single critical disability: The child with early infantile autism is grossly impaired in a function basic to all cognition: the ability to relate new stimuli to remembered experience… The child is thus virtually divested of the means for deriving meaning from his experience…

Review of Clinical Psychology, 9, 555–587.

Fletcher, P.C. & Frith, C.D. (2009).

Perceiving is believing: A Bayesian approach to explaining the positive symptoms of schizophrenia. Nature Reviews Neuroscience, 10, 48–58.

Frith, U. (1989). Autism: Explaining the enigma. Oxford: Blackwell.

Frith, U. & Snowling, M. (1983). Reading for meaning and reading for sound in

He cannot integrate his sensations into a comprehensible whole.’

In his subsequent work, Rimland moved away from cognitive theorising.

He promoted some questionable biomedical interventions and was a strong advocate of the now discredited notion that autism is caused by traces of mercury in vaccines. However, the ideas laid out in Infantile Autism inspired a generation of researchers to investigate autistic cognition.

Half a century later and eight years after his death, Rimland’s original ideas are back in vogue. In a 2012 paper, Liz Pellicano and David Burr proposed that autistic cognition could be understood in terms of Bayesian statistics – a mathematical framework for combining new and old information. Autism, they suggested, is characterised by a reduced influence of prior knowledge. In response to Pellicano and Burr, other researchers have argued that autistic cognition might be more usefully characterised in terms of a related theoretical framework, predictive coding and, more specifically, how the brain deals with the inevitable discrepancies between reality and expectations.

Central coherence Rimland’s ideas about autistic cognition were highly speculative, based on observation and intuition alone. However, UK psychologists Beate Hermelin and Neil O’Connor were already beginning to conduct experiments that spoke directly to his hypothesis (Hermelin & O’Connor, 1967).

In one study they gave children a series of words to repeat out loud.

As expected, non-autistic children made fewer errors if the words made up meaningful sentences. ‘The fish swims in the pond’ was easier to recall than the random word string ‘By is go tree stroke lets’. Children with autism, however, failed to show this effect, suggesting that they were repeating the individual words without considering the meaning of the

autistic and dyslexic children. Journal of Developmental Psychology, 1, 329–342.

Friston, K.J., Lawson, R. & Frith, C.D. (2013). On hyperpriors and hypopriors: Comment on Pellicano and Burr. Trends in Cognitive Sciences, 17, 1.

Geschwind, D.H. & Levitt, P. (2007).

Autism spectrum disorders: Developmental disconnection

syndromes. Current Opinion in Neurobiology, 17, 103–111.

Happé, F., Ronald, A. & Plomin, R. (2006).

Time to give up on a single explanation for autism. Nature Neuroscience, 9, 1218–1220.

Hermelin, N. & O’Connor, N. (1970).

Psychological experiments with autistic children. Oxford: Pergamon Press.

Kahan, J. & Foltynie, T. (2013).

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sentence, exactly as Rimland might have predicted.

Hermelin and O’Connor were unaware at the time of Rimland’s book, but it inspired their PhD student Uta Frith, to continue this line of work.

In one ingenious experiment (Frith & Snowling, 1983) she and Maggie Snowling gave children 10 sentences to read out loud. Each contained a homograph – a word such as tear with a dual meaning. By noting how the children spoke the homographs, Frith and Snowling could determine which meaning had been assigned – and whether it made sense in the broader context of the sentence. Children with autism performed poorly on this task.

They would pronounce tear the same, regardless of whether the sentence suggested crying or ripping, indicating that they had failed to take the earlier sentence context into account. These and other findings led Frith to propose her ‘weak central coherence’ account of autism. Autistic cognition, she argued,

is characterised by a focus on detail and a failure to ‘weave together’ information to extract meaning (Frith, 1989).

Central coherence was, in essence, a fleshing out of Rimland’s earlier proposal.

It provided a way of understanding some of the difficulties facing people with autism, including problems with language and social understanding where contextual nuances are often critical.

Importantly, however, the account also emphasised the strengths of autistic individuals. Being able to ignore the bigger picture and focus on the details might in some circumstances be advantageous. Frith and her colleague, Amita Shah had found that children with autism performed relatively well on certain visuo-spatial tasks that required attention to detail. For example, on the embedded figures test in which they had to locate geometric shapes hidden in a larger more complex picture, autistic children outperformed non-autistic children of similar overall cognitive ability (Shah & Frith, 1983).

MARK RIMLAND/KENSINGTON GALLERY, SAN DIEGO & GERARDO YEPIZ/ACAMONCHI ART STUDIO, SAN DIEGO

Bernard Rimland’s quest to understand his son Mark – who created this artwork – led to the publication of Infantile Autism in 1964

Understanding DCM: Ten simple rules for the clinician. Neuroimage, 83, 542–549.

Lawson, R.P., Rees, G. & Friston, K.J. (2014). An aberrant precision account of autism. Frontiers in Human Neuroscience, 8, 302.

Mitchell, P., Mottron, L., Soulières, I. & Ropar, D. (2010). Susceptibility to the Shepard illusion in participants with autism: Reduced top-down

influences within perception? Autism Research, 3, 113–119.

Pellicano, E. & Burr, D. (2012). When the world becomes ‘too real’: A Bayesian explanation of autistic perception.

Trends in Cognitive Sciences, 16, 504–510.

Rimland, B. (1964). Infantile autism: The syndrome and its implications for a neural theory of behavior. Chicago: Appleton-Century-Crofts.

read discuss contribute at www.thepsychologist.org.uk

The central coherence account proved highly influential. Over the years, it has inspired hundreds of studies and has succeeded in focusing attention on the non-social, non-diagnostic features of autism. However, the account remains frustratingly vague. The term ‘central coherence’ is not one that is recognised in mainstream cognitive psychology and it’s unclear what cognitive mechanism might actually be involved. It’s more a description of the kind of explanation researchers are looking for than an explanation in and of itself. Pellicano and Burr’s Bayesian account is an attempt to go beyond central coherence and pin it down to something more precise, testable and, ultimately, falsifiable.

The Bayesian perspective The basic premise underlying Bayesian statistics is that information is inherently unreliable, so a better estimate of reality comes from combining new information with prior knowledge. Perhaps the bestknown example of Bayesian statistics in action came from the 2012 US presidential election campaign, when the New York Times blogger Nate Silver was able to correctly predict the results in all 50 states. Rather than just relying on the latest opinion poll, Silver, developed a mathematical model of voting intentions.

He then used Bayesian theory to incrementally adjust the model in the light of each new opinion poll. The weight put on a new poll depended on its margin of error – how much it fluctuated from poll to poll and how well it had predicted the outcome of previous elections.

The Bayesian principles underlying Silver’s model have also been applied to cognitive theories of perception. In the same way that an opinion poll has a margin of error, incoming sensory information is inherently ambiguous and unreliable. For instance, the light hitting the back of the eye could come from an infinite number of different arrangements of objects in the real world. However, the

Shah, A. & Frith, U. (1983). An islet of ability in autistic children. Journal of Child Psychology and Psychiatry, 24, 613–620.

Teufel, C., Subramaniam, N. & Fletcher, P.C. (2013). The role of priors in Bayesian models of perception.

Frontiers in Computational Neuroscience, 7, 25. van Boxtel, J.J. & Lu, H. (2013). A predictive coding perspective on

autism spectrum disorders. Frontiers in Psychology, 4, 19. van de Cruys, S., de-Wit, L., Evers, K. et al. (2013). Weak priors versus overfitting of predictions in autism: Reply to Pellicano and Burr (TICS, 2012). i-Perception 4, 95–97.

Wass, S. (2011). Distortions and disconnections: Disrupted brain connectivity in autism. Brain and Cognition, 75, 18–28.

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problem is constrained by our experience of what objects are likely to be out there, and we are rarely conscious of the potential for alternative interpretations.

Pellicano and Burr’s proposal is not that people with autism ignore prior knowledge altogether, but rather that their priors are broader – and so perception is less constrained by past experience. In terms of the US election analogy, this is akin to placing less weight on previous opinion polls and thus being extra-sensitive to the most recent opinion poll. The result, Pellicano and Burr suggest, is that the world is somehow ‘more real’ for people with autism. There is, however, some poetic licence here.

Under most circumstances, the prior information is useful and so improves the accuracy of perception, bringing us closer to reality (see Teufel et al., 2013).

A notable exception is the case of visual illusions. In the Shepard illusion, for example, the dimensions of the two table tops are identical (see Figure 1).

However, our experience of rectangular surfaces in the real world leads us to perceive the table on the left as being long and thin, while the one on the right appears short and fat. Prior knowledge helps us to make a judgement about the three-dimensional object being represented, but it hinders judgements about the actual two-dimensional image.

Consistent with the Bayesian account, Peter Mitchell and colleagues found that people with autism were less susceptible to this effect than non-autistic people, suggesting in turn that they are less affected by what Mitchell and colleagues term ‘the curse of knowledge’ (Mitchell et al., 2010).

Pellicano and Burr’s Bayesian account is essentially a mathematical formalisation of Mitchell and colleagues’ proposal – and of Rimland’s original idea. But this formalisation is important. It finally grounds research on autistic cognition in mainstream cognitive psychology research. It also generates novel and testable predictions. In any situation where performance can be understood in terms of the combining of current and prior information, prior knowledge should be underweighted in individuals with autism. While the current emphasis is on visual perception, the Bayesian framework could in principle be applied to a wide range of symptoms associated with autism.

Predictive coding Rimland’s initial focus in Infantile Autism was on cognition, but he was conscious that differences in information processing

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must ultimately arise from differences in brain function.

‘In some very real way’, he suggested, ‘memories, thoughts, and ideas are somehow locked into separate compartments of the autistic child’s Figure 1: The Shepard illusion – knowledge of three-dimensional brain’. This same objects makes the two table surfaces appear to have different intuition underpins proportions, despite having the same two-dimensional shape the more recent ‘underconnectivity’ and colleagues suggest that autism could hypothesis (see Wass, 2011), according in fact be characterised by over-precise to which, the symptoms of autism arise prediction errors (van de Cruys et al., due to a lack of communication between 2013). Somewhat counterintuitively, this different parts of the brain. There is now could have very similar effects to reduced growing evidence for atypical brain precision because even small deviations connectivity in autism, but the from predictions are treated as significant relationship between brain activity and prediction errors. cognition in autism remains opaque.

Within the predictive coding In a commentary on Pellicano and framework the brain is conceived as Burr’s paper, Karl Friston and colleagues a hierarchy, with information cascading suggested that the Bayesian account of up and down the different levels. Brain autism could be usefully reframed in Region A will make predictions about terms of the predictive coding framework activity in Brain Region B, and the (Friston et al., 2013; see also van Boxtel prediction error will then be sent back & Lu, 2013). Like the Bayesian approach, to Brain Region A. Region B will interact this concerns the way in which old and with Region C in a similar way, and so on new information are combined, but it down the chain. Differences in predictive provides a more explicit link to neural coding thus correspond mechanisms. Predictive directly to the way in coding starts with the simple which brain regions at idea that the main purpose of “Autism is complicated different levels of the the nervous system is to try and messy… There are hierarchy interact. In to anticipate what will no clear boundaries” principle at least, it happen next. Put another should be possible to test way, the organism tries to hypotheses about atypical minimise its prediction connectivity by applying dynamic causal errors – the difference between what modelling to neuroimaging data from it predicted would happen and what individuals with autism. This involves actually transpired. To some extent, generating different models of how brain prediction errors are inevitable. A key regions interact during a particular task feature of predictive coding, therefore, is and then determining which model that the organism encodes the precision comes closest to predicting the of its predictions – that is, how confident neuroimaging data recorded (see Kahan it is in their accuracy. If precision is low, & Foltynie, 2013). then the organism takes even large Predictive coding also offers insights prediction errors in its stride. But if into how changes in brain connectivity precision is high and strong predictions and cognition might arise from are violated, this is cause to sit up, take differences at the synapse (Lawson et al., notice – and learn from the experience, 2014). The precision of predictions is allowing better predictions to be made thought to involve NMDA receptors, in future. which act like an amplifier in a hi-fi Friston and colleagues hypothesise system, determining the size of a neuron’s that precision is reduced in autism: response to prediction errors. NMDA individuals with autism make less strong receptors are part of the glutamate predictions and so their perception is neurotransmitter system, which in turn dominated by the noisy, ambiguous interacts with other neurotransmitters, sensory information. However, in a including serotonin, dopamine and further commentary, Sander van de Cruys

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GABA, as well as the hormone oxytocin, all of which have all been implicated in autism. There may, therefore, be a number of different but converging routes to atypical predictive coding and connectivity.

The schizophrenia connection While still in their early days, the Bayesian and predictive coding accounts of autism have considerable potential for understanding autistic cognition, its underlying neurobiology and, ultimately, its genetics. But like all theories of autism, they face a number of challenges.

Prominent amongst these is to specify exactly how autism differs from other conditions. In particular, very similar accounts have been proposed to explain schizophrenia (see Adams et al., 2013).

Historically, autism was considered to be an early-onset form of schizophrenia, and there are certainly overlaps between the two conditions (see De Lacy & King, 2013). Both are associated with impaired social reasoning and executive skills, as well as a reduced sensitivity to context (although the term ‘central coherence’ is not used in the schizophrenia literature).

Both have been attributed to reduced or atypical brain connectivity, and certain genetic variations appear to convey risk for both conditions. There are, however, some clear differences. As Rimland remarked in Infantile Autism, ‘the writer is reminded of the story of the two men who were indistinguishable in appearance except that the tall thin one had a red beard and only one leg’ (p.68).

In particular, schizophrenia is associated with hallucinations and delusions in schizophrenia, which are not generally present in autism. Paul Fletcher and Chris Frith (2009) have argued that these ‘positive’ symptoms can be understood as the failure of predictive coding. Ordinarily, our internally generated thoughts and actions have highly predictable consequences – because we have made them ourselves.

However, if prediction breaks down, then our own actions may feel like we didn’t initiate them. Likewise, our inner voice may seem like it is someone else’s. The question then is, if people with autism also have issues with predictive coding, why don’t they too experience hallucinations and delusions?

One possibility is that autism and schizophrenia are both disorders of predictive coding, but the exact nature of the impairment is different. However, it is also important to consider the different developmental trajectories. In schizophrenia, atypical predictive coding

is occurring in the context of relatively well-developed adult internal model of the world. In autism the same atypicality present from very early in life (and possibly before birth) would entail that the individual’s model of the world is atypical from the start.

Studies directly comparing autism and schizophrenia may prove particularly useful in refining accounts of both disorders. However, there is an underlying assumption here that autism is a distinct condition that a person either does or does not have; and that it makes sense, therefore, to think of a theory of autism – an explanation that applies to all or at least the majority of people with autism. This view, however, is one that is increasingly under question.

One autism or many?

As an appendix to Infantile Autism, Rimland provided an 80-item symptom checklist to assist in the diagnosis of autism. Total scores over a certain threshold indicated that the child was autistic. Although many different combinations of symptoms could lead to an autism diagnosis, Rimland’s assumption was that the variation reflected different manifestations of the same underlying condition. Modern diagnostic checklists work in much the same way (and carry the same assumption), but the concept of autism is far broader than in the 1960s, and the heterogeneity within autism is accordingly even greater. Two individuals may both meet diagnostic criteria for an autism spectrum disorder but present with very few symptoms in common.

Recognition of this heterogeneity problem is growing. In an influential 2007 paper, Daniel Geschwind and Pat Levitt argued that we should think of ‘the autisms’ (plural) as a collection of disorders that share some superficial similarities. The central challenge for autism researchers, then, is to tease apart the various autisms in order to identify the most appropriate interventions and support required by any individual. One possibility, therefore, is that the Bayesian/predictive coding account only applies to a subset of the many autisms. In other words, there will be some autistic people who show atypical priors or precision across a wide range of situations. Other individuals will be similar to non-autistic people in this regard – and would, therefore, require an alternative explanation for their symptoms.

A different and arguably more radical viewpoint is that we should stop thinking about syndromes like autism altogether

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and instead focus research efforts on specific symptoms (Happé et al., 2006).

Rather than considering atypical priors or precision to be a whole-brain phenomenon affecting all of cognition equally, it might make more sense to think of atypicalities in relation to specific brain systems and cognitive processes.

Our own work on language comprehension tends to support this view (Brock et al., 2008). A strong prediction of the Bayesian/predictive coding account is that children with autism should make less use of contextual information when identifying spoken words. By testing autistic children with a wide range of language skills, as well non-autistic children with and without language impairment, we were able to show that context sensitivity was in fact related to a child’s degree of language impairment irrespective of whether they had an autism diagnosis.

What next?

The issues that face the Bayesian and predictive coding accounts of autism are by no means unique. Autism is complicated and messy. Almost every aspect of cognition can be affected, but the pattern of strengths and difficulties varies hugely across the autistic population. Even so-called ‘core’ symptoms manifest differently in different individuals and at different stages of development. There are no clear boundaries. Autism overlaps with a wide range of other supposedly distinct conditions and appears itself to have multiple different causes.

Despite his remarkable percipience, it is now apparent that Rimland wildly underestimated the complexity of the challenge he faced. Indeed, it seems unlikely that there will ever be a straightforward answer to the autism puzzle. Seen in this light, the Bayesian and predictive coding accounts of autism are clearly over-simplistic, but they do at least provide a framework for testing hypotheses and guiding research. As Rimland’s successors, we may at last be edging closer to an understanding of how and why autistic individuals think differently to those of us without autism.

Jon Brock ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Australia jon.brock@mq.edu.au

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Risk and resilience in the developing brain Mayada Elsabbagh looks at lessons from autism For over a decade now, researchers have explored the developmental pathways leading to autism early in life. Converging evidence suggests that within the first year of life, remarkably little overt behavioural risk signs of the condition can be detected. Yet, dynamic changes in early brain development lead to divergent and increasingly variable pathways over time. There is also emerging evidence for resilience, where some infants may overcome the impact of genetic risk through active processes of neural reorganisation. Improvements in understanding risk processes in autism have great potential in informing clinical practice. The process of translating this knowledge into community impact rests on careful consideration of ethical and social issues.

question

Elsabbagh, M. & Johnson, M.H. (2010).

Getting answers from babies about autism. Trends in Cognitive Sciences, 14(2), 81–87.

Zwaigenbaum, L., Bryson S., Lord, C. et al. (2009). Clinical assessment and management of toddlers with suspected autism spectrum disorder: Insights from studies of high-risk infants. Pediatrics, 123, 1383–1391.

references

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When and how does autism emerge in infancy?

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Bedford, R., Elsabbagh, M., Gliga, T. et al.

(2012). Precursors to social and communication difficulties in infants at-risk for autism. Journal of Autism and Developmental Disorders, 42(10), 2208–2218.

Elsabbagh, M. (2012). Perspectives from the common ground. Autism Research: Official Journal of the International Society for Autism Research, 5(3), 153–155.

stimates of the global prevalence of autism vary considerably, reaching up to 1 per cent of the total population and even higher in few countries (Elsabbagh, Divan, et al., 2012).

In spite of the sparse research data, especially in low- and middle-income countries, mapping of research priorities across diverse communities suggests that the condition has become one of the most urgent public health challenges (Khan et al., 2012). In industrialised economies like the UK the annual cost of autism is around £3 billion (Knapp et al., 2009).

Much of these social and ethical costs are due to limited uptake of evidence-based practice in the community, often complicating and delaying diagnosis and access to appropriate services several years beyond the point of initial parental concern. This situation is particularly problematic in view of growing consensus that early identification and intervention can improve long-term outcomes.

Central to meeting these global autism challenges is a life-course approach, whereby early identification and intervention are believed to prevent the long-term disabling consequences of autism for the affected individual, and to substantially reduce demands and costs to health and social care systems (Khan et al., 2012). In this article, I review recent advances in understanding the root causes of autism and its developmental pathways in childhood, clarifying how these advances provide impetus toward addressing long-term translational goals.

Indeed, these advances have already challenged and reshaped influential

Elsabbagh, M., Bedford, R., Senju, A. et al. (2013). What you see is what you get: Contextual modulation of face scanning in typical and atypical development. Social Cognitive and Affective Neuroscience, 9(4), 538–543.

Elsabbagh, M., Divan, G., Koh, Y.-J. et al.

(2012). Global prevalence of autism and other pervasive developmental disorders. Autism Research, 5(3), 160–179.

accounts of how and when the condition emerges early in life. In the 1970s, research into the genetic and neurobiological basis of autism led to the debunking of the myth that the condition is caused by so-called ‘refrigerator mothers’ who fail to show affection toward their children. Today, the field has moved away from ‘blaming’ mothers, instead stressing the critical role that families and supportive environments play in improving the lives of affected individuals.

Notwithstanding these accomplishments, there is increasing recognition of the complexity, heterogeneity and variable impact of autism across individuals. This challenge currently hampers basic clinical and translational research and complicates discovery of root causes. For this reason funders have increased investments to facilitate ‘big science’ – large-scale studies and data repositories. Indeed, the increased investments have allowed researchers to make leaps on the path of scientific discovery. Among the key advances are: I the discovery of rare genetic underpinnings in approximately 20 per cent of individuals with autism and those with overlapping conditions (e.g. Lionel et al., 2011; Scherer & Dawson, 2011); I increasing refinement in our understanding of atypical brain connectivity underlying the condition (e.g. Lewis & Elman, 2008); and I specification of variable rates of developmental progress within the autism spectrum, as they occur along distinct functional, cognitive and language dimensions, that are much broader than what narrow diagnostic categories capture (e.g. Georgiades et al., 2007).

These and other findings are gradually shifting the way scientists model the root causes of autism. We have abandoned a simplistic view of etiology where a single gene, brain region or neatly defined

Elsabbagh, M., Fernandes, J., Jane Webb, S. et al. (2013).

Disengagement of visual attention in infancy is associated with emerging autism in toddlerhood. Biological Psychiatry, 74(3), 189–194.

Elsabbagh, M., Gliga, T., Pickles, A. et al.

(2012). The development of face orienting mechanisms in infants atrisk for autism. Behavioural Brain Research.

doi:10.1016/j.bbr.2012.07.030 Elsabbagh, M. & Johnson, M.H. (2010).

Getting answers from babies about autism. Trends in Cognitive Sciences, 14(2), 81–87.

Elsabbagh, M., Mercure, E., Hudry, K. et al. (2012). Infant neural sensitivity to dynamic eye gaze is associated with later emerging autism. Current Biology, 22(4), 338–342.

Georgiades, S., Szatmari, P., Boyle, M. et

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which has in the last decade succeeded cluster of symptoms can account for in getting answers from babies about autism (Happé et al., 2006; Nickltheir development, cognition and Jockschat et al., 2012). Furthermore, communication. instead of defining the phenotype as Because autism is rarely diagnosed a narrow categorical disorder, there is before two years of age, several ongoing growing evidence around the classic large-scale studies have idea of a spectrum of been tracking the conditions affecting development of infants individuals differently; at-risk for autism, by some can lead independent virtue of having an and fulfilling lives, but older diagnosed many develop substantial sibling. These infants, cognitive, medical, relative to those with educational, functional no family history of and social difficulties that autism, are at have a serious negative substantially higher effect on their quality of risk for developing the life. Consistently, some condition as toddlers scientists suggest that these (Ozonoff et al., 2011). ‘autisms’ may well have As these independent distinct root causes, and large cohorts underlying biological advance along their processes, and developmental developmental pathways. trajectories, it is In sum, autism poses a becoming possible to complex scientific challenge prospectively account where heterogeneity in the for patterns of brain root causes or in the and behavioural resulting phenotype needs change. to be taken seriously.

It is becoming possible to Among these Therefore, it is paramount prospectively account for studies is the British to understand the emergence patterns of brain and Autism Study of Infant of the condition from the behavioural change Siblings (BASIS), which earliest stages, and prior to recently completed the onset of symptoms in follow-up of the first 100 infants from toddlerhood. It is within this early period around six months to three years of that we have a window of opportunity to age. About 30 per cent of these infants observe and study the unfolding neural received an autism diagnosis in and behavioural phenotype before it toddlerhood, and several others in the becomes complicated by atypical at-risk group exhibited various forms interactions within brain systems and of developmental concerns, such as with the environment. language delay or attentional difficulties, without meeting criteria for autism.

Babies debunk prevailing BASIS, in my view, complemented the growing body of literature in this area accounts in three unique ways. First, controlled Seeking to understand the complex laboratory experiments showed that, interplay between genes, phenotypes and contrary to prevalent theories in this area, environment, a rapidly growing area of those infants who went on to develop research falls at the crossroads of research autism as toddlers initially show many of on infancy and autism. This emerging the typical social responses expected for field draws on innovative basic science,

al. (2013). Investigating phenotypic heterogeneity in children with autism spectrum disorder. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 54(2), 206–215.

Georgiades, S., Szatmari, P., Zwaigenbaum, L., et al (2007).

Structure of the autism symptom phenotype. Journal of the American Academy of Child & Adolescent Psychiatry, 46(2), 188–196.

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Trajectories of autism severity in children using standardized ADOS scores. Pediatrics, 130(5), e1278–1284.

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their age. Second, direct measurement of brain activity signalled atypical neural processes preceding the emergence of overt behavioural signs of the condition.

Finally, the earliest manifestations of autism were detected across multiple social and non-social systems, rather than being restricted to precursors of the core social and communication symptoms that define the condition. A few illustrative findings reviewed next highlight the significance of these claims to the goal of understanding root causes in autism.

Influential hypotheses suggest that autism results from an initial lack of attention to or interest in socially relevant information. This initial impairment precludes later development of key social and communicative milestones, such as joint attention, and leads to the emergence of characteristic symptoms of autism. In contrast to these claims, several previously published studies with infants at risk (reviewed in Elsabbagh & Johnson, 2010) suggest that overt social and communicative behaviours may appear typical in this group within the first year of life. One limitation of these findings is that they come from observational studies or those employing unstructured settings, which potentially mask more subtle but reliable differences in infants who go on to develop autism.

In a series of highly controlled laboratory experiments with BASIS infants, we showed that seven-month-old infants at risk who later developed autism typically orient to faces embedded among distractors (Elsabbagh, Gliga, et al., 2012). The same infants reliably follow gaze of another person toward an object in the periphery (Bedford et al., 2012).

Moreover, they typically scan internal face features, including the eyes and mouth, when viewing dynamic faces displaying various communicative cues (Elsabbagh, Bedford, et al., 2013).

In contrast to these behavioural findings, direct measurement of brain response to socially relevant information within the same developmental period characterised the subgroup of infants who

Time to give up on a single explanation for autism. Nature Neuroscience, 9(10), 1218–1220.

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(2008). Can children with autism recover? If so, how? Neuropsychology Review, 18(4), 339–366.

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areas like language developed autism as toddlers and attention in (Elsabbagh, Mercure, et al., toddlerhood, but 2012). Specifically, infants in without meeting the control group and those criteria for autism. at risk who did not develop This pattern, known autism showed clear as the broader autism differentiation between faces phenotype, has been looking directly at them vs. previously faces looking away, which documented in older we interpreted as an relatives of diagnosed understanding of the individuals (Pickles et referential nature of gaze cues al., 2000). Therefore, (a well-established precursor familial history of to joint attention). Yet, infants autism confers risk who went on to develop for variable pathways autism exhibited a diminished where an autism response difference to diagnosis is only one dynamic gaze cues (toward of the possible vs. away). Therefore, neural childhood outcomes. processes relevant for One of the reasons why autism signs in infancy are very difficult to Here too BASIS interpreting gaze cues are establish is because those at risk who do not develop autism share provided a unique already atypical, prior to the many of these signs with those who do perspective on these onset of overt signs of the variable developmental condition. systems and with the environment pathways. Preliminary findings suggest What happens after the first year? become compounded and amplified, that at least in some cases, the infant Dynamic developmental changes leading to characteristic symptoms that brain may respond to genetic risk by continue to unfold and more reliable define the disorder. Of course, these spontaneously reorganising in order to characteristics become increasingly clear findings hold in cases of familial risk, and prevent the onset of disabling symptoms in the second year of life in the infants different underlying risk process might be from emerging. Support for this claim is who later develop autism. In the BASIS found in cases where there is no familial based on findings where atypical cohort, these include atypical processing risk, a possibility yet to be explored. responses observed in a range of brainof social information (Bedford et al., function measures in the first year were 2012), delays in motor development not always driven by the subgroup who (Leonard et al., 2014) and decreased Rethinking developmental developed autism as toddlers (Elsabbagh, flexibility of visual attention (Elsabbagh, Mercure, et al., 2012). In fact, some Fernandes, et al., 2013). It is also in this pathways atypical responses were uniquely period that interactions between these The putative pathway of infants who later associated with the subgroup of infants infants with their caregivers become develop autism, described above, is only who did not develop any clinical increasingly asynchronous (Green et al., one among several hypothetical and outcomes in toddlerhood. Therefore, 2013; Wan et al., 2012). Still, signs at this observed pathways seen in these largeat least some infants may be actively age are variable across infants and only scale studies. A wide range of tasks responding to early genetic risk by indirectly map onto diagnosis at three revealed developmental differences in the recruiting alternative neural mechanisms, years of age. at-risk group as a whole relative to those a pattern described as ‘canalisation’.

In sum, contrary to previously with no family history of autism Therefore, this developmental approach proposed accounts, autism is not the (reviewed in Elsabbagh & Johnson, has further highlighted the variable and result of impairment in orienting or 2010). Indeed, one of the reasons why probabilistic nature of pathways leading sustaining attention to socially relevant autism signs in infancy are very difficult to autism. information. Infants who later develop to establish is because those at risk who The notion of dynamic developmental the condition initially exhibit a range of do not develop autism share many of pathways is not restricted to the early age-appropriate social and these signs with those who do. Moreover, infancy period, but is also neatly captured communication precursors, but over time infants who do not develop autism may by studies of young diagnosed children atypical interactions across multiple brain still exhibit developmental concerns in

disorder. European Journal of Developmental Psychology, 11, 18–35.

Lewis, J.D. & Elman, J.L. (2008). Growthrelated neural reorganization and the autism phenotype. Developmental Science, 11(1), 135–155.

Lionel, A.C., Crosbie, J., Barbosa, N. et al. (2011). Rare copy number variation discovery and crossdisorder comparisons identify risk genes for ADHD. Science

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Nickl-Jockschat, T., Habel, U., Michel, T. et al. (2012). Brain structure anomalies in autism spectrum disorder. Human Brain Mapping, 33(6), 1470–1489.

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(2011). Recurrence risk for autism spectrum disorders. Pediatrics. doi:10.1542/peds.2010-2825 Pickles, A., Starr, E., Kazak, S. et al.

(2000). Variable expression of the autism broader phenotype. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 41(4), 491–502.

Scherer, S.W. & Dawson, G. (2011). Risk factors for autism. Human Genetics, 130(1), 1–26.

Szatmari. P., Georgiades, S., Duku, E. et al. (in press). Developmental trajectories of symptom severity and adaptive functioning in an inception

cohort of preschool children with autism spectrum disorder. JAMA. Walsh, P., Elsabbagh, M., Bolton, P. & Singh, I. (2011). In search of biomarkers for autism. Nature Reviews Neuroscience, 12, 603–612.

Wan, M.W., Green, J., Elsabbagh, M. et al. (2012). Parent–infant interaction in infant siblings at risk of autism.

Research in Developmental Disabilities, 33(3), 924–932.

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who are followed up over time. For example, a large Canadian study (ASD: Pathways to Better Outcome) has been prospectively following 400 children from the time of diagnosis onward. Findings suggests that the architecture of autism symptoms differs significantly around the time of diagnosis (two to four years) vs. later at six years (Georgiades et al., 2013).

Observed differences between these two time points encompass differing levels of symptom severity, adaptive functioning skills and emotional/behavioural problems. Additional analysis of the same dataset also suggests that over time, subgroups of children take on distinct and increasingly divergent developmental pathways. Notably, a minority exhibit a clear reduction in symptom severity over time (Szatmari et al., in press).

Converging findings come from an American cohort of over 300 children followed from two to 15 years of age, highlighting that a minority of children improve over time (Gotham et al., 2012).

While there is general agreement across studies – despite variation in samples and analytic methodology – that some children improve over time, there is less consensus on whether this pattern signals ‘recovery’. One review suggested that 3–25 per cent of diagnosed children may eventually lose their diagnosis (Helt et al., 2008). However, major limitations need to be overcome before this claim is substantiated. First, there is disagreement on how to define recovery and whether it should be restricted to changes in autism symptoms, or inclusive of general cognitive and adaptive levels. Second, in many studies, it is not clear that children in this putative recovery group warranted a diagnosis in the first place, given wellknown instability of diagnosis early in childhood (especially for some forms of autism). Specifically, the group may include children who experience early developmental challenges that resemble autism but are resolved spontaneously over time. Third, current evidence draws on inadequate small samples often studied using retrospective designs or trials, rather than being prospectively followed for a long period of time. Finally, many factors have been proposed to explain putative recovery, including age of diagnosis, cognitive characteristics, access to treatment, and so on. However, there is currently no explicit theoretical proposal regarding the neural processes mediating recovery and those potentially influenced by the environment. Indeed, such processes may relate to the neural reorganisation suggested in the case of canalisation (Elsabbagh & Johnson, 2010).

In sum, there is growing consensus that autism is associated with a wide range of possible developmental pathways from infancy onward. Intermediate diagnostic outcomes in cases of familial risk are much broader than an autism diagnosis but encompass other developmental challenges and of course typical outcomes. Beyond the period of diagnosis, children progress along variable pathways of symptomatology, cognitive achievement and adaptive functioning. There is hope that pathways of canalisation and recovery may prove real, but evidence for such pathways is currently limited. More robust theoretical models are needed to generate testable hypotheses about factors promoting such pathways and the neural processes mediating them.

The ‘true’ value of understanding development Converging findings from various research areas support probabilistic and indirect mapping between genetic and/or environmental factors and developmental outcomes. Dynamic gene by environment interactions during the period of maximal brain plasticity lead to variable developmental pathways, not readily predicted by a simple model of risk. In some cases, early manifestations of risk, observed as differences in very early brain function, are compounded and amplified in leading to autism in toddlerhood. In other cases the infant brain may be resilient in the face of genetic and/or environmental risk, restoring the typical trajectory through processes of brain adaptation and plasticity. Later in life, seemingly divergent developmental pathways may share the same etiological pathway.

Turning back to the beginning of this article, how does this knowledge bring us closer to meeting the global challenges of autism (Khan et al., 2012)? It has been frequently suggested that the value of this research area is to identify warning signs and develop early therapeutic approaches.

As a result, our field is now hampered by several scientific and ethical controversies centred on the issues of When does autism begin? and Does it ever go away?

For example, there is a lively debate as to about a hypothetical behavioural or biological test that can be used in the doctor’s office to diagnose autism in infancy, and the related clinical and ethical issues that are yet to be resolved.

There is also disagreement as to whether laboratory measures such as EEG, MRI, and eye tracking, will eventually aid or replace behavioural diagnosis in

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childhood (Walsh et al., 2011). Moreover, the proposed case of ‘recovery’ in autism caused a backlash where scientists were accused of providing false hopes, when many in the community are advocating for the idea that autism is a lifelong condition that warrants acceptance and support.

In view of this, I would like to wrap up with three concrete proposals for where the ‘true’ value of the science lies.

First, ‘good science’ does not need to be justified and does not directly yield products other than knowledge. Its intrinsic value is to move us forward in an incremental, iterative and slow path.

In the case of research on infants at risk, I think it is remarkable that, in only a few years, we have already challenged fundamental assumptions about the origins of autism in infancy. While we can hope for breakthroughs along the scientific discovery path, any hype surrounding the possibility of immediate diagnostic tests will only serve to undermine true progress.

Second, formal translational research in this area has already started and is no longer a distant goal. For example, the success of experimental and clinical research in BASIS provided the necessary impetus and infrastructure to develop an integrated intervention research arm (iBASIS). The goal is to evaluate, using a randomised controlled trial, whether supporting parents within the early period may help prevent disabling consequences from emerging (Green et al., 2013).

Finally, there remains a very wide gap between, on the one hand, advances in scientific understanding of brain development and, on the other, the integration of this knowledge into policy and practice. In this vein, each community has its own immediate and pressing needs. Therefore, each community needs tailored solutions that not only build on existing evidence, but also harness their existing capacity and unique strengths (Elsabbagh, 2012; Khan et al., 2012). Scientists have played and continue to play a critical role in supporting communities to map research knowledge onto these needs and contribute towards development of tailored solutions bringing about immediate impact.

Mayada Elsabbagh is Assistant Professor, McGill University, Canada mayada.elsabbagh@ mcgill.ca

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Annual Conference 2015 5-7 May / ACC, Liverpool Note the change of dates Call for submissions now open

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BIG PICTURE

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Alien invasion Picture by William Tipple, with comment from Professor Uta Frith

William Tipple is a 15-year-old with autism.

This illustration, an entry to the Create Art for Autism People’s Choice Award 2014, is just one of thousands of variations on a theme.

William explains: ‘Alien Invasion 245 is a picture in Microsoft Paint. I really like using Paint. I have made lots and lots of Alien Invasion pictures, they are all different. I got the idea from Chicken Little which is one of my favourite films.’

Professor Uta Frith, the world-renowned expert in autism from University College London, says: ‘Alien invasion perfectly conveys the enthusiasm and fascination of a talented artist

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with autism, inspired by his special interest.

The art form he has chosen is digital realisation with vibrant colour that allows him to use both repetition and systematic variation to wonderful effect. It also reminds us that repetition is not the enemy of creativity but, on the contrary, is a technique explored by many great artists. Digital technology opens artistic possibilities to a wider range of individuals, including those whose fine motor skills might not suit pencil and brush. In such art, as in music, it is easy for neurotypical and autistic minds to find a

common space of appreciation and pleasure.’

Christian Lewis, Community Manager at The Abbey School, which William attends, comments: ‘Even in the recent past William would have been described as having typically autistic traits, but surely this cannot be his defining characteristic? He has those no more than we all have typically human traits.

‘William is William, a unique and creative individual in his own right. We are proud of William and his work, just as we are of all of our students, but far more importantly William is proud of his work too.’

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NEW VOICES

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What is autism, anyway?

Eilidh Cage with the latest in our series for budding writers (see www.bps.org.uk/newvoices for more information)

Whereas young children and dogs attach themselves to a given caregiver, cats seem to be far more independent. With that in mind, perhaps people on the autistic spectrum are more like cats than dogs? As a cat owner, I know my pet loves me in her own way, but she interacts on her own terms, not mine.

Perhaps that’s what autistic people do too?

hese words come from some correspondence with one of my research participants, who has Asperger’s. What he highlights, to me, is the fact that we still don’t really know what autism is, despite decades of autism research. The fact that the criteria for diagnosing autism in the new version of the Diagnostic and Statistical Manual (DSM-5: American Psychiatric Association, 2013) re-categorises and redefines autism demonstrates this ensuing definition problem.

Many people will have had no experience of autism. Conversations about my PhD with others – the hairdresser, the dentist, people within academia but outside psychology – suggests that even if they have not met an autistic person, they may have a general idea of what autism might be. This is often the stereotyped view of autism, perpetuated by the oftcited film Rainman, and now by more modern fictional characters, such as Sheldon from The Big Bang Theory (although his diagnosis is not explicit, see http://bit.ly/145wz4w). Outside of the

references

T

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American Psychiatric Association (2013).

Diagnostic and statistical manual of mental disorders (5th edn). Arlington, VA: American Psychiatric Publishing.

Bauminger, N. & Kasari, C. (2000).

Loneliness and friendship in highfunctioning children with autism.

Child Development, 71(2), 447–456.

Cage, E., Pellicano, E., Shah, P. & Bird, G. (2013). Reputation management: Evidence for ability but reduced

fictional world, autism can be found in documentaries, such as Channel 4’s The Undateables, to frequent stories in the news postulating potential causes of autism. It feels like autism is more in the public eye than ever before, and understandably, people may form ideas of what autism might be.

Yet, despite doing my PhD about autism, I often feel confused about what autism actually is. Every research article I read chants the same catchphrase: ‘Autism is a neurodevelopmental condition, characterised by social and communicative difficulties, and restricted and repetitive behaviours and interests’.

Although this wide definition does cover a general sense of autism, I don’t feel it quite captures how an autistic individual might describe what it’s like to have autism, or how a parent would describe their child with autism.

So who can tell us what autism is?

People with autism themselves are a natural place to start, and there are many eloquent examples. The well-known Temple Grandin (2006) has given us all an insight into her life, as well as others like Wendy Lawson (2000) and Donna Williams (1992). However, this may only give a view from the intellectually able end of the spectrum. Recently, author David Mitchell translated the memoirs of a non-verbal 13-year-old Japanese boy, Naoki, with severe autism, who originally wrote his memoirs by pointing to the letters on a piece of cardboard (Higashida et al., 2013). This account beautifully

propensity in autism. Autism Research, 6(5), 433–442.

Calder, L., Hill, V. & Pellicano, E. (2013).

‘Sometimes I want to play by myself’: Understanding what friendship means to children with autism in mainstream primary schools. Autism, 17(3), 296–316.

Frith, U. & Frith, C. (2011). Reputation management: In autism, generosity Is its own reward. Current Biology,

portrays how Naoki experiences the world around him. Every account is different, and highlights this diverse spectrum of individuals with autism.

When we read about autism research, though, how much of it tells us something about this spectrum? In psychology, we strive to match our groups – for example, you might match individuals on their age, gender and intelligence score, to ensure that any differences between your groups are not due to these variables. However, this matching process presents a problem – many autistic individuals inherently have language difficulties that will affect how they perform on tests of verbal ability, making it difficult to match them to those without autism. So the group of autistic individuals you often end up with constitutes a representation of those who have better verbal ability (e.g. Asperger’s and ‘high-functioning’ autism), surely limiting the picture of what we really know about autism as a highly heterogeneous condition.

The fact that autism forms such a wide-ranging spectrum may be part of the problem with deciding how we define autism. Yet, those who have developed typically show great variance in their personalities, likes and dislikes, and sociality. If we ‘neurotypicals’ (those who developed ‘normally’) can accept one another’s differences, can we not accept too that autistic individuals show great variation in their personalities, likes and dislikes, and sociality? For me, this acceptance is what we should strive towards, if we were to live in a perfect world. Through my research and volunteering experience I have met some of the most brilliant, honest, warmhearted children and adults – all with autism in varying severity. Surely autistic individuals deserve to have the right support and understanding to enable them to have fulfilled lives?

Perhaps psychological theory can tell us more about what autism is. Happé & Ronald (2008) argue that autism is ‘fractionable’ – that the three core

21(24), R994–R995.

Grandin, T. (2006). Thinking in pictures.

London: Bloomsbury.

Happé, F. & Ronald, A. (2008). ‘The Fractionable autism triad’.

Neuropsychology Review, 18, 287–304.

Higashida, N., Mitchell D. & Yoshida, K.A. (2013). The reason I jump. London: Sceptre.

Izuma, K., Matsumoto, K., Camerer, C.F. & Adolphs, R. (2011). Insensitivity to

social reputation in autism.

Proceedings of the National Academy of Sciences, 108, 17302–17307.

Lawson, W. (2000). Life behind glass: A personal account of autism spectrum disorder. London: Jessica Kingsley.

Pellicano, E., Dinsmore, A. & Charman, T. ( 2013). A future made together.

London: Institute of Education.

Williams, D. (1992). Nobody nowhere.

Canada: Doubleday.

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difficulties in autism (social interaction, more money – and while autistic adults communication, and restricted and did change their behaviour slightly in this repetitive behaviours and interests) are situation, they did not change it as much separable, with different genes underlying as the typical participants, who gave the each, and each manifesting themselves person watching considerably more with varying severity. By this account, money. One possible reason autistic adults there is no single cause of autism, and changed their behaviour less could be each individual will have different degrees because they are less drawn to this need of each symptom. Another way of to manipulate. Such honesty in autism has encapsulating autism comes from been noted by many before (Frith & Christopher Gillberg, who claims that Frith, 2011), and perhaps we can learn a autism rarely exists on its own – it is few lessons from it. Why is it that typical almost always associated with other disorders, such as attention deficit hyperactivity disorder, specific language impairment, or obsessive compulsive disorder (http://bit.ly/1az08f2). He argues that we should not focus on ‘the autism’, but these comorbidities too, in order to gain a full understanding of each individual. Both of these accounts lend to an approach of considering the individual when it comes to autism.

In my own PhD research, the results of my first study with autistic adults were considerably more confusing than Are autistic adults less drawn to the need to manipulate anticipated, which may behaviours? in part have triggered my questioning of what autism really is. individuals often lie, manipulate and I came to the conclusion that it is not protect their own image? a simple case of autistic individuals One of the reasons many of us find completely lacking an ability to do one psychology so interesting is because we thing – rather, there are a number of don’t really understand why people do factors that reduce the likelihood that the things they do. This is probably why they show the ‘neurotypical’ behaviour. people with autism add in a whole new In other words, we shouldn’t immediately dimension of intrigue for researchers. assume that an autistic person cannot do However, this can sometimes come across something – rather there might be a as a search for ‘deficits’ and ‘disadvantages’ myriad of reasons why they don’t. For compared to typical people, with example, my research focuses on the fact discussions of ‘impairments’ and ‘failures’. that people change what they’re doing Although this is not intentionally harmful, when other people researchers should try to be careful with are around, probably so they can maintain their phrasing. a good reputation. Those with autism, When another psychology PhD however, don’t give more to charity when student asked what my research was in, they’re watched (unlike typical adults), I broadly told her ‘autism’. I was taken perhaps due to difficulties with thinking aback by her reply: ‘Ugh – autism. about what other people are thinking Everyone’s researching that. I’m so bored (Izuma et al., 2011). of autism’. Indeed, a lot of people do In my study (Cage et al., 2013) we research autism, but this is not without gave our participants a reason to change good reason. Autism has a real impact on their behaviour when watched – that the people’s lives, and its incredibly important person they were donating money to was research helps give those with autism the not only watching them donate, but she best chance at life. However, a recent would have the chance to donate to them survey of autism research in the UK from next. Here, you can essentially my research centre found that many manipulate another person to get some people with autism and their families

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report a discrepancy between what they want to be researched and what British researchers are actually researching (Pellicano et al., 2013). Autistic adults reported that they would be most interested to see research into how public services can best meet the needs of autistic people. Research by the National Autistic Society suggests that only 12 per cent of adults with autism are employed, even though many could do well working in a structured environment (http://bit.ly/1k6M8Pu). Why are so few employed? Imagine how it must feel to have autism in such a social world, where job applications so often specifically ask for ‘excellent interpersonal and communication skills’.

Yet autistic people are capable of being social, and evidence suggests that many do want to have friends, even if they may find it difficult to make them (Bauminger & Kasari, 2000). On the other hand, some individuals with autism just want to be alone (Calder et al., 2013). Understanding more about autism could help autistic individuals to gain and hold down full-time employment.

We can all do our bit in accepting autistic individuals and understanding the struggles that families may face, even if we don’t know exactly what autism is right now. We can do this by a number of means. As researchers, perhaps thinking of ways of engaging – for example, forums where voices can be heard and listened to – is one way of guiding research towards important issues that autistic individuals and their families feel need to be addressed. Autistic voices are just as interesting as autistic brains. There should also perhaps be more dialogue between clinicians, teachers and academics so that we are all on the same page before we listen. The next generation of autism researchers (myself included), also need to be aware of the ethical issues linked to autism research, so that we produce the best possible research.

So what is autism? Autism could not be what we think it is. Autism is something we’ll probably never all agree about. Autism is not just found in children. Autism is close to many people’s hearts. Maybe, people with autism are a bit like cats.

Eilidh Cage is a PhD student at the Centre for Research in Autism and Education (CRAE), Institute of Education, University of London e.cage@ioe.ac.uk

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INTERVIEW

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A creative, interpersonal, social scientist Editor Jon Sutton meets Professor Francesca Happé to talk about autism, DSM-5, women in science, and more

ou were on the neurodevelopmental disorders work group for the latest Y revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

How have you found that?

It’s been an experience, for sure! It led me to think of lots of questions about autism that I hadn’t before, like is autism a lifelong condition? To ask all those kinds of questions, counter to the things that I had grown up being taught. It was challenging, because particularly in the States the health system is so different that it has implications in terms of money for patients that are completely alien to anything we would know here.

So that makes it even more of a political issue for the work group?

Yes. I don’t feel jaundiced by it, because the people on the panel all had the best intentions, and it wasn’t a matter of the loudest voice winning, which I thought it might be. It was genuinely collaborative and positive in its aims. Of course it’s worrying to change anything, and the fear of doing harm is real. But I think there are good reasons for the changes made.

Professor Francesca Happé is Director of the MRC Social, Genetic and Developmental Psychiatry Centre at the Institute of Psychiatry francesca.happe@kcl.ac.uk

Just talk me through them. DSM-5 overall treats things as more dimensional, and in autism it’s a collapsing of several categories into autism spectrum disorder?

Yes. We were told that for the whole of DSM-5 we should recognise that things are typically dimensional, and that there should be more specification and description of the individual. So across

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categories, things like adverse living circumstances and additional mental health difficulties should be specified and considered, all of which I think is really positive.

When it came to autism, and notably Asperger syndrome, although everyone said ‘oh, I know what Asperger syndrome is’, they were all using it slightly differently. First of all we thought ‘can we put a sticking plaster on DSM-IV?’, and tinker with the criteria so that they do work. But doing that would effectively say

that Asperger syndrome is autism without a language problem and without intellectual deficits. But since autism isn’t defined by a language problem or intellectual deficits, that doesn’t really make sense.

So it ended up that the evidence was that clinicians are really good at telling

what’s on the autism spectrum vs. what’s not, but they’re really bad at agreeing with each other about how you cut it up into these artificial categories of Asperger’s, PDD-NOS, autism…

So it can end up depending more on what clinic you go to?

Exactly. And we know that naturalistically some children start off ‘Kanner type’, very classically autistic, and by adolescence they look ‘Asperger’s’. In some sense Asperger syndrome is a really useful exemplar-based definition, you’ve got in mind a prototypical person with Asperger syndrome and then a fuzzy set around that. People will still use Asperger’s as a descriptive, but it doesn’t work as a diagnostic category because it doesn’t have any clear boundaries or anything that qualitatively distinguishes it from autism.

So the idea is instead to have a big category, then within that the individual is described, the clinician needs to say what their level of language functioning is, what their intellectual functioning is, did they have an unusual onset. The individual gets better described, you’re not trying to shove people into slots they don’t really fit into. Because also, although I’m not a clinician, the experience I have in clinical settings is that people are saying ‘well, he doesn’t really fit Asperger’s, but it’s the nearest we can get’, or ‘it will get him the services that he needs’.

And that seems to be in accord with what critics of DSM have been asking – that social circumstances are taken into account, that things are considered on a spectrum. But how in line with the research can all this be, when it seems to me there’s so little agreement, even amongst top autism researchers, in terms of causes?

At the beginning of the DSM-5 process, they asked everyone to consider whether neurobiological information, including genetics and anything you can think of on the biological side, could be used to aid diagnosis in any of these conditions, and the resounding answer was no, or at least ‘not yet’.

Which I find surprising, given that every study that you see on the biological side, even if it isn’t directly related to autism, tends to be press released with the line ‘this may be of use in the early diagnosis of autism’.

It’s a stock thing that’s trotted out, as if that's the great hope. You don’t see that coming, you don't even see that as the holy grail?

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happens when people with autism No. The sense that getting hold of the grow up? genes, or knowing exactly which part Yes, and in fact that grew out of the DSMof the brain is abnormal in autism, that 5. We were encouraged to think about that’s the holy grail itself… I think that’s the presentation of conditions in different the view more in America than here, cultures, in both genders and across the that the biology is the be all and end all. lifespan. I thought ‘that’s interesting, I think that’s a very limited view, and I don’t know anything about autism in everything we know about genetics old age, I’ll go and look that up’. And suggests that knowing your genetic there was nothing, I mean there was just profile will only map fairly loosely nothing! Not even, onto your behavioural say, documentation profile. So you never want of whether people to replace face-to-face “in old age we might be with autism have diagnostics, which is about more heart the need that someone has, able to do even more… to problems in old with some kind of read-out improve quality of life” age. That seemed to of their genetic or neural me such a striking gap. make up, because you will Of course when you get mismatch. You’re bound stop and think about it there are good to have, say, fathers of children with reasons why there would be a gap there, autism who have much the same genetic to do with autism being a relatively new or neural read-out but aren’t affected and diagnosis, and the criteria having certainly aren’t impaired. broadened, so the people we recognise I’m much more interested in how now are different from the people we people with autism understand the world, used to recognise, but still it’s a that’s much more useful. The issue about tremendous gap. And it’s been really whether earlier and earlier diagnosis is disappointing to me that the people the most important thing is also a bit of who usually fund our work on autism a red herring. People rarely discuss the in children have not been as enthusiastic cost of false positive diagnosis, and there about funding our work on autism in is a real cost. If you talk to some parents old age. who have had that happen to them, where for example a language impairment Why is that, children are just more has been misdiagnosed as autism, they’re appealing when it comes to research actually very cross and very upset. The funding in general? whole idea that we have to make I don’t know, maybe I just wrote bad diagnosis earlier and earlier is predicated grants! But it does make you wonder, on the idea that the earlier you intervene perhaps that’s the corollary of the early the better, and while that may be true for intervention banner – ‘if you miss that some things it’s simplistic. There may be boat, it’s too late’. I think in old age we a window of opportunity at a particular might be able to do even more for people, stage, and it may not be right at the to improve their quality of life. Temple beginning. The work of Mark Johnson is Grandin says that her brain switched on really interesting, with the infant sibs who at 50. So it may be that there are fantastic are genetically at risk of autism, showing opportunities later in life. that there are markers early on, not so much behaviourally but in terms of eventThere seems to be a strange kind of related potential, for example, which are mystery around autism in children, common to sibs of kids with autism who where you have this unreachable child do and who do not turn out later to have and that presents a challenge to autism. So the earlier the signs we look scientists and the public in general. at, the more non-specific they will be.

Whereas maybe with an adult with That work could be really important, if autism the general feeling might be it teaches us what determines who ‘that’s just some weird old guy, that’s transitions off an autistic pathway. But the way he is, we’re never going to get I’m not so excited by chasing earlier and through to him’. It just seems to me earlier diagnosis, unless we know what that autism is perpetually fascinating we are going to do with that information, in the public eye as well as the what we can do for that child and family. scientific eye… I think you could argue that it’s quite overrepresented.

You mention the autistic pathway…

It is. I think if I were the parent of a taking that lifespan approach seems child with intellectual disability of the to be quite unusual in developmental ‘ordinary’, unlabelled sort, I’d be jolly psychology and in autism in particular. cross how much money autism research It’s very much focused on autism in gets, and how much press it gets. It is children, but you’re interested in what

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disproportionate. And it is because it’s fascinating. You’re right, there’s this stereotype of the beautiful, unreachable child with autism, with the faraway look.

But what about the old guy with autism, with the faraway look? He’s just as beautiful. It’s part of our cultural lack of respect for the elderly too… they’re already a disliked minority, add autism to that, these poor people have got no one to fight for them.

You’ve talked about the ‘beautiful otherness’ of the autistic mind, and again a lot of the coverage of autism you see in the press and on TV is very much about the fascination of the high end of the autism spectrum. But the parent of a child at the low end, who is rocking, biting, non-communicative... would they identify with the ‘beautiful otherness’ of the autistic mind?

When I started with Uta Frith’s ideas of assets in autism, looking at what people with autism are good at, trying to think of tasks that children who are non-verbal can access, like embedded figures and block design, self-explanatory visual tasks, I did worry that if I was talking about assets in autism that would be seen as wishing away all the problems. But the response from families has been really positive, they’re really pleased to hear people talking about things that people with autism are good at, even if there’s plenty they struggle with.

The thing is to have a broad recognition of what those sorts of skills and talents are. They’re not always the mathematician at Cambridge, they can be the child who amazes their parents because they get upset about tiny changes in their environment, an ornament moved a fraction of an inch, or who shows that they remember somewhere they’ve been before by going straight to a particular location. Parents are really aware that pretty much every individual with autism is surprisingly good at something, compared with their other abilities, and like us as parents of neurotypical kids, we’re kind of pleased and intrigued by that, but it doesn’t mean we don’t recognise that our children find other things difficult.

You want to focus on the positives.

Yes, and it’s delightful when your child surprises you by how different they are from you. So I think it is really important to recognise, particularly when you’re talking about talents, that it is infuriating for parents when a well-meaning neighbour says ‘Oh, I hear your child’s autistic, what’s his talent?’, and they want to say ‘Well, his talent is lying down in

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the supermarket and screaming and screaming because the fluorescent lights are upsetting him’. But if you talk about it in another way, they often will say ‘I do realise his world is utterly different, and there are some things about how he sees the world that are really extraordinary, and opened my eyes’.

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autism

And you believe that all people with autism have the potential to develop those skills to the level you would call savant ability?

I don’t know. I think there’s a lot of untapped ability. I think people with autism all have something that would stand out against their other background of skills that’s unusual.

Pam Heaton’s work suggests that a large number of musically untrained people with autism have the potential to develop perfect pitch, and that is a real starting point for developing musical skills. It’s important that we don’t somehow prize some things or value the individual because they’re good at certain things. If one’s interested in talents in autism it’s because those are ways that the individual can find more of a niche or be more integrated into society to the extent that they want to be, that give them pleasure, that help neurotypicals to understand that People with autism all have something that person… It’s not that it gives the person would stand out against their other background more value; the child whose talent is of skills that’s unusual watching drops of water drip from their type 1’ and ‘autism type 2’, or something fingers for hours on end, seeing the where we can link it to particular minute differences between them, has aetiologies that have particular absolutely inherently as much value, consequences for prognosis or treatment. whether or not they then go on to But we’re a long way from that. So the develop beautiful drawings or something. heterogeneity that I’ve been interested in So it is a difficult area, but I think we are is the idea that there are different causes shortchanging people with autism if we for the different parts of what we call don’t recognise that there is potential autism, so for the social and the there that’s hard for neurotypicals to communication and for the non-social recognise because they don’t show it aspects. And that is debated. So we talk in the ordinary way due to their social about an autism spectrum, and some difficulties. people like John Constantino would say ‘yes, there’s one dimension: you're a bit Coming back to this disagreement autistic, you’re a bit more autistic, you’re between autism researchers… If really autistic’. Whereas I would sketch it autism is increasingly being treated in a multidimensional space, where how as dimensional, and there’s a lot of much social and communication difficulty debate around whether the triad of you have is pretty much independent of impairments is ‘coherent’, genetically, how rigid or repetitive you are, which are cognitively and neurally, does it still again independent of how your make sense to think of autism as a intellectual functioning is and how your unitary concept at all? language is. But I don’t think that’s the People increasingly talk about ‘the same as ‘there’s no such thing as autism’. autisms’, because autism is so heterogeneous. I think it’s probably pretty Until we get to the stage where there’s certain that there are going to be lots of autism 1, autism 2, autism 3, and different causes in different individuals. they’re shown to be so different as to In the future we might talk about ‘autism

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not all be autism, you’re happy carry on down the road of autism research?

One of the things that people have thought about this ‘fractionated triad’ idea is that it means there’s no such thing as autism; there’s just the unlucky coincidence of these different difficulties or cognitive styles, and when they come together we call it autism. I don’t really mean that, because there is something about getting that particular set of difficulties that has a catalytic effect that qualitatively changes them. So if you just have social and communication difficulties, but you don’t have an extraordinary eye for detail and a sort of rigidity perhaps due to executive problems, you can compensate for some of your social and communication problems in such a way that they will look different. When you get the particular mix that is autism all together, you get something that qualitatively looks different so that that really is autism. And autism is incredibly easy to recognise in its core form. And even when I talk about type 1 and type 2 and the idea that at some point the different aetiologies might be useful to us, it could be that at the behavioural level all those aetiological subtypes look identical. So people quite often ask me if I think that everyone’s a bit autistic, and it depends what level you’re looking at. Behaviourally, you can certainly put everything on a continuum and it’s all shades of grey, and you make your clinical cut off where somebody is impaired and asking for help. You don’t just go out and start Asperger spotting.

So just because I put my CDs in alphabetical order…

Exactly. Or I hate all this, ‘Einstein…’ …historical diagnosis?

Yes. So that’s at the behavioural level, it all merges together difficulty keeping conversations going, small talk and all the rest. At the cognitive level I think it’s more complicated, so problems in theory of mind, and representing others’ mental states, probably is a qualitative difference.

Most neurotypicals can do this, and most people with autism can’t, at least initially – they may find ways later in life to do it.

That’s a real big difference, not shades at all. But then the eye for detail, we hypothesise very much on a continuum, and you see it in the relatives of people with autism, that don’t have any difficulties, and so on.

Then aetiologically, who knows? It could be that it’s like high blood pressure and it’s a continuum and then you pass a threshold and it’s a problem, and it really begins to show behaviourally. Or it could

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be that it’s like the rare mutations, genetically, something really special.

Still so much to do, then! What are your main research priorities at the moment, what are the most promising directions?

I’d like to do something on ageing and autism just because it’s so important. I’d like to see if we can turn our ideas about detail focus into educational interventions. We think at the moment it’s rather separable – how good you are at details, and how difficult you find it to put information together to get the big picture, are different dimensions. That encourages us to think that we can improve the ability of people with autism to see the big picture when they need to, without taking away their eye for detail.

We want to develop interventions to help, for example, kids to learn that some problems are ‘zoom out’ problems and others are ‘zoom in’, if you take a video analogy.

We’ve been doing some work with girls, trying to understand whether some of the difference in the gender ratio is us missing girls with autism, or that girls genuinely compensate better. And then the fractionated triad work has led us to realise that there are quite a lot of kids out there in the population who only have one aspect of autism; they might just have rigid and repetitive behaviour, they might just have communication problems, or they might just have social problems, and I really want to know what those kids are like. Parents rate their difficulties as just as severe as those who have the full triad of autism – how impairing are they? Are they getting any diagnosis, do they need help, or actually when you don’t strip away compensation routes, can they manage all right?

Well that should keep you busy! And as if that wasn’t enough, I know other areas are important to you, such as being a female scientist.

Yes. I was lucky to get the Royal Society’s Rosalind Franklin Award in 2011, and that was for a project that’s still ongoing to create some books for primary school children called ‘My Mum’s a Scientist’.

This came about because I was in the playground dropping off my own children and a friend of my daughter came up and said, in front of me, ‘Is your mum a scientist?’, and my daughter said ‘Yes’, and he said ‘Wow!’ and he was really amazed.

And I found that so interesting and funny, it was as if he’d asked whether I was an astronaut or something really exciting!

That set me thinking about what kids know about what it is to be a scientist.

So I’m trying to produce these books based on real women scientists, teaching a bit about the science but also about what it means to be a scientist.

Recently I was asked to give a lecture in Cambridge about women in science, so I’ve started to do some thinking about where young children get ideas about science and scientists, and why it is that – at least in America and Britain, although it’s very different in different cultures – children aged seven are already saying ‘maths is for boys’, even though at that age there’s absolutely no sex difference in achievement? Similarly, girls are saying in some big surveys ‘I like science, but I can’t imagine being a scientist’. What is it that they think a scientist is, that they can’t identify with?

So there’s a really interesting story to be told there. The story that I’m interested in telling, because it relates to social intelligence and social insight, has to do with conformity and the way that unlike people with autism, neurotypicals from very early on not only can read minds but they can’t help but read minds. So there’s an obligatory osmosis of other people’s attitudes and views.

Resources Papers Happé, F. & Frith, U. (2014). Annual Research Review: Towards a developmental neuroscience of atypical social cognition. Journal of Child Psychology and Psychiatry, 55, 553–577.

Robinson, E.B., Lichtenstein, P., Anckarsäter, H., Happé, F. & Ronald, A. (2013). Examining and interpreting the female protective effect against autistic behavior.

Proceedings of the National Academy of Sciences USA, 110, 5258–5262.

Dworzynski, K., Ronald, A., Bolton, P. & Happé, F. (2012).

How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders?

Journal of the American Academy of Child and Adolescent Psychiatry, 51, 788–797.

Happé, F. & Charlton, R.A. (2012). Aging in autism spectrum disorders: A mini-review. Gerontology, 58, 70–78.

Happé, F. (2011). Criteria, categories and continua: Autism and related disorders in DSM-5. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 540–542.

Books Happé, F. (1994). Autism: An introduction to psychological theory. Psychology Press.

Happé, F. & Frith, U. (Eds.) (2010). Autism and talent.

Oxford: Oxford University Press.

Other recommended resources The latest edition of the IACAPAP Textbook of Child and Adolescent Mental Health is free online at tinyurl.com/nte3tj7 and has an excellent chapter on ASD (with links to video materials) The National Autistic Society has a variety of resources on ageing and autism: tinyurl.com/m7hu4f5

That’s interesting, because my perception of a lot of your peers and mentors is that you’ve been embedded within really formidable, socially intelligent, socially supportive network of female scientists.

I’ve been incredibly lucky, to have Uta [Frith] as a fantastic supervisor and mentor, and many other really wonderful women scientists, and wonderful male scientists who’ve been very promoting of women. But it’s still shocking, maybe you experience it too as a parent, young kids in primary school will somehow form the assumption that nurses are women and doctors are men. So the base rate of assumptions about what girls are good at and not good at is still very biased against science. There are kids and older adults who are good at being different and don’t mind being different, but for the ones who do want to be like others, which is the majority because of social osmosis, we

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have to give them role models of scientists so they can think ‘yes, I want to be like that’.

And to be like that in terms of an approach to life as well, like you were saying about ‘zoom out’ and ‘zoom in’ on problems. I’ve found with my own children, trying to pass on that scientific way of thinking, regardless of trying to pass on the idea of being a scientist as a career move… I think children respond to the idea of looking for evidence and solving mysteries.

Absolutely. But I think science is just taught in entirely the wrong way. We’re training people to memorise facts, and conduct experiments that are like recipes where they can go wrong and you've failed. We don’t convey that science is creative, interpersonal, that actually social skills matter, that it’s about discovery…

I think we need to change a lot.

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filled some people with horror. In the modern world, comedy is often seen as cruel, that there must be a target or a figure of ridicule in it all. For example, last year I was invited on to the Radio 4 Today programme to talk about ‘comedy and dark subjects’. And on the telephone the young researcher eagerly asked me, ‘What’s the most offensive joke you tell John Williams on being a parent of ‘The Boy’ with autism about your son on stage?’ It genuinely took me aback, that someone honestly thought I was going to stand up in front of a roomful of people and ridicule my own child in some way. accompanying blog of our life together.

So if there is a target in the show, then ’m a comedian. I’ve stood backstage I called them ‘My Son’s Not Rainman’; just it’s other people’s perceptions of The Boy at a comedy club on a Friday night to try and dispel the myth that everyone and those like him. There is joy in our hearing the noise of the baying crowd with autism is some kind of a genius in world, that’s all our story is about. And the other side of the curtain, knowing full from joy comes laughter. well I’m about to be fed to the lions.

Nobody will ever make me Yet even when I look back at those laugh more than him – he’s moments, none of them seem as made me look at the world daunting as writing an article about differently, he’s made me autism for a professional magazine. question so many thing You see, I’m no academic. And I took for granted, and I’m certainly no expert. My above all else he’s made me knowledge doesn’t come through realise that socks are just books or studying, it simply comes a weird bit of material that from living with one boy. My boy. you don’t really need. What And I suppose over the 12 years he’s isn’t there to be grateful for? been on this planet if I’ve become an I didn’t always see the expert on anything, it’s an expert on positive in our situation, him. Just him. I’ve watched his it’s fair to say. For so many continuous struggle to adapt and years it just felt like the make himself heard in a world that never-ending battle I neither of us will ever truly described earlier. It was understand. forever about getting him The truth is, autism to the two of the right level of support. us has in many ways felt like a battle.

Or any level of support. For Just a long, laborious fight, both in us, the diagnosis of autism the physical and non-physical sense. closed doors rather than From a very young age The Boy opened them. ‘It’s because (as I refer to him, just to save his he’s autistic’ became the blushes) learnt that if you want answer to most concerns Shane’s toy car, but Shane won’t give raised, and now the medical you his toy car, and you can’t find the community had a label its words to be able to ask Shane for his work was done. toy car, then a short sharp bite to For parents the Shane’s arm will get you that toy car. frustration that schools And if a quick bite doesn’t do it, a and healthcare work so push or pull will. The Boy has used independently of each other this knowledge in too-many-to-count I John Williams is a professional comedian and single dad can’t be overstated. Here was clubs, care settings and even schools. john@mysonsnotrainman.com a boy deemed ‘unteachable’, And that’s why I decided to tell excluded from two mainstream schools some way. Wonderful though these our story. Because his life was forever and a special school. Headteachers, skills are, The Boy has never sketched shaped by his behaviours, and very few educational psychologists, speech and the London skyline from memory or people could see past them. But I didn’t language therapists – they all memorised every bus route between want his behaviour to define him. He’s recommended CAMHS referrals. Yet still Harlow and Portsmouth since 1904. so much more than that. The Boy who years on we have moved no further up He prefers the company of others, has I laughed uproariously with at home, the elusive CAMHS waiting list. Apart no real interest in trains and his worst he was lost to the world at large. And from one meeting to assess his suitability subject is maths. His greatest ‘skill’, if he the relatively few people in his life who for medication, The Boy hasn’t been seen has one, is just being him. have taken the time to look a little deeper by a medical professional with regard to There have been a few hurdles to have been rewarded with an amazing, his autism since he was diagnosed so overcome with the show and the blog fun, witty, charismatic boy just waiting many years ago. that I hadn’t foreseen. The idea of using to shine.

That’s the parental-moan-bit over comedy and humour to tell our story So I wrote a comedy show and an

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with. Apologies, it comes with the territory. I’m not even sure what it is I want that would make everything better – I’m not naive enough to believe that it will all go away one day. I suppose much of the concern is based on fear – we forever hear the horror stories of adult services, so for parents we think we have to cram everything in before they turn 18, because after that there’s nothing.

If I had a wish list, I would love to see a system where children are reassessed every five or ten years. The difference in The Boy and his peers as they age is fascinating – some making great strides, others far less so. Especially given that children are diagnosed even earlier nowadays, some reassessment at a later period in their lives would at least offer a glimpse into how the condition changes. And it may provide an answer why some do better than others.

Now I’m in the middle of my utopian dream, I’ll carry on. Without being too altruistic, it would be good to see more support for parents too. The years of school exclusions, running the gamut of other parents in the playground every morning, the family members who even question you – it all takes its toll. I know what a pain in the backside parents can appear at times, but it’s because everything is a fight. And at any point we expect the door to be slammed in our face again so we have to get in quickly before that happens. And, sadly, parents quickly learn that the system is now very much geared towards ‘those who shout the loudest’ rather than assessed on need.

That’s it with the ranting and moaning now, I promise. For the most part, life is good. The Boy is settled in his latest special school, and they seem to understand him more than anyone has before. He’s getting older, and as a result I never have to sit through another episode of Ben 10 in my life. The Rugrats will remain a work-in-progress.

The last few years have been a steep learning curve, not just for him, but also for me. I have finally learnt that a positive outlook can make all the difference to both our lives. I spent so long trying to find out what was wrong with him, I forgot to look for what was right. He will forever be the person who has taught me more about what it means to be alive than anyone else ever could. He’s made me question the human condition, make me realise that the lack of empathy and understanding often doesn’t come from within the autistic community but outside it. And above all else, he’s made me realise that in the darkest moments, there’s nothing a multipack of barbecue flavour Hula Hoops can’t make better.

Driving Miss Daisy The Boy has been travelling independently to school for a few weeks now. I was going to tell you about it earlier, but once again the fear I might jinx something that seemed to be going so well meant I left it for a little while, just to be certain.

I say travelling independently, he goes in a taxi. With an escort. But it’s as independent as life will be for the moment, and he seems to love it. Mainly because apparently the car is better than mine. And although I miss our chats on the drive to school, I love this new found independence too. It’s another opportunity for him to break away and be his own person without awkward, stupid Dad always stepping in and controlling things, even if it is with the best of intentions.

He travels each day with another lad from school, The Boy Who Always Carries His Teddy, the taxi driver and the escort (in keeping with the rest of this blog I was going to call her Mrs Escort, but that just seems wrong on so many levels... we’ll settle for Mrs T). Each Monday follows the same routine, the week starts with The Boy and The Boy Who Always Carries His

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Teddy sitting together on the back seat, with Mrs T and the driver in the front.

By Tuesday morning they’ve been separated and The Boy sits in the front seat. (I don’t ask the reason why any more, I’ve decided I’m better off not knowing some things).

Each afternoon when the taxi pulls up at the door to drop him off I hear The Boy and Mrs T chatting away together on the doorstep.

Laughing. I know he likes her, and the bit that makes me happiest, it’s very obvious that she likes him.

As I open the door I’ll interrupt their conversation mid-flow. The Boy will stop talking instantly, and I’m left feeling like I’ve gatecrashed the world’s greatest party.

Whatever they were talking about is of no concern to my prying ears. They can pick up where they left off again tomorrow. He’ll say goodbye to Mrs T and step inside.

Her name will pop up now and then, but The Boy keeps their conversations to himself. And although it’s taken some getting used to, I like it. I like that he’s taking more and more steps towards a life outside me.

I like that there are things going on in his world that

I know nothing about. Like the time last year he came home from school and suddenly declared he liked football and supported Arsenal, despite showing no interest whatsoever at home. Sometimes as parents I suppose letting go can be as important as holding on.

I did get one little glimpse into his new life. At Christmas, he got out of the taxi with a present from Mrs T. I could tell by the shape it was an annual. I guessed at Doctor Who or Minecraft, thinking that I’d suddenly discovered the topic of their conversations all this time.

Of course I was wrong.

He opened it, it was a football annual. Manchester United.

‘Yessss!!!!’, The Boy shouted. ‘I thought you supported Arsenal?’, I said confused. ‘I do’, he replied with a heavy sigh, feeling the burden at having to once more explain everything to someone so stupid.

‘I support Arsenal at school... I support Man United on the way to school’. © John Williams 2014 First published as a blog post at www.mysonsnotrainman.com/blog Reproduced here with permission.

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Generic images of autism Douwe Draaisma on stereotypes in novels, films and real life

n 1877 prison authorities called on Francis Galton with a pressing question. Could it be the case that certain types of crimes correlated with particular facial characteristics? They presented him with a large number of photos of delinquents and Galton set out to arrange them in an effort to find natural classes of faces connected with crimes like murder, fraud and forgery.

The request led to a wonderful invention: by superimposing photographs Galton produced what he called a ‘pictorial average’ of their faces (Galton, 1879).

The first demonstration of composite portraiture caused a flurry of applications.

Its use as a method for identifying typical murderers’ or fraudsters’ faces, though, was ill-fated. The individual faces were villainous enough, Galton reported, but they were villainous in too many different ways. As an instrument in criminal anthropology, ‘pictorial statistics’ was a failure. But Galton did notice the potential of his technique as an analogy for the way the human brain generalises from individual sense impressions to more abstract, ‘generic images’. By watching a series of individual dogs, he argued, we let their similarities blend into a prototypical dog. What is peculiar to only a couple of dogs will have disappeared from our composite representation of dogs in general.

Viennese paediatrician Hans Asperger (1906–1980) never mentioned composite photography. He was raised in an entirely different scientific tradition, infused with

references

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Asperger, H. (1944). Die ‘autistische Psychopathen’ im Kindesalter. Archiv für Psychiatrie und Nervenkrankheiten, 117, 76–136.

Burks-Abbott, G. (2008). Mark Haddon’s popularity and other curious incidents in my life as an autistic. In M. Osteen (Ed.) Autism and representation (pp.289–296). New York/London: Taylor & Francis.

Draaisma, D. (2010). Stereotypes of

Gestalt psychology. Yet, his account of the way a diagnostician intuitively learns to classify and label his patients is curiously reminiscent of Galton’s prototypes emerging from individual impressions.

This was especially true of the category of what Asperger called ‘autistic psychopathy’ – today’s Asperger’s

The account of the autistic experience in successful fiction must be a major force in shaping lay understandings of autism

syndrome. Cumulating experience with clinical observation, he wrote, allows one to recognise the disorder at first glance, even before the child begins to speak (Asperger, 1944). An accomplished diagnostician discards the particular and accidental, and sees the Gestalt of the condition.

Empirical research on the development of prototypes, stereotypes and exemplars has bolstered much of what Galton and Asperger hypothesised.

But modern studies of categorisation have gone beyond perceptual processes and

autism. In F. Happé & U. Frith (Eds.) Autism and talent (pp.209–217).

Oxford: Oxford University Press.

Galton, F. (1879). On generic images.

Proceedings of the Royal Institution, 9, 161–170.

Hacking, I. (2007). Kinds of people: Moving targets. Proceedings of the British Academy, 151, 285–318.

Haddon, M. (2003). The curious incident of the dog in the night-time. London:

diagnostic practices. Generalised representations and stereotypes are shown to reign in many domains, often implicitly; they steer the way we think about gender, age, class, ethnicity, sexual orientation, politics – and autism.

In his book Send in the Idiots: Stories from the Other Side of Autism, Kamran Nazeer (2006) recalls his meeting with André, a former classmate in a special school for autistic children: I know computer scientists who do their programming from inside tubes made out of tin foil, who obviously wear pants with embarrassing holes in them, who devote their livingrooms to experiments in supercooling processor chips, or who can recite Ovid’s Metamorphoses backwards,

and then finishes off with: ‘and none of them are autistic.’ Only if these last few words held no surprise at all to you, you may consider yourself to be free from stereotypical views on autism, or, more probably, you have never cared much for the literature on autism.

Thinking in stereotypes has a moral connotation to it. We don’t like to be caught at it. It is associated with sloppy thinking, prejudice, intellectual laziness.

At the same time, the combination of computer science and eccentricities almost irresistibly conjures up the image of an intensely nerdy, socially odd person, arguably one of the most forceful presentday stereotypes of autism. It is an image fed by CSI-like TV series, novels, talk shows, documentaries, movies like Mozart and the Whale (2005) or Snow Cake (2006), autobiographies such as those by Daniel Tammet and Temple Grandin, public controversies like the one on computer hacker Gary McKinnon, and a host of other stages where autistics, real or fictionalised, have made their appearance.

At this point one may ask whether we shouldn’t draw a few lines. After all, autism is a psychiatric category. Shouldn’t we leave matters of diagnosis and

Jonathan Cape.

Howlin, P., Baron-Cohen, S. & Hadwin, J. (1999). Teaching children with autism to mind-read. Chichester: Wiley.

Murray, S. (2008). Representing autism: Culture, narrative, fascination.

Liverpool: Liverpool University Press.

Nazeer, K. (2006). Send in the idiots.

London: Bloomsbury.

Simsion, G. (2013). The Rosie Project.

London: Michael Joseph.

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of focus and dedication. Lack of categorisation to specialists? Surely they talent for small talk comes with have the tests and the protocols, the lists straightforwardness. A heightened and criteria to help them do the job? capacity for systemising allows one to What script writers and novelists choose handle complex data sets. Restrictions in to write on autistics is their responsibility. one area allow for expansion elsewhere.

It may have an effect on the perception Most Aspies feel that the stereotype of of autism by a lay audience, but still these Asperger’s syndrome as a set of are – or should be – separate spheres. pathological limitations is misleading, This division doesn’t work, neither perhaps to the point where it is wrong to in practice, nor in principle (Draaisma, call it a ‘condition’ at all. Watching 20 or 2010). Movies featuring an autistic 30 of these self-presentations suffices to protagonist are more often than not experience the emergence of a radically informed by specialist advice from different stereotype, psychiatrists. Actors one that features spend time with compensatory talents autistic persons to “fictionalised autistic and capacities, an present a truthful persons in movies or novels image that is fit to rendition of autistic are there for particular figure on an agenda behaviour. Novels may reasons” of emancipation. be equally supported Well into the 1980s by specialised it was the specialists – knowledge. paediatricians, psychiatrists, clinical Christopher, the young autistic psychologists – who shaped the public protagonist of Mark Haddon’s The Curious image of autism. Today, the general Incident of the Dog in the Night-time, had understanding of autism is shaped from to take a test. His teacher holds a tube of many different sides, such as education, Smarties and asks him what he thinks is literature, film and news media. With it inside. ‘Smarties’, Christopher says. Then came a proliferation of stereotypes, even she pulls out a small red pencil, puts it to the point where one may ask just how back in and says: ‘If your mummy came much variation is compatible with the in now and we asked her what was inside very idea of a stereotype. How much the Smarties tube, what do you think she diversity can stereotypes assimilate before would say?’ ‘A pencil’, Christopher says it becomes meaningless to think of them (Haddon, 2003). This scene actually came as stereotypes at all? And even if one from a guide for people who work with evades the naive question which of these autistic children (Howlin et al., 1999). stereotypes are ‘true’, one may still Another case in point are the selfwonder why it is that some stereotypes presentations of ‘Aspies’ on YouTube. are felt to be convincing while others There are literally thousands of these. seem unlikely and far-fetched.

What can’t fail to impress the viewer is Part of the answer, no doubt, is that the degree to which these monologues fictionalised autistic persons in movies are impregnated with the central concepts or novels are there for particular reasons. of modern research on autism. Aspies Stuart Murray analysed a series of movies discuss – and often contest – their featuring autism and demonstrated that purported lack of empathy, their problems it is mostly the savantism – having with establishing central coherence, their computers for brains or possessing sensitivity to sensory overload, their ‘male supernatural pattern-recognition skills – brain’ and the tendency to systemise that that drives the plot (Murray, 2008). comes with it, their limited capacity for Autistic persons in movies are often mind reading or their inability to handle extremely gifted in some arcane domain. false beliefs, figurative speech, innuendos In actual fact, savantism is extremely rare, and jokes. In some presentations it seems also among autistics. as if a psychiatrist is discussing one of When they make their appearance his patients with a colleague. Selfin novels, autistics likewise serve descriptions such as these are part of circumscribed narrative goals. Don what philosopher Ian Hacking has Tillman, in The Rosie Project, is an autistic called the ‘looping effect’, the intricate geneticist who has had several interaction between the label and the unsuccessful dates and now decides that understanding of the person so labelled the best solution to his ‘Wife Problem’ (Hacking, 2007). would be to devise a questionnaire to But by these very same selfnarrow down the number of plausible presentations, Aspies also define candidates (Simsion, 2013). Following themselves as a counter culture. They Don on his erratic course, the reader gets emphasise the productivity and benefits a fresh appreciation of just how subtle of some of their limitations. Single the do’s and don’ts of budding mindedness can be translated as a sense

read discuss contribute at www.thepsychologist.org.uk

relationships are. The novel is really about the complexity of love and romance. A comparable lesson teaches Christopher in The Curious Incident. He dislikes lies and fantasies because his reality is complicated enough as it is. But most of the other characters lie to him, if that suits them better. Again, the boy’s inability to handle alternative versions of reality serves to contrast autistic sincerity with ‘normal’ dishonesty.

Both Christopher and Don succeed in their pursuits: solving a murder mystery and finding a wife. In both cases it is a victory against all odds, of challenges overcome. In the process they have become endearing to the reader. But for many real-life autistics, entering romantic relationships is a thorny project that easily ends in failure and sometimes in a life of loneliness and isolation. This is not to say that the Don Tillman character is ‘wrong’, rather that, sadly, Don’s success is not very representative of what most autistic individuals experience in their own lives.

Burks-Abbott (2008) pointed out that there are dozens of books on autism written by autistic authors, but that lay audiences still prefer fictionalised accounts of autism over non-fiction accounts. He hints at the possibility that the stereotypes set up by novels and movies may eclipse those of psychiatrists and other experts. This is not unlikely at all. Both The Curious Incident… and The Rosie Project were bestsellers. Their account of the autistic experience must have been a major force in shaping lay understandings of autism.

In a later publication on the analogy of compound photography, Galton addressed the objection that generalisations are not so much determined by the number of components, but rather by the impression they make. He conceded that the same thing happened if one of the individual portraits had sharp contours, determining a disproportionate part of the composite portrait. It was easily solved: he threw the sharp portrait a little out of focus, thus quietly correcting its biasing influence on the pictorial average. This, sadly, can’t be done with the kind of stereotypes that emerge in society. And perhaps it isn’t necessary. Rather than trying to expel stereotypes or asking which ones are ‘true’, we should be aware of their origin, the forces that shape them and the agendas they’re on.

I Douwe Draaisma is Professor Theory and History of Psychology at the University of Groningen d.draaisma@rug.nl

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President’s column Dorothy Miell

President Professor Dorothy Miell

Contact Dorothy Miell via the Society’s Leicester office, or e-mail: presidentmiell@bps.org.uk

President Elect Professor Jamie Hacker Hughes Vice President Dr Richard Mallows Honorary General Secretary Professor Pam Maras Honorary Treasurer Professor Ray Miller Chair, Membership Standards Board Dr Mark Forshaw Chair, Education and Public Engagement Board Professor Catriona Morrison Chair, Research Board Professor Judi Ellis Chair, Professional Practice Board David Murphy

e have just published our new plan for the Society’s work until 2020 (available via www.bps.org.uk), and will be ensuring that our Boards, member networks and teams of staff in the Leicester office discuss how to work on the various key areas of the plan in their meetings this autumn. The greater focus on key priorities will require reviews and likely changes in how we operate as a Society and we want to ensure that members are kept informed of these changes as they are planned.

Developing the website to ensure our internal communications are improved will therefore be a very important early step.

The new plan has been developed through consultation with our membership and staff and has benefited from their input.

Our aim is to make the Society more strategic and focused and its work more visible and effective in Strategic Plan benefiting society and supporting our members. Below I’ve summarised the six main goals that have been identified as the priorities for the next phase of the Society’s work. This doesn’t give all the detail, but hopefully gives an overview of what we’ll be doing and more details are available on the webpage.

W

The British Psychological Society

Promoting excellence in psychology

2015–2020

www.bps.org.uk

The Society has offices in Belfast, Cardiff, Glasgow and London, as well as the main office in Leicester. All enquiries should be addressed to the Leicester office (see inside front cover for address).

The British Psychological Society was founded in 1901, and incorporated by Royal Charter in 1965. Its object is ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied and especially to promote the efficiency and usefulness of Members of the Society by setting up a high standard of professional education and knowledge’.

Extract from The Charter

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1. Promote advancements in psychological knowledge and its practice The Society will promote psychology, building on the success of our conferences, journals and grant schemes. We will give members the opportunity to access wider audiences in the UK and internationally to share their expertise. We will support enhanced access to professional development. We will invest in our grants and bursary schemes to encourage new developments in psychological science, education and practice.

2. Develop the professional skills of our members We have a made a commitment to ensure that services for our membership are at the heart of what we do. The Society recognises the importance of providing excellent continuing professional development opportunities and will update members on the latest psychological knowledge at every career stage. As well as continuing to provide high-quality CPD courses

and events, we will expand our portfolio of professional guidelines and publications.

3. Maximise the impact of psychology on public policy We will ensure that external audiences, and particularly public policy makers, have better access to the excellent research and insight psychologists can offer. We will strengthen relationships with partner organisations to help achieve our aims of increasing the impact of psychological knowledge and practice on policies that enhance society.

4. Increase the visibility of psychology and raise public awareness The Society is already recognised by the UK and international media as a key source of information about psychology. We will continue to develop our capacity to give timely and authoritative comment on matters relating to our discipline, and use spokespeople to ensure we present a clear, evidence-based and responsive voice.

We will build on our successful programme of public engagement through lectures, talks, exhibitions and information stands at public science fairs.

Growing use of our Public Engagement Grants will help members to reach out to wider audiences to promote the value of psychological research and practice.

5. Attract new members and broaden our membership Our future rests in the strength of our membership and so we aim to grow this.

We have already embarked on partnerships to open up national and international routes to membership. We also need to promote progression through the grades of membership and support our members at every career stage.

The new subscriber grades for those with a broad interest in the subject will help us to build a wide audience for our other key objectives.

6. Develop our organisation to support change We appreciate and welcome the engagement of our members with the Society and want to further harness their collective power. We will continue to ensure there are opportunities for

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Lifetime Achievement Award Peter Venables A former President of the BPS and world-leading authority on the psychophysiological basis of schizophrenia has been given the Society’s Research Board Lifetime Achievement Award. Peter Venables, now 91, has had a career spanning ‘the entire development of modern psychology’ according to Professors Andy Young and Steven Tipper (University of York) who nominated him.

Professor Venables has formerly been President, not only of the BPS, but also the Society for Psychophysiological Research and the Experimental Psychology Society. He is an Emeritus Professor in Psychology at the University of York and received his BA in the subject from UCL in 1951. He received his PhD from the Institute of Psychiatry (1953) and later became Dean of the Faculty of Science at Birkbeck (1968–1970) during time spent there as a Reader and Personal Chair in its Psychology department. In 1974 he founded the Department of Psychology at the University of York where he was Pro-Vice Chancellor from 1981 to 1985 He began his research career in 1951 and is still actively publishing papers, Professors Young and Tipper said in their nomination: ‘He is widely acknowledged as a leading figure in establishing the field of experimental psychophysiology, playing a key role in setting up this discipline in Britain throughout the 1950s and 1960s. His work was unusual at the time, emphasising an experimental psychological rather than clinical approach to understanding schizophrenia.’

The Professor’s work with schizophrenia began in 1953 and his first citation classic was 1962’s ‘Level of arousal and the subclassification of schizophrenia’, published in Archives of General Psychiatry. This illustrated a theme that has been reiterated for several decades, that there are two types of schizophrenic patient: those who show active behaviour on hospital wards and those who are withdrawn. Venables later went on to show that these groups differed in terms of physiological arousal. This contribution became the forerunner of the positive–negative symptomatology distinction in schizophrenia that was influential in the 1980s and 1990s.

His contributions have not only been in the clinical field, but in cognitive, neuroanatomical, psychophysiology and neurodevelopmental areas too. One of his most original, influential and seminal works, according to Professors Young and Tipper, was his paper on input dysfunction in schizophrenia, which built on his earlier work on selective attention, withdrawal and cortical activation, a paper that is recognised as a citation classic. His laboratory was also the first to demonstrate that schizophrenic people fall into distinct subgroups of electrodermal non-responders and electrodermal hyper-responders.

In the early 1970s he also set up the Mauritius Joint Child Health Project along with colleagues Sarnoff Mednick and Fini Schulsinger, a prospective longitudinal study that involved the collection of psychophysiological, psychological, social and medical data on 1795

our members to be active within the organisation. To achieve this we will continue to review, simplify and strengthen the Society’s governance structures and provide them with support and training.

three-year-old children. The project continues to collect data today under the direction of Adrian Raine, with whom Peter Venables publishes current research.

Professor Venables worked as a telephone engineer before the start of WWII and subsequently in radar in the Navy, he told The Psychologist: ‘I thought that going to university after the war to do the obvious thing and to study physics or electronics might be difficult with so many in the same position as myself. One of the aspects of being in telephones or radar was that it involved trying to find faults in circuits by sending a signal into a virtual “black box” and finding out what was happening inside by measuring the response.

‘I had read something of psychology while I was in the Navy and had indeed joined the BPS as an “attached member”. I also had the British Journal of Psychology sent to me and I thought, on the basis of rather scanty knowledge, that there was an analogy between “stimulus” and “response” in the human brain as a black box and what I had been doing before. So when after the war as a veteran I went to UCL it was with the idea of eventually doing research in psychology.’

After graduating, Professor Venables got a job with the MRC Social Psychiatry Research Unit to look first into stress in bus conductors. He added: ‘What more obvious way (to me) to tackle the topic than to use psychophysiological methods? I built my own apparatus with the help of knowledge from telephones and radar and surplus stores in Tottenham Court Road. The formidable Aubrey Lewis, my boss, backed me and from then there was no holding me.’

Professor Venables said some of his happiest times, among many others, included working with postgraduates, starting the Child Health Project in Mauritius, and helping to bridge the two legs of the field together by being President of both the EPS and BPS. He added to his list of most worthwhile achievements: ‘Publishing a chapter entitled “Input dysfunction in schizophrenia” in 1964, which made something of a hit and which took me on a lecture tour in the US making so many friends with whom I have collaborated over many years and resulting in awards by the Society of Psychophysiological Research and the Society for Research in Psychopathology.

‘And of course founding one of the best (“the best”) psychology departments in the country, and then perhaps living to the age of 91, luckily with my marbles relatively intact!’

He added: ‘I was of course very honoured and delighted that the Society of which I was once President had decided to give me this award. I was particularly delighted to receive an award that had also previously been given to colleagues in my Department at York, Alan Baddeley and Andy Young. The award, of course, honours also all those colleagues in the MRC Social Psychiatry unit in the 50s and 60s. Birkbeck College in the 60s and 70s and York in the 80s to the present, without whom I could not be in this happy position.’

Ella Rhodes

We will review and improve our ways of working to ensure the Society is flexible, coordinated and an effective communicator to ensure all our efforts are focused on achieving our goals.

read discuss contribute at www.thepsychologist.org.uk

I hope that this brief summary gives a flavour of what we’re aiming to achieve over the next five years in and with the Society, and that you’ll be involved in helping the goals to be achieved.

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Branching out with ‘Hubs’ Most of the nine active Society Branches have developed ‘Hub’ networks to connect with members across their geographical areas: some are well established, some are in the process of being set up. Here we consider how this initiative has been bringing psychology to society in new places and new ways.

London & Home Counties The London & Home Counties Branch does not have any hubs at present. We have looked at setting them up but did not have enough committee members to take such a project forward. We think it would be possible to have hubs in Kent, a hub to the north covering Luton and High Wycombe and west towards Slough. We would actively welcome suggestions from members about possible venues. We could run talks in one area as a pilot and expand the hubs with the help of members in the area. Please contact us at londonandhc@googlemail.com

Wales The Welsh Branch has recently developed

five regional hubs – Cardiff, Swansea, Aberystwyth, Bangor and Wrexham – each run by a team of volunteers. The hubs are still establishing themselves but are hoping to hold a variety of events including scientific meetings and joint talks with university psychology societies.

It is hoped that the events will allow psychologists in the regions to network, provide peer support and socialise. In the past year, the Cardiff Hub has held ‘Psychology in the pub’ talks, and the Swansea hub organised the 2014 Welsh Branch Conference in September.

Scotland The Scottish Branch has been developing hubs over the last 18 months, and plans to support three hub events each year.

The first hub was held in Tayside, followed by Highland Region (May 2014), with a third planned for Grampian region in November. Each event is coordinated and hosted by a small team of local psychologists, in collaboration with our Scottish Branch Hubs Working Group.

This has enabled us to develop a standardised process for setting up and

evaluating our hubs. Topics covered to date have been well received and have included health psychology and adolescent mental health in remote and rural areas.

North West of England Traditionally the majority of our activities have been focused in the Manchester area.

Following our recent members’ survey and aligning with one of our key priorities for future growth, we are aiming to expand our offering of events and activities around the North West. Our members have shown an interest in events in both Liverpool and Chester and this will form part of our strategy moving forward. Get in touch ff you’d like to participate, promote or help in any way: north.west@bps.org.uk.

South West of England The South West Branch committee has spent the last three years developing local hubs and we now have five wellestablished hubs (Bristol/Bath, Exeter, Plymouth, Truro and Jersey). Each hub is

Understanding psychosis Next month a new report on understanding psychosis and schizophrenia will be launched by the Society’s Division of Clinical Psychology in London. The Division’s report gives an overview of the current state of knowledge about why some people hear voices, experience paranoia, believe things that others find strange, or appear out of touch with reality. It also explains what can help.

The report’s editor, Anne Cooke from Canterbury Christ Church University, said the project has been 15 years in the making. Her active involvement with the Division of Clinical Psychology began in 1997 when, motivated by despair about the widespread misinformation and unhelpful stereotypes that were dominating media coverage of

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mental health, she became Press Officer.

Anne said that she felt her profession had a responsibility to challenge these stereotypes.

She added: ‘I also felt that as psychologists we had something unique to contribute. That was the time when research into the psychology of psychosis was beginning to burgeon, and so many of our findings challenged the stereotypes.

‘For example, we were finding how common “psychotic” experiences are – thousands of people have unusual beliefs or hear voices, but live successful lives and never come into contact with mental health services.

Evidence was also emerging that rather than being some scary mystery brain disease, psychosis can often be a

reaction to the things that happen to us – for example abuse and trauma – and the way we make sense of those events.’

In 2000 the Division published its first public information report Recent Advances in Understanding Mental Illness and Psychotic Experiences, which Anne edited with Peter Kinderman.

This report is still widely downloaded and cited. The Department of Health later supported the Division and Anne’s employer, Canterbury Christ Church University, to produce a training pack based on the report, Psychosis Revisited, which became a bestseller.

In 2010 the Division published a second public information report about bipolar disorder, edited by

Steven Jones, Fiona Lobban and Anne Cooke. It later commissioned Anne to produce a new, updated report on psychosis, summarising the huge progress that has been made in this area since the first report.

The document describes a psychological understanding of psychosis and has two main aims. Firstly, it is intended as a resource for people who experience psychosis and their families. Secondly, the hope is that it will help change not only mental health services, but also our whole approach as a society to this issue. The report has involved contributions from 24 people, among them many of the leading researchers in the field.

They include many of those who were involved with the first report, together with

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run by a team of local psychologists, who organise and host all the local events.

Each month we hold our ‘Psychology in the pub’ talks – these have become an excellent source of networking in our region. We also organise up to four CPD events across our hubs each year.

committee meetings and events are located throughout the North East. We would actively support a group that wanted to set up a hub in the North East and welcome proposals via north.east@bps.org.uk

up of a hub in the South West of Ireland to endeavour to engage more closely and effectively with BPS members who live there. Members interested in becoming involved in hub activity in either area should in the first instance e-mail n.ireland@bps.org.uk

West Midlands Wessex

The West Midlands Branch currently does not have a hub network, however, this is something the committee wants to change! The Branch covers a large area from Stoke-on-Trent to Swindon, so the committee is passionate about developing hubs, which it sees as focal points for talks, networking and CPD events and much more. They are currently exploring the potential for hubs in the region: if you would like to get involved with hubbuilding please contact us at emma.vardy@coventry.ac.uk.

Finally, in celebrating the work of the existing Branches and their hub networks it is important to remind members in the East Midlands and East of England geographical areas that the Society would be delighted to support Branch networks in your areas. East Midlands members who have not yet shown their support for a Branch should visit tinyurl.com/bpseastmids – 10 per cent of the membership in the area need to respond in order for the Branch to be formed.

To form a Branch in the East of England the Society requires 20 members from that geographical area to put forward an initial expression of interest to the Trustees. Interested members should contact me (see below).

If you would like to get involved in hub activities in your area please contact me and I will put you in touch with your local branch committee.

Anne Kerr, Branch Advisor on behalf of the Branches Forum n.ireland@bps.org.uk

The Wessex Branch has five hubs in Sussex, Thames Valley, Dorset, Surrey, and Solent. Each hub hosts a series of varied activities throughout the year. A highlight is the quarterly Solent Seminars at the University of Portsmouth. Recent events include ‘Risk & Restoration in Nature: Is Nature Scary and Dangerous or Relaxing and Healing?’ at our Surrey hub, ‘All is Not Lost! Unlocking the Potential for Cognitive Rehabilitation’ at the Sussex hub, and the Prosopagnosia Public Engagement Grant launch event hosted by our Dorset hub. We welcome suggestions from our members for topics for events.

North East of England The North East of England Branch currently has one hub situated in Sheffield, which holds a series of events throughout the year. The NEEB does not focus its activities to a particular area, and

Northern Ireland The Northern Ireland Branch (NIBPS) is launched its first hub in the North West of Ireland in September and is delighted with the enthusiasm of the academics and researchers at University of Ulster who have worked with the Branch to produce a calendar of events hosted at University of Ulster campuses in Coleraine and Derry.

Discussions are ongoing about the setting

UPCOMING CONFERENCE younger researchers who have come to prominence since, for example Tony Morrison and Daniel Freeman. About a quarter of the contributors have themselves experienced psychosis.

Anne added: ‘I hope that the report demonstrates, rather than merely stating, the value of psychology in developing useful theory and interventions in this area.

More importantly, my dream is that our document will contribute to a sea change in attitudes so that rather than being “othered” and stigmatised, people who experience psychosis will find those around them accepting, open-minded and willing to help. Perhaps one day, too, the default approach in psychosis services will be a psychological one, with a psychological

formulation driving every decision and the content of every conversation.’

The report launch event in London on 27 November will include talks from Norman Lamb (Minister of State for Care and Support) and Geraldine Strathdee (National Director of Mental Health) together with report contributors including Anne Cooke, Peter Kinderman, Jacqui Dillon, Philippa Garety, Richard Bentall, Rufus May, Elizabeth Kuipers and Tony Lavender. It will take place at Friends Meeting House, Euston Road and is open to all, subject to booking (see www.kc-jones.co.uk/ understanding). The document will be accessible on www.understandingpsychosis. net from the same date.

Ella Rhodes

read discuss contribute at www.thepsychologist.org.uk

Following the success of the joint divisional conference on Therapeutic Interventions with a Difference: Action not Words held in October 2013, a followup conference will be held on the topic of Action not Words II: Negotiating Multiple Identities.

The conference will be held on 17 October 2014 from 9.30am to 4.30pm at the University of East London.

The conference will emphasise and develop knowledge around culture and black and ethnic minority experience for those involved in applied psychology including community psychology. It will specifically consider the issue of multiple identities with reference to issues of equality and diversity. Topics include migration and its effect on individual identity, human rights, social justice and

psychology, the globalisation of ‘mental health’ and ‘mental illness’ and cross-cultural neuropsychology.

A range of excellent speakers and a choice of two out of 10 workshops will be available to all participants. The organising committee consists of a range of applied psychologists including clinical, counselling and educational and child psychologists with the support of several BPS Divisions and will be of interest to psychologists at all levels of the profession, those in training and in related professions.

We hope that you will come along and join us.

Further details will be available from www.kcjones.co.uk/action. We recommend booking early to ensure that you can obtain a place.

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Is autism a get-out-of-jail-free card?

Jon Sutton reports from a one-day conference on autism and the criminal justice, funded by the Society’s Public Engagement Grant scheme ‘I had my favourite hoody on, I wore it all the time. I used it to block out peripheral vision, and I liked the sensation on my cranium’. So said Alex Evans, from Optimism in Autism. So when the burly security guard in the Job Centre barked ‘Take down your hood!’ repeatedly, grabbing Alex’s shoulder, he ‘went into meltdown’. ‘The word “subtlety” doesn’t come into our vocabulary very often.’ The situation went from bad to worse, and Alex found himself in a confusing and stressful police interview.

Could autism awareness training have helped the professionals involved to deal with the situation differently?

Alex thinks so, pointing to numerous aspects of such encounters which don’t suit a person with autism: flashing lights and a big police presence lead to sensory overload, fast talking and the

autistic tendency towards literal interpretations can lead to serious misunderstandings.

Alex admitted that his own failure to disclose his autism meant he ‘lost all rights as a vulnerable adult’, but he said that as an 18-year-old it was not the easiest thing to admit: he was still ‘in denial’ about his diagnosis. The use of an ‘Autism Alert Card’, produced by the National Autistic Society, could help. ‘One of my friends calls it “the get-outof-jail card”,’ said Alex wryly.

The victim perspective came from Robyn Steward (autism consultant, author and

broadcaster), with a deeply affecting account of her own experiences. The ‘black and white’ view of the world, which Alex had also mentioned, made it extremely difficult for Robyn to come to terms with what had happened to her. ‘I found the whole thing really confusing,’ she said.

‘Putting the pieces together and seeing the bigger picture.’

Robyn said that people with autism can struggle to understand the justice system: ‘I eventually came to realise that just because a person does not get prosecuted does not mean the crime didn’t happen.’

Turning to the research, Professor Glynnis Murphy (Tizard Centre, University of Kent) described the difficulties in finding unbiased samples and good-quality diagnoses.

However, through systematic review Professor Murphy found that if anything –

certainly when it came to young people – fewer with autism spectrum disorder commit crimes than those without. According to Dr Juli Crocombe (St Andrews Healthcare), the ‘issue of the internet is more and more prevalent’ in those who do.

Outlining the case of Gary McKinnon, saved from extradition to the US on hacking charges after a decade-long fight, Crocombe considered the ‘promising but immature science’ of cybercrime offender profiling.

There’s a need for early recognition and diagnosis of autism (in McKinnon’s case in came part way through), and preventative education around the use of IT. But how do you risk assess, monitor and manage? ‘They’re four steps ahead of me in the IT world,’ admitted Crocombe.

People with autism are not in such an advantageous

Testing in forensic contexts – new qualification standards In January 2015 the Society will be launching its newly developed qualification standards in testing in forensic contexts.

The qualifications have been developed by a working group directed by the Committee on Test Standards (CTS) and sponsored by the Division of Forensic Psychology (DFP). The working group’s terms of reference were defined by the Professional Practice Board (PPB). Those using testing in forensic contexts may be working in prisons, secure hospitals, courts or probation services or elsewhere in a justice context and may be assessing offenders’ risk of reoffending.

The qualifications are available at the following levels: I Assistant Test User (Test administration) I Test User (Forensic) Chartered Members of the Society are

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invited to apply for the qualifications via two grandparenting routes:

qualifications by this route.

Grandparenting Route 1

Open to BPS Chartered Members.

Applicants will be required to provide portfolio evidence of how they have applied the standards in testing in forensic contexts.

The portfolio will be assessed by members of the Forensic Testing Verifiers Group.

The following fees are payable in order to offset the cost of assessing portfolios: I Assistant Test User level only – £75 I Assistant Test User and Test User levels combined – £125

Grandparenting Route 2 Open to Chartered Members with a current entry on the Register of Qualifications in Test Use (RQTU). Applicants will be required to sign a self-affirmation that they are competent in the forensic testing module sets and that they will apply these competencies in future when using tests in forensic contexts.

If you are not able to meet a few competencies, you can obtain the necessary training/experience during the two years that grandparenting will be open or supply portfolio evidence for just those competencies (please see the Route 2 process below).

No fee is required to receive these

An application form containing details of the forensic testing module sets, and a portfolio template can be downloaded from www.psychtesting.org.uk, or by e-mail from enquiry@psychtesting.org.uk.

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position when it comes to understanding the police caution, with its complex conditional double negatives.

Inspector Huw Griffiths (Hampshire Police) described an alternative, based on ‘Widgit’ symbols and pictures.

Failure to understand rights may lead to miscarriages of justice, so it was good to hear that implementation of the new system in two Hampshire custody centres was yielding promising results. But for DS Mick Confrey (Greater Manchester Police) much more is needed. He suggested that autism advocate groups should look at the transgendered community to see how they got an appendix to the Police and Criminal Evidence Act, and that the police should be less wary of using powers under the Mental Health Act: ‘It’s there for a reason but we keep shying away from it.’ Sue Mulcahy (University of Liverpool) wrapped up before lunch with a call for more training of police, barristers and prosecutors: ‘Those attending training can be surprised by the prevalence of autism and the hidden nature of many difficulties.’

After the break, Dr Katie Maras (University of Bath), Dr Laura Crane (City University) and Michelle Mattison (Lancaster University) considered how to obtain best evidence at police interview.

Police need to manage sensory issues in the interview room, set boundaries to questions and give careful consideration to how to ‘reinstate context’ in recall. The traditional ‘cognitive interview’ appears not to work too well for those with autism, and the speakers advocated the use of a ‘sketch plan’ as an alternative.

Drawing can help people to focus, retrieve more information and reduce anxiety. With appropriate preparation and support from an intermediary (also advocated by David Wurtzel of City University later in the day), people with autism can provide detailed and accurate

evidence.

So is autism a ‘get-out-ofjail’ card? Professor Simon Baron-Cohen (University of Cambridge) recounted his experiences as an expert witness, considering whether the person is fit to plead and to participate effectively in the legal process. ‘Judges are actually very keen to get people with autism into court’, he said: ‘They want to give them the chance to present their defence.’ We need to make sure courts aren’t ‘off limits’ for people with autism: reducing some of the formality; avoiding ambiguity, metaphors and idioms in questioning; and being mindful of the extremely high levels of suicidal thoughts in adults with autism (a factor in the successful blocking of extradition for Gary McKinnon). But autism is not a get-out-of-jail card, BaronCohen concluded, citing the case of Simon Thompson (who received 20 years in prison after killing his daughter). Instead, autism should lead to reasonable adjustments to ensure access to a fair trial.

Describing such reasonable adjustments, Helen Johnson (Emery Johnson Astills) spoke about her work in the trial of Michael Piggin, a teenager whose trial on terrorism charges collapsed earlier this year. Johnson described how she and her team would get Michael to sit in the witness box during breaks in proceedings, answering questions on his specialist interest (the war). ‘It was about enabling the defendant to communicate and participate,’ Johnson said. As Baron-Cohen had concluded before her, this was not about avoiding justice, it was about accessing basic human rights.

I The Society’s Brain Injury and Criminal Justice Working Party is drafting a paper on Children and Young People with Neuro-disabilities in the Criminal Justice System. For more on the Society’s Public Engagement Grants, see www.bps.org.uk/pegrant

read discuss contribute at www.thepsychologist.org.uk

LAST CHANCE TO VISIT MIND MAPS This month will be the last chance to visit the Society-sponsored Mind Maps: Stories from Psychology exhibition at the Science Museum in London. This free exhibition opened in December 2013 and has been widely praised for presenting a fascinating story and for its sensitive curation. If you haven’t been to see it yet, it’s certainly worth paying a visit, but you only have until Sunday 19 October to do so.

I Lots more information about the exhibition at tinyurl.com/pfcjs25 and you can see an introductory video at tinyurl.com/n625x6w

SOCIETY NOTICES Division of Occupational Psychology Annual Conference, 7–9 January, Glasgow See p.728 South West of England Branch, Psychology in the Pub See p.742 North West of England Branch conference ‘A Risky business?

Challenges and Complexities in Modern Forensic and Legal Systems’, 17 October, Manchester See p.758 Annual Conference 2015, Liverpool See p.i Division of Occupational Psychology/Daedalus Trust conference ‘Leadership: Stress and Hubris’, 17 November, London See p.776 BPS conferences and events See p.776 2014 CPD workshops See p.777 Wessex Branch 3rd Military Psychology Conference ‘The Psychological Well-being of the Military in Transition’, 5–6 November, Shrivenham See p.799

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Division of Occupational Psychology ONE-DAY CONFERENCE

Leadership: Stress and hubris MONDAY 17 NOVEMBER Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE Hubris – distortions of thinking and changes in personality associated with the exercise of power – is one of the most dangerous issues in leadership today.

This important conference will explore ways hubristic behaviour may be triggered by stress, how collective or organisational hubris can be prevented and how the potential for hubris in senior leaders can be managed.

The impressive line-up of speakers includes: Andy Haldane, Bank of England chief economist; Lord David Owen, former Minister of Health, Foreign Secretary, and author of The Hubris Syndrome; Professor Adrian Furnham; Professor Jo Silvester; Dr John Coates, former Wall Street trader and neuroscientist; Professor Ian Robertson; and Jon Snow, Channel 4 News presenter.

See the full agenda and book your place now: http://tinyurl.com/pe28gsd CPD credits: 6

Organised by BPS Conferences

2015

2014

BPS conferences are committed to ensuring value for money, careful budgeting and sustainability

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CONFERENCE

DATE

VENUE

WEBSITE

Psychology4Students – Sheffield

20 November

Mercure Sheffield

www.bps.org.uk/p4s

Psychology4Students – London

2 December

Kensington Town Hall, London

www.bps.org.uk/p4s

Psychology4Graduates

3 December

Kensington Town Hall, London

www.bps.org.uk/p4g

Division of Clinical Psychology

3–5 December

Radisson Blu Hotel, Glasgow

www.bps.org.uk/dcp2014

Division of Occupational Psychology

7–9 January

Hilton Glasgow

www.bps.org.uk/dop2015

Annual Conference

5–7 May

ACC, Liverpool

www.bps.org.uk/ac2015

Division of Forensic Psychology

1–3 July

Manchester Metropolitan University

www.bps.org.uk/dfp2015

Division of Counselling Psychology

10–11 July

Majestic Hotel, Harrogate

www.bps.org.uk/dcop2015

Developmental Section & Social Section

9–11 September

The Palace Hotel, Manchester

www.bps.org.uk/devsoc2015

Division of Health Psychology

16–18 September

Radisson Blu Portman, London

www.bps.org.uk/dhp2015

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2014 CPD Workshops Professional development opportunities from your learned Society Developing mindfulness in schools (DECP)

29 September

Mindfulness: Compassion, choice and gratitude (DCoP)

30 September

Assessment, formulation and therapy with women who commit offences within the family (DFP)

1 October

Working sucessfully in private practice

2 October

A psychological perspective on hoarding: What is it? What can we do about it? (DCP)

6 October

Mild traumatic brain injury and stress: The influence of trauma and prolonged stress on cognitive functioning (DoN)

9 October

Implementation science: Leading evidence-based practice in psychology (DECP)

13 October

Mental health at work: Improving well-being in the workplace (DOP)

15 October

Facilitating preferred changes using narrative approaches for those with physical health problems (DCP / DHP)

17 October

Expert witness: Presenting evidence in court (Level 3)

24 October

Adaption-based Process Therapy (APT) for personality disorders (DCoP)

31 October

Expert witness: The use of psychometric assessments for court (Level 4)

7 November

A reflective-relational-systematic approach to forensic psychology: Bringing your family to work (DCP / DFP)

11 November

Working with distressing psychosis: The challenge of developing meaningful therapeutic outcomes (DCoP)

18 November

Working sucessfully in private practice

20 November

Meta-synthesis (DHP / QMiP)

21 November

Applied psychology practice to support vulnerable families (DECP)

26 November

Engagement surveys and business performance (DOP)

28 November

For more information on these CPD events and many more visit www.bps.org.uk/findcpd.

The 2015 Professional Development Programme will be live for bookings in November, so watch out for news.

Follow us on Twitter: @BPSLearning #BPScpd

www.bps.org.uk/learningcentre

read discuss contribute at www.thepsychologist.org.uk

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Our courses are British Psychological Society Learning Centre Approved and are held at the BPS London, Borehamwood and Edinburgh or in-house. We have trained 1000s of practitioners on our recognised modular courses since the 1980s. The Founder Director of the Centres and Academy is Prof Stephen Palmer PhD. Our experienced trainers have authored books and/or articles in their particular fields. They include Chartered Psychologists: Prof Stephen Palmer, Dr Siobhain O’Riordan, Nick Edgerton & Kasia Szymanska.

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Practitioner Doctorate (PsychD) in Psychotherapeutic & Counselling Psychology The first of its kind to be accredited by the British Psychological Society, this professional doctorate offers full-time training over three years. Completion of the Doctorate also confers eligibility to apply for Chartered Psychologist status with the BPS and registration as a Counselling Psychologist with the Health and Care Professions Council.

record. Only 13–14 trainees are accepted to ensure a high staff/trainee ratio. Entry requirements: Graduate Basis for Conditional Membership from the BPS; normally at least an upper 2nd class degree in psychology; sufficient personal maturity and robustness to cope with the course demands.

Open day for prospective students: 15 December 2014

Trainees are exposed to the main theoretical traditions with a focus on psychodynamic and cognitivebehavioural theories, and will apply them under supervision in 3 one-year-long practice placements.

These can be within NHS, student counselling, voluntary and other settings identified and monitored by the course team. We have a strong research tradition and an outstanding trainee publication

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Introducing the Second Edition of the bestselling authoritative book on psychopathology...

Psychopathology Research, Assessment and Treatment in Clinical Psychology Second Edition Graham C. Davey Professor of Psychology, University of Sussex

V Comprehensive coverage of both psychopathology and clinical practice, including extensive treatment techniques for a range of mental health issues

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Apply for January DCPsych in Counselling Psychology and Psychotherapy by Professional Studies Joint programmes with Middlesex University

EMDR Training Schedule 2014/15 Fully accredited EMDR trainings for Psychologists EMDR International Association (EMDRIA) and EMDR-Europe Association (EMDR-E) accredited trainings conducted by Alexandra (Sandi) Richman, Chartered Psychologist. Learn how to integrate this evidence-based therapy into your existing clinical skills.

Richman EMDR Training offer small interactive EMDR trainings (max 20 participants), incorporating the complete ‘standard’ EMDR training accredited and approved by EMDRIA/EMDR-Europe plus an Intermediate workshop between Part I and Part 3 training. After Part I participants are able to practice EMDR and Part 2 revises the protocol and offers supervision of case material. Part 3 training teaches EMDR with more complex cases and offers further case consultation.

EMDR 2014/15 Trainings are as follows: MA in Existential Coaching Validated by Middlesex University

On-line MSc in Psychotherapy Studies Validated by Middlesex University

To apply please contact: Tel: 0845 557 7752/ 0207 6240 471 Email: admissions@nspc.org.uk www.nspc.org.uk

(London unless otherwise indicated) Part 1 (3 day training) 16-18 October (Leicester), 29-31 October, 21-23 January 2015, 11-13 February 2015 Part 2 (1 day training) 15 October (Leicester), 23 October, 12 November (Glasgow), 4 December, 29 January 2015 Part 3 (3 day training) 13-15 November (Glasgow), 26-28 November, 18-20 February 2015 For more information contact Mary Cullinane, Training Co-ordinator.

Tel: 020 7372 3572 Email: mary@alexandrarichman.com

www.emdr-training.com

Sussex Mindfulness Centre

Foundation training programme in Mindfulness-Based Approaches (MBCT/MBSR) • • • •

One year intensive training based in Sussex from January 2015 Tailored as far as possible to trainees’ interests in developing MBCT within a clinical/ NHS setting, or MBSR within a community setting Enables graduates to meet criteria set out in the national Good Practice Guidelines for teaching mindfulness-based courses £4,900 for the whole course

For more information about the course, the handbook and an application form, please go to: http://www.sussexpartnership.nhs.uk/gps/education/smc/mindfulness-training Applications should ideally reach the Sussex Mindfulness Centre electronically at smc@sussexpartnership.nhs.uk or by post at Sussex Partnership NHS Foundation Trust, Aldrington House, 35 New Church Road, Hove, BN3 4AF by 24th October 2014.

Interviews will be on 21st, 26th and 28th November in Brighton. For further information about the training, please contact smc@sussexpartnership.nhs.uk or call 01273 778383 ext 2191.

read discuss contribute at www.thepsychologist.org.uk

Mindfulness Master Classes 2014-15 A series of one day workshops offered in conjunction with the year-long training but also available as stand alone events open to mindfulness teachers and members of the public who are not doing the Foundation training. Events are led by SMC teachers and by national experts including Vidyamala Burch, Ven Bodhidharma, Christina Feldman and John Peacock.

For further details, visit: http://www.sussexpartnership.nhs.uk/ gps/education/smc/smc-events

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CPD Workshops Teaching Clients to use Mindfulness Skills

With Dr Maggie Stanton & Christine Dunkley 3rd Oct 2014 – Sheffield University 18th Oct 2014 – London University

Understanding Acceptance & Commitment Therapy

Calling out for new voices

With Prof Sue Clarke 31st Oct 2014 – Uffculme Centre Birmingham

Introduction to Compassion Focused Therapy

With Prof Paul Gilbert 21st Nov 2014 – London South Bank University

When someone is making waves in psychology in years to come, we want to be able to say they published their first piece in The Psychologist. Our ’new voices’ section will give space to new talent and original perspectives.

We are looking for sole-authored pieces by those who have not had a full article published in The Psychologist before. The only other criteria will be that the articles should engage and inform our large and diverse audience, be written exclusively for The Psychologist, and be no more than 1800 words. The emphasis is on unearthing new writing talent, within and about psychology.

The successful authors will reach an audience of 48,000 psychologists in print, and many more online.

So get writing! Discuss ideas or submit your work to jon.sutton@bps.org.uk. And if you are one of our more senior readers, perhaps you know of someone who would be ideal for ‘new voices’: do let us know.

For details and for our full range of workshops :stantonltd.co.uk or grayrock.co.uk

• Teaching: Parent Infant Psychotherapy • Intake: Oct/2014, Jan/2015

MSc Developmental Disorders This course provides the opportunity to acquire an in-depth appreciation of the issues associated with assessment, treatment and intervention for a range of developmental disorders. This interdisciplinary programme focuses on the complex and overlapping patterns of strengths and needs shown by those presenting with a range of developmental disorders, such as ADHD, DCD/Dyspraxia and Dyslexia. The course explores the crucial relationship between research and practice in this area and will introduce you to new ways of evaluating and working with individuals with developmental disorders.

The course is part-time and can span a total of 5 years, although individual modules can be taken for CPD purposes. You will study alongside a range of professionals (e.g. from health, social care and education fields) and your classes will be facilitated by the specialist team from the Dyscovery Centre (University of South Wales). You will learn through a combination of face to face blocks of study and online learning and your experience will be enhanced by expert contributions from those at the forefront of research and practice.

Given the importance of applying the knowledge gained, you would be eligible for the MSc if you are an appropriately qualified practitioner currently (or formerly) working in the field of developmental disorders.

If you would like more information about this course or wish to discuss an application, you can find this on our website: http://courses.southwales.ac.uk/courses/1259-msc-developmental-disorders or can call our Enquiries & Admissions team on 03455 76 77 78

read discuss contribute at www.thepsychologist.org.uk

onsiteoronline We are pleased to announce some exciting new training opportunities.

Parent Infant Psychotherapy This four-year training (two-year conversion training for qualified professionals) is available online or at our London premises. The course covers all aspects of infant mental health and parent infant psychotherapy. Completion can lead to accreditation with the UKCP. Short courses programme Weekend seminars, suitable for CPD. These seminars take place in our London premises. Topics TBA. Infant observation groups In these online and London-based groups, participants discuss their weekly observations of an infant from birth onwards. This provides a unique opportunity to deepen an understanding of the infant’s and parents’ early experience.

Online support group for practitioners working with parents and infants. Participants need not be qualified psychotherapists, but should want to strengthen their skills in working with this client group.

•

CLINICAL SERVICES Our associated clinic offers a range of services for parents, babies and children, adolescents, couples and families.

The School was established in 1990 by Dr Stella Acquarone and offers the only UKCPaccredited training in parent infant psychotherapy. For more information, please visit www.infantmentalhealth.com or call 020 7433 3112

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‘Autism can be of a positive type’ Ian Florence talks with Stella Acquarone about her work and her own problems in social interaction

arrived early at Finchley Road for my interview with Dr Stella Acquarone, founder and principal of three organisations in the field of child and infant mental health. I used up time by visiting Karnac Books, a shop specialising in psychotherapy and psychoanalysis titles, where I found Dr Acquarone’s Infant–Parent Psychotherapy: A Handbook.

Walking to her house I passed blue plaques marking where the children’s book artist Kate Greenaway and classical musician Denis Brain lived. Dr Acquarone

jobs online

I

www.psychapp.co.uk is open to all.

Advertisers can reach beyond the prime audience of Society members that they reach in print, to include the many other suitably qualified individuals online.

Society members have the added benefit of being able to sign up for suitable e-mail and RSS alerts, and we are looking to add more

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is as cultured as the area she lives in, talking quietly but passionately about her interests.

‘The baby is a passionate communicator’ ‘I grew up in Argentina as one of four siblings. My mother was a science professor, my father an engineer and businessman with a national construction company. As a child I was shy and felt left out, though I had a happy childhood and

a very supportive wider family. I became fascinated by social relationships because I found them so difficult to understand.

My father had a huge library and, around the time I started getting interested in psychology, I was reading a book on autism in our garden, thinking “So that’s why I think and feel like that”. My father joined me and I announced, “I think I may be autistic.” He had read the book and said, “Me too.” Perhaps that’s why I’ve never thought of autism as a purely negative condition. Autism can be of a positive type when you are aware of it, learn to manage it, organise you life to take account of it. There is, of course, a negative version as well.’

Our conversation took a detour when I asked Stella if she’d started studying psychology to understand herself. ‘Yes, later on. But initially I didn’t set out to be a psychologist. I was a very good pianist, at concert level, and initially studied at the Conservatoire in Buenos Aires. The problem was I couldn’t face playing in public – I tried three times but it didn’t work. My parents said “You need to study something else”, so it was only then that I changed tack. My mother wanted me to become a medical student but psychology won.’

Stella studied at the Jesuit University in Buenos Aires. ‘In 1960s Argentina approaches to studying psychology were quite different from those we’re used to in the UK now. I’m glad 50 per cent of the course was medical so I got a grounding in neuroscience. A lot of people associated with psychoanalysis had moved to Argentina to escape the war so they were a strong influence on how we did things; Freud is still cited as a huge influence on many aspects of Argentinean life. On the other hand, the sort of psychology vs. psychiatry conflicts so prevalent in Europe at that time seemed less important. It was natural for me start studying psychoanalysis.’

Stella came to the UK and finished her training in child and adult psychotherapy at the Tavistock Clinic.

‘I wanted to do another PhD here after

member-only benefits as the site develops over the coming years. Please let the Managing Editor know what features you would appreciate, on jon.sutton@bps.org.uk.

Please help us to spread the word. Recruiters can post online from just £750, and at no extra cost when placing an ad in print.

For more information, see p.790.

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careers

the one I’d done in Argentina but it was very competitive. I liked the UK straight away. People talk softly to each other, which suits me. I love living in north London which has huge numbers of associations with Freud and the psychoanalytic movement.’

Stella worked as a child psychotherapist in the NHS for 32 years.

‘I quickly realised that parents seemed to know what was happening with their children at a very young age, and were upset that professionals didn’t act on this. I started doing three hours a week outreach in clinics and GP surgeries, trying to calm fears if parents were projecting and identify issues in their children that could be treated. I worked with Katherine Aitkins, an astonishingly insightful community paediatrician. We opened up the field of working with mothers and children and began to see that parents were identifying unusual children – unsmiling ones, fearful ones, those who didn’t want to be picked up.’

On the website of Stella’s Parent Infant Centre (of which more later, and see p.785), www.infantmentalhealth.com, she describes a very wide variety of approaches including neurobiology, psychodynamics, behavioural, cognitive, humanistic, bio-psychological, sociocultural. ‘Psychology is a way of understanding. It provides you with a range of approaches and these should not constrain you. They should help you to look at all factors. So I can use both what are seen as psychological and what are seen as psychoanalytic approaches as the client or situation requires. And I think any therapist should draw on other areas: I get insights from philosophy and poetry.’

Stella emphasises the influence other thinkers have had on her. ‘I was considered odd because I actually talked to babies. I felt that you should try to understand what very young children were trying to communicate. I was hugely influenced by the work of Colwyn Travarthen whose famous quotation “the baby is a passionate communicator” is central to what I do. And there are other influences too numerous to mention – including, Freud, Melanie Klein and, to some extent, John Bowlby, who was at the Tavistock when I was there, Allan Schore and Jaak Panksepp.’

‘The issue is the potential, not the harmful’ Stella stopped working in the NHS seven years ago (‘this happened when I was no longer allowed to work with health visitors’), concentrating on the two organisations she set up in 1990 and also

a third, more recent one. The Parent Infant Centre, runs a linked clinic and training organisation. The clinic offers help and therapy to parents and infants with all sort of difficulties from postnatal depression to sleeping and also social and communication difficulties. The School of Infant Mental Health trains professionals working with infants and parents, such as psychologists, health visitors and paediatricians, in the approaches Stella has developed and provides more intensive training for professionals working with parents and children 0–5.

More recently, the Centre has become associated with ipAn, the International pre-Autistic Network – which increases autism awareness, promotes early identification and intervention, and raises funds for treatment and research, Given Stella’s description of her own problems in social interaction I suggest this move to managing organisations must have been difficult. ‘It was, but my father was a business man and I learnt a lot from him. We try to keep things simple. Most of the people I work with are freelance rather than employed.

I travel around the UK with trainings for the Centre, and some of my work involves looking for grants, for instance.

Our aim now is to gain greater national coverage. In April our training goes online, giving us greater reach. We already provide certain services through Skype, which allows us to reach beyond London and the South East while still keeping it a personal and confidential service.’

Have your overall objectives changed?

‘No. To go back to something I mentioned at the beginning my aim has long been to help those troubled by their autistic tendencies – to help them become positive autistics. I don’t want to get rid of autism, if that was even possible. The issue is the potential, not the harmful.

The approach is to help people to think about autism, to help what we call “preautistic” children structure their mind to allow cognitive and emotional development to occur. Too often people go too quickly with various treatment and therapeutic approaches, for all sorts of reasons. In my view you must first create the foundations which will allow treatment regime to work and be able to feel emotions. The book I am writing now is about Re-Start, an intense infant–family programme, and will emphasise this issue.’

You started out on a journey to understand yourself. Has your career helped you? ‘Yes, particularly studying the autistic mind. We know a lot more than we did about the whole topic, and media

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coverage has raised public understanding, even though it’s tended to emphasise the negative aspects. But there’s still more to learn. You can say that I’m a work in progress. I can speak in public now and I’ve been told I do it quite well. It’s important for me to see listeners’ faces if I am to do that.’ There was a piano in the room where Stella and I talked so I asked her if she could play in public now.

‘No. it’s a private act, a sort of meditation.

I have particular composers who I play to myself.’

If there was one book, apart from your own, that you would recommend to readers of this interview as an introduction to your very syncretic approach to treating families, what would it be? ‘Ben Bradley’s Visions of Infancy is a wonderful introduction to child psychology. It looks at a huge range of thinkers from Darwin to Bowlby and beyond and argues that child psychology is an interpretative discipline rather than part of natural science, perhaps a useful makeweight to some present attitudes.’

On my way back after the interview I see the house of Alma Tadema the Victorian painter and divert to Abbey Road recording studios where the Beatles recorded. In truth, I’d just met a fascinating psychologist in a fascinating area.

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Finding reward in rejection Aidan Horner (Institute of Cognitive Neuroscience, University College London) presents his ‘negative CV’ hen asked to judge the success of a football team, the first thing we might want to know is how many games they have won in the past season.

However, some teams may have played more games than others. If team A has won 15 games but played 50 whereas team B has won 10 but only played 12, the number of games won suddenly looks like a useless statistic. The ‘win rate’ would be more revealing: in this case team B has a better win rate of 0.83 compared to team A’s 0.30.

However, when academics (and nonacademics) apply for jobs they are judged on the quality of their CV. Any individual’s CV is, in essence, the number of times they have won. It summarises the jobs they have successfully obtained, the grants they have been given and the academic prizes they have been awarded.

It makes no mention of the numerous

W

failures that anyone within academia will have undoubtedly suffered along the way.

If team A and B were judged on their CV alone, we would conclude team A were the better team.

One possible issue with this situation is that whereas we have an in-depth knowledge of our own failures, we know very little of other people’s. We might hear about a colleague failing to get a job interview, but we are unlikely to know of every failure and setback they have experienced. I think this situation is somewhat corrosive, and may add to the feeling of ‘impostor syndrome’ experienced by many throughout their career – the feeling that they are frauds and do not deserve the success they have achieved. (Incidentally, I have never felt this phenomenon more acutely than writing this piece: who am I to dispense career advice to others?).

With these issues in mind, I recently wrote a blog outlining all of my academic failures (tinyurl.com/ahornercv). My hope was that revealing the amount of failure that has gone hand-in-hand with the limited level of success I have so far achieved might provide insight for those at the very beginning of their research career. For instance, whereas my CV says I started my PhD in 2006 following an MSc, it makes no mention of the fact that I originally applied for several PhD places in 2005, at the end of my undergraduate degree, but could not obtain funding that year. As a result of this, I joined an MSc programme and applied again the following year. The second time round I was obviously successful. Similarly, my CV outlines my postdoc positions since completing my PhD in 2010. This again appears seamless, moving smoothly from one position to another. In reality, I was

Taking the medicine Nick Hatton on his unusual career destination nspired by stories of others’ career paths using their psychology degree, I wanted to tell people about my slightly less conventional route into PhD study. I am currently involved in a multidisciplinary clinical research project at Hull York Medical School. In an environment of people trying to find cures for cancer, drugs for HIV and map the human genome, there is a danger that the contribution of psychology can be seen as trivial. However, I would argue that the skillset provided by undertaking a degree in psychology makes us an asset to any research group and indeed an indispensable part of healthcare provision.

In the current climate of cutbacks and ‘restructuring’, psychologists and other professionals have been required to demonstrate flexibility; in their roles, in their working patterns and in their

I

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overall career ambitions. After a few periods of unemployment, I was becoming frustrated at the lack of opportunities available to me in the big wide world. The only advice that I could seem to get from academics and people working in the field was to get more experience. Having worked in mental health for over three years, managed to get my name on two research papers and undertaken voluntary work until I could no longer afford it, this seemed like a never-ending cycle. I obtained respectable grades on my undergraduate and master’s degrees. I had a broad base of technical and ‘soft’ skills that I was keen to develop further. So why wasn’t I getting the break that I needed?

Looking back, part of it was fussiness on my part. I didn’t want to rush in to doing a PhD on a topic that I wasn’t sure

about, or make a commitment that I didn’t know whether I could fulfil.

Furthermore, I didn’t want to put myself in a position where, in three years’ time, I would once again be at the mercy of the jobs market.

So I made the decision to get as wide a variety of work experience as possible.

On finishing my master’s degree in 2010, I received numerous offers of short-term research-based positions at my former university. Not understanding the jobs market at the time, I naively relocated and undertook these jobs with the best of intentions, only to be informed after a few weeks/months that they could no longer afford to keep me.

Following two years of this, I decided that a different

approach was necessary.

After a brief stint working in finance, I relocated again and took on a diverse series of ‘lowlevel’ jobs that helped to rebuild my confidence and prepare me once again for the workplace. Of these, working in health promotion allowed me to use the ‘soft’ skills gained during my degree. It also gave me experience of working with other health professionals and an insight into another aspect of medicine. During this time I also qualified as a lifeguard and swimming instructor. Whilst this may seem a little ‘off the wall’ in relation to a career in psychology, this gave me firstaid skills, communication skills and most importantly kept me in employment.

So, why a PhD in medical science? A number of people that I had studied with previously had gone on to study

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rejected from a further eight advertised postdoc positions and fellowships.

This list could go on. I could outline the number of papers I have had rejected from various journals or the number of scientific prizes I wasn’t awarded (though this is obviously slightly disingenuous, as I was at least nominated for them in the first place). The question is why might this information be useful for others, and what nuggets of wisdom, if any, can be extracted from my track record of failure?

First, rejection is endemic in academia. If you don’t deal with it well, you might want to reconsider a career in academia. That said, rejection gets easier.

No single rejection is likely to result in the complete destruction of your entire career. It was actually surprisingly difficult to piece together all the rejections I have experienced largely because I had forgotten about them. The rejection you just received may seem incredibly important the day you receive it, but in six months’ time it is unlikely to seem quite so salient and career-threatening.

Second, I admit to being nervous about posting the blog. I wrote it several months ago, but only recently felt secure graduate medicine. However, for me, the rewards of working in research had always appealed beyond anything else. I didn’t want to leave behind my background as a psychologist, with the firm grounding in research methods and statistics that my BSc had given me. For my master’s I had studied neuroimaging, which gave me knowledge of anatomy and a diverse skillset directly applicable to medicine. I had an interest in other aspects of health (e.g. cardiovascular) from other jobs that I had done, so when the opportunity arose I was delighted to take it.

The SEDA Research Group that I am currently involved with specialises in palliative medicine. There are clear applications of psychology, and I am not the only psychology graduate in the department.

However, there are also major contributions from fields as diverse as sociology, chemistry and health science. In terms of clinical experience, I am surrounded by doctors but there are also research projects involving registered nurses,

enough to actually post it. It is one thing to admit to failure in front of your friends, another to admit to it publicly where prospective employers might read it.

The key point though is that all of us, no matter how successful, have been rejected numerous times. Often the individuals that are the most successful have also suffered the most rejection. It is the manner in which we deal with the rejection, not the amount of rejection suffered, that is more likely to determine our future level of success. The realisation that you’re likely to be judged on your successes, rather than your failures, can be liberating.

Finally, I believe we should be more open about our failures and successes.

The ‘open science’ movement is dedicated to making science research accessible to all. I think part of this approach should also involve openly discussing ‘being in’ science, as well as the science itself.

Many on Twitter are already openly discussing career paths and being very honest about their individual experiences.

In particular, the fortnightly #ECRchat (http://ecrchat.wordpress.com) created by Katie Wheat (@KL_Wheat) can be hugely

physiotherapists and pharmacists.

It can be a little daunting working with successful doctors with intercalated research degrees on top of a degree in medicine. Many have also managed to obtain a wealth of clinical experience. However, it is important to remember that everybody is fallible and they are in need of our skills and experience as much as we theirs.

I have developed an immense respect for the medical profession through undertaking this research.

In psychology, a conflict is sometimes seen between a ‘medical’ and a ‘psychological’ model of treatment. However, this way of thinking obscures the aim and the purpose of all healthcare professionals: better treatment, interventions and outcomes for those most in need.

In terms of my own project, the field I am working in has lain dormant for years, and in my view is in great need of some psychological input.

I have long had an interest in

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informative about a range of issues concerning early career researchers.

Sharing our experiences in such a manner can be both useful and supportive. I was overwhelmed by the positive responses I received from many undergrads, PhDs, postdocs and lecturers, simply for writing a detailed list of my failures.

As with all ideas, someone has always had them before you. Bradley Voytek actually lists his failures on his official CV (tinyurl.com/voytek-cv) and Melanie Stefan has previously espoused the virtues of keeping track of your failures (tinyurl.com/knuypx7). I also know of at least one person who has followed suit and published his own list of failures since I uploaded my original blog post (tinyurl.com/nwaafa6). It seems a few of us have struck on to the idea that keeping track of our rejections and failures can, perversely, be rewarding. I’d encourage you to do the same. Don’t dwell on your failures at the expense of your achievements, but do make a list. You don’t need to openly publish yours, but the ability to look back over your failures and realise you have achieved, despite such setbacks, can be fortifying.

psychopharmacology. The opportunity to apply this in a way that may improve the lives of cancer patients was too good to turn down. So many of us are affected by cancer every year, either directly or through family (my own included). To undertake research on the psychological effects of the drugs given to these patients is vital to inform clinical practice.

Problems with the work in the area currently include methodological issues familiar to many of us: poor sample size/power, lack of ecological validity due to difficulties in recruiting cancer patients, and inferior testing tools and instruments. Many of the studies looking at cognition in cancer patients have used clinical tools such as the Mini Mental State Exam (MMSE).

Whilst this is great for diagnosis of conditions such as Alzheimer’s disease, it is known to lack sensitivity. The MMSE has a skewed distribution and is therfore poor at picking up ‘milder’ forms of cognitive impairment. In addition, it is inefficient at detecting deficits in

frontal-lobe function and spatial working memory. These two aspects of cognition have been shown to be affected by psychoactive drug use in other populations.

Better information in this area will go some way to alleviating phenomena such as ‘opiophobia’. This is a reluctance on the part of clinicians to prescribe such drugs, based on excessive concerns about ill effects. Similarly, the research will also aid in the design of more effective treatment regimens for patients.

So, my ‘take home’ advice?

Do not underestimate the breadth of options that your degree in psychology gives you.

Whether you want to work with people, or would be happier sitting at a desk number crunching, your skills can be used virtually anywhere.

Looking back, the main thing that held me back as a freshfaced graduate was the ability to ‘market’ my skills effectively. If you’re entering the jobs market, my advice would be that a little bit of shameless self-promotion goes an awfully long way.

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Sessional Assessment and Staff Positions Dyslexia Action is seeking: A) Experienced, HCPC Registered psychologists who can conduct psychometric assessments to Dyslexia Action’s specifications in some of its centres in Great Britain B) Additional members of the psychology team to strengthen our capacity to develop, deliver and manage its assessment and research services Successful candidates will be subject to checking by the Disclosure and Barring Service.

Please send a recent C.V. and completed application form, available at http://www.dyslexiaaction.org.uk/jobs/consulting-psychologists to: Dr Barry Johnson, Principal Educational Psychologist & Head of Assessment Services, Dyslexia Action, Knowle House, 4 Norfolk Park Road, Sheffield, S2 3QE. E-mail: bjohnson@dyslexiaaction.org.uk For further information telephone Barry on 0114 2815909.

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Clinical psychological training requires students to learn clinical skills so the research component of a DClinPsych is more modest than with a traditional PhD. This puts clinical psychologists at a real disadvantage in a competitive academic world. The scheme provides the opportunity to do a full research doctorate after clinical training under conditions that make sense for a qualified clinical psychologist. The scheme pays a full clinical salary so candidates are not financially disadvantaged. It makes a point of building on the skills acquired in clinical training which will be a great asset for making significant advances in the wide range of potential supervisors and project areas. The fellows will have the opportunity to spend a day a week in internationally renowned clinical units that specialise in developing and disseminating new assessments and treatments for anxiety disorders, dementia, depression, eating disorders, insomnia, neurological disorders, stroke, and psychosis among other areas. The fellows can choose to sample several such units.’

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REVIEWS

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Looking down on a phobia from 3000 feet Hilarious, enlightening and inspiring The Man with His Head in the Clouds is anything but ordinary. Smith has artfully created a category-defying juxtaposition of historical biography and autobiographical recovery story.

The author captures the ventures of the scarcely remembered, decidedly daring aeronaut, engineer and inventor James Sadler (1753– 1828), the first English person to fly.

Sadler’s determined indifference to the dangers of his chosen career is in striking contrast to Smith’s own lifelong, allconsuming fear of heights – he is terrified even at the prospect of climbing a flight of stairs.

Using a confidently comic, self-deprecating style, Smith depicts his struggles with height phobia, or acrophobia. Smith has been crippled by severe height anxiety since early childhood when he fell down the stairs twice, and was terrorised by the 150-step spiral staircase of Tattershall Castle. After counselling, graded exposure, mantras, reassurance seeking and 12 cancellations of the flight due to imperfect weather conditions, Smith looks down on Oxford from a hot air balloon.

Paradoxically, a failed attempt at flying and returning a dog safely instilled Sadler with sufficient confidence to propel himself into the English skies in a balloon of his own design, fuelled by ingenuity, audacity and highly flammable hydrogen gas (and with oars fitted to help him ‘paddle to a higher height’). Torrential rain and galeforce winds were no impediment.

Seemingly insatiable, Sadler broke records and bones; he crashed but remained unabashed. On one occasion he was forced The Man with to jump from the balloon and reportedly described it as ‘a tremendous experience’.

His Head in He both inspired ‘balloonomania’ and the Clouds terrified farmers (who mistook the balloon Richard O. for an alien intent on stealing their cattle).

Smith Astonishingly, after 50 death-defying expeditions and repeatedly being deemed ‘fortunate to survive’, Sadler died in his bed aged 75.

Entertaining but controversial is a chapter on the terminology of phobias, together with the excessive use of diagnostic labels throughout the book. For those not in favour of diagnostic labels it is like walking on a lawn laden with thistles.

The author refers to himself as acrophobic and bathmophobic, two labels that would never be used collectively in clinical practice – the former encapsulates the latter; we would likely instead call it ‘fear of falling’. There is admittedly a difficult

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balance to be struck in between overpathologising, activating stigma and the use of multiple labels versus normalising and acknowledging the extent of someone’s difficulties. As Oxford University clinical psychologist Dr Hannah Stratford explains, ‘It’s a double-edged sword. It’s validating, it’s helpful it’s containing, it shows others people have this problem… and we know how to treat it… On the other hand… it may also come to mean “there is nothing I can do about it, this is how it is going to be”.’

The reader accompanies Smith on the steep and rocky road to his recovery, learning about phobias with him along the way.

With the help of Dr Hannah Stratford, phobias are placed firmly in an evolutionary context and linked to the fight and flight response, which lends a normalising and validating feel. Smith nicely depicts the merits of psychoeducation: ‘Just learning about the psychology of anxieties and phobias has helped reduce their potency… Once you understand how the circuitry works, you can start tampering with it.’

In an unorthodox therapy set up with two trainee counsellors, the author explores and tackles his height phobia. He frequently refers to cognitive behavioural therapy (CBT) and provides some very neat and accessible descriptions and explanations of this approach. However, a slightly confusing inconsistency in the later part of the book is the lack of clarity that his counsellors are actually using CBT, aside from a little graded exposure.

Smith captures the slow, gradual process of exposure-based practices and fear-extinction learning: ‘the frightened panic does not wholly subside, although the volume level of anxiety becomes progressively turned-down after repeated exposure’.

He raises the issue of recovery and what this means: symptom absolution or management? Smith states: ‘Although I still do not willingly embrace heights, I cannot tolerate them enough for acrophobia to stop being a barrier excluding me from life experiences… I never expected to be cured… Instead, I have crucially learnt to manage and thereby control, my anxieties and phobias.”

The author’s determination and hard work to overcome his difficulties, much of it done independent of therapist guidance, is exceptional and admirable.

Smith says: ‘In a way, overcoming a phobia is standing up to a bully.’ He doesn’t just stand up to the bully, he looks down on it from 3000 feet, with his head in the clouds.

The Man with His Head in the Clouds is a fun and accessible read for anyone interested in anxiety and phobias.

I Signal Books; 2014; Hb £14.99 Reviewed by Petrina Cox who is at the Oxford Centre for Anxiety Disorders and Trauma, University of Oxford See also ‘Letters’, p.722

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Little psychological insight Horizon: Should I Eat Meat? – The Big Health Dilemma BBC Two

Helping abused men cope Living Well App Living Well The Living Well App is a free app designed to reach out to male survivors of child sexual abuse. The app is easy to navigate and contains information and practical resources to help male survivors understand more about the effects of abuse and learn ways of improving their lives and well-being. It is intended to complement, not replace, professional help.

The Well-being section emphasises the importance of taking care of oneself and contains many helpful suggestions; starting with the basics of improving physical well-being and gaining support from others. The app also includes ways to help manage the symptoms and difficulties arising from sexual abuse and provides a large number of relaxation and mindfulness audio files for men to listen to. A section of the app uses a timer to help users learn to breathe slowly and regain control of their anxiety and bodily sensations.

The app does not attempt to be a substitute therapist and so does not directly tackle the psychological impact of abuse.

It does, however, contain many useful ideas and audio files to help men cope with their symptoms and day-to-day living; as well as encouraging them to seek further help.

I Reviewed by Kay Toon who is author of the k2n apps for survivors of sexual abuse

Epidemiological studies suggesting the effects of food on our health litter the media on a daily basis. Marking the first in its new series, Horizon and Dr Michael Mosley team up again to investigate a latest concern: the effect of meat on our health. With meat consumption worldwide doubling in the last 50 years, it seems meat has moved from being a centrepiece of occasion eating to a feature in most meals.

Various large-scale studies are presented: evidently providing a mixed picture. In line with his other documentaries, Mosley again turns medical guinea pig in an N = 1 case study. By beefing up his daily consumption of meat for 30 days, his cholesterol, body fat and blood pressure all rose greatly. However, there was no discussion of other potential health behaviours and lifestyle factors at play in these changes, such as stress, drinking and ability to exercise. As with most food documentaries of this nature, the resulting conclusion is an ‘everything in moderation’-type affair.

Unfortunately this unclear body of evidence seems sure to have only further confused the viewer, rather than informing their purchasing and consumption choices. From a psychology perspective, what was missing was a greater appraisal of how individuals and society perceive

meat and its origins. We do eat ever-increasing quantities of meat, but why? If there is a health effect, especially of processed meat, how can we introduce lasting adoption of replacement foods?

A second episode considered the impact of our meat consumption on the environment but again provided little psychological insight. Meat eating is evidently impactful on our environment, but how can we change food choices to reflect this?

Although evidence presented across both episodes was thought-provoking, there was no consideration of how meat eating as a health and environmental behaviour can be managed. Given the vast amount of psychological research in these two areas – for example see the article by David Uzzell in the November 2010 issue, at tinyurl.com/uzzellmeat – it is disappointing that neither was evidently considered.

I Reviewed by Emma Norris who is a PhD student at University College London and Associate Editor (Reviews)

Essential resource The Elderly Eyewitness in Court Michael P. Toglia, David F. Ross, Joanna Pozzulo & Emily Pica (Eds.) This is an important book for the legal profession, for the police, for forensic and forensic clinical psychologists, and, indeed for all interested and concerned with the administration of justice.

Although it primarily focuses on the criminal justice system it is equally applicable to civil litigation where eyewitness testimony may be vital.

In the UK the number of people 65 and older is predicted to rise by 23 per cent between 2010 and 2018, thus older adults are increasingly likely to be both the witnesses of crime and its victims. Whilst taking a developmental perspective incorporating research on witnesses of all ages, the chapter authors use the findings to focus on issues unique to the older eyewitness.

read discuss contribute at www.thepsychologist.org.uk

The book is divided into three sections: ‘Memory for People’, which includes research into memory into line-ups and ‘mugshots’, with a chapter on improving the performance of the elderly on identification procedures; ‘Memory for Events’, covering topics such as false memory and ageing, accuracy of memory for events across the lifespan and issues around interviewing the elderly eyewitness; and finally four chapters on ‘Special Topics’ dealing largely with the issue of the credibility of the older witness including jurors’ reactions to the older witness.

The book is entirely

research-based, each chapter being written by acknowledged experts in their field.

It thus provides a valuable overview of what is currently known and identifies what is not yet known.

The chapters end with suggestions and recommendations for further research, which will be invaluable to prospective researchers entering the field.

I have no hesitation in recommending this book as an essential resource on eyewitness memory.

I Psychology Press; 2014; Pb £39.99 Reviewed by Clive Sims who is a Chartered Psychologist

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After the storm

Extend your analysis possibilities

Treating Traumatic Bereavement: A Practitioner’s Guide Laurie Anne Pearlman, Camille B. Wortman, Catherine A. Feuer, Christine H. Farber, Therese A. Rando

Bayesian Cognitive Modelling: A Practical Course Michael D. Lee & Eric-Jan Wagenmakers

Treating Traumatic Bereavement provides a much-needed rope of hope into the area of disturbing bereavement and psychological therapy.

Combining therapeutic methods for post-traumatic stress disorder, including resource building, exposure techniques and cognitive behavioural principles, this book helps clinicians to treat those cases that are so rare that previously in their career, they may never have encountered or read about anything similar.

Traumatic bereavements may include accidents, homicide, suicide, natural disasters and war. The child who sees a sibling murdered in front of them; the eyewitness who must testify in court after witnessing a mob murder; a survivor of a paedophile ring who witnessed human sacrifice; these are all examples of cases that clinicians may be presented with on any given day.

Sensitively written and drawing both on personal experience of the authors and on vignettes of clinical cases, this book offers skills, tools and hope, both for the practitioner working in this difficult field and for clients who are plagued by traumatic flashbacks, sleep disturbances, and internal turmoil. This book presents a multifaceted therapy for these survivors, based on building resources, processing trauma, and facilitating mourning.

This treatment will help those who have suffered a traumatic bereavement develop the internal and external resources they need to process the traumatic dimensions of the death, and ultimately move forward in their lives. This excellently researched book covers in depth every aspect of bereavement including the shattering of the bereaved’s assumptions, the relevance of individual spiritual beliefs and attachment style. It serves as a therapeutic mentor to the practitioners involved in these cases also, and is a good reminder that in the depths of the turmoil of these cases, that practitioners are not alone.

Well-referenced, and well-written, a stimulating read that is difficult to put down. It is not, however, a bedtime read.

I Guilford; 2014; Pb £25.99 Reviewed by Kirsten Nokling who is a trainee clinical psychologist for South Wales and Vale NHS Trust, Cardiff University

The Bayesians are coming.

Their innovative approach to the analysis of quantitative data has already become a standard fixture in some disciplines, but has yet to be fully exploited in psychology and cognitive science. Those who do embrace Bayesian modelling in these fields are promised a flexible, yet easily applied, set of methods that will extend the possibilities for analysing data.

If this has whetted your appetite, then your first stop should be Lee and Wagenmakers’ text, which is intended as a primer on Bayesian modelling for those from a psychological background. Its emphasis is on encouraging the reader to see for him-/herself how the methods work by having a go at using them. Right from the start, the explanations are interspersed with practical exercises and questions for the reader to reflect on, which makes the book quite an interactive experience. At first the exercises cover basic techniques and study designs, but they become progressively more advanced, to the point where the reader is tackling some rather complex real-life case studies.

Lee and Wagenmakers are clearly knowledgeable and enthusiastic about the topic, but

Accomplished and profound We Are All Completely Beside Ourselves Karen Joy Fowler Start in the middle, Rosemary is urged by her psychologist father at the beginning of this novel; so she does. It’s 1996, she’s 22, and she’s a student at the University of California.

A frenzied scene in the student cafeteria throws Rosemary into the orbit of Harlow Fielding, wild-child and ‘psycho bitch’. As they get to know each other, we realise that Rosemary is weighed down by a family secret.

Is it to do with her missing brother Lowell, last seen when Rosemary was 11, and

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apparently pursued by the FBI? Or her sister Fern, also absent? We step back to 1979… maybe this is the start of Rosemary’s story?

Attentive readers may work out the secret at the heart of this family from the hints Fowler drops along the way. Wise readers are also alert to the dangers of having a psychologist as a father in the 1970s.

are also keen to make it accessible to those who are less familiar with the technical background. So while there are enough nods to the underlying algebraic concepts to excite the hardcore mathematicians amongst the readership, you need not understand any of this in order to get to grips with the core material; just the basics of probability from your undergraduate stats lectures and access to a computer with the required software (freely available from the internet). The authors have set up a booksite from which you can download the R or MATLAB code for the practical exercises, as well as answers to the questions posed in the book.

For all its potential to revolutionise psychological research, Bayesian modelling is something of a departure from the approach to statistics that is routinely taught to psychologists, and you may be wondering what it is, how it works and whether it is for you.

A few hours working through this book will give you the knowledge you need to answer those questions.

I Cambridge University Press; 2014; Pb £27.99 Reviewed by Denham Phipps who is a Research Fellow at the University of Manchester

Try to avoid hearing the big reveal before you read this book, but even if there is no surprise this is a story so well told that enjoyment is inevitable. Fowler’s writing is accomplished without showing off, funny without being crass and profound without being pretentious. At the heart of the book are questions about what it means to be a family, sibling love and rivalry, and how we live with loss. And if there’s one moral for us as psychologists, it’s that we must avoid repeating our discipline’s sometimes inhuman history.

I Serpent’s Tail; 2013; Pb £7.99 Reviewed by Kate Johnstone who is a postgraduate student at UCL

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Finding meaning in drawings Inside Children’s Minds Valerie Yule As the well-known quote (attributed to Albert Einstein) goes, ‘Imagination is everything. It is the preview of life’s coming attractions’; however, imagination is also much more than that. As Inside Children’s Minds highlights, imagination is an important way of gaining a true insight into a child’s current state of mind and experiences.

This book is certainly different from most others as it doesn’t have paragraph after paragraph of theories and references. Instead, it includes dozens of examples of actual drawings and stories created by children that the author has come across in her work as a psychologist.

Each chapter covers one particular factor that is likely to have an impact on the drawings and stories that children create, such as families, wars and mental disorders. By looking at each of these in turn and focusing on the different ways in which children draw or speak of them, the author successfully demonstrates how a simple story or picture can represent what a child is experiencing in that moment of time. This is especially effective in chapter 4, which concentrates on the topic of houses; the author explains that houses represent security and safety, which is why a disturbed child may tell stories of houses being broken and destroyed.

This is an enlightening read that conveys how meaningful drawings can be and what they really represent about the artist.

The book truly does what it promises and gives the reader an insight into children’s minds, making it useful for both educators and psychologists.

I Book Pal; 2014; Pb £12.80 Reviewed by Aleesha Begum who is a recent BSc (Hons) Psychology graduate from the University of Central Lancashire

Belief in hope Fostering Resilience and Well-being in Children and Families in Poverty: Why Hope Still Matters Valerie Maholmes This new book is a timely reference that focuses on ‘hope’ and how this can be a way to manage and overcome adversity for children and families who are experiencing challenges due to economic difficulties.

Throughout the book, interviews with families who have faced adversity, but have overcome challenging times through intervention, brings the theory into a real-world context that everyone can learn something from, both professionally and personally. The examples bring to life how parents and communities can help children overcome the difficulties they are facing and develop into adolescents and adults with a determination to succeed.

This book has a far wider audience than just those who work with children and families in poverty or academics. The discussions around building resilience and hope in children are relevant for all who believe in giving children the best start in life. The author’s true belief that ‘Hope still matters’, and that hope is a primary construct to help understand how the effects of poverty can be overcome, shines through all aspects of this book and leaves the reader taking away some of her beliefs.

I Oxford University Press; 2014; Hb £35.99 Reviewed by Anna Mary Cooper,University of Salford

read discuss contribute at www.thepsychologist.org.uk

A useful listen Should Research Fraud Be a Criminal Offence?

BMJ podcast The existence of research fraud is now common knowledge. Highprofile cases ranging from infamous MMR claims to more recent stem cell and pharmaceutical examples are widely publicised in mass media and within academic circles. Research misconduct in biomedicine has real potential to cause bodily harm, with psychological misconduct potentially leading to the provision of ineffective services to at-risk groups. Currently, consequences are provided at institutional level, with fines or banning in extreme cases. However, are these methods enough? This thoughtprovoking podcast posits an interesting question: Should research fraud be criminalised?

In a ‘head to head’ format, two researchers convincingly present their views. Professor Zulfiqar Bhutta, from the Hospital for Sick Children in Toronto, argues for the criminalisation of research fraud. He presents research misconduct as a gradient, ranging from sloppy research and plagiarism to more severe research fraud: actively falsifying results to provide a preferred outcome. This may happen in researchers keen to satisfy research funders or promote their careers. Professor Bhutta believes research fraud is no different from economic fraud, as both involve misleading a funding source.

He criticises the inadequacies of institutional sanctions not leading to criminal prosecution, even when economic fraud is detected. With often no lasting consequences for researchers, a soft touch, ‘slap on the wrists’ approach does not deter researchers from reoffending.

He also argues that fraud is often committed not by juniors but by researchers at the top of their game, looking to have the highest impact results. Although Professor Bhutta does not seek to outline specific penalties to be imposed under criminalisation, he is keen that fraudulent researchers are made examples of with lasting repercussions.

Professor Julian Crane, from the University of Otago Wellington, New Zealand, argues against criminalisation. Instead of criminalising researchers and adding further burden onto the justice system, he argues that a change to the nature of research itself is required.

By making research across all fields conducted and presented in the most open way, a culture of trust could thrive. Instead of criminalising a small proportion and tarnishing the wider research community, more sufficient policing by institutions is required.

Professor Crane also argues that researchers of all levels need to ensure they are fully aware of all work accredited to their name. By having an environment of collective responsibility where questions can be asked rather than sanctions made, researchers could feel more accountable for their actions.

This 15-minute podcast brought to life a question that is relevant to researchers of any discipline. This question has huge implications for how all studies portrayed in mass media are perceived by the public. It is a useful listen for any researcher or student in any research field.

I Available at tinyurl.com/m3nb96x Reviewed by Emma Norris who is a PhD student at University College London and Associate Editor (Reviews)

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A continuing journey Patricia Howlin considers where more than 70 years of research and intervention has left us in understanding autism

t is now more than 70 years since Kanner (1943) first described the condition he named ‘childhood psychosis’ but which is now known today as autism or autism spectrum disorder (APA, 2013). This special issue therefore presents a timely opportunity to consider the many changes that have taken place in psychologists’ understanding of autism over the past seven decades.

I

in prevalence estimates reflects a real rise in incidence and, although that remains a possibility, the change in estimates is generally thought to represent increased awareness of autism among many different groups of professionals as well as by the general public. Suggestions of an ‘epidemic of autism’ remain without foundation.

Epidemiology

When autism was first described in the 1940s psychodynamic theories of causation and treatment pervaded much of psychology and psychiatry. Kanner, along with others at the time, regarded autism as ‘the earliest manifestation of

Classification

references

Initially considered to be a very rare condition, prevalence estimates for autism have increased steadily over the decades.

Early epidemiological studies were fairly consistent in suggesting rates of around 0.4 per 1000. However, following the inclusion of autism as a specific disorder in the DSM-III in 1980, clinicians and educators became increasingly aware of the condition. It was also evident that autism occurred in individuals of all levels of ability, from profound intellectual disability to superior IQ, and that it affected adults as well as children. Thus, prevalence estimates have been steadily revised upwards over the years, with recent figures from the Centers for Disease Control and Prevention in the US (CDCP, 2014), for example suggesting rates of 14.7 per 1000 (i.e. 1 in 68 children, although it should be noted that the estimate range varies widely from around 5 to 21 per 1000). There is as yet no evidence that this increase Leo Kanner

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American Psychiatric Association (2013).

Diagnostic and statistical manual of mental disorders (5th edn). Arlington, VA: American Psychiatric Publishing.

Bettelheim, B. (1967). The empty fortress: Infantile autism and the birth of the self. London: Collier-Macmillan.

Centers for Disease Control and Prevention (2012). Prevalence of autism spectrum disorders – Autism and Developmental Disabilities

Monitoring Network, 14 sites, United States, 2008. Retrieved 22 May 2014 from tinyurl.com/p44dldq Cox, A., Rutter, M., Newman, S. & Bartak, L. (1975). A comparative study of infantile autism and specific developmental receptive language disorder: II. Parental characteristics.

British Journal of Psychiatry, 126, 146–159.

Ecker, C. & Murphy, D. (2014).

childhood schizophrenia’ noting that ‘I do not believe that early infantile autism will at any future time… be separated from the schizophrenias’ (1949). Indeed, one of the leading journals in this field (now the Journal of Autism and Developmental Disorders) was originally called the Journal of Autism and Childhood Schizophrenia.

Experimental and clinical studies conducted during the late 1960s and 1970s contributed to increasing awareness of the distinction between autism and other psychiatric or developmental disorders. Early research and reviews by Michael Rutter (1968, 1972) for example, provided clear evidence of the differences between autism and schizophrenia. In 1970, Hermelin and O’Connor published their classic text Psychological Experiments with Autistic Children in which, via a series of innovative and imaginative experiments, they demonstrated the many cognitive differences between children with autism and children with intellectual disabilities.

Their work, and subsequent experimental studies by Uta Frith (cf. Frith, 1989) also highlighted particular areas of skill among children with autism, as well as areas of deficit.

Many other studies of the characteristic cognitive phenotype associated with autism, and how this differed from other disorders, also emerged during the 1970s. Rutter (1968) had already highlighted the central role of social communication deficits in autism, while Uta Frith’s studies of cognitive processing first brought attention to the deficits in ‘mentalising’ or understanding others’ minds that are characteristic of the disorder (Frith, 1989). Her work was a spur to many other studies of cognitive functioning by individuals such as Francesca Happé and Simon BaronCohen, leading to theories about the potential roles of ‘theory of mind’, weak central coherence or executive functioning deficits in determining how individuals with autism experience and relate to the world about them. Frith was also responsible for translating Hans

Neuroimaging in autism. Nature Reviews Neurology [Advance online publication]. doi:10.1038/ nrneurol.2013.276 Frith, U. (1989). Autism: Explaining the enigma. Oxford: Blackwell.

Frith, U. (1991). Translation and annotation of ‘Autistic Psychopathy in Childhood’ by Hans Asperger. In U. Frith (Ed.) Autism and Asperger syndrome (pp.36–92). Cambridge:

Cambridge University Press.

Green, J. & the PACT consortium (2010).

Parent mediated communication focused treatment in children with autism (PACT): a randomised control trial. Lancet, 9732, 2152-60.

Hermelin, B. & O’Connor, N. (1970).

Psychological experiments with autistic children. Oxford: Pergamon Press.

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2,

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Asperger’s accounts of autistic psychopathy in childhood (Frith, 1991) and in highlighting both the similarities and differences between his accounts and those of Kanner.

As functional imaging techniques became increasingly available to experimental psychologists, it became possible to explore the difference between autism and other conditions in much greater depth. However, although resulting in various different theories about cognitive and social processing, brain localisation and function (and lots of pretty pictures), many of these studies have involved very small or poorly ascertained groups of participants, and use experimental paradigms that only distally represent real-world interactions.

Thus, although it is now evident that changes in brain structure, functioning and connectivity are associated with autism (Ecker & Murphy, 2014) the condition is characterised by wide aetiological and phenotypic heterogeneity.

There are currently no imaging techniques that can reliably identify autism at an individual level, and claims for various other biologically based diagnostic techniques (e.g. blood samples or measurement of head circumference) remain without foundation.

Causation As with schizophrenia, autism was initially viewed by many as being caused by disruptions to early ego development, which, in turn, were attributed to inadequate or insensitive parenting.

Although Kanner himself initially believed that the signs of autism appeared so early in life that they must be due to ‘inborn disturbances of affective contact’ he subsequently wrote extensively on the ‘coldness and obsessiveness’ of many parents (Kanner, 1949). He viewed the condition as a combination of biologically based perturbations of development combined with unfavourable environmental factors; but a much more extreme, and widely popularised theory,

217–250.

Kanner, L. (1949). Problems of nosology and psychodynamics in early childhood autism. American Journal of Orthopsychiatry 19(3), 416–426.

Kasari, C. & Patterson, S. (2012).

Interventions addressing social impairment in autism. Current Psychiatry Reports 14(6), 713–725.

Lovaas, O.I. (1987). Behavioral treatment and normal educational and

was that of Bettelheim (1967). He parents of children with autism compared considered autism to be directly caused with parents of children with other by parental pathology and that it could communication disorders. The only be cured by separating children from comparative lack of effectiveness of their parents – a theory that resulted in psychoanalytic-based therapies compared unnecessary distress for parents in many with more structured educational countries of the world. approaches for school-aged children Psychoanalytical views about parents’ was also confirmed by the same research role in aetiology proved very difficult to group (Rutter & Bartak, 1973). dispel despite growing recognition of the In the US, too, from the late 1960s association between autism and organic onwards, there was a rapid growth in conditions (e.g. links with epilepsy, the use of operant-based techniques thalidomide, or rubella virus, etc.) with children with autism. These initially Early suggestions that autism might focused on the elimination of ‘challenging be due to genetic causes were also behaviours’ (often using aversive dismissed, but twin and family studies procedures including electric shock), with conducted by teams of psychologists and a very mechanistic approach to teaching psychiatrists in the developmental skills, and 1970s and 80s somewhat simplistic began to provide notions of reinforcement “Theories about the role of strong evidence of (food rewards the highly heritable predominated). However, ‘refrigerator’ parents took nature of autism. they did provide evidence many years to dispel ” However, despite that the behaviours of recurrent media children with autism, far claims that the from being irreversible, could ‘gene for autism’ has been discovered, the be significantly modified. Unfortunately genetic mechanisms involved in autism most of the children involved in these remain uncertain. Both common and rare programmes were treated as inpatients, genetic variations have been identified in often over long periods of time, with the families with a child with autism, but the result that when they returned to their role of these variants is unknown. families any advances that they had made Moreover, many of these variants have while in hospital tended to disappear. also been identified in other psychiatric Eric Schopler was among the first to conditions, such as schizophrenia, emphasise the importance of working depression, bipolar disorder and ADHD with parents as co-therapists (Schopler (Smoller et al., 2013). et al., 1982). His TEACCH programme (Treatment and Education of Autistic and related Communication handicapped Children), whilst based on behavioural Intervention principles, focused on the generalisation Theories about the role of ‘refrigerator’ of life skills to the child’s regular parents took many years to dispel and environment. Ivar Lovaas, one of the resulted in early-intervention programmes earliest proponents of operant techniques frequently being psychodynamic in for children with autism also became approach. The first empirical aware that the direct involvement of psychological studies to disprove the parents was necessary in order to achieve theory of parental inadequacy/pathology successful generalisation and maintenance were conducted by Rutter and colleagues of behaviours. However, his claim (Cox et al., 1975). They were able to (Lovaas. 1987) that 40 hours a week of demonstrate that there were no early, intensive home-based behavioural differences in parenting style, parenting intervention (EIBI) for two years or more characteristics or psychopathology in

intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.

Magiati, I., Tay, X W. & Howlin P. (2012).

Early comprehensive interventions for children with autism spectrum disorders: A critical synthesis of recent review findings.

Neuropsychiatry, 2(6), 543–570.

Moree, B.N. & Davis, T.E. (2010).

Cognitive-behavioral therapy for

read discuss contribute at www.thepsychologist.org.uk

anxiety in children diagnosed with autism spectrum disorders: Modification trends. Research in Autism Spectrum Disorders, 4, 346–354.

Piven, J., Rabins, P. & the Autism in Older Adults Working Group (2011). Autism spectrum disorders in older adults: Toward defining a research agenda.

Journal of the American Geriatric Society, 59(11), 2151–2155.

Rogers, S.J. & Dawson G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement. New York: Guilford.

Rutter, M. (1968). Concepts of autism: A review of research. Journal of Child Psychology and Psychiatry, 9(1),1–25.

Rutter, M. (1972). Childhood schizophrenia reconsidered. Journal of Autism and Childhood Schizophrenia, 2(4),

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could result in ‘normal’ functioning has continued to generate much controversy.

Although, when compared with ‘treatment as usual’, early intensive programmes supervised by highly trained (and expensive) consultants have been found to result in greater intellectual and/or behavioural improvements at a group level, individual change is much more variable (Magiati et al., 2012).

Over the last two decades interventions based on behavioural strategies have continued to be the predominant approach to psycho-social problems. However, these have moved a long way from the mechanistic approaches of the early 1970s, which paid little attention to normal developmental trajectories, or the importance of learning in naturalistic settings. The Early Start Denver Model (Rogers & Dawson, 2010) for example is founded on behavioural principles but also takes account of normal developmental processes and sequences. In particular, there is a strong focus on reciprocal social interaction, and evidence from a randomised control trial suggests that children involved in the programme (20 hours a week over two years) showed greater improvement in cognitive and language abilities and adaptive behaviour and fewer autism symptoms than did non-treated children.

Several other recent randomised control trials add to the evidence base for early social communication focused programmes, designed to encourage parental synchrony (see Kasari and Patterson, 2012). Language training programmes, too, have moved a long way from the very mechanistic sound imitation procedures of the 1970s, with the focus being much more on reciprocity between adult and child, using multiple communication forms.

For older children, there is now a wide range of different approaches available to enhance social skills or deficits related to ‘theory of mind’ (Green et al., 2010; Kasari & Patterson, 2012); the effectiveness of cognitive behavioural therapy is also being explored in the

315–337.

Rutter, M. & Bartak, L. (1973). Special educational treatment of autistic children: A comparative study. II. Follow-up findings and implications for services. Journal of Child Psychology and Psychiatry, 14, 241–270.

Schopler, E., Mesibov, G.B. & Baker, A. (1982). Evaluation of treatment for autistic children and their parents.

Journal of the American Academy of

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autism

Autism does not disappear at age 18, but unfortunately most interventions and support networks do!

treatment of comorbid mental health problems (Moree and Davis, 2010).

Although initial findings from such research are encouraging, there remains great variation in treatment response (both among individual children and according to the different domains assessed); evidence of generalisation of treatment effects to new skills or new settings is limited, and there is no evidence of long-term impact or significant improvements in functioning in later childhood/adolescence. Claims, for example, that two years of EIBI result in significant lifetime savings are both spurious and misleading. Research into the individual characteristics of children or families that are related to outcome is also in its infancy although more recent treatment trials are beginning to focus much more on moderating and mediating factors that are associated with treatment outcomes.

It is important, too, to recognise that most intervention research continues to focus on children who come predominantly from relatively highfunctioning, middle-class families who

Child Psychiatry, 21, 262–267.

Smoller, J.W. & the Cross-Disorder Group of the Psychiatric Genomics Consortium (2013). Identification of risk loci with shared effects on five major psychiatric disorders: A genome-wide analysis. The Lancet, 381(9875), 1371–1379.

Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological medicine, 11, 115–129.

have the resources to participate in clinical studies. This excludes the majority of children with autism, and future research needs to include these underrepresented groups to broaden our understanding of intervention effectiveness (Kasari & Patterson, 2012).

A further need is to focus more on the development of effective short-term programmes that will help to improve access to high-quality treatment for a majority of children with autism, not just the privileged few.

Finally, it is crucial to recognise that autism is not a childhood disorder.

Individuals are adults with autism much longer than they are children with autism.

Autism does not disappear at age 18, but unfortunately most interventions and support networks do! Several recent studies and systematic reviews have highlighted both the scarcity of studies of adults with autism and the poor quality of what little intervention research does exist. As highlighted by Piven and colleagues (2011), we need systematic studies on the characteristics (behavioural, neuropsychiatric and medical) associated with ageing in autism, and potential interventions, both individual and societal, that may improve outcome and quality of life. If the advances in comprehensive treatment programmes for very young children can be applied across the lifespan, then the current generation of children with autism may face a more positive future.

I Patricia Howlin is Emeritus Professor of Clinical Child Psychology at the Institute of Psychiatry, London patricia.howlin@kcl.ac.uk

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3rd Military Psychology Conference 2014

The Psychological Well-being of the Military in Transition The Defence Academy of the United Kingdom, Shrivenham Wednesday 5 & Thursday 6 November 2014

Keynote speakers Dr Nicola Fear, Matt Fossey & Brigadier Maurice Sheen CBE

Fees (Early bird rate, inclusive of VAT) BPS Members: 1 day = £126; 2 days = £210. Non-members: 1 day = £174; 2 days = £288 This is a wonderful opportunity for clinical, counselling, educational, health and occupational psychologists, as well as military personnel and civilians working closely with the military and their families. We welcome interest from organisations, both public and private, in transition partnerships with the military and their families.

For further information, please visit the website: www.kc-jones.co.uk/militaryintransition

read discuss contribute at www.thepsychologist.org.uk

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ONE ON ONE

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… with Simon Baron-Cohen

coming soon

‘Stories of forgiveness are inspiring to me’

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One moment that changed the course of your career In September 1981, June Felton, headteacher of Family Tree School for Autism, phoned me to say she’d heard I’d just graduated. She said she had a vacancy for a teacher in her small experimental unit of just six kids and six teachers that she ran in the back of her house in Hadley Green in Barnet, North London. It was experimental in that she had video cameras in every room: staff meetings at the end of each school day comprised analysis of the videos, to learn what did or didn’t work in specific teacher–child interactions.

It was an amazing environment because in those days there were so few specialist schools for these kids, because the school learned by observation and evidence, and because the headteacher invited a stream of stimulating professionals to come visit. I was the teacher,

the school minibus driver, the cook, whatever was needed.

That inspiring year allowed me to get to know those six children in detail, and their parents, and led to my writing to my wonderful former tutor in Oxford, Peter Bryant, to ask him where to study for a PhD in autism. He wrote back to say ‘There is no one better than Uta Frith’. He was of course right.

Just this year I met up with June Felton again, who has just turned 80 and lives in Jerusalem. She came to Cambridge and presented me with a most special gift: a complete set of the videos from the early 1980s at Family Tree, as a donation to the Autism Research Centre, with the original parents’ consent.

She and I are still in touch with the parents of those original six children, now in their early forties. We talked about how those films – even though from a small sample – might give clues from a microanalysis of what predicts longterm outcome.

Simon Baron-Cohen is Professor of Developmental Psychopathology and Director of the Autism Research Centre at the University of Cambridge

One cultural recommendation The film The Enigma of Kaspar Hauser by Werner Herzog (1974). It is the story of a young man who turned up in Nuremberg in 1828. He had

A special feature on Sherif and Robbers Cave; how relationships help us age well; can reassurance hurt?; and much more...

I Contribute: reach 50,000 colleagues, with something to suit all. See www.thepsychologist.org.uk/contribute or talk to the editor, Dr Jon Sutton, on jon.sutton@bps.org.uk, +44 116 252 9573 I To advertise: Reach a large and professional audience at bargain rates: see details on inside front cover.

almost no language, no social skills, and just a few letters in his pocket that hinted at his history of how he had been reared in social isolation for the first 17 years of his life.

It is also a fascinating factual drama depicting the efforts

by Herr Daumer, back in the early 19th century, to teach language and social skills to Kaspar, despite his uncertain mental age. Daumer’s empathy for someone who is different shines through.

ask more probing questions.

A ‘systemising’ approach to social interaction may mean their difficulties with cognitive empathy ‘leak out’ via rather subtle clues such as frequent faux pas, or talking too loud, or standing too close to others, or failure to understand socially appropriate boundaries. It’s what Franky Happé and Uta Frith called ‘hacking out’ social skills, a good phrase that underlines how complex a phenomenon it is that we are dealing with, where a person may try to ‘emulate’ what others do more intuitively.

One inspiration In 2013 I gave the ‘Forgiveness lecture’, and on the panel with me was Mary Foley, mother of One proud moment 15-year-old Charlotte.

3 June 2014, when we Charlotte was stabbed published our paper in and killed in east London Molecular Psychiatry, showing in an unprovoked attack by a stranger called Beatriz, who believed Charlotte was someone else.

Beatriz wrote to Mary from prison, wracked with pain and guilt, asking for forgiveness for killing Charlotte in a moment of madness.

Mary realised Beatriz was a troubled young person who had made the worst mistake a person could ever make, and wrote back, saying ‘I forgive you’.

Taking amniotic fluid Stories of forgiveness over-riding the desire for elevated rates of fetal revenge and the emotion of testosterone (and the fetal sex hatred are inspiring to me, steroid hormones from which and give me hope that, even FT is synthesised) in the in currently desperate regions amniotic fluid of babies who like Israel and Palestine, later received a diagnosis of humanity may resurface. autism or AS (see Find out more about the tinyurl.com/n64k2qy). As I remarkable charity called cycled home from the Autism the Forgiveness Project here: Research Centre that day and www.theforgivenessproject.com crossed the bridge over the River Cam, I reflected on the /stories/mary-foley-england long journey from our first amniocentesis study in 1997, One autism myth to this one 17 years later. To That a woman can’t have the rest of the world, it was Asperger syndrome (AS) if just another paper… to me it she can chat, make eye was one of those deeply contact, fit into a friendship group, and raise a family. This satisfying moments, marking a special milestone for our hard myth is one of the reasons working and dedicated many women who seek a research team. diagnosis are turned away or misdiagnosed, and it persists because many clinicians focus Many more answers at on surface behaviour and don’t www.thepsychologist.org.uk

vol 27 no 10

october 2014

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