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New research on autism

Therapy for parents found to cut diagnosis of autism spectrum disorder by two thirds.

Photos above: Parents in the study were given a five-month course aimed at improving the communication between them and their children. (ALAMY)

Article by Kat Lay, the Health Editor of the Times, issued on Monday September 20, 2021:

Giving therapy to the parents of babies showing potential signs of autism reduced the babies’ chance of going on to have the condition diagnosed by two thirds, according to a new study.

At age three, 6.7 per cent of children targeted by a five-month course aimed at improving communication between parents and their infants had autism spectrum disorder (ASD) diagnosed. In a comparable group who did not take part the figure was 20.5 per cent of children.

It is the first time that such an improvement has been shown worldwide and researchers said that it could have a “gobsmacking” impact.

Between 1 per cent and 2 per cent of people have autism so more than 10,000 infants a year in the UK could benefit.

The trial involved babies in Australia aged nine to fourteen months who were selected for inclusion because they were showing potential signs of autism such as differences in spontaneous eye contact, social gestures, imitation or how they responded to their name.

The research team was led by Professor Andrew Whitehouse of the University of Western Australia, and included Professor Jonathan Green of the University of Manchester. The treatment is known as iBASIS-VIPP.

Green said: “These findings are the first evidence that a pre-emptive intervention during infancy could lead to such a significant improvement in children’s social development that they then fell below the threshold for a clinical diagnosis of autism. Many therapies for autism have tried previously to replace developmental differences with more ‘typical’ behaviours. In contrast, iBASIS-VIPP works with each child’s unique differences and creates a social environment around the child that helps them learn in a way that was best for them.”

He emphasised that it was “not some miracle cure that makes them neurotypical” but said that it had improved the children’s social engagement and reduced stress in their lives. The study, published in JAMA Paediatrics, also demonstrated improvements in how the children interacted with others and a reduction in repetitive movements and unusual sensory interests.

The therapy involves videoing the children interacting with a parent. The parent then watches the video with a therapist who helps them to understand how the child might be communicating with them in atypical ways.

Green said: “The theory behind the intervention is how crucial these early caregiver-infant interactions are to brain and social development.” He said that differences in the brains of autistic children, present from infancy, could have a subtle effect on those early social interactions, leading to parents and babies getting “a bit out of sync”.

“This can lead parents to be highly perplexed by how to communicate, and understand their baby. And for the babies, they are getting less simple and useful feedback from parents because of that,” he said. “We think that these early social interaction difficulties can then cascade and amplify existing problems for the baby into an autistic trajectory.”

The researchers assessed 89 children at the start of the study, after the therapy period, and at ages two and three. The children who fell below the diagnostic threshold for autism still had developmental difficulties but the researchers said: “By working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years.”

Use of the therapy by the NHS would require changes to how support to families with autistic children is provided. Many complain that they cannot access help without a formal diagnosis.

Whitehouse said that follow-up of study participants in later childhood, when the behaviours for autism may be more apparent, would be crucial to determining the longer-term significance of the video intervention.

He said, however, that he hoped that intervention during a time when the brain was rapidly developing “may lead to even greater impact on developmental outcomes in later childhood”.

Dr Marie Schaer, assistant professor at the Faculty of Psychiatry, University of Geneva, said intervening “before the onset of full-blown autism” would represent “a paradigm shift” in the field. “ASD is a neurodevelopmental disorder, often associated with increasingly deviant developmental trajectories as the child grows,” she said. “The increasing deviance from typical development explains why it is often easier to diagnose autism in children older than three, when the signs are more prominent. But it also explains why, if we intervene as early as possible when autism is diagnosed, we can most efficiently narrow the gap.”

Tim Nicholls, head of policy, public affairs and research partnerships at the National Autistic Society, said that some autistic people and their families might be concerned at the suggestion that the intervention could have an impact on “autism behaviour severity”. He said: “Autism is not a disease and not something that should be cured or lessened.”

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Training in Boyaca, Colombia

On the 16 of August 2021, ICDP trainer Luis Fernando started to conduct virtual and face-to-face trainings with 3 different groups of professionals who are all linked to the Secretariat of Health.  The purpose of the training is to strengthen and follow up facilitators who have been delivering the ICDP programme to families in all of the 123 municipalities of the department. The roll out of the ICDP programme is supported by Martin Barrera, the Secretary of Health. Most of the participants of the recent trainings are psychologists.

Background

Since 2004, ICDP has been present in the Department of Boyacá, where the ICDP programme was initially implemented as part of a wider peace promoting strategy by UNICEF. When the Governor of the Boyacá department launched the project, he said that ICDP represented an important contribution towards the future development of the Colombian society and that ICDP was officially adopted as a long-term strategy. In 2008, the Colombian national award for human rights was given to the Boyacá department for their work with ICDP, the programme had  at that time reached 50 000 families.

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Pilot project in Ghana

In June 2021, a group of professionals who have been cooperating with ICDP Ghana for some time, started to receive training to become ICDP facilitators. After the June workshop and as part of their training they have been carrying out a pilot project by implementing the ICDP programme with twenty parents divided in 3 groups. Here is a report describing the progress of the pilot project:

Report by ICDP Ghana regarding training of facilitators and families.

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New plans for Brazil

In the second half of 2021, the ICDP chair has started to make plans with an ICDP facilitator on developing a new initiative for Brazil.  The ICDP facilitator Rosilene Thilesen became enthusiastic, inspired and determined to introduce the ICDP programme to social workers and families in Sao Paolo, in her native Brazil, where she has both family and good connections.

Rosilene Thilesen is currently receiving ICDP training online from Nicoletta Armstrong to become an ICDP cerrified trainer. She is also in contact with the ICDP trainer Polyanna Magalhães – Polyanna is also the representative for ICDP in Brazil and will offer background support to Rosilene’s work in the future.

“It is an opportune time to start ICDP in Sao Paolo, as it is a period of great need due to the COVID-19 pandemic. Many families require support, and most of all they need a sensitive approach and warm emotional support, which ICDP can provide so well. I am very excited to be working towards this goal and look forward to the first phase of the project. ” – says Rosilene.

This new ICDP training project in Sao Paolo will start in January 2022. The training will be provided for the local network of social workers linked to the Evangelical church Prova Viva and its pastor Bianca Toledo.

The second phase of the project will be working on introducing the ICDP programme to Rio de Janeiro, in the second half of 2022.

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ICDP trainer report from Dhaka

In July 2021, a meeting of the ICDP Bangladesh core team took place at which ICDP trainer and Project Co-Coordinator Sajeda Boby Akter presented a report in order to update the team on the developments of the ICDP programme in Bangladesh.

ICDP is expanding in the country in partnership with four major partners, namely LAMB, Friends of Basha, Salvation Army and Normisjon. The ICDP project has established an ICDP Support Group comprised of the Country Coordinator, expat volunteer, expat consultant and ICDP staff. Normisjon’s director and finance officer are also members of this group. This group meets online for the purpose of supervision of project activities.

In addition to ICDP facilitators, ICDP in Bangladesh has two trainers and several trainee trainers. Apart from Sajeda Boby Akter, Gerd Eli Haaland is the other ICDP trainer – they have together spearheaded most of the ICDP developments in the country. Since Eli returned to Norway during the summer 2021, she will support the ICDP team via Zoom and she also plans to offer support to the project in person during her visit to Bangladesh that is planned for November 2021. The project counts on the support from two other ICDP consultants as well as the ICDP chair.

During the first half of 2021, a number of planned trainings and follow-up progammes had to be cancelled due to the continuous threat from COVID-19. A Baseline Survey was conducted with10 facilitators, 15 children and 15 mothers from LAMB English Medium school and SIM Bangladesh project. One Facilitator level training was completed with seven participants from LAMB. Two more trainings are supposed to be held by the end of August for the participants from the Dhaka and Dinajpur region. In addition, two persons are receiving training so that they can start to train Normisjon project partners.

A total of 48 facilitations and 43 online meetings online were managed during the pandemic crisis. Supervision and monitoring had to be mostly conducted online. After lockdown/shutdown ICDP team hopes to complete all their planned targets.

The ICDP future implementation will involve five organizations in the first year (2022) and seven in the second year (2023). Each partner organization will nominate one person to represent them in the core team. An online training course to form new trainers is planned for ten facilitators from Normisjon, Lamb and SIM, so that by the end of June 2022, there will be seven ICDP certified trainers in Bangladesh.

The translation of a book about scientific research behind ICDP was finished and proof reading is in process.

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ICDP pedagogical days in Medellin

The Secretariat for Women which is linked to the local government in the city of Medellin, Colombia, organized a series of pedagogical days as part of their traditional yearly celebration of the Day of the Mother and Family. Within the framework of this celebration and in order to  exalt the work of caring for others, ICDP was invited to participate and present its programme.

The pedagogical days were established by the Medellin municipality in 2008, and in the current year 2021, these days aim to provide knowledge and tools to promote awareness about women’s autonomy, in terms of gender and early childhood, making visible the contribution they make to the country’s economy and  development. 

Juliana Zapata Romero from the Secretariat for Women created an alliance with ICDP Colombia and as a result two volunteer professionals, Carolina Montoya and Angélica Díaz, developed and conducted six  pedagogical days on the humanizing content and training in the ICDP programme. This ICDP training was attended by 94 women from three different groups linked to the Welfare Homes Programme of the ICBF institute (Instituto Colombiano de Bienestar Familiar/ICBF is the Colombian Family Welfare Institute) and it took place during the second week in June 2021.

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Stories from Nepal

ICDP trainer Bishwa Pun, coordinates ICDP at Save the Children Nepal.

She shared the following news:

Parenting comes with its fair share of joys and challenges. Navigating parenting during COVID-19 has become even more challenging as parents and children spend an unprecedented amount of time together at home. Most of us have experienced this for ourselves. (Link to #BecomingAParent )

Save the Children has been collaborating with Stories of Nepal https://www.facebook.com/TheStoriesOfNepal in order to bring stories of the parents who have adopted gentler and affirmative parenting techniques inspired by the International Child Development Programme (ICDP).

These stories talk about parents taking care of children with love, enriching interactions, and providing a positive limit for supporting children’s physical, emotional, social, and intellectual development. Our Child Sensitive Social Protection Programme provides technical support to local governments to run parenting programmes for parents and caregivers of the Child Grant beneficiaries. The Child Grant is the Nepal government’s cash transfer programme aiming to reduce malnutrition of children aged below 5 years.

For the next few weeks, we hope that you will be able to read and engage with stories of parents who are supported through our Child Sensitive Social Protection programme.

Stories will be shared on our Facebook page however they will first appear on the Stories of Nepal Page: https://www.facebook.com/savethechildren.np

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ICDP plans for Serdaja and Tashkent

The Happy Start preschool has extended its work from Tashkent to Serdaja, a town about an hour and a half from Tashkent, in Uzbekistan. The new preschool is called Happy Start 3 and the ICDP programme will be integrated as part of the work of its teachers, whereas the children’s parents will also be offered a course in ICDP later in 2021.

In June 2021, two ICDP facilitators, Valentina Tan and Mardalena Brannstrom (on photo above) visited the Serdaja Happy Start 3 preschool in order to attend the end of year celebration for the 6- and 7-year-old pupils. They had a special programme for the children but they also conducted a session about empathy for the parents, inspired by the ICDP programme. The group explored how they show empathy to their children.

“It was really nice and the parents liked it. We had lots of parents sharing their experiences and showing interest to participate in the training. We showed some videos of positive Interaction which we had made at the Happy Start preschool in Tashkent, where we already trained a group of preschool teachers. One of the fathers said that when we start rolling out the ICDP programme for parents in the autumn of this year, he will join and participate in the training.” – says Magdalena.

Photo above is of one of the participant mothers with her two children.

Autumn 2021 will be a busy time for the ICDP facilitators, Magdalena and Valentina. They plan to train parents as well as teachers at Happy Start and in addition, they are preparing a leaflet and a promotional video about the ICDP programme directed at preschool teachers in general. They plan to visit different schools in order to inform them about ICDP and to offer to run a training programme at their school.  

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Introduction of ICDP at a nursery school in Japan

The ICDP programme was introduced in the Higashi Mikata Hoikuen nursery school. The nursery is located in the Hamamatsu (浜松市, Hamamatsu-shi) city in western Shizuoka Prefecture. Link to the nursery website: ひがしみかた保育園 (h-mikata.com).

Hitoshi Maeshima, ICDP trainer and doctor by profession, shared his story about this new ICDP endeavour:

This year (2021), I was contacted by a nursery school director who asked me to become their school doctor. The school in question is the Higashi Mikdat Hoikuen nursery, which opened in April 2021. It can accommodate 120 children and 27 nursery teachers. Several months later, around the 10th of June, the director, the secretary and a nursery teacher visited my clinic and we agreed that I should become their official doctor. I used this opportunity to talk about ICDP; I explained that I went to England three times to participate in ICDP training workshops and afterwards I started to apply the  ICDP programme in Japan. During the ten years of using the ICDP programme I discovered how by following the simple ICDP guidelines the relationship between caregivers and their children can be improved, promoting a balanced development of the child’s emotions and intellect. The director has many years of experience in childcare and immediately expressed interest in the programme and showed her appreciation and understanding about the importance of the ICDP guidelines in childcare.  She confirmed that she would like to apply the ICDP programme in practice in the nursery and also with the nursery teachers. I agreed to help introduce the programme and we made plans for the training. My first visit to the nursery took place on 14th of July 2021 – during this visit I started the training of the nursery teachers ( see photo above).

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Smacking Children makes their behaviour worse, scientist find

Kat Lay Health Editor, Tuesday June 29 2021, The Times

Physical punishment is banned in Scotland and Wales but still permitted in England and Northern Ireland

Smacking children does not make them better behaved and is harmful, says a review of two decades of research.

It found that children subjected to physical punishment displayed increased behavioural problems, and that it was likely that smacking had caused the increase. This was true regardless of the child’s sex or ethnicity, or the family’s overall parenting style.

Studies did not find any improvement in children’s attention, cognitive abilities, relationships with others, reactivity to stress, social behaviour or social competence if they had been physically punished.

Experts said it was time for England and Northern Ireland to follow Scotland, Wales and 62 other countries by introducing an outright ban on physical punishment of children.

The Royal College of Paediatrics and Child Health and the National Society for the Prevention of Cruelty to Children are among groups that back a ban.

The paper’s lead author, Dr Anja Heilmann of the department of epidemiology and public health at University College London, said: “Physical punishment is ineffective and harmful, and has no benefits for children and their families. This could not be clearer from the evidence we present.”

The review, led by researchers at UCL and published in The Lancet, looked at 69 studies following children over time. The review searched for links between physical punishment and outcomes, including children’s behaviour, attention and relationships.

Heilmann said: “We see a definitive link between physical punishment and behavioural problems such as aggression and antisocial behaviour. Physical punishment consistently predicts increases in these types of behavioural difficulties. Even more worrying are findings that children who are the recipients of physical punishment are at increased risk of being subjected to more severe levels of violence.”

She said that physical punishment violated children’s rights and that countries should honour obligations under the United Nations Convention on the Rights of the Child, which is clear that children should have the same protection against violence as adults.

“This means England and Northern Ireland should follow the example of Scotland and Wales and give children equal protection in law,” she said.

In England and Northern Ireland parents are not allowed to smack children unless it amounts to “reasonable punishment”, a measure that takes into account how old the child is and the force used. Any smack that leaves a mark such as a bruise or graze could mean a prosecution for assault.

Scotland and Wales removed the defence of reasonable punishment.

Professor Elizabeth Gershoff of the University of Texas at Austin, a senior author of the review, said: “Our research found clear and compelling evidence that physical punishment does not improve children’s behaviour but makes it worse.”

The studies looked at smacking, spanking and slapping. Researchers excluded severe forms of physical punishment such as hitting a child with an object, hitting them on the face or head, or washing out their mouths with soap.

Joanna Barrett, NSPCC associate head of policy, said: “It cannot be right that in 2021 children are the only group in society that it is legally acceptable to assault in England. The case for reform is beyond doubt.” She said Westminster was “behind the curve” and needed to give children in England the same protection as elsewhere in the UK.

THE LANCET: 

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(21)00582-1.pdf