Realistic workloads, supportive managers, fairness, and a bit of recognition for good work: are things like this too much to ask for employees? I’ve always been interested in work psychology, even before I knew it was possible to study it; after all, who wouldn’t be interested in making work better and less ‘stressful’? Despite recommendations from the National Institute for Health and Care Excellence that preventative interventions (strategies that target potentially stressful working conditions rather than employees’ ability to cope with them) should be prioritised, there is relatively little research of this type. Many years later, and having just completed my PhD looking at how employers might improve work for employees, and I’m probably a bit more realistic about how challenging that can be!
Who wouldn’t be interested in making work better and less ‘stressful’?
Can we make work better?
I was initially surprised when I started my research that the evidence for methods of improving work for employees and supporting their psychological health and well-being was rather mixed; some studies reported reasonable results, but many seemed to suggest they didn’t do any good at all. I soon found that this is in part because preventative approaches are usually very complex and involve lots of people and decisions, as well as relying on effective implementation. On top of that, there are likely to be many contextual and practical factors that can influence the process: unexpected events, organisational changes, limited resources, and even cynical employees, have the potential to derail even the most careful plans. So my initial focus on whether or not preventative approaches were effective quickly shifted to look at why even the most well-intentioned efforts can lead to disappointing results. My research aimed to add to our understanding of the factors that can derail them and learn lessons that can help with future efforts.
It’s certainly not all bad news, because there are things that employers can do to improve things, they just need to be aware of some of the pitfalls and get the planning and implementation right. For example, ensuring that employees have a say in identifying what aspects of the workplace should be prioritised, rather than senior managers deciding what’s best for them. Then there are seemingly obvious things – that are often forgotten – which can make a huge difference: communication, and follow-up. If you’re going to start a project to improve your workplace, it is vital to keep employees up to date on plans and progress, and that any promises are followed-up – fail to do that and employees might see yet another ‘well-being initiative’ introduced with great fanfare before it silently disappears under layers of new priorities. Is it any wonder employees might be cynical at times? There’s no one-size-fits-all solution, it’s incredibly complex, but thankfully the evidence suggests there are things that can be done.
Research in the ‘real world’
It can also be challenging to conduct research in organisations – although well worth doing – because, let’s face it, they are not there for the benefit of researchers. They naturally have their own priorities. For example, in my research, the organisation I worked with were supportive of my work and very keen to take action to improve things for their employees. However, because they were severely hampered by substantial cuts to their budget during my PhD project it meant large-scale restructuring was required, making it very difficult for them to fulfil all their original plans. As a researcher this was hugely frustrating, particularly as I had to complete my work within a set timescale, but it was obvious the organisation was being stretched and doing their best under very difficult circumstances. As a result, things didn’t happen when they were supposed to, or didn’t happen at all in some cases; welcome to the ‘real’ world of research! However, it taught me so much and it is probably a better piece of work because of some of these challenges, to be honest. There were also some positive outcomes (and plenty of lessons) for the organisation to use as they continue with their work to support employee well-being. And, as I graduated at The Lowry on the 18th July 2017, and having progressed to a lecturing post at Staffordshire University, I was able to look back with so much pride and wonder how on earth I got there!
The organisation was very keen to take action to improve things for their employees
Why the Lindsey Dugdill award is so special
The graduation was made all the more special by receiving the Professor Lindsey Dugdill award for my PhD thesis. Knowing how much Lindsey meant to her many friends at Salford, it’s quite hard to adequately express how much more this award means as a result. I was fortunate to meet Lindsey during my PhD, but I’d like to finish with an experience that took place several years previously when I submitted a proposal for a different PhD to the university. I had lots and lots of questions, and I was advised to contact Lindsey as the proposal was in her field. She was incredibly generous with her time and advice – spending her own time talking through my ideas and giving feedback. It is worth emphasising that this is despite Lindsey not being involved in the project, and had never even met me before – I was just a potential student with an interest in Lindsey’s field of expertise (or one of them!). It would be a better story if my application had been successful but circumstances at the university meant the funding was unavailable – Lindsey still got in touch with some encouragement. I cannot tell you how much I appreciated the time and trouble she took to help someone she didn’t even know, and I was delighted to be able to tell her in person when I actually joined the University a couple of years ago. Having met Lindsey, and having worked alongside so many of her close friends in Public Health and Psychology, I know this sort of support and encouragement was not a one off, which says it all really. A lovely person.
John Hudson receives his award from Dean of Health Sciences Kay Hack
If you’re interested in studying MSc Public Health at the University of Salford, join us on Facebook on Wednesday 12 July to see our live interview with the Programme Leads and Admissions Tutor from our MSc Public Health course. Dr Anna Cooper and Dr Margaret Coffey will answer questions about the course, the modules you will study and how it could help with your career.
For a limited time we are also offering two students the opportunity to receive a 50% reduction in the course fees for the MSc Public Health (closing date Monday 7th August). You can find out more about this on our website
The Facebook Live session starts at 3.00pm (GMT) on Wednesday 12 July, simply join our Facebook pageand watch. If you aren’t able to join us, the session will be recorded for you to watch at a time that suits you.
James is a researcher with experience using both qualitative and quantitative research methods and an understanding of the social determinants of health, particularly the role of work and how the psychosocial work environment impacts on employees’ mental and physical health and wellbeing.
His PhD explored the impact of working in a social enterprise on employee health and wellbeing through the lens of ‘good’ work, culminating in the development of an empirically informed conceptual model that illustrates how working in a social enterprise may lead to improved health and wellbeing outcomes.
Following the completion of his PhD, he secured the role of Researcher at the Work Foundation, a think-tank based in London, which is dedicated to promoting the concept of ‘good’ work and its benefits for employees and employers alike. Drawing on the knowledge and research skills acquired through his PhD, he is, primarily, focused on developing evidence-based policy recommendations relating to the health and wellbeing at work agenda. Recent projects include: overseeing the development of an ‘early intervention toolkit’ designed to make the case, using the example of musculoskeletal conditions, for the implementation of early intervention services across the European Union; and a service evaluation of a newly-formed early intervention clinic, based in Leeds, which aims to get people signed-off work with a musculoskeletal condition back to work as soon as possible. To read more about this see – http://earlyinterventiontoolkit.com
James was awarded a BA (Hons) in History and Politics from Keele University in 2008 and an MA in Political Economy from the University of Manchester in 2010. His MA dissertation explored the relationship between income inequality and health, which focused his interest on the areas of public health and health inequalities. Prior to starting a PhD in Public Health at the University of Salford, James conducted a literature review for the university in 2011 on the impact of working for a social enterprise on employee health and wellbeing – this project served as a platform for his PhD research.
His PhD explored the experience of working for a social enterprise – an organisation with social aims that uses profits for that purpose – and whether these organisations provide good quality work conducive to employee health and wellbeing. Using a mixed-methods approach, comprising (i) a mapping study that identified social enterprises active in the Greater Manchester region, (ii) semi-structured qualitative interviews, and (iii) a survey completed by social enterprise employees across the region, the research finds that social enterprises provide good quality work environments conducive to employee health and wellbeing – furthermore, when compared to a national sample of individuals working in non-social enterprise organisations, social enterprise employees report significantly higher levels of control over their work, support at work, job satisfaction and job-related wellbeing.
The Teams4U motto is ‘real people making a real difference’, and one of the aims of the programme is to give the volunteers a life-changing experience. Some of the volunteers already knew each other and have done this trip before; others, like me, are new. It is amazing how quickly everyone has bonded and started to work as a real team. See my previous post for more information about the interventions. The games that we play with the children during the morning continue to be enormous fun, both for the volunteers and the children. The ‘Develop with dignity’ element has been refined and developed as we go along. The team members that deliver this element include a doctor, a nurse, a teacher as well as me. The final team member is a social worker from the local area. Fortuitously between us we have a combination of relevant skills, knowledge and experience.
Training the teachers
On day three, our usual format of our day was to be extended–after the main school programme, we went to a different school where we delivered a training session to all the senior female Primary 6 teachers in the district. The Head of Education in the district is a big supporter of the programme, and has strongly encouraged the teachers to come and facilitated their journey to the school where the training is to take place. P6 children are the target of the intervention–they can range in age from 12 up to 17 (because those who do not pass their exams do not move up to the next class). Whilst this was going on, other Team4U members did games, stories and face painting with the school children.
In the classroom with the teachers
For the train the trainer session we decided to give an overview of our aims and then present the same material as we present to the children to the teachers, so that they could see exactly how we delivered the intervention. It seemed to go well and was enjoyable from my perspective. At the end we asked the teachers for their views and feedback. We had a long discussion about the other contexts of the child’s life, and how for some children there is a lack of encouragement to go to school. Some are given no money to buy the necessary equipment, many have no food for the middle of the day. Teachers commented that some children were spending the time away from school, with neither the school nor the parents knowing where they are. This potentially puts girls in situations where they are at risk of rape. Teachers often saw their school girls alone after dark–again this is risky. The teachers felt that we needed an intervention for parents, a suggestion that we agreed to take back for consideration. We had a long discussion about whether the intervention was aimed at the right age, and while there was a feeling that some children at that age were innocent (and it was tempting to ask why they needed to know about sex and condoms), there was general acceptance that children of this age can and do get pregnant. We heard a shocking story of a 9 year old girl who had given birth recently.
On the way home we stopped and visited one of the little mud hut settlements in a very rural area. A father showed us around. He allowed us to see into each hut: the smallest was where there was a simple fireplace made of stones on the floor. The cook pot rests upon stones, and the smoke is chokingly thick. Three children were in one of the other huts and the father had his own hut. His wife and baby slept in a different hut.
The Games in the morning were great–the smile and excitement on the girls’ faces when they had a ball in their hands was just a picture, and it is so hard to put into words the satisfaction that we get from doing this. It seems to be reciprocated! The headmaster of today’s school made a special effort to tell us how important this visit was for him and the school, and a senior teacher told us that they will be adopting the games to play with the children every Monday from now on. I loved the pink uniforms in this school!
In this school many children received a school lunch, for which the parents have to make a modest payment. We learned that in some schools parents do not pay for lunches, and nor do they send food from home. School days are from 8am until 5pm in Uganda, which is a long time to go without food.
Other Team activities proceded as usual including the HIV counselling and testing. We have tested hundreds of people this week, both school children and their parents, and it is really good to be able to report that we have found very few people with HIV. About 7% of adults are estimated to be living with HIV in Uganda. Substantial progress has been made with testing and treating HIV, so that between the years of 2005 and 2013 the number of Aids-related deaths dropped by 19%.
Taking a small drop of blood for HIV testing
In the afternoon were were honoured with a visit from Vaughan Gethin (Cabinet Secretary for Health, Wellbeing and Sport, Welsh Government) and Jon Townley (from Wales for Africa). They were able to see Teams4U at their best, with an action-packed afternoon of HIV/AIDS & TB testing, Reproductive & Sexual Health Education, our Develop with Dignity programme; and of course, the smiles of hundreds of children having enormous fun with our enthusiastic volunteers!
L to R: Ben Omoding (T4U), Vaughan Gething (Welsh Gov), Penny Cook, Jon Townley (Wales for Africa), Ciara O’Donnell (volunteer), Father Deogratias Tembo, Sarah Sankey (volunteer), Dave Cooke (T4U founder)
I have been given the amazing opportunity to take part in some practical public health interventions in rural Uganda, with Teams4U, an organisation with many years’ experience of work with poverty. My aim is to get some insight so that I can plan trips in the future for University of Salford’s public health students.
Our journey here from Kampala had taken us 5 hours, during which we had glimpsed some of the poverty that is a reality of everyday life in rural Uganda: the roads were dirt tracks; people were pumping and carrying their water; children were dressed in rags; homes were shacks with little in the way of a decent roof.
Basic living conditions
Day one of the field-work happens to be Sunday. On Saturday night, the leader of our team of volunteers discovered that we were expected to be at a local Church for the 7am service. Thus, at 5.45am we were up, ready to set off at 6.30am. We learned that no practical intervention in the community can happen around here without the involvement of the church–it is the hub of the community, and it serves as a means to spread practical messages to the local people. The priest will be working with us all week in the various schools that we will be visiting. The church service lasted 2 hours, during which we had to get up at the front and introduce ourselves to a few hundred people. It was through the church that the community had been told about our visit, and invited to one of the local schools for a day of fun and activities.
Going to church
By 10am we were at the school. Being a Sunday, we were uncertain of how many people would turn up. In a very well organised operation we started to play team games with the children. There were hundreds. We did the games with batches of 8 children (for each of the 14 team members). We did this 3 times–first with some smaller boys (aged 5 to 12), then with girls (9-14) and then with some older boys (10-16). The games all involved running up and down, sometimes with a ball. They varied in each set, depending on age and gender; for example, games were more complicated for the older ones, and we had been warned that girls often did not own underwear, so we did not do any games involving somersaults. We were on the field without a break for nearly two hours, in the heat: absolutely exhausting but really good fun.
The games served as a draw to the local community, and while the fun was going on, adults were being tested for HIV, and if needed, able to obtain antiviral drugs straight away. We now also had the opportunity to do some basic health interventions with the children, after the games were over.
‘Develop with dignity’ intervention
Sanitation is very poor at this school. There is no water and open pit latrines. Once the girls have started their monthly menstrual periods, the lack of facilities, and lack of any means to manage their periods causes them to leave school for a few days each month. Girls typically manage their period using rags to absorb the blood. Fear of soiling clothing and embarrassment keep them away from school, causing them to miss up to quarter of their education. The aim of our intervention was to explain some basic facts about puberty, sex and management of menstruation. The highlight of the intervention is when we supply the girls with their own pack of re-usable, washable ‘Afripads’, and knickers to hold the pads in place. We also had a sack of donated bras, which the girls were absolutely delighted with!
The girls were very pleased with their washable pads and new knickers
As we left the school, children squabbled over our empty water bottles, which appeared to be a much sought after prize, reminding us how much we have and how much we take for granted. When we saw small groups of children we were able hand out little toys and gifts.
Five early career researchers from the Directorate of Psychology and Public Health won the runners up prize in this year’s Vice-Chancellor’s Research Excellence Awards, including two Public Health lecturers, Dr Anna Cooper and Alex Clarke-Cornwell.
Dr Clare Allely, Robert Bendall, Alex Clarke-Cornwell, Dr Anna Cooper and Dr Jo Meredith, contribute to three of the research programmes within the School of Health Sciences: Applied Psychology: Social, Physical and Technology Enabled Environments; Equity, Health and Wellbeing; and, Measurement and Quantification of Physical Behaviour.
The ‘Fabulous Five’ would like to thank Dr Sarah Norgate for the nomination; as part of the nomination Sarah wrote “People make a research environment, and our early career researchers (ECRs) are our lifeblood”. We are grateful for her continued support, the support we receive within the Directorate and also from the School as we continue to develop as researchers.
Four of the ‘Fabulous Five’ picked up their award from Dr Jo Cresswell as part of the University Day celebrations on 8th June 2016. Dr Clare Allely, one of the Fabulous Five, could not attend because she was in Sweden on a research visit at the Gillberg Neuropsychiatry Centre at the University of Gothenburg.
Left to right: Dr Jo Meredith, Dr Anna Cooper, Dr Sarah Norgate, Alex Clarke-Cornwell, Robert Bendall
As part of their research, the ‘Fabulous Five’ all work with external stakeholders/users in psychology, health and health-related areas. The aim of many of their projects is to be interdisciplinary, both within and outside the University. The short sections below aim to provide brief details about each of the five early career researchers:
Dr Clare Allely is an affiliate member of the Gillberg Neuropsychiatry Centre (GNC) at Gothenburg University in Sweden. She is currently collaborating with colleagues at the GNC on a number of papers and projects including one looking at cholesterol metabolism and steroid abnormalities of various kinds (cortisol, testosterone, oestrogen, vitamin D) in autism spectrum disorder (ASD) and another looking at immunology and ASD. She is also working on projects with colleagues in the UK looking at ASD in the criminal justice system. Specifically, one looking at the experience of individuals with ASD in the prison environment and another looking at the experience of defendants with ASD as well as how they are perceived by judges and juries (e.g., whether a diagnosis of ASD is considered to be a mitigating and aggravating factor in sentencing and to what extent an ASD diagnosis impacts on criminal responsibility, criminal intent, etc.).
Robert Bendall’s research initially focused on the interactions between the arousal system and the circadian system. This work investigated the impact of circadian and photic influences on the neuropeptide orexin and included research positions at the Department of Pharmacology, University of Cambridge and the Faculty of Life Sciences, University of Manchester. Recently Robert’s research has focussed on the cognitive sciences – both cognitive psychology and cognitive neuroscience. His main interests are how emotion influences aspects of cognition (e.g. visual attention) as well as the role of the prefrontal cortex during emotion-cognition interactions. Robert uses both neuroscientific and behavioural techniques in his research including the novel neuroimaging technique functional near-infrared spectroscopy. His recent research has been presented at the Annual International Conference on Cognitive and Behavioural Psychology and published in the journal Frontiers in Psychology. http://dx.doi.org/10.3389/fpsyg.2015.01592
Alex Clarke-Cornwell’s research interests include the measurement and quantification of sedentary behaviour, physical activity and workplace health using the activPAL™ and ActiGraph activity monitors; she is currently writing up her PhD. Alex’s research on the measurement of sedentary behaviour from accelerometers has recently been presented at international conferences in Limerick and Brisbane. She is also currently working with European colleagues as part of the consortium or the Determinants of Diet and Physical Activity Knowledge Hub, on sedentary time and physical activity surveillance in four European countries. Alex and Dr Anna Cooper (editor) have worked together on a book chapter around the impact of office design and activity in a book of blogs entitled Dialogues of Sustainable Urbanisation: Social science research and transitions to urban contexts (researchdirect.uws.edu.au/islandora/object/uws:30908). Alex has recently been awarded £17,607 from the University of Salford’s Research Capital Investment Fund, in order to purchase physical activity behaviour monitors for future research projects.
Dr Anna Cooper’s current research focuses on behaviour change in primary school children; the role of digital technology in research with primary school children; and NHS Health Checks in regards to the health check journey. The outputs from Anna’s PhD contributed to the outputs of the World Health Organisation (WHO) Collaborating Centre for Oral Health Research in Deprived Communities. In 2015 Anna helped to co-edit a Book of Blogs with Dr Jenna Condie (Dialogues of sustainable urbanisation: Social science research and transitions to urban contexts), which is now freely available as an e-book. Since joining the University Anna has been successful in a number of internal and external funding projects both as PI and CoA, presenting at conferences, and also the production of reports for external bodies and peer-reviewed journal articles. Anna was also returned in the 2013 REF as an Early Career member of staff. One of Anna’s current projects is around the development and testing of an Application (Digitising Children’s Data Collection (DCDC) for Health Project) designed to support the collection of data with children in a variety of settings and a collaborative research project with Liverpool John Moores University.
Dr Jo Meredith researches online communication and interaction, and is particularly interested in developing innovative methods for collecting and analysing online data. She uses methods such as conversation analysis and discursive psychology to analyse a range of online data. Since joining the University of Salford in April 2015, Jo has had a paper published in a peer-reviewed journal on the development of a transcription system for screen-capture data. She has also contributed chapters on the collection and analysis of online data to two prestigious qualitative methods textbooks. She is currently working with colleagues from radiography on the WoMMeN project. She is also collaborating with colleagues from the University of Manchester and Keele University on a number of projects and papers, including the analysis of psychotherapy using conversation analysis, the analysis of tweets around #dyingmatters and the analysis of police 999 calls. Jo is currently organising an international conference, with the media psychology team, on the micro-analysis of online data.
A collaborative research project looks into health benefits of green infrastructure
The University of Salford is partnering with the University of Manchester and Manchester Metropolitan University on a £700,000 research project that looks into the benefits and values of green infrastructure on an ageing population.
Green infrastructure (GI), a term used in reference to green and blue spaces (areas of grass, and canals or waterways), has direct and indirect influences on human health and wellbeing. However access to such health and wellbeing benefits isn’t shared equally amongst the population, particularly for those based in urban areas. Additionally with people aged 65 and over more susceptible to environmental stressors, this age group in particular may also be the least likely to benefit from GI.
The ‘Green Infrastructure and the Health and Wellbeing Influences on an Ageing Population’ project (GHIA), which has been funded under the Valuing Nature Programme by NERC, ESRC and AHRC, intends to look into the relative benefits and stressors of GI and how GI should be valued in the context of the health and wellbeing of older people. This value might include the monetary value of preventing ill-health but also broader interpretations, such as the historical, heritage or wildlife value which influences whether older people actively seek experiences in green and blue spaces
The project will involve collaboration with Greater Manchester health organisations that specialise in improving the health and wellbeing of older people and the design and management of GI across GM – an example of the health ICZ. These organisations will include GM’s Red Rose Forest, Public Health Manchester, Manchester City Council and Manchester Arts and Galleries Partnership.
Penny Cook will be working with Philip James from the School of Environment and Life Sciences on Salford’s contribution to the GHIA project. Salford’s role will be to look for relationships between health outcomes, using hospital data, and the occurrence of green infrastructure across space. Researchers will work with the Salford Institute for Dementia to involve people with early-onset dementia to understand how they appreciate the urban landscape through different sensory perceptions.
On the 27th January over 200 people congregated at the University of Salford for the MECC conference run by Health Education England with support from Public Health England. The conference started off with a welcome and a bit of a dance (as we are told is tradition in some other conferences), but it proved to set the scene for what was an informative but also welcoming event. Sir Stephen Moss in his forward outlines MECC as ‘enables the systematic delivery of consistent and simple lifestyle advice, helping people to make positive changes that will improve their health and wellbeing.’
To start there was a bit of a race through some of the evidence, policy and local level examples of MECC. Shirley Cramer outlined the definition of the wider workforce and next steps, but also the importance of the workers’ situation in the community that they serve, while Sir Stephen Moss talked about changing the culture to embed MECC into everyday practice. Dr Charles Alessi reiterated the important message of ‘don’t let there be more missed opportunities when we could be doing something’. Dr Paul Chadwick reminded us that we need to reflect on our own behaviour and motivations as health practitioners, since MECC relies on us having the confidence to raise sensitive issues. A challenge of MECC is gaining consistent evaluation to explore the impact due to the diverse nature and content on the brief interventions; what is clear is that it can impact communities – as shown by Professor Kate Arden in Wigan.
The keynote session was followed with presentations on examples of tools kits, those produced at both a local and national level. There were examples provided by Claire Cheminade, the Public Health Wider Workforce lead in Wessex and Sally James the Public Health Workforce Specialist for the west midlands, which showed how MECC is embedded across all areas right from training of the new workforce. Nigel Smith and Mandy Harling used the session to help launch the ‘MECC: quality checklist for training resources’ and ‘MECC: implementation guide’, developed by Public Health England and Health Education England.
On breaking out for the session before and after lunch there was a chance to hear about more examples, but also look at settings and behaviour change, to help with understanding the theory and practice. During lunch there was an opportunity to take a seat in the MECC cinema where a short film was shown which illustrated different people who have undertaken MECC training and put it into practice successfully. In the afternoon, one of the workshops, titled ‘NICE Guidelines and Behaviour Change Approaches’ was led by Dr Paul Chadwick. This included an interesting lecture and some useful group work. It enabled attendees to consider how their own behaviour and beliefs could impact on the implementation of MECC in their setting.
As part of @SalfordPH involvement throughout the day, eight of the MSc public health students (as pictured below), were on hand to support the event staff and delegates with their day. Additionally Penny and Anna chaired the initial sessions around “what the system is saying about MECC and why it is important” and “Implementing MECC”.
Volunteer MSc Students
This also provided our students with the chance to hear from some leading experts in this area and be able to hear examples of how what we talk about in lectures relates to worked examples. Our thanks go to each of the students for taking the time to support the day.
Although MECC is going through a difficult time in many local areas in relation to funding, it is clear from this day there are many people who carry out the premise of MECC in their everyday working and it is something we can all be more aware of doing.
Alcohol and pregnancy are a dangerous mix. The physical effects of alcohol on a developing foetus are well known and potentially devastating. It is known to impact physical development – causing stunted growth, craniofacial abnormalities, reduced head and brain size, sight and hearing problems, and limb and organ defects. Foetal alcohol exposure causes problems in cognitive and psychological functions such as learning, speech and language, memory, attention, inhibition, social cognition, planning, motor skills, attachment, and behaviour. The name given to the range of outcomes caused by prenatal exposure to alcohol is foetal alcohol spectrum disorder (FASD).
Double jeopardy: adding childhood neglect
Children who are exposed to alcohol prenatally are also at risk of what has been described as a case of double jeopardy: they are much more likely to experience adverse environmental experiences during the first months and years of development. These experiences can include neglect of daily care, abandonment, and emotional, sexual and physical abuse. The effects of such experiences can compound the effects of prenatal alcohol exposure, as they impact development in a similar way. Maltreatment such as neglect and abuse, especially if this is prolonged and lasts beyond the first six months of life, can have a significant impact on attachment, cognitive, psychological and social development and even physical growth.
By D Sharon Pruitt [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
To make matters worse, children who suffer maltreatment during early childhood miss out on normal attachment development. This can seriously impact their own parenting skills as adults, and lead to dysfunctional attachment behaviour if and when they become parents themselves. Those who suffer from foetal alcohol spectrum disorders are more likely to develop alcohol misuse issues, and are more likely to be involved in risky sexual behaviours. This can increase the risk of unplanned pregnancies, and so the cycle can be self-perpetuating.
Forthcoming research on FASD and neglect
The effects of a) prenatal alcohol exposure and b) early childhood maltreatment are well documented, but there is a surprising lack of research into their combined effects. My research will address this gap, first of all by conducting a systematic review into all published studies into the combined effects of prenatal alcohol exposure and early childhood maltreatment. I am currently writing up the results of this review for publication. It found only six articles on the subject, four of which used experimental methods to assess the impact of both issues. The main finding of these four articles is that speech and language deficits are more likely in children with both issues, compared to children with one or the other.
There are several other aspects of cognitive development that are yet to be addressed in this population, and so the next stage of my research will assess deficits in social cognition and executive function – two of the most prominent areas of deficit in children with foetal alcohol spectrum disorders and in children with a history of maltreatment. I aim to study these deficits using a combination of caregiver reports and behavioural tasks conducted in a lab at the University of Salford. I am also planning to incorporate a measure of brain activity using functional near infra-red spectroscopy (fNIRS) – a non-invasive technology that uses light waves on the near infra-red spectrum to measure blood movement in the cerebral cortex – the outer layer of the brain. This technology is especially useful in samples of young children, and this will be the first time fNIRS will have been used in this population.
I am currently in the process of applying for ethical approval, and hope to begin data collection soon.
The new Department of Health guideline on alcohol says that there is no safe alcohol limit for pregnant women. Alcohol should simply be avoided.
Alcohol exposure during pregnancy can cause damage to the body and brain of the baby, causing a range of lifelong problems. These problems are grouped under the umbrella term “foetal alcohol spectrum disorders” (FASD). The most recognised form of FASD is foetal alcohol syndrome (FAS). People with FAS have distinctive facial features, are small for their age and have problems with learning.
The exact number of drinks a woman can have before harming her baby is unknown (and is likely to vary from woman to woman), so most countries, including Canada, Australia and the USA, have taken a conservative approach and recommended that no alcohol is the safest option. This new guideline now brings the UK in line with those and many other countries.
Recent research has revealed a large number of problems experienced by people with FASD. Around half of all people with FASD have attention-deficit hyperactivity disorders (ADHD), 62% have vision impairment (a rate more than 30 times higher than the general population), 58% have hearing problems (more than 100 times higher than the general population), 83% have speech and language delays and 91% suffer from impulsivity and inappropriate behaviour.
Each person with FASD may have some or all of these problems, and each person may have these problems from a mild to severe degree.
May be as prevalent as autism
We don’t know how many people have FASD in the UK, but based on a large review of data from other countries, it’s estimated that it may affect as much as 2% of the population. This would put FASD on a par with well-recognised developmental disorders such as autism spectrum disorder. In fact, a significant proportion of children currently diagnosed with ADHD or autism may have undiagnosed FASD as an underlying cause of their learning problem.
One problem with recognising the extent of the hidden epidemic is that FASD is significantly under reported. For example, out of a search of five years’ worth of outpatient hospital data in England, no cases of FASD were recorded. The researchers also looked at hospital admission data, expecting to find that areas with higher levels of alcohol-related illness in young women (such as in the north-west and north-east of England) would also have higher levels of FASD. This was not the case, suggesting that either FASD is not diagnosed, or it is diagnosed but not routinely recorded in hospital data.
A difficult diagnosis
Diagnosis is dogged by difficulties, including the fact that many healthcare professionals don’t know much about FASD and specialist training is needed to make a diagnosis. A diagnosis has to be made by a team of different professionals following a thorough assessment of the child that involves a physical examination, intelligence tests, occupational and physical therapy, and psychological, speech and neurological evaluations, as well as genetic tests to rule out genetic causes of problems.
Another difficulty with getting a diagnosis is that the behavioural and developmental problems that are signs of FASD may not emerge until a child is at primary school, by which time vital evidence about whether the birth mother drank during pregnancy may be missing. This information is crucial to make a diagnosis if the distinctive facial features seen in full-blown FAS are not present. Another difficulty is that people with FASD usually have other disorders (such as ADHD or autism spectrum disorder), making it difficult to isolate FASD.
To get the true number of people with FASD, it would be necessary to screen a whole group of the general population. This has been done in other countries, such as Italy, the USA and Canada, but there has been no such study in the UK.
Action at last
Last summer, a cross-party group of MPs took an interest in FASD, forming the All Party Parliamentary Group (APPG) for FASD. In its first report, released in December 2015, it made a number of recommendations including the call for a public health campaign to raise awareness of FASD. The APPG also called for “urgent consideration to be given by the government into commissioning a UK-wide study to ascertain the prevalence of FASD”. This would be a vital first step in uncovering the true extent of FASD.
Why is such recognition important? The consequences of unrecognised and unsupported FASD are wide, including addiction, mental health problems and disengagement with education. Children can appear bright and talkative and can appear to learn, but often forget what they have learned by the following day. They can also behave inappropriately. Because the cause of their difficult behaviour is not understood, they frustrate teachers and are often labelled as “naughty”. Sadly, another tragic consequence of unrecognised FASD, is that many go on to find themselves in trouble with the law.
Early detection and intervention are important because with the right support, there is growing evidence that people with FASD can live and work independently. But, until the UK catches up with the USA, Canada and Italy, many people with FASD will continue to suffer in silence.