ISSUE 65 Spring/Summer 2012

BridgeBRIDGING KNOWLEDGE• BRIDGING DISCIPLINES • BRIDGING BARRIERS

ACAMH Emanuel Miller National Conference: Speech, Language, Communication and Child and Adolescent Mental Health

This issue of The Bridge highlightsand reports on this year’s EmanuelMiller conference – which wassuccessful and well attended,particularly by our members from

disciplines concerned with education. Thecombination of clinical, research and educationalspeakers and delegates was a fine example ofwhat this Association is for. At our AGM I will bewelcoming Professor Kathy Silva as the nextChair of the Association, and I am sure that herappointment will be another step in theinvolvement of all the disciplines connected withyoung people’s mental health. The Jack TizardConference on 22 June will be highlighting socialaspects, with a focus on inequalities andadversities that challenge children’s development.Everything we are doing - from our publicationsto our branch meetings, national conferences,master classes, special interest groups,encouragement to young researchers, and ourcurrent development of a really useful website -is designed to help our members to help childrenbetter. And, of course, monthly and quarterlyissues of our journals, JCPP and CAMH, alwaystargeted, always expert, always considered, alwaysbalanced. Your continuing support for theAssociation will be continually, and fittingly,rewarded; new ideas, thoughts and proposalsalways welcome!

CHAIR’S WELCOME

the

Highlights: recognised for its academic quality, relevance and international reputation of its presenters, this

conference was designed to build on 2011’s Year of Communication and re-inforced both the importance for

children and young people to develop good c-ommunication skills as well as the necessity to strengthen

provision for those with speech, language and communication problems. Presenters were without exception

passionate about their particular areas of expertise and keen to continue their excellent work – hugely

encouraging at a time of government austerity – measure cutbacks.

Opening Addressee: the Rt Hon John Bercow MP, Speaker of the House of Commons,

began with a statement that would be a resounding theme throughout the day:

communication is crucial! Central to his 2008 Bercow Re port – still as relevant today as then

– he highlighted other key themes which remain vital to providing support for those with

speech and language needs, namely the importance of early identification and subsequent

intervention, the need for a long-term view of ‘spend to save’, and the need requirement for

extra surveillance during the transition to secondary school when provision can sometimes

fall by the wayside. The addressee’s powerful concluding refrain, that in today’s financially-strained climate it is

doubly important to protect the delivery of care for those with speech, language and communication

difficulties, inspired each attendee to speak up for those who cannot speak up for themselves.

Bercow Report: (Bercow Review of Services for Children and Young People (0-19) with Speech, Language and

Communication Needs) was published in July 2008 as the result of an independent cross-government review

chaired by John Bercow, MP and RCSLT vice-president. It was the culmination of a major consultation process

over ten months, gathering evidence and analysis, and including a questionnaire which received over 2,000

responses, meetings with groups of parents and visits to children's centres, nurseries, primary and secondary

schools across England. It was commissioned as a response to the current arbitrary access to services for

children and young people with speech, language and communication needs and the failure to meet their

needs, despite the hard work and commitment of many professionals in health and children’s services. The

report attempts to chart a course to enable speech, language and communication services to improve

educational outcomes, promote public health, tackle anti-social behaviour and bolster the skills of the

workforce. It makes recommendations to Government about the steps it should take to transform provision

for and the experiences of children and young people with speech, language and communication needs and

their families to facilitate improved educational outcomes, promote public health, tackle anti-social behaviour

and bolster the skills of the workforce.

Five key themes were identified – issues that need to be addressed for real change and improvement to occur

– linked with which are a number of recommendations:

• communication is crucial;

• early identification and intervention are essential;

• a continuum of services designed around the family is needed;

• joint working is critical; and

• the current system is characterised by high variability and a lack of equity.

For a copy of the complete report, please see http://www.johnbercow.co.uk/pdf/Bercow_Report_Final.pdf

Emanuel Miller Memorial Lecturer, Professor Dorothy Bishop, Professor of

Neurodevelopmental Psychology, University of Oxford, based her presentation on a premise

that Emanuel Miller would assuredly have fully supported, namely that behavioural data

should be at the forefront of language intervention studies. With research increasingly

focusing on measuring effects in the brain, often in an attempt to add authority to

interventions, particularly commercial ones which frequently publish colourful images of

brains pre- and post-treatment and publish these alongside pseudoscientific explanations to

enhance the credibility of what might that would otherwise be judged as poor scientific accounts. Studies show

that such strategies can enhance their credibility, even among scientists! Professor Bishop explained the

importance of adequate control groups to confirm whether an intervention has been effective at the

behavioural level, only then being able to be applied to find out what is going on in the brain. However, more

behavioural studies are required on the process of language learning, the presenter’s own current work adding

valuably to this resource. A couple of future directions of research, such as transcranial direct-current

This edition of The Bridge presentsa healthy balance of international,national and local content - fromthe National Emanuel MillerConference to the North East

Branch’s Dyadic Developmental Psychotherapy,to a summary of work carried out by an ACAMHmember in India. A list of forthcoming ACAMHevents features prominently - please take a lookand see if any of them capture your interest andaddress your CPD needs. Some conferences arenow so popular that early application is your onlyguarantee of a place. There are currentlydiscussions underway to develop The Bridge intothe kind of format you would find most helpful,perhaps to expand into more of a magazineformat. However, it’s your resource, so please doshare your views and suggestions:bridge@acamh.org.uk. We will potentially belooking for more contributions so do submit anyarticles that you think may be of interest to thewider readership.

EDITOR’S OVERVIEW

Bridge2

the

stimulation (tDCS) and smart drugs were highlighted which are useful in

furthering our understanding, but development of more neuropsychological

intervention studies around solid behavioural evidence are still lacking.

Professor Karen Bryan (University of Surrey) focused on

speech, language and communication disorders as a risk

factor for re-offending. The incidence of young offenders with

speech and language difficulties is all too high with a

prevalence of around 60% of those in Young Offenders

Institutes (YOI); given that such impairments are a risk factor

for re-offending, urgent recognition of the need to reduce the

risk factors is critical. Frequently masked by behavioural problems or the

reluctance of those suffering communication disorders to admit it, early

identification is not always easy. However, an intervention study which

incorporatesd speech and language therapy with a more general programme

of surveillance and supervision (ISSP) for those recently released from YOIs,

found that the additional focus on speech and language was useful and that

those individuals were better able to re-engage with education and with the

community.

Professor Maggie Snowling (University of York) stressed

the importance of good early language skills in positively

influencing later educational success. The presence of early

language difficulties can influence attainment even if speech

problems resolve themselves; such children often experience

poorer literacy in later development in spite of normal

language, achieving fewer high grade GCSEs than their typically developing

peers. An early intervention targeting reading skill worked especially well when

combined with phonology training, highlighting pointing to the prominence of

oral language skill in underpinning reading ability. A subsequent intervention,

which focused on improving oral language ability, did see some positive effects

but did not seem to benefit reading. A targeted approach with younger

children in nursery and the early school years (Language4Learning) also

yielded improvements, with a combined approach training oral language,

narrative and phonological skills being most successful. Although such

interventions are often effective in the short term, there is a more limited

understanding of the longer term benefits. Such studies indicate that oral

language training in young children can significantly improve their reading

comprehension, this being especially effective when combined with intensive

vocabulary learning.

Guest Lecturer Sheena Reilly, Professor of Paediatric

Speech Pathology at the University of Melbourne, presented

data from the Early Language in Victoria Study (ELVS), a large-

scale prospective population study focusing on identifying

early predictors of poor language in later life and tracking

trajectories. Despite language being central to everyday

communication and functionalit, language impairments remain under-

researched compared with other prevailing conditions such as diabetes or

autism, in spite of their higher prevalence. Preliminary findings from ELVS

suggest that trajectories are very moveable and language levels at two years

are not necessarily a good predictor of later language ability. A parent-led

intervention given to those assessed to have poor language skills at 12 months

surprisingly found no differences between intervention and control groups,

which could be caused by due to screening such young children being

problematic due to sensitivity of measures, the low intensity of the

intervention or its reliance on parental enthusiasm and commitment, or it

could simply be ineffective in children this young or effective but with benefits

only seen later in development. To conclude, rather than focusing on ‘red flags’

at particular ages, trajectories should receive more attention with a focus

placed on surveillance and not screening.

Professor James Law discussed the mediating effect of

communication on behaviour, and the potential implications

for intervention. Data from the Avon Longitudinal Survey of

Parents and Children (ALSPAC) demonstrated that early

social risk was associated with behaviour problems as

measured on the Strengths and Difficulties questionnaire at

age 13 and the Children’s Communication Checklist (CCC)

showed pragmatics at 8 years to be a partial mediator of the behaviour score.

Professor Law explained that identifying such mediators is crucial for the

effective design of interventions; interventions that act on a mediator give

positive results, even with small sample sizes. With this is mind, the Social

Communication Intervention Project (SCIP), a language-based intervention,

was designed for children with pragmatic and social communication problems.

School-aged children took part in up to 3 one-hour speech and language

therapy sessions a week. Parent report data found that children who took part

in this intervention had significantly improved in measures of language skills,

social communication, social situations, and peer relations compared to a

control group, leading to the conclusion that further work on the impacts of

such interventions; most importantly on behaviour, is urgently

required.

Maggie Johnson, speech and language therapist advisor,

focused on the importance of defining selective mutism

accurately. Defined as the failure to speak in specific situations

where speaking is expected, it is frequently misinterpreted as

the child choosing not to speak, ; the term ‘specific mutism’

may therefore more accurately capture the true nature of the condition. The

Diagnostic and Statistical Manual of Mental Disorders (DSM) intends to put

selective mutism under social anxiety in its next version, though many children

who have selective mutism are not socially anxious and can be happy playing

in a social situation but just not want to speak. Under the wrong category in

the DSM may lead children to be referred to services which do not best meet

their needs, and the presenter advocated that a more useful classification in

would be specific phobia. Without the correct diagnosis and referral, selective

mutism can lead to isolation, low self-esteem and social anxiety, even though

there is gathering evidence that these effects can be avoided and selective

mutism completely overcome with the right treatment; the preferred method

being cognitive behavioural therapy (CBT). However, the DSM proposed

change in definition, may mean that these children cannot access the help they

require.

Conclusion: an informative, engaging and interactive day, bringing alive the day’s

important theme and reinforcing that communication is crucial, in particular

helping children to communicate from a young age and throughout childhood

thus setting them up for later life; without such resources and time, children

with speech, language and communication problems frequently go on to

encounter academic, behavioural, social, and mental health problems. The

expert presenters showed that it is possible to help these children, and that

we should endeavour to create the best possible interventions to do so.

Annie Brookman and Nicki Gratton, Research Assistants, University of Oxford

Researcher Perspective: in keeping with its aim to support those still

in training or in the early years of professional CAMH life, the

Association was once again delighted to be able to offer

complimentary attendance for a number of such trainees. Below is

an overview from one such trainee, a first year PhD student:

“My research will explore the relationship between child mental

health and exclusion from school, and will involve a systematic

review of the literature, secondary analyses of two epidemiological

studies and a case control study of children who have been excluded

from school or at risk of the outcome. The aim is to see whether

there are specific difficulties that could be systematically assessed

should a child have repeated disciplinary crisis, particularly relevant

given that there is currently no set systematic assessment to identify

children who are struggling with school. Attending this conference

has helped me to reflect upon my own research and given me a great

opportunity to listen to experts in the field presenting relevant and

up to date perspectives and experiences around this area. I hope my

PhD work will enable more understanding and clarity about the

children that are being excluded from our schools and may could

potentially minimise or remove the risk of exclusion from school.

Claire Parker Peninsula College of Medicine and Dentistry in Exeter

ACAMH Emanuel Miller National Conference: Speech, Language, Communication and Child and Adolescent Mental Health

Bridgethe

Revised DSM-5 proposed changes …Publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 marks one the

most anticipated events in the mental health field. As part of the development process, the preliminary draft revisions to the

current diagnostic criteria for psychiatric diagnoses were made available for public review - proposed changes as well as its history,

impact, and developer:

3

IT’S ALL ABOUT AUTISM

Autism Rates Rise:Federal health authorities in Los Angeles, have significantly raised their estimate of the prevalence of autism in children,

concluding in a new study of 8-year-olds that 1 in 88 has some form of the disorder (previous estimate in 2006, 110). For the

analysis, researchers sourced tens of thousands of health and special education records in 14 states, looking for an autism

diagnosis or the symptoms that would add up to one. Opinion is divided as to reliability of the data – Dr Bryan King of the

Seattle Children’s Autism Center is not surprised by the results: “we’re up against a tidal wave of need”, whereas other experts,

such as Dr David Mandell of the University of Pennsylvania, question the validity of relying on records to estimate the disorder’s true

prevalence: “. As does likewise Dr Daniel Geschwind, autism expert at UCLA: “what we’re looking at is mostly due to practices and

infrastructure and culture, rather than some underlying biological phenomenon”. Whilst the CDC acknowledge the shortcomings, they

hope that the study will draw attention to the need for more vigorous screening early in children’s lives, particularly given that early

intervention offers autistic children the best long-term prospects.

Autism Redefined – new diagnostic criteria more restrictive:Getting an autism diagnosis could be more difficult in 2013 - proposed DSM-5 changes may affect the proportion of individuals who

qualify for a diagnosis of autism spectrum disorder, according to preliminary data presented by Yale School of Medicine researchers:

"Given the potential implications of these findings for service eligibility, our findings offer important information for consideration by

the task force finalizing DSM-5 diagnostic criteria," said Yale Child Study Center (CSC) director Fred Volkmar MD, who conducted the

study with colleagues Brian Reichow and James McPartland. They found that in a group of individuals without intellectual disabilities

who were evaluated during the 1994 DSM-IV field trial, it was estimated that approximately half might not qualify for a diagnosis of

autism under the proposed new definition. Volkmar stressed that these preliminary findings relate only to the most cognitively able and

may have less impact on diagnosis of more cognitively disabled people: "Use of such labels, particularly in the United States, can have

important implications for service," he said. "Major changes in diagnosis also pose issues for comparing results across research studies."

Volkmar and colleagues will publish full study results in the April print edition of the Journal of the American Academy of Child andAdolescent Psychiatry.

Higher Maternal Age Predicts Risk of Autism: In a recent study led by Mr. Sven Sandin, of the Karolinska Institutet, Sweden and King's College London, researchers analyzed past

findings (25,687 cases of autism spectrum disorder and over 8.6 million control subjects, drawn from the 16 epidemiological papers

that fit inclusion criteria for the study as defined by the investigators) to investigate possible associations between maternal age and

autism. All studies controlled for paternal age which is an independent risk factor for autism. While much research has been done to

identify potential genetic causes of autism, this analysis suggests that non-heritable and environmental factors may also play a role in

children's risk for autism. The researchers compared the risk of autism in different groups of material age (under 20, 24-29, 30-34, and

35+) and found that children of mothers older than 35 years had 30% increased risk for autism, that c hildren of mothers under 20

had the lowest risk of developing autism, and that the association between advancing maternal age and risk for autism was stronger

for male offspring and children diagnosed in more recent years. The researchers identified and discussed several potential underlying

causes of the association between maternal age and risk for autism such as increased occurrence of gene alteration during the aging

process and the effects of exposure to environmental toxins over time. Sandin said of the study, "The study makes us confident there

is an increased risk for autism associated with older maternal age, even though we do not know what the mechanism is. It has been

observed in high quality studies from different countries, including the US.. This finding adds to the understanding that older age of the

parents could have consequences to the health of their children."

JCPP Contribution - Annual Research Review: re-thinking the classification of autism spectrum disorders: a recently published article (JCPP, April 2012) by Catherine Lord and Rebecca Jones, discussed the nosology of ASD, highlighting

that the field has reached a critical point as it seeks to better define dimensions of social-communication deficits and

restricted/repetitive behaviours on an individual level for both clinical and neurobiological purposes. These different dimensions

also suggest an increasing need for quantitative measures that accurately map their differences, independent of developmental

factors such as age, language level and IQ. Psychometric measures, clinical observation as well as genetic, neurobiological and

physiological research from toddlers, children and adults with ASD are reviewed and the question of how to conceptualize ASDs along

dimensions versus categories is discussed within the nosology of autism and the proposed changes to the DSM-5 and ICD-11, and

differences across development are incorporated into the new classification frameworks. The authors conclude that it is crucial to

balance the needs of clinical practice in ASD diagnostic systems, with neurobiologically based theories that address the associations

between social-communication and restricted/repetitive dimensions in individuals. Clarifying terminology, improving description of the

core features of ASD and other dimensions that interact with them and providing more valid and reliable ways to quantify them, both

for research and clinical purposes, will move forward both practice and science.

Source: Yale University (20 January 2012) Autism redefined; ScienceDaily

Source: Seattle Times News

Source: www.sciencedaily.comJAACAP

www.dsm5.org

To read the full article, please visit http://bit.ly/I3g119:

Bridge4

the

Forthcoming National Events, Conferences and Meetings

3 September 2012, full day, Scotland

Attention Deficit Hyperactivity DisorderClass Presenters: Professor Eric Taylor and Dr Jody Warner-Rogers

Emeritus Professor of Child and Adolescent Psychiatry / Chartered Clinical Psychologist and Child Neuropsychologist

ACAMH Master ClassesAutumn 2012, full day, Dublin

Mindfulness

Class Presenter: Professor Susan Bogels

Chris Williams, Professor of Psychosocial Psychiatry, University of Glasgow; Yvonne McNeill, Clinical Psychologist, Glasgow

3rd Egyptian Child and Adolescent Psychiatry Conference early December 2012, Giza, Egypt

National Conference Keynote and Pre-Conference Master ClassTrauma-Focused CBT Model and Treatment

Presenters: Emeritus Professor William Yule and Dr Patrick SmithInstitute of Psychiatry, Kings College London

Co-hosted ACAMH-YoungMinds Conference November 2012, full day, London

Theme: The Changing NHS Landscapewith particular focus on practice and service delivery

ACAMH Jack Tizard Lecture and Conference 22 June 2012, full day, London

Inequalities and Children’s Mental HealthNamed Memorial Speaker: Professor Robert McCall

Professor, Department of Psychology and Co-Director, Office of Child Development, University of Pittsburgh, USGuest Lecturer: Dr Lynne Jones OBEHonorary Research Associate in Developmental Psychiatry, University of Cambridge

Opening Addressee: Professor Christopher BentleySheffield Hallam University; Former Head, National Support Team for Health Inequalities Department of Health

Conference PresentersEnver Solomon, Director of Policy and Public Affairs, The Children's Society, LondonDr Tamsin Ford, Clinical Senior Lecturer, Peninsula Medical School, University of Exeter and Devon Partnership TrustDr Matthew Hodes, Senior Lecturer in Child and Adolescent Psychiatry, Imperial College, London

ACAMH International Travelling Speaker Fellowship 20127 June 2012; Dublin

Tics and TourettesFellowship Speaker: Professor James Leckman

James Leckman, Neison Harris Professor, Professor of Pediatrics & Psychiatry and Director,

Research at Child Study Center, Yale University, US

For further details, please visit our website or contact Ingrid King:ingrid.king@acamh.org.uk, +44 20 7403 7458

Bridgethe 5

“MULTI – DIMENSIONAL TREATMENT FOSTER CARE”Midlands Branch: Half-day Conference 21 June 2012

Speakers: Maureen Moss, Dr Michael Slowik Venue: Parkview Clinic, Birmingham

“CRISIS IN CHILD MENTAL HEALTH”North West Branch: Half - day Meeting 20 June 2012

Speakers: Craig Mearns, Vicky Oldfield Venue: Warrington

“EMOTIONAL LITERACY: WHY FEELINGS MATTER”

Welsh Branch: Half - day Meeting 27 June 2012

Speakers: Cris Hoskin, C H Consultancy, Training and Consultancy Support Venue: Cardiff

“ADHD: RECENT DEVELOPMENTS IN RESEARCH AND PRACTICE”Southern Branch: Day Conference 29 June 2012Speakers: Professor Eric Taylor and Professor Edmund Sonuga-Barke Venue: Southampton

“THE USE OF INTENSIVE INTERACTIONS WITH CHILDRENAND ADOLESCENTS WITH AUTISM”Yorkshire Branch: Day Conference 19 July 2012Speakers: Phoebe Caldwell Venue: Innovation Centre York

“WHY ATTACHMENT MATTERS – IN EDUCATION”Scottish Branch: Day Conference 14 September 2012Speakers: Louise Bomber, SAIA Conference supported by ACAMH Venue: The Thistle Hotel, Glasgow

“EATING DISORDERS”Midlands Branch: Day Conference 11 October 2012Speakers: Dr Agnes Ayton Venue: SIMTR Solihull

“TRAUMA AND IMMIGRATION: A PRESSING PROBLEM FOR CAMHS”Yorkshire Branch: Day Conference 27 September 2012Speakers: David Trickey and Lynne Fordyce Venue: Leeds

“ATTACHMENT THEORY AND ITS CLINICAL IMPLICATIONS”North Wales and Merseyside Branch: Day Conference 8 November 2012Speakers: TBC Venue: Ellesmere Port, Liverpool

“AMBIT AND OTHER THERAPIES”East Anglia Branch: Day Conference 9 December 2012Speakers: TBC Venue: Peterborough

“THE EFFECT OF PARENTAL MENTAL HEALTH ON CHILDREN”Scottish Branch: TBC 7 December 2012

Speakers: TBC Venue: TBC

“ASD”Devon and Cornwall Branch: Day Conference 10 December 2012

Speakers: TBC Venue: Totnes Devon

“EATING DISORDERS”Southern Branch: Day Conference 9 December 2012Speakers: TBC Venue: Southampton

“CYBERBULLYING”Scottish Branch: Twilight Meeting TBCSpeakers: Respectme and ChildLine (TBC) Venue: TBC

“BEHAVIOURAL DISORDERS”Scottish Branch: Day Conference Q4 2012/Q1 2013Speakers: TBC Venue: TBC

For further details, please visit our website or contact Charlotte Edge:charlotte.edge@acamh.org.uk, 020 7403 7458

Forthcoming Local Events, Conferences and Meetings

Bridge6

the

Highlights: A dynamic ACAMH North East

event, led by internationally acclaimed Dan

Hughes, a popular and renowned presenter,

for his conceptualisation of dyadic

developmental psychology (DDP).

Launching his presentation with an

immediate invitation to delegates to share

his world of PACE: Playfulness, Acceptance,

Curiosity and Empathy, he eloquently

described the therapeutic practice,

important role of engagement in tune with

the young person’s experiences and

emotions, and necessity of sensitive

progress towards re-experiencing

traumatic events. Greater success if

practised in an adequately contained

environment with scope to explore care

giving and attachment processes

was highlighted.

Helen Minis followed, framing her

presentation on maltreatment, the brain

and social development within the relevant

social and cultural context. Raising the

question of what constituted ‘good enough’

care giving, she drew attention to the

neuro-biological changes which occur when

neglect is present and the stress responses

which deregulate when care giving is not

successful. The potential for physiological

problems to persist with age, resulting in

reactive attachment disorder was

highlighted. The plasticity of the

physiological stress system was considered,

in particular the ability of this system to

‘heal’ in later life through careful attention

to the management of stress and

stimulations through relationships which

might otherwise be known as ‘attunement

principles’.

John Sands, in his discussion

of attachment focused

work in practice, spoke

about the need for

flexibility in the therapeutic

setting for attachment

work including the proximity of parents and

young people in the therapy room. Eloquent

case examples were given from a DDP

perspective, and a series of questions raised

about the application of theory to practice,

eloquently responded to by Dan Hughes.

Conclusion: A valuable conference spanning

theoretical, biological and pragmatic issues

of attachment focused interventions which

could be readily taken and used in clinical

work.

Intervention Overview: Dan Hughes

Dyadic Developmental PsychologyConference Overview: Putting Theory into Practice

Dyadic developmental

psychotherapy (DDP) is a

treatment approach to

trauma, loss, and/or other

dysregulating experiences,

based on principles derived

from attachment theory and research and

also incorporating aspects of treatment

principles that address trauma. It is a

specialised form of attachment-focused

family therapy which is utilised for all

families.

It involves creating a safe setting in which

the child can begin to explore, resolve, and

integrate a wide range of memories,

emotions, and current experiences, that are

frightening, shameful, avoided or denied.

Safety is created by insuring that this

exploration occurs within an

intersubjective context characterized by

nonverbal attunement, reflective dialogue,

acceptance, curiosity, and empathy. As the

process unfolds, the client is creating a

coherent life-story which is crucial for

attachment security and is a strong

protective factor against psychopathology.

Therapeutic progress occurs within the

joint activities of co-regulating affect and

co-creating meaning.

Primary intersubjective experiences

between a parent and infant contain shared

affect (attunement), focused attention on

each other in a way such that the child’s

enjoyable experiences are amplified and

his/her stressful experiences are reduced

and contained, and a congruent intention to

understand the other/be understood by the

other. This is done through contingent,

nonverbal (eye contact, facial expressions,

gestures and movements, voice prosody and

touch) communications. These same early

parent-child experiences, fundamental for

healthy emotional and social development,

are utilized in therapy to enable to the child

to rely on the therapist and parents to

regulate emotional experiences and to

begin to understand these experiences

more fully. Such understanding develops

further through engaging in affective-

reflective (A-R) dialogue about these

experiences, without judgment or criticism.

The therapist will maintain a curious

attitude about past and present events and

behaviors, facilitating the client’s ability to

explore them to better understand their

deeper meanings in his life and gradually

develop a more coherent life-story. This

process may be stressful for the client, so

the therapist will frequently

“take a break” from the work, go

slower, provide empathy for the negative

affect that may be elicited, and repair the

treatment relationship.

Routine features of DDP include:

• playful interactions, focused on positive

affective experiences, are never forgotten

as being an integral part of most

treatment sessions, when the client is

receptive. When the client is resistant to

these experiences, the resistance is met

with PACE.

• shame is frequently experienced when

exploring many experiences of negative

affect. Shame is always met with empathy,

followed by curiosity about its

development, organization, exceptions,

management, and impact on the

narrative.

• emotional communication that combines

nonverbal attunement and reflective

dialogue and is followed by relationship

repair when necessary, is the central

therapeutic activity. All communication is

“embodied” within the nonverbal.

• resistance is addressed and met with

PACE, rather than being confronted.

• treatment is directive and client-

centered. Directives are frequently

modified, delayed, or set-aside in

response to the child’s response to the

directive.

Bridgethe 7

Cognitive BehaviourTherapy is very rarelyavailable within child andadolescent or adult mentalhealth services in India.Though there has been oneexcellent randomised

control study of CBT for anxious adultspublished five years ago a recent reviewidentified only 40 papers on Behaviour orCognitive Behaviour Therapy written in theIndian Journal of Psychiatry since the1940s. Pockets of expertise do existamongst therapists generally trained in theUK or USA, but there is no structure ofaccreditation, supervision or training fortherapists or dedicated CBT training

courses although it isincluded in some psychiatryand psychology trainingprogrammes. Over the past6 months staff from theCAMHS team in the CentralManchester Foundation

Trust and the Salford Cognitive TherapyTraining Centre have been working with DrVirudhagirinathan and colleagues at theCARE Institute of Behaviour Science inChennai to develop a modular trainingprogramme using UK trainers with a viewtowards making India self-sufficient in CBTpractice, supervision and training withinfive years. Around half of the 50 participantswho have taken part in training there so far

have been from a child and adolescentmental health background including clinicalpsychologists, psychiatrists and collegecounsellors.

Highlights: A dynamic, interactive day, with a

well-balanced programme of expert speakers

Morning Keynote: Phoebe Caldwell, specialist in

learning disabilities gathered over 40 years local,

national and international professional life, she

focussed on “Can we Talk: emotional engagement

with non-verbal people with autism”, illustrating

that reality is different for everyone and

judgements are subjective, based on personal

experiences. Through the use of videos showing

her own working with children, delegates shared

ACAMH Board Members 2012Chair Professor Eric Taylor PsychiatryChair Elect Professor Kathy Sylva EducationAcademic Secretary Dr Paul Ramchandani PsychiatryBranch Liaison Officer Dr Mark Lovell PsychiatryEditorial Representative (JCPP) Professor Edmund Sonuga-Barke Psychology

Editorial Representative (CAMH) Dr Tamsin Ford Psychiatry

Board MembersDr Eilis Kennedy Psychiatry Professor Michael Kerfoot Social Work Dr Kapil Sayal PsychiatryDr Daphne Keen Paediatrics Mrs Cathy Laver-Bradbury Nursing Dr Jody Warner-Rogers Psychology

ACAMH members working to develop Cognitive Behaviour Therapy in India

In July 2010 ACAMH member Dr AndrewBeck, Consultant Clinical Psychologist at CMFTand trainer at the Salford Cognitive

Therapy course, ran two introductory days

on CBT for over 40 mental health staff in

Chennai in collaboration with the CARE

Institute of Behaviour Science. Initial

feedback was very good and there was a

consensus amongst participants that there

was a clear need for further training and

that the CBT as a therapy suited the child

and adult Indian mental health context. In

March 2012 a five-day foundation

workshop was run in Chennai, the first part

of a modular programme based on the

curriculum developed by the Salford

Cognitive Therapy training centre and

including specific teaching on parenting

programmes and adapting CBT for younger

children. Over the next five years several

staff from the Salford training centre and

Manchester and Salford CAMHS will

volunteer their time to provide week long

training courses with the intention to

enable Indian

colleagues work towards international

standards of training and qualification

Conference Overview: When Words are Not Enough: working with children with learningdisabilities and autism

Whil

st ev

ery

effor

t is

made

by

ACAM

H to

see

that n

o ina

ccur

ate o

r misl

eadin

g da

ta, s

tatem

ent o

r opin

ion is

exp

ress

ed a

t this

mee

ting,

the A

ssoc

iation

wish

to m

ake

clear

that

data

and

opini

ons

given

at t

his p

artic

ular

meeti

ng ar

e the

sole

resp

onsib

ility o

f the c

ontrib

utor o

r spe

aker

[s] co

ncer

ned a

nd ac

cord

ingly,

ACA

MH ac

cepts

no re

spon

sibilit

y for

the c

onse

quen

ces o

f any

inac

cura

te/mi

slead

ing da

ta, op

inion

, stat

emen

t. T

he

Ass

oci

atio

n f

or

Ch

ild

and

Adole

scen

t M

enta

l H

ealt

h

St

Sav

iour’

s H

ouse

, 39

/41

Un

ion

Str

eet,

Lon

don

SE

1 1

SD

Tel

: 0

20

74

03

74

58

F

ax:

02

0 7

40

3 7

08

1 W

ebsi

te:

ww

w.a

cam

h.o

rg.u

k E

mai

l: a

cam

h@

acam

h.o

rg.u

k

A C

om

pan

y L

imit

ed b

y G

uar

ante

e

Reg

iste

red

in

Engla

nd

and

Wal

es N

o.2

99

03

85

Reg

iste

red

Ch

arit

y N

um

ber

10

42

76

0

T

he A

ssoc

iatio

n fo

r C

hild

and

Ado

lesc

ent M

enta

l Hea

lth

ww

w.a

cam

h.or

g.uk

SP

EAK

ERS

PROF

ESSO

R CH

RIST

OPHE

R BE

NTLE

Y Sh

effie

ld Ha

llam

Unive

rsity

; For

mer

Head

, Nat

ional

Supp

ort T

eam

for H

ealth

In

equa

lities

Dep

artm

ent o

f Hea

lth

PROF

ESSO

R RO

BERT

MCC

ALL

Co-D

irecto

r, Un

ivers

ity of

Pitts

burg

h Of

fice o

f Chil

d Dev

elopm

ent;

Prof

esso

r of

Psyc

holog

y, Un

ivers

ity of

Pitts

burg

h, US

A

ENVE

R SO

LOM

ON

Dire

ctor o

f Poli

cy an

d Pub

lic A

ffairs

, The

Ch

ildre

n's So

ciety

, Lon

don

DR T

AMSI

N FO

RDCli

nical

Senio

r Lec

ture

r, Pe

ninsu

la Me

dical

Scho

ol, U

niver

sity o

f Exe

ter a

nd

Devo

n Par

tner

ship

Trus

t

DR L

YNNE

JON

ES O

BE

Hono

rary

Rese

arch

Ass

ociat

e in

Deve

lopme

ntal

Psyc

hiatry

, Univ

ersit

y of

Camb

ridge

DR M

ATTH

EW H

ODES

Se

nior L

ectu

rer i

n Chil

d and

Ado

lesce

nt

Psyc

hiatry

, Imp

erial

Colle

ge, L

ondo

n

Jack

Tiz

ard

Lect

ure

and

Day

Con

fere

nce

Frid

ay 2

2 Ju

ne 2

012;

Inst

itute

of

Phys

ics,

76 P

ortla

nd P

lace

, Lon

don

W1B

1N

T

INEQ

UA

LITI

ES

AN

D

CH

ILD

AN

D A

DO

LESC

ENT

MEN

TAL

HEA

LTH

Th

e Em

anue

l Mill

er L

ectu

re w

as e

stab

lishe

d in

197

2, in

mem

ory

of E

man

uel M

iller

, one

of

The

Jack

Tiz

ard

Nat

iona

l Con

fere

nce

is on

e of

two

pres

tigio

us A

CA

MH

mem

oria

l eve

nts

and

is de

signe

d to

app

eal t

o bo

th th

e ac

adem

ic a

nd c

linic

al w

orld

s. It

is na

med

in m

emor

y of

Pro

fess

or

Jack

Tiz

ard

(191

9-19

79),

an a

vid

supp

orte

r of

AC

AM

H a

nd c

ontr

ibut

or to

the

deve

lopm

ent o

f so

cial

just

ice,

com

mun

ity c

are

and

child

and

ado

lesc

ent m

enta

l hea

lth, p

artic

ular

ly th

e re

latio

nshi

p be

twee

n po

licy,

man

agem

ent a

nd p

ract

ice;

and

impr

ovem

ent o

f se

rvic

es. H

is im

men

se w

ork

was

re

cogn

ised

inte

rnat

iona

lly a

nd h

e w

as a

war

ded

both

the

Kenn

edy

Inte

rnat

iona

l Sci

entif

ic A

war

d (1

968)

and

the

Rese

arch

Aw

ard

of th

e A

mer

ican

Ass

ocia

tion

on M

enta

l Def

icie

ncy

(197

3)

Plea

se v

isit

www.acamh.org.uk

for

ful

l det

ails

CO

NFE

REN

CE P

ROGR

AMM

E

0900

Re

gistra

tion

0930

W

ELCO

ME:

Conf

eren

ce Ch

air (M

ornin

g), Pr

ofes

sor E

ric Ta

ylor,

Outg

oing C

hair,

ACA

MH

0935

OP

ENIN

G AD

DRES

S: GI

VING

EVE

RY C

HILD

THE

BES

T ST

ART

WE

CAN

- Pro

fess

or Ch

ris Be

ntley

1000

JA

CK T

IZAR

D M

EMOR

IAL L

ECTU

RE: T

HE C

ONSE

QUEN

CES

OF EA

RLY

INST

ITUT

IONA

LIZA

TION

: CAN

INST

ITUT

IONS

BE

IMPR

OVED

? SH

OULD

THE

Y?Pr

ofes

sor R

ober

t McC

all

1100

Mo

rning

Coffe

e

1130

TH

E GO

OD C

HILD

HOOD

REP

ORT

2012

: A R

EVIE

W O

F OU

R CH

ILDR

EN’S

WEL

L-BEI

NG -

Enve

r Solo

mon

1215

CASE

COM

PLEX

ITY

AND

OUTC

OMES

: WHA

T DO

WE

KNOW

AND

WHA

T DO

WE

NEED

TO

KNOW

? Dr

Tams

in Fo

rd

1300

Lu

nch a

nd A

nnua

l Gen

eral

Meet

ing fo

r ACA

MH M

embe

rs; P

OSTE

R DISP

LAY O

F RES

EARC

H

1400

AF

TERN

OON

OVER

VIEW

- Co

nfer

ence

Chair

, Pro

fess

or K

athy

Sylva

, Inc

oming

Chair

, ACA

MH

1405

GU

EST

PRES

ENTE

R: R

ESPO

NDIN

G TO

THE

NEE

DS O

F W

AR A

ND D

ISAS

TER

AFFE

CTED

CHI

LDRE

N - D

r Lyn

ne Jo

nes O

BE

1500

IN

EQUA

LITI

ES A

ND M

ENTA

L HE

ALTH

OF

UNAC

COM

PANI

ED A

SYLU

M S

EEKI

NG C

HILD

REN

- Dr M

atth

ew H

odes

1545

A

CAM

H NA

TION

AL R

ESEA

RCH

PRIZ

E CER

EMON

Y

1600

A

ftern

oon T

ea an

d Con

fere

nce C

lose

Jack

Tiz

ard

Mem

oria

l Lec

ture

r :

Prof

esso

r R

ober

t McC

all

ASS

OC

IAT

ION

FO

R C

HIL

D A

ND

AD

OLE

SCE

NT

ME

NTA

L H

EA

LTH

39-4

1 U

nio

n S

treet,

London S

E1 1

SD

; tele

phone 0

20 7

4037458; f

acsi

mile

020 7

4037081

em

ail:

acam

h@

acam

h.o

rg.u

k; w

ebsi

te w

ww

.aca

mh.o

rg.u

k

AN

NU

AL

GE

NE

RA

L M

EE

TIN

G: 2

012

Notice

is

here

by

give

n t

hat

the A

ssoci

atio

n’s A

nnual

Genera

l M

eeting

will

be c

onve

ned

Fri

day

22 June 2

012, 1

.00pm

, Inst

itute

of Phys

ics, 7

6 P

ort

land P

lace

, London W

1B

1N

T

for

the p

urp

ose

of tr

ansa

ctin

g th

e follo

win

g busi

ness

1. T

o r

eco

rd t

hose

pre

sent

2. T

o a

ppro

ve t

he m

inute

s of th

e A

nnual

Genera

l M

eeting

held

on 6

June 2

011

3. T

o r

ecei

ve a

nd a

ppro

ve the

ann

ual f

inan

cial s

tate

men

ts fo

r th

e ye

ar e

nded

31

Dec

embe

r 20

11

4. T

o r

ece

ive t

he r

eport

s of th

e H

onora

ry O

ffice

rs

5. E

lect

ions

to t

he B

oar

d

5.1

To n

ote

the follo

win

g:5.1

.1 P

rofe

ssor

Eri

c Tay

lor

will

com

ple

te h

is t

erm

of offi

ce a

s C

hai

r of th

e A

ssoci

atio

n

and w

ill b

e s

ucc

eeded b

y C

hai

r Ele

ct P

rofe

ssor

Kat

hy S

ylva

5.1

.2 D

r Ja

ne A

kis

ter

will

be r

etiri

ng

as H

onora

ry T

reas

ure

r of th

e A

ssoci

atio

n a

nd w

ill

be s

ucc

eeded b

y D

r Jo

Fle

tcher

5.1

.3 D

r Pau

l R

amch

andan

i w

ill b

e s

tandin

g fo

r re

-ele

ctio

n t

o a

seco

nd t

erm

of offi

ce a

s H

onora

ry A

cadem

ic S

ecr

eta

ry o

f th

e A

ssoci

atio

n5.1

. 4Pro

fess

or

Edm

und S

onuga

-Bar

ke w

ill b

e s

tandin

g fo

r re

-ele

ctio

n t

o a

seco

nd t

erm

of offi

ce a

s Jo

urn

al o

f C

hild

Psy

cholo

gy a

nd P

sych

iatr

y Editori

al R

epre

senta

tive

5.1

. 5 D

r Ja

ne A

kis

ter

will

be s

tandin

g fo

r re

-ele

ctio

n t

o a

seco

nd t

erm

of offi

ce a

s Boar

d

Mem

ber

5.2

To e

lect

the B

oar

d o

f th

e A

ssoci

atio

n for

the y

ear

2012-2

013

6. T

o a

ppoin

t th

e A

uditor

for

the y

ear

2012-2

013

7. T

o t

ransa

ct s

uch

oth

er

busi

ness

as

the B

oar

d s

hal

l dete

rmin

e:

7.1

To a

ppro

ve a

mendm

ents

to t

he A

ssoci

atio

n’s C

onst

itution (

Mem

ora

ndum

and A

rtic

les)

to e

nab

le:

7.1

.1 D

ivers

ifica

tion o

f m

em

bers

hip

cat

ego

ries

7.1

.2 Identific

atio

n o

f ad

ditio

nal

Honora

ry O

ffice

r posi

tion a

nd a

ppoin

tment

there

to7.1

.3 R

equired n

ew a

nd a

mended w

ord

ing

to fac

ilita

te t

he a

bove

7.1

.4 A

dditio

nal

required r

evis

ions

to c

lause

s w

ithin

Const

itution t

o r

efle

ct legi

slat

ive

chan

ges

7.2

To a

gree t

he m

em

bers

hip

subsc

ription fees

for

2013

7.3

To c

onfir

m A

CA

MH

’s m

em

bers

hip

of th

e follo

win

g:•

IA

CA

PAP

• Y

oung

Min

ds

• N

atio

nal

Child

ren’s B

ure

au•N

CVO

8. T

o t

ransa

ct a

ny

oth

er

busi

ness