Artist in Residence, Clive Wilkins, publishes Count Zapik
By Diane FitzMaurice from News. Published on Dec 19, 2014.
OCD patients’ brains light up to reveal how compulsive habits develop
By cjb250 from University of Cambridge - Department of Psychology. Published on Dec 19, 2014.
The research, led by Dr Claire Gillan and Professor Trevor Robbins (Department of Psychology) is the latest in a series of studies from the Cambridge Behavioural and Clinical Neuroscience Institute investigating the possibility that compulsions in OCD are products of an overactive habit-system. This line of work has shifted opinion away from thinking of OCD as a disorder caused by worrying about obsessions or faulty beliefs, towards viewing it as a condition brought about when the brain’s habit system runs amok.
In a study funded by the Wellcome Trust, researchers scanned the brains of 37 patients with OCD and 33 healthy controls (who did not have the disorder) while they repetitively performed a simple pedal-pressing behavioural response to avoid a mild electric shock to the wrist. The researchers found that patients with OCD were less capable of stopping these pedal-pressing habits, and this was linked to excessive brain activity in the caudate nucleus, a region that must fire correctly in order for us to control our habits.
Basic imaging work has long since established that the caudate is over-active when the symptoms of OCD are provoked in patients. That the habits the researchers trained in these patients in the laboratory also triggered the caudate to over-fire adds weight to the suggestion that compulsions in OCD may be caused by the brain’s habit system
The research team thinks these findings are not specific to OCD and that, in fact habits may be behind many aspects of psychiatry.
“It’s not just OCD; there are a range of human behaviours that are now considered examples of compulsivity, including drug and alcohol abuse and binge-eating,” says Dr Gillan, now at New York University. “What all these behaviours have in common is the loss of top-down control, perhaps due to miscommunication between regions that control our habit and those such as the prefrontal cortex that normally help control volitional behaviour. As compulsive behaviours become more ingrained over time, our intentions play less and less of a role in what we actually do.”
The researchers think this is the work of our habit system.
“While some habits can make our life easier, like automating the act of preparing your morning coffee, others go too far and can take control of our lives in a much more insidious way, shaping our preferences, beliefs, and in the case of OCD, even our fears,” says Professor Robbins. “Such conditions – where maladaptive, repetitive habits dominate our behaviour – are among the most difficult to treat, whether by cognitive behaviour therapy or by drugs.”
Co-author Professor Barbara Sahakian adds: “This study emphasizes the importance of treating OCD early and effectively before the dysfunctional behaviour becomes entrenched and difficult to treat. We will now focus on the implications of our work for future therapeutic strategies for these compulsive disorders.”
Dr John Isaac, Head of Neuroscience and Mental Health at the Wellcome Trust comments: “Research such as this marks a shift in how we understand Obsessive Compulsive Disorder, a condition which affects hundreds of thousands of lives in the UK alone. Unravelling the underlying causes of OCD could lead to improved treatment of the condition, and may provide an important step forward in the management of compulsion in other forms, from binge-eating to alcohol abuse.”
Gillan, C. et al. Functional neuroimaging of avoidance habits in OCD. American Journal of Psychiatry; 19 Dec 2014
Misfiring of the brain’s control system might underpin compulsions in obsessive-compulsive disorder (OCD), according to researchers at the University of Cambridge, writing in the American Journal of Psychiatry.
The text in this work is licensed under a Creative Commons Licence. If you use this content on your site please link back to this page. For image rights, please see the credits associated with each individual image.
Enhancing Rudolph: The Psychopharmacology of Christmas - Prof. Trevor Robbins gives BNA Symposium keynote speech
By Diane FitzMaurice from News. Published on Dec 16, 2014.
JNP Best Paper Prize 2014 goes to members of the BCNI
By Diane FitzMaurice from News. Published on Dec 10, 2014.
Prof. James Russell's A True-Dream Run named as a 'winter selection' by the Poetry Book Society Bulletin
By Diane FitzMaurice from News. Published on Dec 08, 2014.
Belief state attribution in children and jays to be investigated under new Leverhulme Project Grant
By Diane FitzMaurice from News. Published on Dec 04, 2014.
A step towards solving the enduring puzzle of ‘infantile amnesia’
By amb206 from University of Cambridge - Department of Psychology. Published on Nov 29, 2014.
Most of us cannot remember toddling around at the age of 18 months or so, let alone being breast or bottle fed as tiny infants. Our early life is a blank to us. It is a blank in the sense that it is not accessible to so-called “episodic memory,” which means conscious or “re-experiential” recall of autobiographical events.
Sigmund Freud coined the term ‘infantile amnesia’ to describe this phenomenon. He explained the lack of early memory in terms of repressed sexual desires. Today, few people find Freud’s arguments persuasive - but the term, infantile amnesia, and the puzzle it presents to scientists, persists.
In seeking to understand how the brain develops its remarkable capacity for episodic memory, cognitive psychologists have tended to explain amnesia for early lives by arguing that our first experiences have the ‘wrong’ kind of format to be accessed by the backward-casting adult mind.
But what does this primitive format lack and when does memory become truly episodic and adult-like?
A team led by Professor James Russell from the University of Cambridge’s Department of Psychology has shed some light on this fascinating puzzle by carrying out a study on two- and three-year-olds, an age that many developmental psychologists believe to be marked by an absence of episodic memory.
The results of the team’s most recent study ‘Pre-school children’s proto-episodic memory assessed by deferred imitation’ were published online last month (October 2014) in the journal Memory.
Russell and co-researchers Dr Patrick Burns (University of Cambridge) and Dr Charlotte Russell (King’s College, London) conclude that young children fail to engage in re-experiential/episodic memories because they are not yet able to bind where and when information to information about objects and actions when recalling something that they have experienced.
“A young child may simply know that mum is wearing a red blouse today without any recollection of the original event that told them this – for example, seeing mum emerging from the bedroom wearing the blouse, on her way downstairs,” said Russell.
Psychologists use the term spatiotemporal information to describe the when and where of an episode. There are a number of reasons why spatiotemporal information is crucial to episodic memory, but Russell has a distinct approach to the matter, one inspired by the work of the German Enlightenment philosopher Immanuel Kant.
Kant argued that perceptual experience itself is marked by its taking place in space and time. If this is so, Russell argues, re-experiential memory will also be spatiotemporal. According to Kant, the temporal aspect of experience consists of coding the simultaneity and order of elements within the event.
Russell explained: “If we have an experience of an event involving, say, a football and a cat, then spatially each of them will be perceived as being in a certain relation to our body - left or right, near or far. In addition, they will be near to, or far away from, each other. Temporally, they will either be simultaneously present in the event or appear one after the other. Crucially, an episodic/re-experiential memory of the event should involve the memory inheriting these spatiotemporal properties.”
Another key feature of re-experiential memory of events is that it will tend to be all-of-a-piece rather than elemental. In other words, because events are experienced holistically rather than element-by-element, the re-experiential memory of them will, again, inherit this holistic property.
“When we hear or read sentences, they will be experienced in a serial or digital manner with phrases embedded in clauses and clauses embedded in sentences. One may call this semantic experience in reference to the term, ‘semantic memory’, used by Endel Tulving in 1972 to distinguish it from episodic memory,” said Russell.
“If we experience an event, by contrast, we experience it as a whole - this is episodic memory. Let’s return to the example of the child with the red-blouse-wearing mother. In the original event, the child saw mum in a red blouse - the what of the potential memory - on her left emerging from the bedroom - the potential where of the memory - as mum was about to descend the stairs - the potential when of the memory.
“These spatiotemporal elements were experienced together, as a whole, as elements of one event. They were not fed to the child as bite-sized factual chunks as in ‘the blouse was red', ‘mum was on my left’, ‘after that she went down the stairs’. This kind of elementally-chunked experience could result in a kind of semantic memory.”
In order to test whether two- and three-year-olds are able not only to retain the what-when-where of an episodic memory but also to recall these three in a holistic, non-elemental way, the team gave more than 370 pre-schoolers two kinds of memory test. In each one, the children had to imitate on the second day what they had seen the experimenter do on the first day.
In the first task the children saw the experimenter move two icons on a touch-screen in a certain order to make the computer show a smiling face and play a happy song. Note that in this task the spatial element (the location to which the icons had to be moved) was defined not only by three-dimensional landmarks but also by the relation to the child’s own body (eg ‘in the corner to my top-right-hand’).
In the second task, the what of the performance was two kinds of action (pumping or twirling) which had to be performed on the handles of a music box belonging to hippo (see photograph) in a certain order to turn it on. Note that in this case the location of the actions could be defined by three-dimensional landmarks such as ‘near the door’ or ‘in front of the window’.
Next, in order to find out if recall was holistic/non-elemental or elemental, the researchers applied a statistical model to determine whether it was likely for children to recall the what-when-where of the memory in elemental fragments (eg just recalling what and where but not when) or whether memory tended to be all-of-a-piece.
The results of the study were very clear. Although performance was better than chance after two-and-half years in both tasks, only in the second task (the music box in a room) was recall non-elemental/holistic.
The crucial difference between the two tasks was in terms of the spatial information. In the second task, in which there was evidence for genuine episodic memory, the spatial information was environment-centred, such as ‘the twirling took place near the window’.
In explaining the apparent dependency of this primitive form of episodic memory on environment-centred spatial coding, Russell said: “The reasons for this are two-fold. Conceptually, while episodic memory tends to be from our own point of view, the very idea of a ‘point of view’ requires it to be a point of view of something – some objective spatial layout. So anything that encourages the child to code actions and objects in terms of their environment-centred features like ‘near the door’ will tend to reveal episodic abilities, if they are there at all.
“In terms of neuroscience, a structure in the brain called the hippocampus is crucial to the performance both of environment-centred spatial coding and to the laying down of episodic memory traces. We know that the hippocampus is undergoing rapid development around two years of age. Though later episodic abilities, such as those developing around four and five years with the acquisition of a theory of mind, are likely to be more frontal in nature.”
The findings of Russell and co-researchers that episodic memory begins, and infantile amnesia fades away, at the age of around two-and-a-half years appear to fit with the results of studies by other psychologists.
“Professor Madeline Eacott at Durham University found that two-and-a-half was the earliest age at which adults can retrieve re-experiential memories for significant events such as the birth of a sibling. We can also recall events about our own birth, but this is obviously going to be semantic in nature,” said Russell.
While discovering more about the earliest origins of episodic memory is of inherent scientific interest, there are practical applications of this work, and it also affords avenues of investigation beyond infantile amnesia.
“Firstly, it suggests that very young children may actually be quite accurate reporters – for example, of abusive events. Secondly, it is possible that even younger children would succeed on tasks like the ones we have carried out if the temporal element were simultaneity rather than order. It’s not hard to believe that an 18-month-old can have a re-experiential memory of what happened in the morning,” said Russell.
“I recall the very full account of a zoo trip my daughter gave me when she was a year-and-a-half. Why shouldn’t this have been based on an episodic trace, albeit not one that would be available to adult recall?”
James Russell is a Fellow of Queens’ College.
A study led by Professor James Russell shines a light on the phenomenon of 'infantile amnesia'. He argues that children's ability to recall events depends on their being able to unify the environmental elements of when, what and where. Most children develop this ability aged between two and three.
The text in this work is licensed under a Creative Commons Licence. If you use this content on your site please link back to this page. For image rights, please see the credits associated with each individual image.
Ebooks@cambridge visit the Department
By Diane FitzMaurice from News. Published on Nov 26, 2014.
A Hundred Years Ago: A temporary appointment that determined the future of the Cambridge Psychological Laboratory
By Diane FitzMaurice from News. Published on Nov 21, 2014.
Language in the Aging Brain. Dr Meredith Shafto & Professor Lorraine K. Tyler review published in Science
By Diane FitzMaurice from News. Published on Nov 19, 2014.
Lifelong learning and the plastic brain
By lw355 from University of Cambridge - Department of Psychology. Published on Nov 19, 2014.
When a group of experimental psychologists moved into their new lab space in Cambridge earlier this year, they took a somewhat unconventional approach to refurbishing their tea room: they had the walls tiled with the Café Wall Illusion.
The illusion, so-named after it was spotted on the wall of a Bristol café in the 1970s, is a much-debated geometrical trick of the eye and brain in which perfectly parallel lines of black and white tiles appear wedge-shaped and sloped.
It’s also an excellent demonstration of how the brain interprets the world in a way that moves beyond what the input is from the eye, as one of the experimental psychologists, Professor Zoe Kourtzi, explained. “In interpreting the world around us, our brains are challenged by a plethora of information. The brain is thought to integrate information from multiple sources and solve the puzzle of perception by taking into account not only the signals registered by the sensory organs but also their context in space and time.
“In the Café Wall Illusion, the brain takes into account the surrounding tiles, but it also relies on our previous knowledge acquired through training and experience when interpreting a new situation.”
From the day we are born, neurons in the brain start to make connections that combine what we can see, hear, taste, touch and smell with our experiences and memories. Neuroscientists refer to the brain’s ‘plasticity’ in explaining this ability to restructure and learn new things, continually building on previous patterns of neuronal interactions.
To unravel the mechanisms that underlie how brains learn, Kourtzi’s team is looking at how brains recognise objects in a cluttered scene. “This aspect is vital for successful interactions in our complex environments,” she explained. “It’s how we recognise a face in a crowd or a landmark during navigation.”
Visual perception is also highly trainable. The brain can use previous experience of similar cues to be quicker at identifying the image from the ‘noise’ – the proverbial needle from the haystack.
But although neuroscientists recognise that this type of brain plasticity is fundamental to our ability to cope with continually changing settings at home, school, work and play, little is known about how we can stimulate our brain to enhance this learning process, right across the life span.
“The process of ‘learning to learn’ is at the core of flexible human behaviours,” explained Kourtzi. “It underpins how children acquire literacy and numeracy, and how adults develop work-related skills later in life.”
One of the important determinants her team has discovered is that being able to multi-task is better than being able to memorise.
“The faster learners are those who can attend to multiple things at the same time and recruit areas of the brain that are involved in attention,” she explained. “Those who are slower at learning try to memorise, as we can see from greater activity in the parts of the brain connected with memory.”
“So, in fact, being able to do the sort of multi-tasking required when interacting in busy environments or playing video games – which requires the processing of multiple streams of information – can improve your ability to learn.”
She also finds that age doesn’t matter: “what seems to matter is your strategy in life – so if older people have really good attentive abilities they can learn as fast as younger people.”
This has important implications for an ageing society. In the UK, there are now more people over State Pension age than there are children. The UK’s Office for National Statistics predicts that, by 2020, people over 50 will make up almost a third of the workforce and almost half of the adult population. The average life expectancy for a man in the UK will have risen from 65 years in 1951 to 91 years by 2050. Older age has become an increasingly active phase of people’s lives, one in which re-training and cognitive resilience is increasingly sought after.
Kourtzi and colleagues are using functional magnetic resonance imaging to detect when areas of the brain are activated in response to a sensory input and how these circuits change with learning and experience. While at the University of Birmingham, she showed that the visual recognition abilities of young and older adults can be enhanced by training, but that the different age groups use different neural circuits to do this.
Young adults use anterior brain centres that are often used in perceptual decisions, where sensory information is evaluated for a decision to be made; older adults, by contrast, use the posterior part of the brain, which is in charge of the ability to attend and select a target from irrelevant clutter. “The clear implication of this is that training programmes need to be geared for age,” said Kourtzi.
Crucially, what she also observed is that some people benefit from training more than others: “although it’s well known that practice makes perfect, some people are better at learning and may benefit more from particular interventions than others. But to determine how and why, we need to go beyond biological factors, like cognition or genetics, to look at social factors: what is it about the way a particular individual has learned to approach learning in their social setting that might affect their ability to learn?”
This multidisciplinary approach to understanding learning lies at the heart of her work. She leads the European-Union-funded Adaptive Brain Computations project, which brings together behavioural scientists, computer scientists, pharmacologists and neuroscientists across eight European universities, plus industrial partners, to understand and test how learning happens.
“In our work, there’s a strong element of translating our findings into practical applications, so creating training programmes that are age appropriate is our ultimate goal,” she added.
“The reason we like the Café Wall Illusion so much is because tricks of visual perception tell us that the brain can see things in a different way to the input. How the brain does this is influenced by context, just as the way we interpret our environment is influenced by learning and previous experience.”
Inset image: Café Wall Illusion, Tony Kerr on Flickr
Our brains are plastic. They continually remould neural connections as we learn, experience and adapt. Now researchers are asking if new understanding of these processes can help us train our brains.
The text in this work is licensed under a Creative Commons Licence. If you use this content on your site please link back to this page. For image rights, please see the credits associated with each individual image.
Professor Trevor Robbins chairs Symposium at SfN's Neuroscience 2014 meeting
By Diane FitzMaurice from News. Published on Nov 16, 2014.
BNA Christmas Symposium 2014: What drugs could Santa take?
By Diane FitzMaurice from News. Published on Nov 13, 2014.
Dr Denes Szucs interviewed on the Tonight programme
By Diane FitzMaurice from News. Published on Nov 12, 2014.
Cambridge professor and ScienceGrrl celebrate women in science with release of She Blinded Me With Science
By cjb250 from University of Cambridge - Department of Psychology. Published on Nov 06, 2014.
The song is performed by Violet Transmissions, a band whose lead singer Tim Bussey is also Professor of Behavioural Neuroscience and a Fellow and Director of Studies in Natural Sciences at Pembroke College, University of Cambridge. Its video features a number of young women scientists including a material scientist, laser physicists and an epidemiologist. All proceeds from the song will go to ScienceGrrl, an organisation dedicated to celebrating and supporting women in science.
Thomas Dolby has himself offered his backing, providing samples from his original hit of British scientist and TV presenter Magnus Pyke, including his off-the-cuff remark “Yes, but as a known scientist, it would be surprising if a girl blinded me with science”.
Professor Bussey says: “In my field, neuroscience – and certainly in my lab – many of the best scientists are women, including my wife Lisa Saksida, with whom I run the lab. And as Director of Studies, I consistently find that many of the top candidates for admission at undergraduate level are women. So it’s shocking that most of the faces at my level of career progression are male. Clearly women are being put off science somewhere along the way. We’ve released this cover of Thomas Dolby’s hit as way of celebrating women in science and helping raise awareness of some of the issues they face.”
Through Both Eyes, a recent report from ScienceGrrl, highlighted some of the issues that face women in science and recommended steps that could be taken to address the problem of underrepresentation of women in leadership positions in science, technology, engineering and mathematics (STEM). Issues include cultural stereotypes which do little to encourage girls to consider a career in STEM subjects and undermine their achievements in the classroom. ScienceGrrl calls on the government and organisations in a position of influence to show leadership in areas of gender equality, careers advice and education.
Dr Anna Zecharia, Director of ScienceGrrl, said: We want everyone to feel empowered to reach their potential. Too often, cultural and social factors mean that girls and women start off on the back foot feeling unsupported and out of place. ScienceGrrl is about showcasing diverse role models, and the different faces of success. We want to show that science and engineering is for everyone and support those who already have a foot in the door. There is still a lot of work to do to bust open stereotypes and break down barriers, but it’s encouraging that researchers like Tim are taking a stand and helping raise the profile – and position – of ScienceGrrls."
Similarly, a report last year by the Wellcome Trust, the UK’s largest charitable funder of medical research, found that a lack of mentoring and career support along with a low number of female role models were cited as key factors that may be driving women in science to move away from academic careers earlier than men.
The University of Cambridge has recently joined a select group of universities with an institutional Athena SWAN Silver Award. The awards are bestowed in recognition of commitment to advancing women's careers in STEM employment in higher education and research.
Professor Anne Davis, Professor of Mathematical Physics and a Gender Equality Champion at the University of Cambridge, said: “The University is keenly aware of the need to retain women as they progress through their careers into senior levels. Back when I got my PhD I suddenly found myself as the most senior women in my subject in the UK.
“The situation is changing, but slowly and there is still a lot more we must do to change the thinking of both men and women, to foster female scientists and ensure those recruiting academics have the right skills. To be a world class University we must recruit and retain the best candidates - from every sector of society.”
The video, together with additional interviews with the ‘science grrls’ can be viewed online at www.sheblindedmewithscience.org.
A Cambridge professor and an army of ScienceGrrls – with a little assistance from the late Magnus Pyke – will be helping celebrate women in science, with the release today on iTunes of a cover version of Thomas Dolby’s 1982 hit She Blinded Me With Science.
Why do we like poetry? The Why Factor asks Professor Usha Goswami
By Diane FitzMaurice from News. Published on Nov 04, 2014.
Visiting Scholar, Leire Salazar, awarded la Caixa Prize
By Diane FitzMaurice from News. Published on Nov 03, 2014.
Child Psychology: A Very Short Introduction - Professor Usha Goswami's new book
By Diane FitzMaurice from News. Published on Oct 31, 2014.
Performance, Madness and Psychiatry: Isolated Acts - a new collection of essays
By Diane FitzMaurice from News. Published on Oct 30, 2014.
How to tell a missile from a pylon: a tale of two cortices
By cjb250 from University of Cambridge - Department of Psychology. Published on Oct 02, 2014.
Now, researchers at the University of Cambridge have identified the two regions of the brain involved in these two tasks – picking out objects from background noise and identifying the specific objects – and have shown why training people to recognise specific objects improves their ability to pick out objects.
In a study funded by the Wellcome Trust, volunteers were given a series of 3D stereoscopic images with varying levels of background noise and asked first to find a target object and then to say whether the object was in the foreground or the background. During the task, researchers applied transcranial magnetic stimulation (TMS) – a technique whereby a magnetic field is applied to the head – to disrupt the performance of two regions of the brain used in object identification: the parietal cortex and the ventral cortex. Their results are published in the journal Current Biology.
The researchers showed that the parietal cortex was involved in selecting potential targets from background noise, while the ventral cortex was involved in object recognition. When TMS was applied to the parietal cortex, volunteers performed less well at selecting objects from the background; when the field was applied to the ventral cortex, they performed less well at identifying the specific objects.
However, the researchers found that after the volunteers had undergone training to discriminate between specific objects, the ventral cortex – which, until then, had only been used for this purpose – also became involved in selecting targets from noise, enhancing their ability to distinguish between objects. The reverse was not true – in other words, the parietal cortex did not become involved in object discrimination.
Dr Welchman, a Wellcome Trust Senior Research Fellow in the Department of Psychology, explains: “The parietal cortex and the ventral cortex appear to be involved in the overlapping tasks to a different extent. By analogy to the World War II analysts, the parietal cortex helped them spot suspect objects while the ventral cortex helped them distinguish the weapons from the pylons. But training these operatives to identify the weapons will have improved their ability to spot potential weapons in the first place.”
The research may have implications for therapies to help people with attentional difficulties. For example, people with damage to the parietal cortex, such as through stroke, are known to have difficulty in finding objects in displays, particularly when the display is distracting.
“These results show that training in clear displays modifies the brain areas that underlie performance in distracting situations. This suggests a route for rehabilitative training that helps individuals avoid distracting information by training individuals to make fine judgements,” he adds.
During the Second World War, analysts pored over stereoscopic aerial reconnaissance photographs, becoming experts at identifying potential targets from camouflaged or visually noisy backgrounds, and then at distinguishing between V-weapons and innocuous electricity pylons.
Presence or absence of early language delay alters anatomy of the brain in autism
By sc604 from University of Cambridge - Department of Psychology. Published on Sep 23, 2014.
A new study led by researchers from the University of Cambridge has found that a common characteristic of autism – language delay in early childhood – leaves a ‘signature’ in the brain. The results are published today (23 September) in the journal Cerebral Cortex.
The researchers studied 80 adult men with autism: 38 who had delayed language onset and 42 who did not. They found that language delay was associated with differences in brain volume in a number of key regions, including the temporal lobe, insula, ventral basal ganglia, which were all smaller in those with language delay; and in brainstem structures, which were larger in those with delayed language onset.
Additionally, they found that current language function is associated with a specific pattern of grey and white matter volume changes in some key brain regions, particularly temporal, frontal and cerebellar structures.
The Cambridge researchers, in collaboration with King’s College London and the University of Oxford, studied participants who were part of the MRC Autism Imaging Multicentre Study (AIMS).
Delayed language onset – defined as when a child’s first meaningful words occur after 24 months of age, or their first phrase occurs after 33 months of age – is seen in a subgroup of children with autism, and is one of the clearest features triggering an assessment for developmental delay in children, including an assessment of autism.
“Although people with autism share many features, they also have a number of key differences,” said Dr Meng-Chuan Lai of the Cambridge Autism Research Centre, and the paper’s lead author. “Language development and ability is one major source of variation within autism. This new study will help us understand the substantial variety within the umbrella category of ‘autism spectrum’. We need to move beyond investigating average differences in individuals with and without autism, and move towards identifying key dimensions of individual differences within the spectrum.”
He added: “This study shows how the brain in men with autism varies based on their early language development and their current language functioning. This suggests there are potentially long-lasting effects of delayed language onset on the brain in autism.”
Last year, the American Psychiatric Association removed Asperger Syndrome (Asperger’s Disorder) as a separate diagnosis from its diagnostic manual (DSM-5), and instead subsumed it within ‘autism spectrum disorder.’ The change was one of many controversial decisions in DSM-5, the main manual for diagnosing psychiatric conditions.
“This new study shows that a key feature of Asperger Syndrome, the absence of language delay, leaves a long lasting neurobiological signature in the brain,” said Professor Simon Baron-Cohen, senior author of the study. “Although we support the view that autism lies on a spectrum, subgroups based on developmental characteristics, such as Asperger Syndrome, warrant further study.”
“It is important to note that we found both differences and shared features in individuals with autism who had or had not experienced language delay,” said Dr Lai. “When asking: ‘Is autism a single spectrum or are there discrete subgroups?’ - the answer may be both.”
This study was supported by the Waterloo Foundation, the UK Medical Research Council (MRC), the Autism Research Trust, the Wellcome Trust, the William Binks Autism Neuroscience Fellowship, and the European Autism Interventions—a Multicentre Study for Developing New Medications (EU-AIMS).
Individual differences in early language development, and in later language functioning, are associated with changes in the anatomy of the brain in autism.
Males and females with autism show an extreme of the typical male mind
By cjb250 from University of Cambridge - Department of Psychology. Published on Jul 16, 2014.
A team of researchers, led by Professor Simon Baron-Cohen and Dr Meng-Chuan Lai from the Autism Research Centre at the University of Cambridge, tested 811 adults with autism, of whom 454 were female. They compared them to 3,906 typical adults, of whom 2,562 were female. Large samples are needed in order to test for subtle sex differences reliably. This is the first time such a large sample, especially of females with autism, has been studied, since autism is less common in females. The results are published today in the journal PLOS ONE.
All adults took three questionnaires online: the Autism Spectrum Quotient (AQ) that counts the number of autistic traits a person has, the Empathy Quotient (EQ) that measures how easily a person shows social sensitivity to others, and the Systemising Quotient (SQ) that measures how interested a person is in systems (such as maps, machines, numbers, and collecting things).
Results showed clearly that typical females scored higher on the EQ, and typical males scored higher on the AQ and SQ. This sex difference was preserved but significantly reduced in adults with autism, and both males and females showed an extreme of the typical male profile on these measures.
The researchers also analysed the results in terms of ‘brain types’, which look at the difference between an individual’s EQ and SQ. The most common brain type in typical females is Type E, where EQ is higher than SQ. The most common brain type in typical males is Type S, where SQ is higher than EQ. The most common brain type in people with autism – both males and females – were Type S and an extreme of Type S, where EQ is below average whilst SQ is either average or even above average.
Professor Baron-Cohen said: “Our study provides strong evidence in support of the ‘extreme male brain’ theory of autism. Importantly, extreme Type S manifests differently in males and females with autism, but these measures nevertheless reveal its presence. The results also fit with other research showing that children who go on to have autism show elevated prenatal levels steroid hormones (such as testosterone), which affect the development of the brain and the mind.”
Dr Meng-Chuan Lai said: “For decades, the role of sex and gender was relatively under-investigated in autism. Females with autism are now beginning to be studied in their own right. In this new study, typical sex differences were reduced in autism, but not abolished. In addition, females with autism as a group show greater variation on these measures, compared to males with autism. We need more research into the differences between males and females with autism, and how these affect the identification of autism, and what support they need.”
Professor Baron-Cohen added: “These results also have implications for education and employment. People with autism – both males and females – love systems, which are rule-based, precise, and predictable, and find the world of emotions, thoughts, motives and intentions fuzzy and confusing. To achieve their full potential at school, college or at work, information should be presented with exactness, avoiding ambiguity.”
The largest ever psychological study of sex differences in adults with autism has found that both males and females with autism on average show an extreme of the typical male mind, where systemising (the drive to look for underlying rules in a system) is stronger than empathising (the ability to recognize the thoughts and feelings of others and to respond to these with appropriate emotions).
University teaching awards honour excellence
By pbh25 from University of Cambridge - Department of Psychology. Published on Jul 01, 2014.
The 21st annual Pilkington Prizes, which honour excellence in teaching across the collegiate University, were held at Downing College last night.
The prizes are awarded annually to academic staff, with candidates nominated by Schools within the University.
The Pilkington Prizes were initiated by Sir Alastair Pilkington, the first Chairman of the Cambridge Foundation, who believed passionately that the quality of teaching was crucial to Cambridge’s success.
This year’s recipients received their awards at a ceremony attended by Vice-Chancellor Professor Sir Leszek Borysiewicz and Lord Watson of Richmond CBE, the University’s High Steward.
The prize-winners, and excerpts from their citations, are given below.
Dr Michael Aitken, Senior Lecturer in Psychology, Department of Psychology: Michael Aitken is a very popular, charismatic and accomplished lecturer who regularly obtains top marks from students in their feedback, even for what are for them lectures on “boring” topics such as statistical theory and practice. He has a rich understanding of undergraduate education and was instrumental in negotiating the new phase of accreditation of the courses in psychology by the British Psychological Society. However, his major abiding achievement has been to establish a new Tripos in this University, in the Psychological and Behavioural Sciences (PBS).
Dr Alastair Beresford, University Lecturer at the Computer Laboratory, Faculty of Computer Science and Technology: Alastair Beresford has revolutionised programming-language teaching for the Computer Science Tripos in the Computer Laboratory over the past six years. His pioneering work, along with fellow Pilkington Prize recipient Dr Andrew Rice, has seen teaching move away from traditional lectures to video and online exercises. The changes are hugely appreciated by the students, who are able to study at their own pace with substantial support from their supervisors. In addition, he has taken on the role of Chair of the Advanced Taught Course Management Committee.
Dr Sally Boss, University Lecturer in Chemistry, Department of Chemistry: Sally Boss is an outstanding teacher of chemistry who has already had a significant impact on several generations of Cambridge chemists. Her lucid and lively introductions to the intricacies of co-ordination chemistry and the mysteries of polyhedral molecular architectures continue to engage and excite the whole class. In addition she is an outstanding supervisor, undertaking a busy load for both her own College and others. Sally has been instrumental in a substantial revision of the first- and second-year practical courses, giving the classes a new vigour and direction.
Professor Richard Fentiman, Professor of Private International Law, Faculty of Law: Richard Fentiman is an exceptional teacher, whose entertaining and invigorating lectures have engaged students for many years. Described by one as making “even the dreariest topic seem exciting”, he is consistently ranked as one of the top-rated lecturers in the Law Faculty. Professor Fentiman has also made a substantial contribution over the years to faculty administration, serving first as director of the LLM and, more recently, as chair of the degree committee. In addition, Professor Fentiman is considered one of the leaders in his field of research.
Dr Rachael Harris, Senior Language Teaching Officer in Arabic, Faculty of Eastern and Middle Eastern Studies: Rachael Harris is, with her close colleague Mrs Nadira Auty, the cornerstone of the Arabic teaching programme in the undergraduate tripos. For the last 26 years at Cambridge she has given heart and soul to the training of our undergraduate students, helping them achieve levels of confident fluency in Arabic recognised as remarkable in the national context. Together they have blazed a trail in the professionalisation of Arabic language teaching. It is difficult to appreciate the difference between what we currently expect our students to excel at and what they were able to do before Rachael and Nadira joined us.
Professor Christopher Howe, Professor of Plant and Microbial Biochemistry, Department of Biochemistry: Christopher is not only an extremely gifted didactic teacher in his own right, regularly garnering plaudits from his undergraduate audiences, but for several years he has also served the department diligently and innovatively as its director of undergraduate teaching. His hard work is marked by several virtues: unbounded enthusiasm, creativity, painstaking preparation and organisation, and the courage to take on, and deal effectively with, often vexing tactical and strategic issues.
Dr Sriya Iyer, Isaac Newton Trust Affiliated Lecturer, Faculty of Economics: Sriya Iyer has been teaching development economics in the Faculty of Economics and St Catharine’s College since 2000. Her approach is to teach development economics passionately and enthusiastically using microeconomic and macroeconomic theory, but to infuse learning with a sense of history and a sound intuition for development policy. Sriya has the ability to explain complex points clearly. Her students value her greatly. As one said: “Dr Iyer is a brilliant lecturer. You get the impression she loves what she teaches and that certainly rubs off in the lectures.”
Dr John Maclennan, University lecturer in Earth Sciences, Department of Earth Sciences: John Maclennan has an enviable breadth of geological knowledge, which students benefit from in all four years of the Earth Sciences degree course. All John's teaching is characterised by a deep understanding of the subject and by a lively and motivating presentation of the material. He is particularly good at conveying that observations and interpretations are there be questioned, and that this scientific process is valuable and fun. John's excellent teaching is not confined to lectures. Students especially comment on his skill at demonstrating practical classes, and in running the fourth year field trip to Spain.
Professor Michael Potter, Professor of Logic in the Faculty of Philosophy: Michael Potter is a dedicated and inspiring teacher of undergraduate and research students. As lecturer and supervisor, Michael has been a major force in the teaching of logic, philosophy of mathematics and history of analytic philosophy in the Faculty for over 15 years. He has been instrumental in establishing a flourishing seminar on the philosophy of mathematics and logic. He has made an outstanding contribution to maintaining and enhancing the quality of supervision and small group teaching that makes the experience of studying at Cambridge excellent and unique.
Dr Sally Quilligan, University Lecturer in Clinical Communication, School of Clinical Medicine: Sally Quilligan is a Lecturer in Clinical Communication in the School of Clinical Medicine and an outstanding medical educator. Sally is committed, conscientious and enthusiastic, always treating the students with respect, paying attention to their views and helping each student develop their potential as effective clinical communicators. Student feedback regularly includes statements such as “she really cares about what we are saying”, “she takes everything we say seriously”, “her feedback is relevant and helpful” and “she is the best facilitator I have had”.
Dr Andrew Rice, Senior Lecturer at the Computer Laboratory, Faculty of Computer Science and Technology: Andrew Rice is recognised for his pioneering work on programming-language teaching for the Computer Science Tripos. Together with Dr Alastair Beresford, Andy has presided over a major shift in how students have carried out their studies over the past six years. Moving away from traditional lectures, he has ensured students can study at their own pace using video and online exercises. A substantial emphasis on the role of the supervisors ensures the teaching remains within the Cambridge context.
Dr Jeremy Webb, Academic Lead for Staff Development, School of Clinical Medicine: Jeremy Webb successfully combines his clinical career as Principal in a busy General Practice in Newmarket with an important educational role at Cambridge for medical students and educators. He is an invaluable member of the Clinical School’s education team. A founder member of the Graduate Entry Programme, he brought his passionate belief that medical students should be taught more often by general practitioners into the development of the Cambridge Graduate Course in Medicine (CGC) programme. Jeremy has in particular supported students in difficulty, both with pastoral guidance and remedial clinical teaching.
Twelve inspirational academics honoured for the outstanding quality and approach to their teaching
Children with autism have elevated levels of steroid hormones in the womb
By cjb250 from University of Cambridge - Department of Psychology. Published on Jun 03, 2014.
The team of researchers, led by Professor Simon Baron-Cohen and Dr Michael Lombardo in Cambridge and Professor Bent Nørgaard-Pedersen in Denmark, utilized approximately 19,500 amniotic fluid samples stored in a Danish biobank from individuals born between 1993-1999. Amniotic fluid surrounds the baby in the womb during pregnancy and is collected when some women choose to have an amniocentesis around 15-16 weeks of pregnancy. This coincides with a critical period for early brain development and sexual differentiation, and thus allows scientists access into this important window in fetal development. The researchers identified amniotic fluid samples from 128 males later diagnosed with an autism spectrum condition and matched these up with information from a central register of all psychiatric diagnoses in Denmark.
Within the amniotic fluid the researchers looked at four key ‘sex steroid’ hormones that are each synthesized, step-by-step from the preceding one*. They also tested the steroid hormone cortisol that lies outside this pathway. The researchers found that levels of all steroid hormones were highly associated with each other and most importantly, that the autism group on average had higher levels of all steroid hormones, compared to a typically developing male comparison group. The results of the study, which was funded by the Medical Research Council, are published today in the journal Molecular Psychiatry.
Professor Baron-Cohen said: “This is one of the earliest non-genetic biomarkers that has been identified in children who go on to develop autism. We previously knew that elevated prenatal testosterone is associated with slower social and language development, better attention to detail, and more autistic traits. Now, for the first time, we have also shown that these steroid hormones are elevated in children clinically diagnosed with autism. Because some of these hormones are produced in much higher quantities in males than in females, this may help us explain why autism is more common in males.”
He added: “These new results are particularly striking because they are found across all the subgroups on the autism spectrum, for the first time uniting those with Asperger Syndrome, classic autism, or Pervasive Developmental Disorder Not-Otherwise-Specified. We now want to test if the same finding is found in females with autism.”
Dr Michael Lombardo said: “This result potentially has very important implications about the early biological mechanisms that alter brain development in autism and also pinpoints an important window in fetal development when such mechanisms exert their effects.”
Steroid hormones are particularly important because they exert influence on the process of how instructions in the genetic code are translated into building proteins. The researchers believe that altering this process during periods when the building blocks for the brain are being laid down may be particularly important in explaining how genetic risk factors for autism get expressed.
Dr Lombardo adds: “Our discovery here meshes nicely with other recent findings that highlight the prenatal period around 15 weeks gestation as a key period when important genetic risk mechanisms for autism are working together to be expressed in the developing brain.”
Professor Baron-Cohen said: “These results should not be taken as a reason to jump to steroid hormone blockers as a treatment as this could have unwanted side effects and may have little to no effect in changing the potentially permanent effects that fetal steroid hormones exert during the early foundational stages of brain development.”
He cautioned further: “Nor should these results be taken as a promising prenatal screening test. There is considerable overlap between the groups and our findings showed differences found at an average group level, rather than at the level of accurately predicting diagnosis for individuals. The value of the new results lies in identifying key biological mechanisms during fetal development that could play important roles in atypical brain development in autism.”
*Within the amniotic fluid the researchers looked at 4 key ‘sex steroid’ hormones that are each synthesized, step-by-step from the preceding one, in the ‘Δ4 sex steroid’ pathway: progesterone, 17α-hydroxy-progesterone, androstenedione and testosterone.
Children who later develop autism are exposed to elevated levels of steroid hormones (for example testosterone, progesterone and cortisol) in the womb, according to scientists from the University of Cambridge and the Statens Serum Institute in Copenhagen, Denmark. The finding may help explain why autism is more common in males than females. However, the researchers caution it should not be used to screen for the condition.
Scientists identify part of brain linked to gambling addiction
By jfp40 from University of Cambridge - Department of Psychology. Published on Apr 08, 2014.
The research, led by Dr Luke Clark from the University of Cambridge, was published on April 7 2014 in the journal PNAS.
During gambling games, people often misperceive their chances of winning due to a number of errors of thinking called cognitive distortions. For example, ‘near-misses’ seem to encourage further play, even though they are no different from any other loss. In a random sequence like tossing a coin, a run of one event (heads) makes people think the other outcome (tails) is due next; this is known as the ‘gambler’s fallacy’.
There is increasing evidence that problem gamblers are particularly prone to these erroneous beliefs. In this study, the researchers examined the neurological basis of these beliefs in patients with injuries to different parts of the brain.
“While neuroimaging studies can tell us a great deal about the brain’s response to complex events, it’s only by studying patients with brain injury that we can see if a brain region is actually needed to perform a given task,” said Dr Clark.
For the study, the researchers gave patients with injuries to specific parts of the brain (the ventromedial prefrontal cortex, the amygdala, or the insula) two different gambling tasks: a slot machine game that delivered wins and ‘near-misses’ (like a cherry one position from the jackpot line), and a roulette game involving red or black predictions, to elicit the gambler’s fallacy. For the control groups, they also had patients with injuries to other parts of the brain as well as healthy participants undergo the gambling tasks.
All of the groups with the exception of the patients with insula damage reported a heightened motivation to play following near-misses in the slot machine game, and also fell prey to the gambler’s fallacy in the roulette game.
Clark added: “Based on these results, we believe that the insula could be hyperactive in problem gamblers, making them more susceptible to these errors of thinking. Future treatments for gambling addiction could seek to reduce this hyperactivity, either by drugs or by psychological techniques like mindfulness therapies.”
Gambling is a widespread activity: 73% of people in the UK report some gambling involvement in the past year* and around 50% play games other than the National Lottery. For a small proportion of players (around 1-5%), their gambling becomes excessive, resulting in features seen in addiction. Problem gambling is associated with both debt and family difficulties as well as other mental health problems like depression.
New research reveals that brain damage affecting the insula – an area with a key role in emotions – disrupts errors of thinking linked to gambling addiction.
Assisted Reproduction and Family Development: The New Parents Study
By sj387 from University of Cambridge - Centre for Family Research. Published on Nov 01, 2013.
Family structure has changed markedly in the past few decades. Starting a family is now possible for a greater variety of intended parents due to the advances in assisted reproduction technologies (ARTs), allowing lesbian and gay parents to start families for example.
Despite the increasing numbers of couples and individuals helped by ARTs, these families have not been sufficiently represented in studies looking into how families develop. In order for policy and support to reflect the reality of life for these families, research needs to include all family forms. The science behind ARTs is developing rapidly and as such the science focusing on the psychological, social and emotional wellbeing of these families needs to keep up.
Of the extensive literature on family development conducted over the last century, comparatively little empirical focus has documented the wellbeing of same-sex parents and their children, in particular in families headed by gay dads. Studies including families with lesbian mothers have found children do not show signs of psychological maladjustment, do not have poorer peer relationships and do not show differences in gender identity. Indeed, children of lesbian mothers appear to be functioning well into adult life.
Even fewer studies have focused on gay fathers and their children. The few studies that have followed children of gay fathers have found these children did not show adverse effects, and were well adjusted.
Understanding the development and experiences of these families is important, as increasing numbers of gay men are becoming fathers. Not enough is known about the well-being of these fathers, and the development of their children. Therefore, more empirical evidence and less assumption is needed to understand the effect of gay parents on their families wellbeing and experiences to ensure the correct support is in place, if needed.
This need for empirical evidence to understand the wellbeing of parents and children following ARTs is what drives The New Parents Study, an ambitious study following families with babies 4 months old are visited at their homes, with a follow-up invitation to Cambridge University when the babies are 12 months old. Families included are those who have gay parents, where the child was born through surrogacy; families with lesbian mothers, where the child was born through Donor Insemination; and heterosexual couples where the child was born through IVF. One father involved with The New Parents Study recently spoke about why he was driven to participate and what it was like being part of the study:
“As a family helped by surrogacy we are a minority, we need studies like this which represent us and our families, at the same time knowing the research is anonymous is also really reassuring….
“Taking part was enjoyable and speaking about our experiences of becoming parents really gave us food for thought. Normally when you talk to people about your children there’s a ticking clock, most people don’t want to hear all about what you’ve been up to and how we felt about everything! The New Parents Study team were really interested in what we had to say and were empathetic to talk to.
“All in all the visit was really enjoyable and I’d really recommend any first time parents who have been helped by ARTs to get involved.”
The New Parents Study is an exciting project to work on as we are following couples who have recently become first time parents (with babies up to 4 months old), inclusive of gay, lesbian and straight couples. The study brings two groups based in Cambridge, the Applied Developmental Psychology Research Group, and the Centre for Family Research, together with groups based at the University of Paris in France and the University of Amsterdam in The Netherlands. All of the groups involved in the New Parents Study have yielded findings over the years that demonstrate that it is the dynamics of a family that is far more important than the family structure when we are trying to understand child wellbeing.
Another reason being involved with The New Parents Study is so exciting is that we will be able to learn more about fathers who are primary caregivers. In addition, we have the honour of seeing these families grow and develop while hearing about their family stories.
With such an ambitious project we are indebted to the on-going support and assistance we receive in reaching potential participating families, from charities, clinics, agencies and support groups.
Dr. Alice Winstanley and Dr. Kate Ellis-Davies recently attended several national and international events for ARTs, fathering and alternative families, including: the Alternative Parenting Show (London); Paternal Involvement in Pregnancy Outcomes from Preconception to First Year of Life (National Institutes of Health, Maryland, MD); New York Fertility Services (New York, NY); Surrogacy UK AGM (Warwick).
In March 2014, the Applied Developmental Psychology Research Group, alongside the Centre For Family Research, will be organising an event for National Science and Engineering Week on “What Makes A Family”, where researchers, clinicians, charities, parent groups and the general public will be able to engage in discussions on recent research into family development, and how researchers can take account of the publics interests in family development.
For further information, please contact Alice Winstanley and Kate Ellis-Davies at firstname.lastname@example.org
Alice Winstanley and Kate Ellis-Davies, are researchers in the Applied Developmental Psychology Research Group working on The New Parents Study, a ground-breaking international project lead by Professor Michael Lamb and Professor Susan Golombok into the experiences of parents who have used assisted reproduction technologies, and the development of their children.
We ask the experts: does society really care about the old and the vulnerable?
By sj387 from University of Cambridge - Centre for Family Research. Published on Oct 28, 2013.
Care of vulnerable groups is an emotive topic, often seen through the prism of crisis, scandal and rising costs. Funding is indeed a critical issue. According to Alzheimer’s Research UK, there are more than 820,000 people in the UK living with dementia: on average each one costs the economy more than £27,600 per annum. But discussions about how the ‘burden’ of care should be met, and by whom, also reveal much about our value systems and how we feel about each other. We asked three people some fundamental questions about care.
Charlie Cornish-Dale is a freelance journalist and editor. As part of his postgraduate research in social anthropology (St Catharine’s and King’s Colleges, Cambridge) he volunteered as a carer in a care home for the elderly where many of the residents had dementia. Dr Gail Ewing is a senior researcher at the Centre for Family Research, University of Cambridge. After training as a nurse, she later moved into research where she has focused on palliative and end-of-life care, particularly from the perspective of unpaid carers. Dr Claire Nicholl is Consultant Physician in Medicine for the Elderly at Addenbrooke’s Hospital. She is a practising clinician and advises on the interface between primary and secondary care as a champion for older people's services.
How do we think about care – and could we think differently?
Charlie Cornish-Dale: As someone trained to think as an anthropologist, I would say that care is a fundamental aspect of human relationships and of societies more generally. Care is something we all must do for each other at some time, through pregnancy, childhood, illness, disability and old age. It’s not something which happens only in institutions; care did not suddenly become a concern with the arrival of the care home. Kinship is care: whether we are brought up in an archetypal nuclear family or as part of an extended lineage or clan, we have obligations and duties towards defined groups of relations (sometimes even including the dead), which we must learn to fulfil. In talking about obligations and duties, we are, of course, entering the realm of ethics.
As different societies think about and do ethics in different ways, so it is with care. But what we think about care, and how we care, has changed, as our own society has changed, over a span of many centuries. The progress of individualism has profoundly changed the way society is organised and with it the structures — kin-based, religious and economic —for organising care. The celebrated anthropologist, Alan MacFarlane, in The Origins of English Individualism, traces individualism back to the 13th century, by which time England, unlike other medieval nations, already had a social structure based around the unit of the nuclear family; this, he claims, was a prerequisite for England’s emergence as the first capitalist industrial power, allowing for rapid industrialisation and urbanisation.
Gail Ewing: Care is part of everyday life for most people; whereby we care about others, not just care for them. From day to day, care is the practical stuff we do for each other as the result of our emotional bonds. We’re cared for within our families and we go on to care for our families. When our children are young we care for them in a hands-on way but as they grow up we move out of that physical sphere of caring. There are, of course, exceptions: some people need life-long care. When care is mentioned, our first thought is care of the elderly – but there are other groups who need care too. When someone develops a long-term condition, he or she may need increasing care over many years. Cancer can progress rapidly, in which case family members find themselves thrown into a caring situation with no preparation. Care is something many people find themselves doing to varying degrees.
Claire Nicholl: I chose to specialise in medicine for the elderly because of the huge variety it offers you as a physician in terms of a career. Most of the time, I absolutely love my job: I now work mainly on the wards and in outpatients clinics, I teach student doctors and train and examine postgraduate doctors. I ‘m also Trust co-lead for dementia services. I see lots of elderly frail people; each has different needs and often there is a chance to make a real difference to their lives. The negative media about the NHS, which I hear when I switch on the car radio, is depressing. Some terrible things have happened and urgently need addressing. But we mustn’t lose sight of the excellent work that goes on or launch an attack on the thousands of people who work in caring roles.
Nevertheless, I do feel that as a society we have moved backwards in terms of how we look out for each other. We tend to stand back in situations where in the past we might have got involved in reaching out to someone in need: if a child falls over we feel nervous about helping them up in case we are accused of touching them inappropriately. In many communities there’s been a loss of reciprocity – the idea of people coming together to help each other. On a more positive note, many of the elderly people I meet do have wonderful families and neighbours.
In terms of what the state does to look after people, there’s been a rise in public expectations of what the NHS can provide. For example, people who experience infertility, now expect to have IVF treatment into their 40s; people diagnosed with cancer want access to the best drugs and treatment which can be very expensive for very small benefits. The NHS doesn’t talk about rationing healthcare, it talks about prioritising – but in effect there’s a finite pot of money and it has to make decisions about who gets what and how much.
Who should be responsible for care?
CCD: What’s interesting is how we, in the west, categorise people and treat them accordingly, and, in particular, how we order lives into distinct stages, each having its own distinct expectations, responsibilities and mode of experience. This affects not only how we experience and understand our own lives but also how we treat others and, in turn, are treated by them. But our categories aren’t the only way of ordering a life. One of my favourite books in anthropology is No Aging in India, by Lawrence Cohen. Cohen considers the idea that, until very recently, there wasn’t such a thing as ageing in India. This might sound like post-modern nonsense; but what he means is that there wasn’t “ageing” as a distinct stage of life, as an irredeemable descent towards death in the way that we understand it. The elderly weren’t sent to liminal environments away from everybody else, but remained a central part of their communities.
It would be a typically anthropological gesture to say there is no ‘natural’ way to care; that there are many possible dispensations for caring for children, the vulnerable, the ill and the elderly, and that these are demonstrated by different cultures. This is all well and good, but it tells us little about what we should do in this, our, situation, other than that we shouldn’t believe our way is or was in any way inevitable. Cohen’s book is provocative, but it isn’t a guide in any meaningful sense. We have very specific problems. For instance, I worry that the terms of the care debate are solely economic. The ‘burden of care’ is always monetary, never moral. But the question of responsibility is a moral question. We have the resources to have a moral debate, but lack faith in them. All too often, moral debate is silenced by somebody who says, “Well, that’s just your opinion”, the implication being that moral opinions are just subjective; we feel confident when we talk about facts, because they have ‘substance’ we can get our teeth into, but we don’t feel the same about values.
GE: Historically, care has been something that families undertake and, when it’s good and families are well supported, nothing can substitute this kind of care. It’s always been the case that most carers - both unpaid and paid – are women. When larger numbers of women spent their lives at home rather than the workplace, care was something they built into their other activities. But families have changed: most women have jobs as well as family responsibilities and they find themselves juggling their roles. Despite these changes, women undertake the overwhelming responsibility of care. And it’s women who more often than men find themselves alone and needing care at the end of life.
CN: As Gail says, care falls largely to women, whether they are paid or unpaid. And in both these cases, women are generally juggling a number of roles. Families are often geographically dispersed and women are likely to be working. So women face all these pressures. Paid carers get minimal training, their work is low status and poorly paid: yet they work they do is demanding, both mentally and physically, and they are in roles that carry a lot of personal responsibility. This isn’t something easy to fix because for people paying for care at home, or for a place in a home, the costs are already high. Those people paying for places in care homes are effectively subsidising the care of those in the same homes who are paid for by their local authorities. So society does face some really big challenges in this respect – and there are certainly no easy answers. And the pressures on families, and on the NHS and other services, are inevitably going to get greater.
Can caring be taught?
CCD: My research focused precisely on the question of learning to care. One doesn’t just walk off the street into a care home and start caring: I had to shadow experienced carers as they worked and learn from them. They told me that in order to care I had to “turn off” my emotions, to dissociate doer from deed and ignore provocations from the residents. Because residents were seen as lacking the necessary stable mental state to be responsible agents, you couldn’t blame them for bad behaviour, and reproaching them would only upset them and aggravate their condition. All this might sound rather different from the official line on caring, but this is exactly what new carers were doing: learning to see the residents as being irresponsible and undeserving of blame. This account of care’s necessary work on the self comes very close to a famous philosophical account of attributing blame. In his essay Freedom and Resentment, PF Strawson argues that attributing responsibility has nothing to do with an objective measure ‘out there’ in the world, but is about the emotional stances we take towards each other.
When we see someone as irresponsible, we suspend our habitual emotional responses, adopting what he calls an “objective attitude” and making that person no longer a full player in our moral games. This was something I had difficulty doing at first, being completely unused to interacting with elderly people with dementia. I had never been in a care home before and my family has been blessed with remarkable longevity: at 94 my great-grandmother Winifred was still taking a restorative Guinness daily and leaning over the banister to pop money in the electricity meter. Though some of the residents seemed to me as close to dead as it is possible to be when alive, others were less obviously incapable, and yet their behaviour could vary quite dramatically from day to day, or even within a single day, making it unclear what to expect of them and how to respond.
GE: I trained as a nurse at the Edinburgh Royal Infirmary and I can clearly remember being shown by the ward sister how to bathe a patient. She demonstrated to me, by the way she went about her this task, just as much as by what she said, that washing someone was not a lowly task but something quite vital. It was an opportunity to assess the patient, observing how they were, talking to them, while the care was provided. When it came to serving meals, there was the same attention to detail: food was selected from the trolley for its suitability to individual patients. We were taught to make a note of how much patients ate and drank, and help them if they needed help. Basic nursing care was something seen as valuable and skilled. I found the example of this sister inspirational; she taught me a tremendous amount about taking a pride in your work and upholding standards of care.
As for learning to “turn off” your emotions, I think that you do need a level of professionalism but I think this can be overdone. It’s not appropriate to be cold – but on the other hand it’s not appropriate to be too matey either. Niceties such as how you address a patient – by their first name or as Mr, Mrs or Miss if that is preferred – are so important to the dignity, and self-esteem, of the patient. All these apparently small things add up to create an environment that is either caring or not.
CN: I think the ability to care generally goes back to how you were brought up – and whether you were encouraged to be kind to people and animals, to think about others, and to respect other people’s space. Communication skills can be taught and improved on through tips and strategies to raise professionalism. But it’s very hard to teach caring from scratch. The extent to which someone feels empathy, or a sense of compassion, varies from person to person. If you don’t feel empathy for the people you’re working with, and paid to look after, you really shouldn’t be working in a hands-on caring role. The reality is, however, that if you’re unskilled and looking for a job, then the jobs readily available to you are likely to be in the care sector. As for how you go about caring, your personal style, it’s also true that everyone has a different way of doing things: an approach works with one patient won’t necessarily suit another. That’s a fact of life we can’t avoid.
Is there a crisis of care?
CCD: I think how the idea of how a care crisis is framed in the media and the public imagination, is as interesting as the question of whether it actually exists or not. Clearly, the economics of care are frightening, and made even more so by the current political and economic dispensation. But we need to make sure we are asking the right questions and looking in the right places. The general idea of a “crisis” might itself be a problem, smuggling in certain assumptions which cloud our thinking or make us favour certain lines of questioning over others.
We should be alert to the fact that we seem only to have economic crises today. The care crisis is no different, being presented as an economic, not a moral, problem. Even a major study like Dementia 2010 sticks to the facts (the figures) and avoids the language of values. It’s the same in the newspapers, more or less. In a recent piece on Labour’s care policy, for instance, Polly Toynbee used the word ‘fair’ essentially to mean ‘distributed along more economically equitable lines’; she did not question whether there might be a way to care for the elderly which not only takes into account the distribution of the cost, but equally asks what they deserve and are due from their loved ones and from society.
When we do discuss morality, usually in cases of abuse by carers, what’s often emphasised is its singularity— there are only individual scandals involving individual care homes and individual carers (Winterbourne View, Mid-Staffs, Hilton Gardens, etc).The French sociologist Pierre Bourdieu famously said that Watergate wasn’t a scandal, because for something to be a scandal it had to be individual or unusual; how many Watergates had there already been, and how many were there to come? American politics itself was the real scandal. He could just as easily have been talking about care today.
GE: The scale of need created by the growing elderly population has been well documented. Many paid carers working in residential homes and in the community do an exceptional job – but they receive minimal training and are rewarded by minimum wages for caring for some of the most vulnerable people in society. This doesn’t give carers – or the public at large - a good message about the importance of their role. It’s shocking that carers paid to support people in their own homes are generally not paid for the time they spend travelling between visits – and sometimes not even reimbursed for their travel costs. Some paid carers are on zero hour contracts which give them no job security. This situation urgently needs addressing.
There is another less immediately visible problem too: a crisis of individual people not recognising the situation they are in. Carers looking after family members or friends start out by providing one level of care but it often escalates so they continue to provide care with no service input – and often no knowledge of what support they could access. This can lead to cases of crisis – especially when one elderly or frail person is looking after another.
CN: I fear that this winter, and if not this winter then next winter, could be a really difficult time for the NHS. In my opinion, we have had far too much political interference and reorganisations which have led to a loss of staff morale and affected the ways in which people feel a sense of ownership of their jobs. In the case of recent scandals, which are inexcusable, most of those involved were not ‘bad people’: they were let down by the system and slipped into struggling to meet targets and jumping through hoops rather than looking at the care provided to patients for whom they were responsible. A system in which one Trust has to compete with another, and is judged on the bottom line, is not a system that is putting compassion first: it’s a system that prioritises targets over people.
Is there a solution to this crisis?
CCD: I think we need to be certain what the nature of the crisis is. There clearly are economic problems. But even if we solved the immediate economic problems— if more funding were made available for dementia research, diagnosis and treatment, for instance — then the structure of care institutions, if it remained intact, might still make abuse and mistreatment inevitable.
As long as the elderly and the vulnerable are treated as objects to be administered to, in a better or worse way, then I think the moral problem will remain. The question is whether we can find ways to allow the elderly and the vulnerable to exist actively, rather than passively, within, rather than outside, society. This is the provocative message at the heart of No Aging in India, that we don’t have to do things this way — that the elderly don’t have to be passive and that their existence and experience can be profoundly meaningful, both to themselves and to those around them. But moral questions barely register at the moment. Making them register won’t be easy.
GE: We certainly need a much better career structure for carers to encourage them to develop and move forward – the introduction of NVQs is a valuable first step and must be encouraged. Care is unpredictable by nature: this is at the crux of the challenge. As the journalist Jackie Ashley, wife of Andrew Marr, has pointed out in interviews about their experience of Andrew’s stroke and recovery, paid-for care is organised to pre-planned time slots. Andrew’s carer would arrive at 7am – but he wanted to get up at 6am which meant that when the carer arrived assistance was no longer needed. This is just a small detail but it reveals so much about a crisis facing not just one family but many others too. Jackie Ashley has also raised the question of whether family leave could be broadened beyond maternity and paternity leave to include a range of situations and scenarios. There is no substitute for quality family care – and we can strive to help families to make that care possible.
CN: Caring for the frail older people whom I see, many of whom have cognitive problems, takes a lot of time and this puts real pressure on staffing budgets. People with dementia don’t necessarily feel hungry at meal times and feeding them takes time, skill and patience. We’re now seeing an increase in the use of volunteers to undertake these tasks in hospitals. At Addenbrooke’s Hospital, Giles Wright, Voluntary Services Manager, is working on a programme to ensure that all volunteers in the hospital have basic training about dementia and those who express a particular interest in working with older people have additional training and on-going support.
There’s a lot of talk about assistive technology and how it can play a role in care. It’s a term used to describe not just devices that allow people to do things like close the curtains, switch the radio on and heat up food remotely, or ways of monitoring people at home – for example whether they are walking around and have opened the fridge – but also covers the development of robots as companions in the home, something that’s been explored in Japan. I’m sceptical about a lot of this: essentially people need people, not gadgets. Pets can provide companionship and a new development is the training of dogs. Dogs can enhance the quality of life of a person with dementia – but once again dogs need people to look after them.
With the number of very old people increasing dramatically it’s likely that attitudes to euthanasia will eventually change. At present, there’s a lot of skirting around the issue in professional circles. Many people, especially older women, tell me that they are worried about becoming a burden on their families, and are really frightened about losing their independence and dignity. These people tell me that they would like to have the choice of going to Dignitas but are concerned that when they might want to end things they will not able to make the journey.
For more information about this story contact Alex Buxton, Office of Communications, University of Cambridge, email@example.com 01223 761673
Inset images from top: Vinoth Chandar, Sceptre Publishers, Jess Golden, Magnus Franklin, Phil and Pam, Marmotte73, Melvyn Bragg
On November 1 Melvyn Bragg will talk about his book Grace and Mary at the Festival of Ideas. The novel is based on Bragg’s own bitter-sweet experience of his mother’s dementia. Looking back across three generations, it raises fundamental questions about social attitudes and how they shape our lives. Three people discuss some of the big challenges that face us.
Family bonds: how does surrogacy impact on relationships?
By amb206 from University of Cambridge - Centre for Family Research. Published on Jul 08, 2013.
When a woman becomes a surrogate to enable others to have a baby, new relationships are formed. Research carried out by the Centre of Family Research, University of Cambridge, suggests that many of these relationships flourish. The research will be presented today at the European Society of Human Reproduction and Embryology (ESHRE) conference in London.
Surrogacy, the process whereby a woman carries and gives birth to a baby for an infertile couple, has become a more widely-accepted way of building a family, helped in part by media coverage of its use by high-profile celebrities. Commercially arranged surrogacy is illegal in the UK and many surrogates, most of whom have children of their own, are motivated by the desire to help others have a family.
To date there has been limited research into the long-term impact of surrogacy on the adults and children involved in the process, but now a study at the Centre for Family Research is looking at whether, and how, surrogacy affects family relationships.
Today Dr Vasanti Jadva and PhD candidate Susan Imrie of the Centre for Family Research will present findings from a two-year ESRC-funded research project which looks at the experiences of surrogacy from a range of perspectives including that of the partners and children of surrogates as well as surrogates themselves.
The research is based on in-depth interviews with 34 surrogates, 36 children of surrogates and 11 partners of surrogates. Twenty of the surrogates had been interviewed by Dr Jadva more than ten years ago in a previous project which looked at the psychological wellbeing and experiences of surrogates one year after the birth of the surrogacy child. The participation of these women allowed the researchers to track relationships over time, adding a valuable dimension to the study.
The findings paint a largely positive picture of the relationships between the surrogate and her own family, and between these individuals and the families created through surrogacy.
“Our research shows that in the majority of cases, relationships formed as a result of surrogacy are valued and enjoyed by surrogates and sustained over time,” said Dr Jadva. The study found that surrogates stayed in touch with the majority of the surrogacy children (77 per cent) and with most of the parents (85 per cent of mothers, 76 per cent of fathers). Of the surrogates who had chosen to maintain contact with the surrogacy families, most would meet in person once or twice a year.
Most of the surrogates’ own children (86 per cent) had a positive view of their mothers’ involvement in surrogacy. Almost half (47 per cent) were in contact with the surrogacy child all of whom reported a good relationship with him or her. A significant number of surrogates’ children referred to the child as a sibling or a half sibling.
There are two types of surrogacy practised in the UK: gestational surrogacy, also known as host surrogacy, in which the surrogate gestates the couple’s embryo (or an embryo created using a donor egg) and becomes pregnant through IVF; and genetic surrogacy, also known as traditional surrogacy, in which the surrogate uses her own egg and is thus the genetic mother of the child.
Interestingly, the type of surrogacy did not affect how the surrogacy child was viewed by the surrogates’ own children and did not appear to have a bearing on whether the experience was seen as positive or negative by those involved.
Susan Imrie said: “It is clear that the children of surrogate mothers do not experience any negative consequences as a result of their mother’s decision to be a surrogate and that this was irrespective of whether or not the surrogate used her own egg. In fact, most of the children we spoke to were supportive of their mother being a surrogate and were proud of what she’d achieved.”
Surrogacy offers a means of having children to a growing number of couples experiencing fertility problems or unable to conceive. The practice is legal in the UK on an altruistic and non-commercial basis, and surrogacy arrangements are non-enforceable in law. The surrogate is the legal mother of the child until legal parentage is transferred to the intended parents through a Parental Order which can be applied for between six weeks and six months after the birth. Since 2010 it has been possible for same-sex couples in the UK to use surrogacy as a means of parenthood. Although no accurate figures are available on the number of surrogacies carried out in the UK, it is estimated that numbers are increasing.
Dr Vasanti Jadva will be presenting her paper ‘Children of surrogate mothers: psychological wellbeing, family relationships and experiences of surrogacy’ at the European Society of Human Reproduction and Embryology (ESHRE) on Monday, 8 July. Susan Imrie’s poster is titled ‘Surrogate mothers: contact and relationships with families created through surrogacy’.
For more information about this story contact Alex Buxton, Office of Communications, University of Cambridge, firstname.lastname@example.org 01223 761673.
Preliminary results from a pioneering study at Cambridge University paint a positive picture of the relationships formed between surrogates and the families they help to create.
How to care for carers
By amb206 from University of Cambridge - Centre for Family Research. Published on Jun 10, 2013.
It is well established that most people would prefer to die at home rather than in hospital. The family members or friends who make this possible (carers) play a vital role in sharing care with the health care professionals involved. Just as the patient has complex and immediate needs, so does the carer. The carer provides the support needed to help someone close to them spend the last stage of their life in the familiar surroundings of their own home, within their own community.
Caring for people who are dying is stressful on multiple levels. Many carers are elderly or infirm and find themselves in situations for which they have had little preparation. Others have to juggle conflicting roles within families – for example as care-givers to relatives and as parents to young children – as well as fitting care around paid work. Pioneering research into the day-to-day experiences of a range of people who have recently provided this kind of support to family or friends has led to the development of an accessible but comprehensive tool for assessing the support needs of carers – and thus providing a point of reference for putting that support into place.
The Carer Support Needs Assessment Tool (CSNAT) has been developed by Dr Gail Ewing, a senior researcher at the Centre for Family Research, University of Cambridge, in partnership with Professor Gunn Grande at the University of Manchester. Both have long experience of palliative and end of life care research, particularly with carers.Their work was carried out in collaboration with the National Association for Hospice at Home.
The CSNAT is based on findings from a study of 75 recently bereaved carers who had cared for a relative or friend at the end of life. Participants shared their experiences with researchers in interviews and focus groups which explored carers’ support needs, particularly in the last two to three months of the life of the person they were caring for. Carers were asked about support needs that were met and input from services that was perceived to be helpful, but also shortfalls in provision where needs had not been met. This enabled the researchers to identify key support domains (areas) for carers at the end of life.
One of the support domains is the matter of knowing who to contact about concerns. “We found that carers often had little knowledge of healthcare systems and who they should contact for help. What appeared to make a real difference was whether the carer had a main contact for support. This was not just a telephone number, but it was a person: someone who they could contact who knew their situation – who could be reached both in the daytime and out of hours. Carers did not necessarily make use of named contacts a great deal but reported reassurance from knowing that there was a person they could call if needed,” said Dr Ewing.
“Our study with bereaved carers showed us that the needs of carers fell into two groupings: support to enable them to care for their relative/friend, but also more direct support for themselves, arising from the impact of their caring role. We built the tool around that understanding.”
Seven of the 14 domains on the tool ask the carer about the support he or she needs in order to fulfil the role of carer to a dying relative or friend, such as ‘do you need more support with managing your relative’s symptoms, including giving medicines?’ The second set of domains asks the carer about the support they need for themselves, such as ‘do you need more support with dealing with your feelings and worries?’
The CSNAT was designed as a screening tool to identify which of the 14 areas of support needs require further detailed assessment, thus enabling it to be short but comprehensive in approach. “The intention is to use it to use it to open up a conversation between practitioners and carers to explore, from the carers’ perspective, what their support needs are and what it most important to them,” explained Dr Ewing.
In 2009-2010 the tool was validated when 225 adult carers were surveyed twice – a baseline survey was followed by a second survey four weeks later where carers completed the CSNAT along with standard measures of the impact of caregiving, preparedness to care and carer health.
Carers’ needs may change over time due to shifts in the situation and the burden of continuing, often escalating, practical and emotional demands. Study findings suggested that the assessment tool was relevant and covered all the main support domains; feedback indicated that that the CSNAT was quick and easy to use. It was also seen as giving carers a voice: one former carer remarked that she felt she “could be heard through this”.
The study found that most carers wanted more support with knowing what to expect in the future and dealing with their feelings and worries. “In end-of-life care, carers often find themselves entering a world they are unfamiliar with – and find themselves coping with medications and equipment they know little about. They may need information about the drugs, or instruction about the equipment and devices they are handling,” said Dr Ewing.
“The assessment tool allows them to voice their worries about aspects of the care they are providing. Just as importantly it offers a framework that recognises the important role they play and legitimises their own needs. The way in which professional support is offered is vital. Sometimes it can be something very simple: carers may just want to be included in aspects of the care of a loved one or even just to have acknowledgement of role they are playing.”
If you would like further information about the CSNAT, please contact Dr Gail Ewing email@example.com.
Carers’ week (10-16 June) will focus on the 6.5 million people who are carers. Many are providing palliative care for a relative or friend at home. A new tool has been developed to identify carers’ needs during end-of-life care at home and enable them to work more smoothly with healthcare professionals.
New conceptions: single mothers by sperm donation
By amb206 from University of Cambridge - Centre for Family Research. Published on Apr 25, 2013.
Earlier this month, we were given the sad news that Professor Sir Robert Edwards had passed away. A Nobel Prize winner, scientist, and fellow of Churchill College, Professor Edwards has received much international acclaim for his significant contribution to the field of reproductive medicine. Here in Cambridge, with colleague Patrick Steptoe, he pioneered in vitro fertilisation, a method to facilitate family-building in the face of infertility. Yet, although the scientific implications of IVF were well thought-through by the duo, the extensive social, ethical and philosophical debates which ensued as a result of their work could not have been anticipated.
Twenty five years on, it is clear that assisted reproductive techniques have raised fundamental questions about the relationship between technology and society, and the role of science in human experience. And while IVF at the outset was explicitly used to assist traditional family-building, today technology has enabled lesbian and gay couples and single men and women worldwide to become parents, causing much deliberation, discussion and debate among professionals, politicians, and the wider public.
At the Centre for Family Research, our team, headed by Professor Susan Golombok, is committed to obtaining empirical evidence on the psychological, social and emotional well-being of parents and children in families formed through assisted reproduction. Having conducted research on hundreds of families of different shapes and sizes, we have learnt that what seems to be most important is not how families are formed or structured, but the quality of family relationships and experiences. One of our most recent research projects focuses on single women who have used a sperm donor to have a child.
In 1990, when the UK government first legislated about the use of assisted reproduction, it was stated that clinicians needed to consider a ‘child’s need for a father’ in deciding whom to offer treatment. In practice, we know that some fertility clinics were already offering, and continued to offer, treatment to lesbian couples and single women, but the ‘need for a father’ was only recently replaced by the ‘need for supportive parenting’ when the legislation was last amended – in 2008.
Many of the arguments against single women using sperm donation assume that these families are likely to face similar issues to those that might affect single-parent families by divorce, such as financial or emotional difficulties. It is often assumed that women who want to use fertility treatment on their own will fit a middle-class, career-focused, 40-something stereotype, suddenly struck by the sound of their ticking biological clock.
This group of women has been widely criticised for the pursuit of a non-traditional path to parenthood which ultimately, it is argued, deprives children of the right to know, and have a relationship with, their biological father. In fact, concerns are raised not only by politicians and the wider public, but by professionals working in fertility treatment services. Clinic staff have questioned whether single women have the adequate material and social resources, and psychological and emotional skills, required to parent effectively. It is often assumed that these women’s single status is indicative of their inability to maintain a successful romantic relationship. This being the case, it is supposed that single mothers by sperm donation will lack the qualities necessary for good parenthood.
Our latest findings at the Centre for Family Research indicate not only that the cohort of single women accessing sperm donation may be more diverse than often assumed, but that concerns about the functioning of their families may be based more upon misinformation than anything else. In our work, we have so far been welcomed into the homes of over 40 single mothers by sperm donation. We have met their children, their families, their friends and, sometimes, their pets, and have been entrusted with significant and often deeply personal information about their experiences. So who are these women, why have they chosen this path to parenthood, and what are their families like?
The women we have seen come from a variety of socioeconomic backgrounds, and they differ vastly in their experiences of education and employment. They have ranged in age from their early 30s to their early 50s, with some women initially accessing fertility services as 20-somethings. Only one woman we visited described her decision to use fertility treatment as a result of her career choices earlier in life. In fact, the majority of mothers discuss their decision as resulting from not having a suitable partner at the time they decided to have a child. Contrary to clinical opinion, most of the women in our study have previously been in long-term relationships, and several have cohabited with a partner. Some have had children in these relationships, and others have previously been married.
But why do these women want to become single mothers? The answer is that in many ways, they don’t. The majority of women we have visited have described how they had always assumed they would have children within a traditional two-parent family, and would have preferred this to be the case. However, they – like the majority of people in the UK today – want to have children, and they want to do so in a way they see as safe and honest, and supported by the services available to them.
When talking about having chosen their specific sperm donor, mothers have described different approaches, including choosing from a sperm donation website in the company of friends, to asking very little information of clinic staff about the donor they have been matched with on the basis of shared physical characteristics. Some mothers tell their family, friends, and their children about their use of a donor, while others do not share this information so readily, and others have opted to refrain from disclosing the information, until their children – who, in our study, are currently aged four to eight – are older.
At odds with the assumption that single women using a sperm donor intentionally deprive their children of a father, most of the mothers we have seen explicitly acknowledge the possibility that their use of a donor may have consequences for how their children feel about their families. Many reflect upon the significance of male role models for their child’s development, and several highlight how they have fostered relationships between their male family members and friends and their children for this reason.
In fact, it seems fair to say that none of the mothers parent single-handedly: they all receive practical and emotional support from family, friends, and others, in raising their children. And although they do see clear differences between their experiences of parenthood and the experiences of their married friends, these differences are not always seen in a negative light. Mothers mostly distinguish between the good and bad families they are familiar with. Their judgments are based upon whether the people in these families are happy and healthy, rather than how many people are in them.
Having now spent over a year listening to their stories, and sharing in mothers’ experiences, it seems reasonable to suggest that politicians, professionals, and the public might do well to take the lead from these mothers in assessing their families in a similar way: irrespective of family structure. Instead of relying on a single stereotype of single mothers by sperm donation, our focus should remain on research which continues to look closely at the well-being of the mothers and children within these families.
Most fundamentally, the debate ignited by Edwards and Steptoe back in 1978 must now move beyond arguments in favour of the traditional family, comprised of two married, heterosexual parents and their 2.4 children. In other words, the need for new conceptions – of family life in general, and of single motherhood specifically – is now clear.
Sophie Zadeh is an ESRC-funded PhD student at the Centre for Family Research, University of Cambridge. Her research with Dr Tabitha Freeman and Professor Susan Golombok focuses on the experiences of single women who have used a sperm donor to have a child, and explores the psychological, social and emotional well-being of mothers and children in these families.
Sophie Zadeh, a PhD candidate in the Centre for Family Research, is contributing to a new study of the well-being of single mothers by sperm donation and their children. Her initial findings confound many of the assumptions about this group of women.
I’ve got two dads – and they adopted me
By amb206 from University of Cambridge - Centre for Family Research. Published on Mar 04, 2013.
In-depth research into the experiences of adoptive families headed by same-sex couples suggests that children adopted by gay or lesbian couples are just as likely to thrive as those adopted by heterosexual couples. It also reveals that new families cope just as well as traditional families with the big challenges that come with taking on children who have had a poor start in life.
A report outlining key findings from the research – which was carried out by a team at Cambridge University’s Centre for Family Research – is published today by the British Association of Adoption and Fostering (BAAF) to coincide with LGBT Adoption and Fostering Week. The study is the first of its kind in the UK.
The research explored in considerable detail the experiences of 130 adoptive families, looking at important aspects of family relationships, parental wellbeing and child adjustment. The study compared three kinds of adoptive families: those headed by gay fathers (41 families), those headed by lesbian mothers (40 families), and those headed by heterosexual parents (49 families).
“We worked with more than 70 adoption agencies across the UK to recruit families. The participating families were similar in terms of ethnicity, socioeconomic status and education,” says Professor Susan Golombok, director of the Centre for Family Research and co-author of the report.
“Overall we found markedly more similarities than differences in experiences between family types. The differences that did emerge relate to levels of depressive symptoms in parents, which are especially low for gay fathers, and the contrasting pathways to adoption which was second choice for many of the heterosexual and some lesbian parents – but first choice for all but one of the gay parents.”
The study took the form of home visits to the families, written questionnaires, and recorded parent-child play sessions. All but four of the children studied were aged between four and eight years old, and all had been placed in their families for at least 12 months prior to being interviewed. All families had two parents.
Each year adoptive families are needed for some 4,000 children. Same-sex couples have had the legal right to adopt since 2005 but remain a small proportion of the total number of adopters. National statistics show that annually around 60 children are adopted by gay couples and a further 60 by lesbian couples.
The bill that brought about the change was fiercely contested and took three years to pass through parliament. Issues raised in the debate included concerns that children adopted by same-sex couples would face bullying from peers and worries that children’s own gender identity might be skewed by being raised by parents of the same sex.
Responses from the same-sex parents, adopted children themselves and the children’s teachers indicates that these issues do not appear to be a significant problem – although the researchers, and some parents themselves, acknowledge that problems of bullying could become a problem as the children become teenagers.
The majority of the children in the study appeared to be adjusting well to family life and to school. Face-to-face interviews with parents, and with those children willing and old enough to take part, showed that parents talked openly with their children about adoption and recognised the value of children maintaining contact with their birth parents.
Some interesting differences emerged in parents’ wellbeing across the three types of family. Gay fathers were significantly less likely to report having depressive symptoms than lesbian mothers and heterosexual couples, most probably reflecting the lower levels of depression shown by men than women generally. However, it should be noted that the level of depression reported by lesbian mothers and heterosexual parents was below, or in line with, the national picture for mental health.
Gay fathers appeared to have more interaction with their children and the children of gay fathers had particularly busy social lives.
Pathways to adoption also differed across the three groups. While most heterosexual couples expected to become parents as a matter of course, fewer same-sex couples expected to have children. This was particularly true of gay fathers many of whom had viewed their sexual identity as incompatible with parenthood.
Most of the heterosexual couples, and a significant number of lesbian couples, had experienced fertility problems. Many had undergone IVF treatment with no success. In contrast, only one of the gay couples had tried (but failed) to conceive with the help of a surrogate. For the remaining gay couples, adoption was the first choice.
Most parents across the family types had had positive experiences of the adoption process with many speaking warmly of the support they received. A number of same sex couples, however, reported that agencies lacked experience in working with gay and lesbian parents and that this showed itself in awkwardness. One gay parent described having the phone put down on him when he said that his partner was a man.
Being adopted makes children different to many of their peers: being adopted by same sex couples could add another dimension to that sense of being different. Interviews with parents showed that they were well aware of the extra challenges they and their children might face – and that they hoped to raise children who were secure in their own identity and valued diversity.
For more information about this story, please contact Alex.Buxton@admin.cam.ac.uk
Research into adoptive families headed by same-sex couples paints a positive picture of relationships and wellbeing in these new families. The study, which was carried out by Cambridge University, suggests that adoptive families with gay fathers might be faring particularly well.
Who do you think you are?
By amb206 from University of Cambridge - Centre for Family Research. Published on Nov 23, 2012.
Jiten was 13 years old when his mother told him that he had been conceived with donor sperm. The man Jiten had always thought was his father, and had lived with Jiten and his mother until he was five, was not his genetic father. He says: “I remember running downstairs to talk to my step-dad. It was a relief as I really didn’t get on with the man I’d seen as my dad – and I’d always got on brilliantly with my step-dad.”
Families are changing, not just as a result of a breakdown of conventional family structures but also because of advances in assisted reproductive technologies. No-one knows exactly how many children born in the UK each year are conceived using donated sperm, eggs or embryos - but in 2009 the Human Fertilisation and Embryology Authority (HFEA) put the figure at 1,756.
Donation allows many thousands of people experiencing fertility problems to become parents. However, the conception of children through assisted reproductive technologies brings into play a raft of tricky ethical issues, the foremost of which is the question of disclosure.
“Should children be told that they were conceived using donated reproductive tissue? It might seem like a simple question, and the obvious answer for some may be yes, but it’s one that many parents find much harder to cope with in reality than in theory,” says John Appleby, a researcher with the Centre for Family Research, University of Cambridge, who is looking at the ethical considerations of disclosure.
“Most parents of donor conceived children face the dilemma of whether, when and how to tell their children about their genetic origins. I say most because, for example in the case of same-sex couples and single parents, the child may well seek answers to obvious questions about their conception though that doesn’t mean that disclosure is an easy task. For many parents, if and when to begin to tell a child that he or she has been conceived with the help of donated tissue is a real dilemma. Every family is different and families are not isolated units but part of wider communities.”
In his research, Appleby, who has a background in philosophy, has focused on the ethical questions that underlie the matter of disclosure, set against the legal and policy landscape in the UK, with a view to creating a framework for discussion.
Legislation took effect on April 1 2005, which allowed anyone conceived with donated tissue after that date to have, at the age of 18, the right to access information about the identity of their donor via records held by the UK’s Human Fertilisation and Embryology Authority (HFEA).
Not until 2023 will it begin to be apparent how many donor-conceived young people might seek out identifying information about their donors from the HFEA. If adoption law is any guide, then the numbers will not be insignificant. Jiten, who is 22, says that not having the right to information about his genetic father doesn’t bother him – although he’d be “curious enough to find out” if he could.
As the legislation stands, young people will not know that they have been donor conceived unless they have been told – and only those with this knowledge will have any reason seek access to the information held about their donor. This situation puts the onus firmly on the parents to make the decision about disclosure.
Existing research into the impact of disclosure (or non-disclosure) has looked at the psycho-social well-being of families, comparing families who have and have not told their child that he/she was donor conceived. Studies conducted at the Centre for Family Research have revealed no marked differences between families who had not disclosed to their children by early adolescence and those who had.
“Given these findings, you might ask: ‘What’s the point of telling children?’ But that ignores the risk of them finding out by accident, such as overhearing a conversation, and suffering some kind of harm,” says Appleby.
“As researchers we know of a few cases where children found out as teenagers that they were donor conceived and reported experiencing certain harms such as feeling lied to or deceived. On the other hand, we know of others who did not report any harm on discovering that they were donor conceived. All in all, we still need to gather more empirical evidence before any significant judgements can be made about the impact of disclosure, or non-disclosure, on the well-being of individuals later in life.”
To date, Appleby has concentrated on the ways in which disclosure impacts on the issues of trust and identity, among others. “When I looked at some of the cases in which individuals reported harm from late or accidental disclosure, one of the harms they reported was from losing trust in others,” said Appleby.
“Basically, if their parents had withheld information from them – lied, in fact – they reported experiencing a loss of trust in their parents, and sometimes in other people in their lives as well. In view of this, parents might be advised to opt for an approach which minimised the chance of losing their children’s trust. Trust is very important to young people and loss of trust in an aspect of a relationship can have a knock-on effect on other aspects.”
Television programmes such as the BBC’s Who Do You Think You Are? and ITV’s Long Lost Family tend to focus on the emotional impact of having to re-think identity in the light of new information about their family backgrounds. As Jiten’s experiences illustrate so vividly, every scenario and every family is different. Identity is an aspect of the human condition that can be fundamental to well-being – but each individual is likely to shape their identity using different points of reference, not all of them related directly to genetic ties.
Jiten says: “My experience is made more complex by the fact that my mum and the man I thought was my dad, as well as my genetic dad, are all Indian. My step-dad is white and I’ve been brought up in a household that blends two cultures. There are certain expectations that go along with being an Indian male and when I was able to separate myself mentally from my first dad, I felt free of these expectations. For me identity is as much to do with culture as genetics. Most importantly, when I was 18 or so, I realised that there was only one person responsible for who I am – and that’s me.”
Each year in the UK over a thousand children are conceived using donor tissue. Many parents find it hard to tell their children that they were donor conceived. Bioethicist John Appleby, from Cambridge University’s Centre for Family Research, is looking at some of the ethical questions surrounding disclosure.
The greatest gift
By ns480 from University of Cambridge - Centre for Family Research. Published on Apr 23, 2012.
Imagine the following scenario. Joelle and Lucia are two women using the same fertility clinic. They are strangers and are never likely to meet. But they have one important thing in common: both have been unable to conceive. Joelle has healthy ovaries; her partner has low quality sperm. In vitro fertilisation (IVF) offers them the best chance of pregnancy but it costs around £4,500. The clinic tells Joelle that she can “share” some of her eggs in exchange for a significant reduction of her treatment costs. Joelle undergoes hormone treatment and the 14 eggs that develop are shared equally between Joelle and Lucia, who is unable to produce her own eggs. Both women’s treatments are successful and each is delighted to be pregnant with the child they so longed for.
Now imagine a slightly different scenario. This time, Joelle’s eggs develop well and two are implanted but they do not develop into a pregnancy. She and her partner are disappointed. Lucia, however, does become pregnant using Joelle’s eggs and has a child. How does Joelle feel in the knowledge that she may well never have a child while another woman has carried her egg to term and has fulfilled her dream of becoming a mother? And how will Joelle feel in ensuing years while the child conceived as a result of her donation grows up and approaches his or her 18th birthday, at which point Joelle may or may not have a phone call from the child she has never known?
Controversy has surrounded the practice of egg donation ever since it began in 1984. Egg-sharing (sharing eggs by women within clinics), first introduced in 1998, has been particularly contentious. While egg-sharing schemes initially supplied just a small proportion of the total number of donated eggs in the UK, today these schemes supply 60 per cent of the total. However, the demand for donated eggs still considerably outstrips supplies. This shortage has become more acute as a result of legislation passed in 2005 that removes donor anonymity and gives donor-conceived children the right to discover the identity of their biological parents at the age of 18.
An article published today in the online journal BioNews sets out the findings of the first ever comprehensive research into the experiences, feelings and attitudes of women who have taken part in egg-sharing programmes, either as donors or recipients.
The research, carried out by Zeynep Gürtin and Susan Golombok at the University of Cambridge’s Centre for Family Research, in collaboration with Kamal Ahuja at the London Women’s Clinic, reveals a high level of empathy and reciprocity between women seeking assistance to become parents – and shines a light on the ways in which women navigate the emotionally-fraught process of undergoing fertility treatments. Some of its findings confound expectations about women’s emotions, especially in cases with mixed or negative outcomes.
The two-year study examined the attitudes, feelings and opinions of 86 women (48 egg-donors and 38 egg-recipients) undergoing treatment at the London Women’s Clinic – a private clinic that treats 1,500 women per year. Gürtin used detailed questionnaires with a variety of both multiple-choice and open-ended questions to encourage women to describe their innermost feelings on aspects of egg-sharing – that ranged from their motivations in signing up to programmes to their retrospective reflections on their experiences.
Opponents of egg-sharing have been concerned that these programmes may have a negative and harmful impact on the long-term welfare of the women opting to donate their eggs – for example that this group of donors, known as patient donors, might be financially motivated, that their consent will be compromised if they are otherwise unable to access much-wanted treatments, or that they might suffer psychological damage, especially if their own treatment ends unsuccessfully.
Clinics operating egg-sharing schemes offer substantially lower IVF costs to those willing to donate their eggs to other women receiving treatments – and sometimes waive donors’ fees altogether. However, The Cambridge University research suggests that much of the criticism levelled at egg-sharing, including concern about financial inducements, is ill-founded. What emerged strongly from the study was that the desire to help others played a significant part in the women’s decision-making and that money was by no means the only factor.
It was clear that both donors and recipients had thought deeply about each other’s predicaments. For example, one recipient wrote: “Taking part in the egg-sharing programme made me feel most comfortable because the donor went through the whole procedure mainly for herself and not just for me. So any health risks she took mainly because she wanted to get pregnant herself.” A donor reported simply that: “It felt right to share – I give blood, I am on the organ donor list and registered on the bone marrow register.”
“The women’s motivations to share their eggs were multiple: their own desire to have a baby, the opportunity of accessing cheaper treatment and the chance to help someone else all played an important role in their decisions. Reassuringly, we also found very low levels of regret among egg-share donors. Contrary to expectations, donors whose own treatments were unsuccessful were not resentful of recipients who became pregnant. In fact, some were comforted by the thought that their efforts, though of no direct benefit to their own situation, may have benefited someone else wishing to have a child.” said Gürtin.
“Many of the feelings and opinions expressed in the questionnaire were moving to read. Donors and recipients clearly empathised strongly with one another, as fellow women experiencing fertility problems, and imagined themselves as part of a reciprocal relationship with this important stranger. It was also clear that every woman has a different way of dealing with the experience of seeking assistance from clinics – for example, some shared information widely with family and friends, others were much more private. We’re very grateful to all the women who shared their experiences with us in order to provide some empirical evidence in a field that is by its very nature highly sensitive.”
The study enabled Gürtin to build a picture of the demographics and background of egg-sharers – both donors and recipients. “When people think about women going through fertility treatment they tend to picture heterosexual couples having problems with conceiving, however the landscape of assisted reproduction is changing. Although it’s true that the majority of our respondents fit into that category, we found that 34 per cent of the recipients in our sample were single women. Moreover, 27 per cent of donors were in lesbian relationships. These women had already embraced the idea of using donated sperm and so the notion of giving eggs made sense to them in a way that one of them described as ‘obvious’ and another as a ‘no brainer’: the concept of donation was something they believed in,” said Gürtin.
“When we compared donors and recipients we did not find any significant differences in ethnicity, religion, educational levels and occupations. The one striking difference was that recipients tended to be older than donors – on average 11 years older – a factor that is directly related to the fertility characteristics of the two groups. It was apparent that, for all the women, there was a highly nuanced balancing of the issues involved, whether practical and pragmatic or emotional and financial.”
Infertility affects growing numbers of women and is the second most common reason (after pregnancy) for women aged 20-45 to consult their GP. Treatments for infertility have seen huge advances in the past 30 years – and clinics offering IVF have proliferated. The shortage of donated eggs, the expense of treatments and long waiting lists, have led to a big rise in the numbers of British women seeking treatments overseas. It is thought that many would prefer to receive treatments in their own country.
After a lengthy review of their donation policies, the Human Fertilisation and Embryology Authority (HFEA) last year announced a flat-rate compensation of £750 in order to encourage more women to donate eggs. It came in effect at the start of April. Gürtin said: “This move is clearly targeted at non-patient donors, and there was no discussion of whether or how egg-sharing within clinics should be increased. However, we think that with more information provision and more focus, egg-sharing schemes have the potential to meet an even greater proportion of the demand for donor eggs in the UK, in a way that is beneficial to both donors and recipients.”
The first comprehensive study of egg-sharing between women undergoing fertility treatment reveals striking empathy on the part of donors and recipients – and may dispel concerns about programmes that offer ‘benefits-in-kind’ in return for donated eggs.
Sibling rivalry and brotherly love
By bjb42 from University of Cambridge - Centre for Family Research. Published on Apr 08, 2011.
The finding is one of a host of conclusions which have emerged from a five-year research project by academics at the University of Cambridge, examining children’s cognitive and social development between the ages of two and six.
Entitled “Toddlers Up”, the project was conceived after other studies showed that even by the age of four, some children already display the conduct and behavioural problems that hinder progress at school and beyond. This suggests that the causes and symptoms of such problems may emerge even earlier, while they are still toddlers.
The need to intervene in the lives of vulnerable children at an earlier stage to address this was highlighted in a recent Government report, led by Graham Allen MP, who will publish a second set of recommendations on the subject later this year.
The findings from the Toddlers Up study appear in a new book, Social Understanding and Social Lives, by Dr Claire Hughes, from the University of Cambridge’s Centre for Family Research. The book will be launched at an event in Cambridge on Friday, 8 April.
It aims to map out the causes and influences behind children’s “social understanding” – their awareness of others thoughts and feelings – and to explain why that of some children lags behind that of their peers.
In all, 140 children were studied, starting when they were just two years old. The group focused on low-income and teen parent families, into which some of the children deemed most at risk are often born. 43% of the children surveyed had mothers who were still teenagers when their first child was born, and 25% of the families involved were living below the poverty line of £12K household income per year.
A wide range of tests were carried out over the course of the five year study. They included video observations of the children interacting with their parents, siblings, friends and strangers; interviews and questionnaires carried out with parents, teachers and the children themselves; and various assessments designed to test the children’s aptitude with language, their planning skills, working memory and inhibitory control.
One of the most striking conclusions concerns siblings, who researchers found can often have a positive effect on a child’s early development, even in cases where the relationship is less than cordial.
Although the project team warn that sustained sibling rivalry can result in behavioural problems and issues with relationship-building later in life, milder forms were shown, in the new study, to have a beneficial impact on development in childhood.
“The traditional view is that having a brother or sister leads to a lot of competition for parents’ attention and love,” Dr Hughes said. “In fact, the balance of our evidence suggests that children’s social understanding may be accelerated by their interaction with siblings in many cases.”
“One of the key reasons for this seems to be that a sibling is a natural ally. They are often on the same wavelength, and they are likely to engage in the sort of pretend play that helps children to develop an awareness of mental states.”
Transcripts taken from video recordings in which pairs of siblings were involved in pretend play show that this is an arena in which children discuss thoughts and feelings in depth. Often they provide what the researchers refer to as the “emotional scaffolding” around which children construct a story that helps them develop their ideas about, and awareness, of different mental states.
Interestingly, even where sibling rivalry was evident, for example with one child teasing or arguing with the other, the exchanges still meant the younger child was often exposed to emotionally rich language from the older one. As a result, although younger siblings showed low rates of mental state talk than their elder siblings at age three, by the age of six their social understanding had increased rapidly, and they were conversing about emotions on an almost equal footing.
A similar lesson for parents also emerges from the study, which argues that the quality, as well as the quantity of conversations adults have with their children concerning thoughts and feelings, helps children’s social understanding to grow.
The researchers found that mothers who were adept at developing a connected and constructive dialogue around their child’s thoughts or feelings again built a more effective “emotional scaffold”, which gave these children a consistently higher level of social understanding by the time they reached the age of four.
“The children who performed best on tasks designed to test their social understanding at the age of six came from families where the mother carried out conversations in which they elaborated on ideas, highlighted differences in points of view, or tuned into children’s interests,” Dr Hughes said.
“A lot of attention has been given to the beneficial impact of children being exposed to lots of family conversation. This shows we need to focus on the nature and quality of that conversation as well.”
Social Understanding and Social Lives, by Claire Hughes, is published by Psychology Press.
Siblings, and even sibling rivalry, can have a positive effect on children’s early development and their ability to form social relationships later in life, according to a new study.
Assisted reproduction and family functioning
By bjb42 from University of Cambridge - Centre for Family Research. Published on Jan 04, 2011.
An estimated one in seven couples experience infertility, and an ever increasing proportion of these couples turn to assisted reproductive technologies as a solution to their childlessness. Many new and often complex family relationships have emerged as a result. It is now possible for a child to have five parents – an egg donor, a sperm donor, a surrogate mother who hosts the pregnancy and the two social parents whom the child knows as mum and dad.
Despite the obvious advantages to parents who have waited for so long to conceive a child, several questions have been raised about potential psychological difficulties for children born as a result of these new reproductive techniques. A major concern relates to the child’s lack of a genetic and/or gestational link with one or both parents, and the impact on parent–child relationships: will parents feel or behave less positively towards a non-genetic or non-gestational child?
Another concern is that the majority of children conceived by egg or sperm donation remain unaware that the person they know as their father or mother is not, in fact, their genetic or gestational parent. Is secrecy about their origins detrimental to children, placing them at risk for psychological problems in the future?
New family forms
A team from the Centre for Family Research led by Professor Susan Golombok, comprising Polly Casey, Lucy Blake, Jennifer Readings and Dr Vasanti Jadva, has been conducting a longitudinal study of parent–child relationships and the psychological well-being of parents and children in families created by assisted reproductive technologies. Donor insemination families (where the child lacks a genetic link with the father), egg donation families (where the child lacks a genetic link with the mother) and surrogacy families (where the child lacks a gestational link with the mother and sometimes a genetic link as well) are being compared with families with a naturally conceived child.
The study, funded by the US National Institutes of Health (NIH), began when the children were one year old, with the most recent phase conducted at age seven. Assessments of family relationships and child development were made alongside children’s growing understanding of the meaning of reproductive origin: genetic or gestational.
The results so far show that the assisted reproduction families appear to be functioning well: the parents have positive relationships with their children and the children themselves are well adjusted. Assisted reproduction mothers displayed a slight tendency to be more emotionally over-involved with their children than mothers of naturally conceived children. This refers to the extent to which mothers are over-concerned or inhibiting towards their children. Furthermore, mothers of egg donation and surrogacy children were found to be more sensitive to the needs and anxieties of their children, all of which may reflect a more involved parenting style.
Secrecy versus disclosure?
Family therapists and researchers in the area of adoption have argued that secrecy may damage communication between family members, creating a divide between those who know the secret (the parents) and those who do not (the child). As a result, legislation in the UK has recently changed to allow donor-conceived children to obtain identifying information about their donor on reaching age 18. However, little is known about children who are aware of their donor conception, largely because so few have been told about their genetic origins.
At the beginning of this study, approximately half of the gamete donation parents and all of the surrogacy parents intended to be open with their child about the nature of the conception. But, by the time the children were aged seven years, the majority of egg donation and donor insemination parents had not yet told their child about their donor conception.
The project enters its next phase as the children reach nine years of age, and the team hopes to continue to follow up the families for as long as possible. Longitudinal studies such as this are essential, and yet to date there are few in this research area. Over time, more parents may tell their child about the nature of their birth, allowing the impact of secrecy or disclosure to be investigated in more detail. Also, as the children get older, they will develop an increasingly more sophisticated understanding of the circumstances of their birth, and it will become ever more important to monitor parent–child relationships and the well-being of all involved.
For more information, please contact the author, Polly Casey (firstname.lastname@example.org), at the Centre for Family Research in the Faculty of Social and Political Sciences. These findings were reported at the Annual Conference of the European Society for Human Reproduction and Embryology in Barcelona in 2008, winning the Fertility Society of Australia Exchange prize for best presentation.
A longitudinal study is accessing the psychological well-being of children created by assisted reproductive technologies.