Sensitive responsiveness and multiple caregiving networks among Mbendjele BaYaka hunter-gatherers: Potential implications for psychological development and well-being.

Attachment theory postulates that there is a particular style of caregiving that, because of its interaction with our evolved psychology, is most likely to result in healthy psychological development. Attachment research has been criticized because most studies have been conducted with Western populations. Critics argue this has (a) overemphasized the importance of sensitive responsive caregiving and (b) limited our understanding of multiple nonmaternal caregiving (allomothering). Here, we analyze the extent of sensitive responsiveness and structural properties of allomothering networks among Mbendjele hunter-gatherers who reside in the Republic of Congo. Humans lived as hunter-gatherers for the majority of our evolutionary history, thus studying contemporary hunter-gatherers can offer insight into the caregiving children may be psychologically adapted to. Based on 12-hr focal follows of 18 children (0-4 years old; 10 male), we constructed caregiving networks across the domains of responding to crying, physical contact, interactive care, and proximity. Crying was virtually always responded to rapidly via comforting and never via scolding. Children received physical contact and care for the majority of the day. Allomothering accounted for 40%-50% of caregiving in each domain. While allomaternal networks were large, they were highly concentrated-the majority of a child's allocare was provided by just a few caregivers. Due to high caregiver:child ratios, "sharing" of caregivers was limited-a child typically had several allomothers who directed a majority of their allomaternal effort to him/her. These findings add to our understanding of the level and sources of sensitive responsive caregiving that children may be evolutionarily primed to expect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Editorial Perspective: What can we learn from hunter-gatherers about children's mental health? An evolutionary perspective.

Humans lived as hunter-gatherers for more than 95% of our evolutionary history, thus studying contemporary hunter-gatherer populations offers insight into the conditions children may be psychologically adapted to. Here, we contrast hunter-gatherer childhoods with those of WEIRD (Western Educated Industrialised Rich Democratic) societies and consider the implications for children's mental health. Hunter-gatherer infants receive continuous physical contact and more sensitive and responsive caregiving than is typical of WEIRD societies, due to the extensive involvement of alloparents (non-parental caregivers) who generally provide 40-50% of their care. Alongside positive attachment outcomes, alloparenting likely reduces the harms of family adversity and risk of abuse/neglect. From late infancy, hunter-gatherers spend their time in mixed-age 'playgroups' where they learn via active play and exploration without adult supervision. This contrasts with WEIRD norms surrounding the need for adult supervision of children, as well as with the passive teacher-led classrooms, which could potentially lead to suboptimal learning outcomes and pose difficulties to children with ADHD. Based on this preliminary comparison, we consider practical solutions to potential harms arising from discordance between what children are adapted to and exposed to. These include infant massage and babywearing; increased sibling and extra-familial involvement in childcare; and educational adjustments.

How evolutionary science can help us understand vaccine refusal in the COVID-19 pandemic.

Unvaccinated people have a mortality rate from COVID-19 that is 32-fold that of fully vaccinated people. Yet, in the UK, more than 4% of adults have not accepted a vaccine to protect them against COVID-19 and at the time of writing only 73% of people were fully vaccinated. Psychological and societal factors underlying vaccine hesitation or refusal are complex. In this paper, we use evolutionary science to help explain how vaccine refusal can be the result of an historic adaptation to protect against the repetition of past trauma, including, for many, that of systemic racism and/or deprivation, and misguided attempt to preserve fertility. We discuss some resulting cognitive biases and conclude with recommendations for practice.

Fifteen-minute consultation: How to communicate with parents who have a child on life support with no hope of recovery.

A child on life support with no hope of recovery is the worst nightmare for parents and for paediatricians. Unfortunately, some children have illnesses or injuries that are not compatible with life. Being in a vegetative state with no meaningful interaction does not safeguard children from feeling discomfort and pain. Letting nature take its course and allowing the child to die may well be the least worse option. However, this decision is fraught with difficulties for parents and for clinicians and can lead to unnecessary and painful conflict between them, even leading to court proceedings. In this paper, the impact of having a child on life support is discussed and recommendations are given in order to improve professional communication. It is hoped that an understanding of the impact on parents, cultural considerations, and the psychiatric concepts of 'denial', 'projection', the 'meta-level', 'transference', 'countertransference' and the techniques of 'motivational interviewing' will help clinicians prevent a breakdown of trust and improve doctor-parent relationships in these tragic cases.

DECRYPT trial: study protocol for a phase II randomised controlled trial of cognitive therapy for post-traumatic stress disorder (PTSD) in youth exposed to multiple traumatic stressors.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a distressing and disabling condition that affects significant numbers of children and adolescents. Youth exposed to multiple traumas (eg, abuse, domestic violence) are at particular risk of developing PTSD. Cognitive therapy for PTSD (CT-PTSD), derived from adult work, is a theoretically informed, disorder-specific form of trauma-focused cognitive-behavioural therapy. While efficacious for child and adolescent single-event trauma samples, its effectiveness in routine settings with more complex, multiple trauma-exposed youth has not been established. The Delivery of Cognitive Therapy for Young People after Trauma randomised controlled trial (RCT) examines the effectiveness of CT-PTSD for treating PTSD following multiple trauma exposure in children and young people in comparison with treatment as usual (TAU). METHODS/DESIGN: This protocol describes a two-arm, patient-level, single blind, superiority RCT comparing CT-PTSD (n=60) with TAU (n=60) in children and young people aged 8-17 years with a diagnosis of PTSD following multiple trauma exposure. The primary outcome is PTSD severity assessed using the Children's Revised Impact of Event Scale (8-item version) at post-treatment (ie, approximately 5 months post-randomisation). Secondary outcomes include structured interview assessment for PTSD, complex PTSD symptoms, depression and anxiety, overall functioning and parent-rated mental health. Mid-treatment and 11-month and 29-month post-randomisation assessments will also be completed. Process-outcome evaluation will consider which mechanisms underpin or moderate recovery. Qualitative interviews with the young people, their families and their therapists will be undertaken. Cost-effectiveness of CT-PTSD relative to TAU will be also be assessed. ETHICS AND DISSEMINATION: This trial protocol has been approved by a UK Health Research Authority Research Ethics Committee (East of England-Cambridge South, 16/EE/0233). Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations and clinical workshops. TRIAL REGISTRATION: ISRCTN12077707. Registered 24 October 2016 (http://www.isrctn.com/ISRCTN12077707). Trial recruitment commenced on 1 February 2017. It is anticipated that recruitment will continue until June 2021, with 11-month assessments being concluded in May 2022.

Fifteen-minute consultation: To prescribe or not to prescribe in ADHD, that is the question.

Attention-deficit hyperactivity disorder (ADHD) is fraught with controversy. Some clinicians believe it is a biological neurodevelopmental disorder which should be treated with medication. Others are adamant that ADHD is a social construct in which children, who have suffered developmental trauma, are medicalised. Evolutionary science may help us find a solution to this dichotomy by seeing ADHD as an example of an evolutionary mismatch in which children with ADHD are caught in a school environment that does not suit their natures. By considering how to improve the 'goodness of fit' between the child and their environment, clinicians can be more flexible in finding solutions that are ethically sound.

Can an evolutionary perspective shed light on maternal abuse of children?

Although the theory of evolution lies at the heart of contemporary biology, its influence on the study of child psychology and psychiatry has been limited. In earlier work we have argued that evolutionary thinking has much of value for clinicians. Here, we explore the possible significance of evolutionary theory for understanding child abuse by mothers, particularly neglect, emotional abuse and physical abuse. We draw on the research of anthropologists, primatologists and evolutionary theorists to make predictions about the environmental circumstances under which one would expect such abuse to be more prevalent. We discuss how in modern, Western cultures there is less understanding of the circumstances that may influence, even predispose, a mother to limit her emotional and material commitment to an infant or child. We use four short vignettes of clinical cases and one longer case description to illustrate the insights offered to clinicians by an evolutionary approach. We see our work both as contributing to greater understanding of these matters and as facilitating more compassionate models of care and intervention for women in such circumstances.

Evolutionary biology: an essential basic science for the training of the next generation of psychiatrists.

Evolutionary science can serve as the high-level organising principle for understanding psychiatry. Evolutionary concepts generate new models and ideas for future psychiatric study, research, policy and therapy. The authors accordingly make the case for the inclusion of evolutionary biology in the postgraduate education of psychiatric trainees.

Fifteen-minute consultation: Attachment as a model to understand and manage difficult doctor-parent relationships.

Paediatricians are often faced with managing the child who is unwell, and parents, who may present in ways that are difficult to manage. Difficult behaviours can range from those who disregard their child's needs, to those who overstate their child's minor symptoms, to those who ask for help but then refuse to accept it. This paper gives a framework using attachment theory to help paediatricians recognise, understand and deal with difficult doctor-parent interactions in a way that is appropriate and sensitive. Making changes to the way we communicate with parents can improve outcomes for the child, the family and the doctor's own well-being.

Fifteen-minute consultation: The angry child.

Children who present with difficult behaviours due to underlying anger are commonly presented to paediatricians for help and advice. This paper gives a basic structure of how to approach the subject, by exploring whether the problems occur at home, school or both, and analysing the behaviour by focusing on antecedents, behaviour and consequences. It is important to find the underlying causes in order to know what to recommend, as this can vary from medication, anger management strategies, school-based interventions, parenting programmes or family therapy.

Fifteen-minute consultation: safety assessment prior to discharge of patient admitted for self-harm.

Paediatricians often admit young people who have self-harmed, as advised by the National Institute for Health and Care Excellence guidelines. A full psychosocial assessment is essential to understand the underlying needs and risks. In this paper we focus on what the discharging doctor needs to know to arrange for a safe discharge. This involves reviewing the admission notes for red flags. We also give advice on the verbal and non-verbal communication skills needed to contain both the doctor's and the patient's difficult feelings.

Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake.

The term niacin is the generic name for the two compounds nicotinic acid and nicotinamide, the major dietary precursors for two important coenzymes, nicotinamide adenine dinucleotide (NAD) and its phosphorylated form, NADP. Niacin is important for the maintenance of cellular integrity and energy production and is involved in more than 500 intracellular reactions. Deficiencies of niacin may contribute to neuropsychiatric and neurodegenerative disorders. Patients who develop nutritional deficiencies as a result of poor dietary intake, especially inadequate intake of proteins and vitamins, could potentially suffer from niacin deficiency and NAD depletion. However, de novo synthesis of niacin and NAD in the kynurenine pathway of tryptophan metabolism may compensate for impaired dietary intake. The rate of synthesis of NAD and niacin from tryptophan oxidation depends on the induction of the enzyme indoleamine 2,3-dioxygenase (IDO) by pro-inflammatory cytokines such as interferon-gamma. Niacin synthesis is not limited by a decrease in tryptophan and excessive IDO activity may therefore lead to a decline in tryptophan levels. Antidepressants have an anti-inflammatory effect, including reduction of interferon-gamma and therefore inhibition of IDO, the rate-limiting enzyme of the kynurenine pathway. In theory, this could account for increased serotonin as more tryptophan becomes available for serotonin synthesis. However, the downside may be that less NAD and niacin are synthesised downstream, which could exacerbate common psychiatric problems. It is our hypothesis that patients with poor dietary intake, who are treated with antidepressants, are at risk of developing niacin/NAD deficiency with possible development of associated neuropsychiatric symptoms. We therefore propose that niacin supplementation be considered in patients with inadequate diets who are treated with antidepressants. We believe that if this does not happen, a subclinical niacin deficiency may result, which would be difficult to detect as it would cause the same symptoms of the original illness (e.g. depression). Niacin deficiency should be considered and ruled out in all patients with treatment-resistant depression, who have a poor response to antidepressants. This is potentially a cost-effective and easy intervention, which could be examined in a randomized controlled trial.