The role of the multiple Index of deprivation in predicting mental health outcomes after the COVID-19 pandemic in adolescents: a cross-sectional study.

BACKGROUND: The number of children and young people (CYP) diagnosed with mental health problems has increased over the past decade. The COVID-19 pandemic also has accelerated this increase, raising significant concerns about adolescent emotional wellbeing. Research suggests that adolescents who live in more deprived areas are more likely to experience poor emotional wellbeing. Children in the northwest of England are among those with the poorest outcomes in the UK. We aimed to investigate the association between deprivation and mental health outcomes from 2019 to 2022. The aim was to support local authorities with targeted provision of public health services as well as predicting service need for 2022 onwards. METHODS: In this cross-sectional study, we analysed routinely collected Schools Health Needs Assessment (SHNA) data. The School Health Needs Assessment dataset contained 32 676 responses from Year 6 (ages 10-11 years) and Year 9 (ages 13-14 years) who completed the annual survey in 2019-22. The questionnaire was offered to all mainstream schools, delivered by the public health school nursing service. Index of multiple deprivation (IMD) data were provided for household postcodes. Data were analysed using IBM SPSS. Factor analysis created a composite emotional wellbeing scale (EWS) and estimates generated by school year (Years 6 and 9) and three academic years (2019-22). We calculated correlations between IMD and EWS overall and within school and academic year samples. FINDINGS: The final total sample across the three consecutive survey years and the two school years was 32 659. The sample consisted of 15 932 (49%) female students and 5066 (16%) students who registered at school as from an ethnic minority. Of the total sample, 9209 (28%) lived in a postcode in the most deprived IMD quintile in England. There was an overall decrease in EWS from Year 6 to Year 9 and from 2019 to 2022. The Year 6 students in 2022 reported mean levels of EWS equivalent to Year 9 students in 2019 indicating a shift toward poorer mental health in younger children. The correlational analyses showed no significant associations between IMD and EWS scores within the school or academic year cohorts. A follow-up analysis of children in receipt or not in receipt of free school meals also showed no significant association with EWS scores. INTERPRETATION: Findings showed that the emotional wellbeing of children and young people in the northwest of England has deteriorated since 2019, with greatest changes observed in the younger cohort of children in Year 6. This was not explained by postcode-based indices of multiple deprivation. Although it is recognised that deprivation is both a cause and a result of poor mental health, policy decisions on service provision for children and young people should not be based solely on IMD or receipt of free school meals. A rapid response is required to address the decline in emotional wellbeing currently observed in younger children of the northwest of England. FUNDING: None.

Exchanging humpty dumpties is not a solution: Why a representational view of knowledge must be replaced with an action-based approach.

In arguing for knowledge representation before belief, Phillips et al. presuppose a representational theory of knowledge, a view that has been extensively criticized. As an alternative, we propose an action-based approach to knowledge, conceptualized in terms of skill. We outline the implications of this approach for children's developing social understanding, beginning with sensorimotor interaction and extending to the verbal level.

Tomasello's tin man of moral obligation needs a heart.

In place of Tomasello's explanation for the source of moral obligation, we suggest that it develops from the concern for others already implicit in the human developmental system. Mutual affection and caring make the development of communication and thinking possible. Humans develop as persons within such relationships and this develops into respect and moral obligation.

SIG-DB: Leveraging homomorphic encryption to securely interrogate privately held genomic databases.

Genomic data are becoming increasingly valuable as we develop methods to utilize the information at scale and gain a greater understanding of how genetic information relates to biological function. Advances in synthetic biology and the decreased cost of sequencing are increasing the amount of privately held genomic data. As the quantity and value of private genomic data grows, so does the incentive to acquire and protect such data, which creates a need to store and process these data securely. We present an algorithm for the Secure Interrogation of Genomic DataBases (SIG-DB). The SIG-DB algorithm enables databases of genomic sequences to be searched with an encrypted query sequence without revealing the query sequence to the Database Owner or any of the database sequences to the Querier. SIG-DB is the first application of its kind to take advantage of locality-sensitive hashing and homomorphic encryption to allow generalized sequence-to-sequence comparisons of genomic data.

Parent-child mentalizing in pediatric epilepsy.

BACKGROUND: Child psychopathology involves inappropriate or biased attributions of others' mental states (mentalizing), and parents' assessment of their children's mentalizing significantly predicts the latter's psychosocial outcomes. Behavioral difficulties are frequent in children with epilepsy (CWE) yet biased mentalizing and parental accuracy in understanding their child's mental states reasoning have not been addressed. METHODS: This study compared the performance of 34 CWE aged 9 to 16 years with 67 language age-matched controls on a biased mentalizing task. The task required children to infer on the mental states of peers in stories involving social scenarios. Responses were scored as positive, negative, or rational mentalizing attributions. To measure parental accuracy, a parent version was administered in the patient group that required a parent to identify their child's responses correctly. Relationships with the child's cognitive, behavioral, and epilepsy-related factors were examined. RESULTS: Patients made greater negative mental states attributions compared with control children. This negative mentalizing bias was accurately identified by parents and was associated with children's behavioral problems. Parental accuracy was reduced for patients with lower cognitive abilities. Parents did not accurately identify an overly positive (OP) bias in their child's mental states attributions. Children's positive response bias correlated with their lower executive function (EF) skills. Epilepsy factors predicted cognitive deficits but not biased mentalizing or behavioral problems. CONCLUSION: Biased mentalizing characterizes social cognition in CWE with behavioral problems. Further investigation of the mentalizing biases and parental awareness of children's mental states reasoning is required to fully understand the greater psychosocial and behavioral difficulties found in CWE.

Social attention in children with epilepsy.

Children with epilepsy may be vulnerable to impaired social attention given the increased risk of neurobehavioural comorbidities. Social attentional orienting and the potential modulatory role of attentional control on the perceptual processing of gaze and emotion cues have not been examined in childhood onset epilepsies. Social attention mechanisms were investigated in patients with epilepsy (n=25) aged 8-18years old and performance compared to healthy controls (n=30). Dynamic gaze and emotion facial stimuli were integrated into an antisaccade eye-tracking paradigm. The time to orient attention and execute a horizontal saccade toward (prosaccade) or away (antisaccade) from a peripheral target measured processing speed of social signals under conditions of low or high attentional control. Patients with epilepsy had impaired processing speed compared to healthy controls under conditions of high attentional control only when gaze and emotions were combined meaningfully to signal motivational intent of approach (happy or anger with a direct gaze) or avoidance (fear or sad with an averted gaze). Group differences were larger in older adolescent patients. Analyses of the discrete gaze emotion combinations found independent effects of epilepsy-related, cognitive and behavioural problems. A delayed disengagement from fearful gaze was also found under low attentional control that was linked to epilepsy developmental factors and was similarly observed in patients with higher reported anxiety problems. Overall, findings indicate increased perceptual processing of developmentally relevant social motivations during increased cognitive control, and the possibility of a persistent fear-related attentional bias. This was not limited to patients with chronic epilepsy, lower IQ or reported behavioural problems and has implications for social and emotional development in individuals with childhood onset epilepsies beyond remission.

Impaired performance on advanced Theory of Mind tasks in children with epilepsy is related to poor communication and increased attention problems.

Children with epilepsy (CWE) have social difficulties that can persist into adulthood, and this could be related to problems with understanding others' thoughts, feelings, and intentions. This study assessed children's ability to interpret and reason on mental and emotional states (Theory of Mind) and examined the relationships between task scores and reports of communication and behavior. Performance of 56 CWE (8-16years of age) with below average IQ (n=17) or an average IQ (n=39) was compared with that of 62 healthy controls with an average IQ (6-16years of age) on cognition, language, and two advanced Theory of Mind (ToM) tasks that required children to attribute mental or emotional states to eye regions and to reason on internal mental states in order to explain behavior. The CWE-below average group were significantly poorer in both ToM tasks compared with controls. The CWE - average group showed a significantly poorer ability to reason on mental states in order to explain behavior, a difference that remained after accounting for lower IQ and language deficits. Poor ToM skills were related to increased communication and attention problems in both CWE groups. There is a risk for atypical social understanding in CWE, even for children with average cognitive function.

Social cognition in children with epilepsy in mainstream education.

AIM: To establish whether deficits in social cognition are present in children with generalized or focal epilepsy in mainstream education, and whether any relation exists between social cognition, communication, and behaviour measures. METHOD: In a cross-sectional study, children with an epilepsy-only diagnoses in mainstream education (n=20 with generalized epilepsy; eight males, 12 females; mean age 11y 6mo, SD 2y 6mo; and n=27 with focal epilepsy; 12 males, 15 females; mean age 11y 8mo, SD 2y 2mo) and comparison participants (n=57; 28 males, 29 females; mean age 11y 2mo, SD 2y 4mo) were administered the Strange Stories task and the Mind in the Eyes task, as well as an IQ assessment. Parents completed the Children's Communication Checklist-2 and the Child Behavior Checklist (CBCL). RESULTS: Both groups of children with epilepsy performed more poorly than control children on the Mental Stories component of the Strange Stories task, F(2,101)=3.2, p<0.001. Performance on Mental Stories was related to pragmatic communication, but only in the generalized epilepsy group (r=0.51, p=0.03, 95% CI=0.2-0.8). There were no differences between epilepsy groups or control participants in the Mind in the Eyes task, F(2,101)=0.4, p=0.4. INTERPRETATION: Children with 'epilepsy only' are at risk of deficits in social cognition and may require appropriate support.

Preserving the Past: An Early Interview Improves Delayed Event Memory in Children With Intellectual Disabilities.

The influence of an early interview on children's (N = 194) later recall of an experienced event was examined in children with mild and moderate intellectual disabilities (CWID; 7-12 years) and typically developing (TD) children matched for chronological (7-12 years) or mental (4-9 years) age. Children previously interviewed were more informative, more accurate, and less suggestible. CWID (mild) recalled as much information as TD mental age matches, and were as accurate as TD chronological age matches. CWID (moderate) recalled less than TD mental age matches but were as accurate. Interviewers should elicit CWID's recall as early as possible and consider developmental level and severity of impairments when evaluating eyewitness testimony.

Touchscreens can promote infant object-interlocutor reference switching.

We re-examine whether the type of object played with influences parent-infant joint attention. A within-participants comparison of 24 parent-9-month-old dyads, used head-mounted eye-tracking to measure parental naming and infant attention during play with touchscreen apps on a touchscreen tablet or matched interactive toys. Infants engaged in sustained attention more to the toy than the tablet. Parents named objects less in toy play. Infants exhibited more gaze shifts between the object and their parent during tablet play. Contrasting previous studies, these findings suggest that joint tablet play can be more interactive than with toys, and raise questions about the recommendation that infants should not be exposed at all to such technology.

A mature second-person neuroscience needs a first-person (plural) developmental foundation.

Schilbach et al.'s model assumes that the ability to "experience" minds is already present in human infants and therefore falls foul of the very intellectualist problems it attempts to avoid. We propose an alternative relational, action-based account, which attempts to grasp how the individual's construction of knowledge develops within interactions.

Effects of maternal worm infections and anthelminthic treatment during pregnancy on infant motor and neurocognitive functioning.

We tested the hypothesis that maternal worm infections in pregnancy affect infant motor and neurocognitive development, and that anthelminthic treatment during pregnancy can reverse these effects. We used measures which examine infant motor, cognitive and executive function, including inhibition. We assessed 983 Ugandan infants aged 15 months, using locally appropriate measures within the Entebbe Mother and Baby Study, a trial of anthelminthic treatment during pregnancy. Key exposures were maternal worm infections and anthelminthic treatment during pregnancy. Effects of other health and social factors were controlled for statistically. Of the five major worm species found in the pregnant women, two had influences on the developmental measures: Maternal Mansonella perstans and Strongyloides stercoralis infections showed negative associations with the A-not B-task, and Language, respectively. Performance on other psychomotor and cognitive measures was associated with illnesses during infancy and infants' behavior during assessment, but not with maternal worm infections. There were no positive effects of maternal anthelminthic treatment on infant abilities. Mansonella perstans and Strongyloides stercoralis infection during pregnancy seem associated with impaired early executive function and language, respectively, but single-dose anthelminthic treatment during pregnancy was not beneficial. The biological mechanisms that could underlie these neurocognitive effects are discussed.

Knee arthroscopy and driving. Results of a prospective questionnaire survey and review of the literature.

Orthopaedic surgeons routinely advise patients when to drive after surgical procedures. There are however very few guidelines concerning the return to driving after an orthopaedic operation. We performed a literature search and found very limited studies or research regarding this topic and in particular following arthroscopic surgery. We subsequently conducted a prospective questionnaire survey from one hundred knee arthroscopy patients attending outpatient follow-up clinics. Results showed the advice given to patients was delivered by doctors of differing levels of experience, but interestingly the majority of patients did not know the grade of doctor they were being consented by. Our study has highlighted that the advice given to patients was inconsistent. Patients returned to driving over a variety of time frames from one day to greater than three weeks. No adverse events were reported but 14% chose not to answer this question. We have illustrated the need for thorough consenting, further research in this area, and the development of universal guidelines surrounding the return to driving after surgery.

Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications.

Tibial pilon fractures are challenging to treat, as they are typically intra-articular and associated with extensive soft tissue damage. We briefly review the anatomy of the distal tibia, as well as the pathophysiology of pilon fractures. The treatment of tibial pilon fractures is still controversial in the literature, and we present some of the available options. Consideration is also given to peri-operative complications, such as preoperative oedema and blistering and late postoperative traumatic arthritis. Finally, we propose a treatment algorithm (used in our institution), taking into account the level of associated soft tissue injuries. The use of a 2-phase treatment protocol is recommended; however, to date, no absolute treatment protocol exists for these injuries.

Executive Function Skills Are Linked to Restricted and Repetitive Behaviors: Three Correlational Meta Analyses.

There is a consensus on the centrality of restricted and repetitive behaviors (RRBs) in the diagnosis of Autism Spectrum Disorder (ASD), yet the origins of these behaviors are still debated. We reconsider whether executive function (EF) accounts of RRBs should be revisited. EF deficits and high levels of RRBs are often pronounced in individuals with ASD and are also prevalent in young typically developing children. Despite this, the evidence is mixed, and there has been no systematic attempt to evaluate the relationship across studies and between task batteries. We examine recent evidence, and in three highly powered random-effects analyses (N = 2964), examine the strength of the association between RRB levels and performance on set shifting, inhibitory control, and parental-report based EF batteries. The analyses confirm significant associations between high levels of the behaviors and poor EF skills. Moreover, the associations remained stable across typical development and in individuals with ASD and across different types of EF measures. These meta-analyses consolidate recent evidence identifying that cognitive mechanisms correlate with high RRBs that are seen in individuals with ASD, as well as in typical development. We propose that the EF account may be critical for guiding future interventions in ASD research. LAY SUMMARY: Restricted and repetitive behaviors (RRBs) are diagnostic criteria for Autism yet also common in typical development, and if they persist over time some can have a negative impact on learning and social acceptance. The present meta-analyses found that high levels of RRBs related to poor performance on set-shifting and inhibitory control tasks, as well as high ratings on parental report scales. Future studies should create interventions that aim to improve these skills as they may help manage challenging RRBs.

Why set-comparison is vital in early number learning.

Cardinal numbers serve two logically complementary functions. They tell us how many things are within a set, and they tell us whether two sets are equivalent or not. Current modelling of counting focuses on the representation of number sufficient for the within-set function; however, such representations are necessary but not sufficient for the equivalence function. We propose that there needs to be some consideration of how the link between counting and set-comparison is achieved during formative years of numeracy. We work through the implications to identify how this crucial change in numerical understanding occurs.

Introduction: Links between social interaction and executive function.

The term executive function is used increasingly within developmental psychology and is often taken to refer to unfolding brain processes. We trace the origins of research on executive function to show that the link with social interaction has a long history. We suggest that a recent frenzy of research exploring methods for studying individual executive skills should pay more attention to the tradition exploring the role of social interaction in their development.

Culture, executive function, and social understanding.

Much of the evidence from the West has shown links between children's developing self-control (executive function), their social experiences, and their social understanding (Carpendale & Lewis, 2006, chapters 5 and 6), across a range of cultures including China. This chapter describes four studies conducted in three Oriental cultures, suggesting that the relationships among social interaction, executive function, and social understanding are different in these cultures, implying that social and executive skills are underpinned by key cultural processes.

Referent selection in children with Autism Spectrum Condition and intellectual disabilities: Do social cues affect word-to-object or word-to-location mappings?

BACKGROUND: There is conflicting evidence regarding whether children with Autism Spectrum Condition (ASC) and intellectual disabilities (ID) follow social pragmatic cues such as a speaker's eye gaze or pointing towards a novel object to assist mapping a new word onto a new object (e.g. fast mapping). AIMS: We test fast mapping from a speaker's gaze and pointing towards objects in children with ASC and ID with varying chronological and receptive language ages compared with receptive language matched groups of typically developing (TD) children. METHODS AND PROCEDURE: Across eight trials, a speaker gazed and/or pointed towards one out of two objects while saying a new word. Pointing was either 'referential' (with intention), or 'incidental' (without obvious intention). To investigate whether children formed more robust word-to-object links rather than associative word-to-location ones, we reversed the original location of the objects in half of the test trials. OUTCOMES AND RESULTS: Children with ASC were as successful as TD children using social cues to form word-to-object mappings. Surprisingly, children with ID did not fast map from referential pointing, or when objects changed location. CONCLUSIONS AND IMPLICATIONS: Children with ID may use different processes to facilitate word learning compared to TD children and even children with ASC.

Developmental differences in children's learning and use of forensic ground rules during an interview about an experienced event.

Children often answer questions when they do not have the requisite knowledge or when they do not understand them. We examined whether ground rules instruction-to say "I don't know," to tell the truth, and to correct the interviewer when necessary-assisted children in applying those rules during an interview about a past event and whether doing so was associated with more accurate accounts. We compared children with intellectual disabilities (mild or moderate severity, n = 44, 7-12 years) with 3 groups of typically developing children (2 matched for mental age, and 1 for chronological age, n = 55, 4-12 years) on their understanding of 3 ground rules, their use of these rules in an interview, and their accuracy in recalling a personally experienced event. Many children were able to demonstrate proficiency with the rules following simple instruction but others required additional teaching. Children applied the rules sparingly in the interview. Their scores on the practice trials of each rule were unrelated to each other, and to the use of the rules in context. Their developmental level was significantly related to both of these skills. Regression models showed that developmental level was the best predictor of children's accuracy when they recounted their experience during the interview but that use of responses consistent with the rules, in conjunction with developmental level, predicted accurate resistance to suggestive questions. Future research should identify how best to prepare children of different ages and cognitive abilities to answer adults' questions appropriately. (PsycINFO Database Record (c) 2019 APA, all rights reserved).