Objectives: Mindfulness-Based Cognitive Therapy for Depression (MBCT-D) has been shown to be effective at repairing positive affect deficits in depressed individuals but the mechanism of action underpinning these changes has not been empirically examined. To address this issue, secondary analyses of two randomised controlled trials in individuals with residual depression were conducted.
Methods: Study 1 was a cross-sectional mediation analysis of a trial reporting superior effects of MBCT-D to a waitlist control in bolstering momentary positive affect (PA) in individuals with residual depression symptoms (n=130). Study 2 replicated this analysis in the subset of individuals with residual depression symptoms (n=117) from a second, larger trial comparing MBCT-D to maintenance antidepressants (M-ADM) to prevent depressive relapse that also included a positive affect outcome.
Results: in Study 1, an increase in external sensory observing uniquely mediated the superiority of MBCT-D over control in repairing momentary PA. Replicating these findings, in Study 2 MBCT-D was superior to M-ADM at repairing positive affect and this was cross-sectionally mediated by changes in external sensory observing.
Conclusions: These findings suggest that one way in which MBCT-D enhances positive affect in individuals with residual depression may be by training the capacity to attend to external sensory experience.

Background
The Incredible Years® (IY) Teacher Classroom Management (TCM) programme may reduce disruptive behaviour in the classroom and improve child and teacher mental health, however few studies have considered how acceptable TCM is to teachers or what facilitators and barriers there are to its implementation.

Aims
In this paper we examine the acceptability of the full six-day TCM programme and teachers’ perceived barriers and facilitators to implementation in the English (UK) primary school context.

Sample
Forty-four English (UK) primary school teachers who attended the TCM programme as part of the STARS trial.

Methods
We completed focus groups and telephone interviews with participating teachers two months after they completed the TCM programme. Thematic analysis was used to examine the data, and a framework approach was applied to organise and summarise themes.

Results
Teachers liked the structure of the course, the peer group learning environment, delivery methods, and the opportunity to reflect outside the classroom on their practice. They reported that the video clips used lacked cultural relevance and highlighted the importance of group leadership style. Perceived facilitators to implementation included an understanding of the theory underpinning TCM and adaptability of the TCM strategies. Barriers included perceived gaps in the course content in relation to challenging behaviour, applying strategies with older children and the school context within which teachers were working.

Conclusion
Our findings suggest high levels of acceptability to TCM overall, but also highlight the need for a whole school approach to combat potential barriers to implementation.

IntroductionAttention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing cluster of traits affecting 2%–5% of children. These children are at risk of negative health, social and educational outcomes and often experience severe difficulties at school, so effective psychosocial interventions are needed. There is mixed evidence for existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting teachers’ preferences for short, flexible strategies that suit a range of ADHD-related classroom-based problems. They are also poorly evaluated. In this study, a prototype intervention comprising a digital ‘toolkit’ of behavioural strategies will be tested and refined. We aim to refine the prototype so that its use is feasible and acceptable within school settings, and to establish whether a future definitive, appropriately powered, trial of effectiveness is feasible. This novel iterative study aims to pre-emptively address implementation and evaluation challenges that have hampered previous randomised controlled trials of non-pharmacological interventions.Methods and analysisA randomised iterative mixed-methods case-series design will be used. Schools will be randomised to the time (school term) they implement the toolkit. Eight primary schools and 16–32 children with impairing traits of ADHD will participate, along with school staff and parents. The toolkit will be refined after each term, or more frequently if needed. Small, theory-based and data driven changes hypothesised as relevant across school contexts will be made, as well as reactive changes addressing implementation barriers. Feasibility and acceptability will be assessed through quantitative and qualitative data collection and analyses in relation to study continuation criteria, and ADHD symptoms and classroom functioning will be tracked and visually evaluated to assess whether there are early indications of toolkit utility.Ethics and disseminationEthical approval has been obtained. Results will be presented in journal articles, conferences and through varied forms of media to reach policymakers, stakeholders and the public.

Background: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have impairing levels of difficulty paying attention, impulsive behaviour and/or hyperactivity. ADHD causes extensive difficulties for young people at school, and as a result these children are at high risk for a wide range of poor outcomes. We ultimately aim to develop a flexible, modular 'toolkit' of evidence-based strategies that can be delivered by primary school staff to improve the school environment and experience for children with ADHD; the purpose of this review is to identify and quantify the evidence-base for potential intervention components. This protocol sets out our plans to systematically identify non-pharmacological interventions that target outcomes that have been reported to be of importance to key stakeholders (ADHD symptoms, organisation skills, executive-global- and classroom-functioning, quality of life, self-esteem and conflict with teachers and peers). We plan to link promising individual intervention components to measured outcomes, and synthesise the evidence of effectiveness for each outcome.

Methods: a systematic search for studies published from the year 2000 that target the outcomes of interest in children and young people aged 3-12 will be conducted. Titles and abstracts will be screened using prioritisation software, and then full texts of potentially eligible studies will be screened. Systematic reviews, RCTs, non-randomised and case-series studies are eligible designs. Synthesis will vary by the type of evidence available, potentially including a review of reviews, meta-analysis and narrative synthesis. Heterogeneity of studies meta-analysed will be assessed, along with publication bias. Intervention mapping will be applied to understand potential behaviour change mechanisms for promising intervention components.

Discussion: This review will highlight interventions that appear to effectively ameliorate negative outcomes that are of importance for people with ADHD, parents, school staff and experts. Components of intervention design and features that are associated with effective change in the outcome will be delineated and used to inform the development of a 'toolkit' of non-pharmacological strategies that school staff can use to improve the primary school experience for children with ADHD.

BACKGROUND: Reducing bullying is a public health priority. KiVa, a school-based anti-bullying programme, is effective in reducing bullying in Finland and requires rigorous testing in other countries, including the UK. This trial aims to test the effectiveness and cost-effectiveness of KiVa in reducing child reported bullying in UK schools compared to usual practice. The trial is currently on-going. Recruitment commenced in October 2019, however due to COVID-19 pandemic and resulting school closures was re-started in October 2020. METHODS: Design: Two-arm pragmatic multicentre cluster randomised controlled trial with an embedded process and cost-effectiveness evaluation. PARTICIPANTS: 116 primary schools from four areas; North Wales, West Midlands, South East and South West England. Outcomes will be assessed at student level (ages 7-11 years; n = approximately 13,000 students). INTERVENTION: KiVa is a whole school programme with universal actions that places a strong emphasis on changing bystander behaviour alongside indicated actions that provide consistent strategies for dealing with incidents of bullying. KiVa will be implemented over one academic year. COMPARATOR: Usual practice. PRIMARY OUTCOME: Student-level bullying-victimisation assessed through self-report using the extensively used and validated Olweus Bully/Victim questionnaire at baseline and 12-month follow-up. SECONDARY OUTCOMES: student-level bullying-perpetration; student mental health and emotional well-being; student level of, and roles in, bullying; school related well-being; school attendance and academic attainment; and teachers' self-efficacy in dealing with bullying, mental well-being, and burnout. SAMPLE SIZE: 116 schools (58 per arm) with an assumed ICC of 0.02 will provide 90% power to identify a relative reduction of 22% with a 5% significance level. RANDOMISATION: recruited schools will be randomised on 1:1 basis stratified by Key-Stage 2 size and free school meal status. Process evaluation: assess implementation fidelity, identify influences on KiVa implementation, and examine intervention mechanisms. Economic evaluation: Self-reported victimisation, Child Health Utility 9D, Client Service Receipt Inventory, frequency of services used, and intervention costs. The health economic analysis will be conducted from a schools and societal perspective. DISCUSSION: This two-arm pragmatic multicentre cluster randomised controlled trial will evaluate the KiVa anti-bullying intervention to generate evidence of the effectiveness, cost-effectiveness and scalability of the programme in the UK. Our integrated process evaluation will assess implementation fidelity, identify influences on KiVa implementation across England and Wales and examine intervention mechanisms. The integrated health economic analysis will be conducted from a schools and societal perspective. Our trial will also provide evidence regarding the programme impact on inequalities by testing whether KiVa is effective across the socio-economic gradient. TRIAL REGISTRATION: Trials ISRCTN 12300853 Date assigned 11/02/2020.

Schools are becoming central to the identification and referral of children and young people with poor mental health. Understanding how well a teacher concern predicts mental disorder in a child or young person is important for mental health teams who need to respond to referrals.

BACKGROUND: Affective dysregulation is central to depression. However, emotion regulation (ER) tendencies in depression remain poorly understood. It is critical, therefore, to validate measures of habitual ER in clinical populations. The current study aimed to validate the Cognitive Emotion Regulation Questionnaire (CERQ) in a sample of individuals with a history of recurrent depression who are currently in remission. METHOD: the CERQ measures ER tendencies with 36 self-report items that are divided into nine subscales. Each subscale is purported to assess one of five adaptive and four maladaptive ER strategies. The CERQ was administered to 476 adults (mean age = 46.76 years; 75% female) that were currently in remission with a history of recurrent depression, who were recruited from primary care settings. We first investigated the CERQ's nine factor structure, internal consistency, convergent and criterion validity. RESULTS: the nine-factor structure did not fit the CERQ structure in a sample of individuals with recurrent depression and convergent validity was poor. Instead, a five-factor structure fit the data best and showed acceptable convergent and criterion validity. LIMITATIONS: the generalisability of the findings may be limited due to relative lack of diversity in terms of gender and ethnicity of the sample. CONCLUSION: These results suggest that the taxonomic structure of the CERQ does not fit emotion regulation patterns in adults with a history of depression. These findings highlight the importance of validating measures in clinical samples.

Background
The Incredible Years® (IY) Teacher Classroom Management (TCM) programme may be an effective way to reduce teacher stress levels, improve child behaviour and promote positive socio-emotional development. However, few studies have considered what teachers think of the course and how it might work.

Aims
In this paper we examine teachers’ perceptions of the impact of the TCM programme and how it might work in the classroom.

Sample(s)
Fourty-four UK primary school teachers who attended the TCM programme as part of the STARS trial (Ford et al. 2018).

Methods
Focus groups and interviews were held with teachers two months after completing the TCM programme. Thematic analysis (Braun & Clarke, 2006) was employed to explore the subsequent data.

Results
Three main themes were identified: impact on the teacher; on children; and on parent-teacher relationships. Impact on the teacher included a positive change in their ethos. Teachers reported being more able to see things from the child’s perspective, placing a greater focus on building positive relationships, thinking before responding, feeling calmer, more confident and in control and employing strategies to create positive interactions with children. Teachers felt this had had a positive impact on their pupils’ development and relationships with parents. Feedback on whether or not TCM was effective in tackling particularly challenging behaviour was more mixed.

Conclusions
Our findings suggest that teachers experience the TCM programme as beneficial. This is discussed alongside other qualitative and quantitative studies in this field.

Background
Teaching is a stressful occupation with poor retention. The Incredible Years® Teacher Classroom Management (TCM) programme is a training program that past research has demonstrated may be an effective intervention for children’s mental health, but little research has explored any impacts there may be on the teachers’ own professional confidence and mental health.
Aims
In this paper we evaluate whether TCM may lead to changes in teachers’ wellbeing, namely a reduction in burnout and an improvement in self-efficacy and mental health.
Sample
Eighty schools across the South West of England were recruited between September 2012 and September 2014. Headteachers were asked to nominate one class teacher to take part.
Methods
Eighty teachers were randomised to either attend a TCM course (intervention) or not (control). TCM was delivered to groups of up to twelve teachers in six whole-day workshops that were evenly spread between October and April. At baseline and nine months follow-up we measured teachers’ mental health using the Everyday Feelings Questionnaire (EFQ), burnout using the Maslach Burnout Inventory-General Survey (MBI-GS) and self-efficacy using the Teachers’ Sense of Efficacy Scale-Short (TSES-Short).
Results
Using linear regression models there was little evidence of differences at follow-up between the intervention and control teachers on the outcomes (the smallest p-value was 0.09).
Conclusions
Our findings did not replicate previous research that TCM improved teachers’ sense of efficacy. However, there were limitations with this study including low sample size.

Abstract
Background. We evaluated the effectiveness and cost-effectiveness of the Incredible Years® Teacher Classroom Management (TCM) programme as a universal intervention, given schools’ important influence on child mental health.
Methods. A two-arm, pragmatic, parallel group, superiority, cluster randomised controlled trial recruited three cohorts of schools (clusters) between 2012 and 2014, randomising them to TCM (intervention) or Teaching As Usual (TAU-control). TCM was delivered to teachers
in six whole-day sessions, spread over 6 months. Schools and teachers were not masked to allocation. The primary outcome was teacher-reported Strengths and Difficulties Questionnaire (SDQ) Total Difficulties score. Random effects linear regression and marginal logistic regression models using Generalised Estimating Equations were used to analyse the
outcomes. Trial registration: ISRCTN84130388.
Results. Eighty schools (2075 children) were enrolled; 40 (1037 children) to TCM and 40 (1038 children) to TAU. Outcome data were collected at 9, 18, and 30-months for 96, 89, and 85% of children, respectively. The intervention reduced the SDQ-Total Difficulties score at 9 months (mean (S.D.):5.5 (5.4) in TCM v. 6.2 (6.2) in TAU; adjusted mean difference
= −1.0; 95% CI−1.9 to −0.1; p = 0.03) but this did not persist at 18 or 30 months. Cost-effectiveness analysis suggested that TCM may be cost-effective compared with TAU at 30-months, but this result was associated with uncertainty so no firm conclusions can be drawn. A priori
subgroup analyses suggested TCM is more effective for children with poor mental health.
Conclusions. TCM provided a small, short-term improvement to children’s mental health particularly for children who are already struggling.

This paper assesses the reliability and validity of the teacher-completed Pupil Behaviour Questionnaire (PBQ), by comparing it to the already extensively validated teacher-completed Strengths and Difficulties Questionnaire (SDQ). Participants included 2074 primary school children participating in a universal school-based trial and 41 vulnerable children who were taking part in a study exploring the impact of exclusion from school. Exploratory factor analysis results (first factor accounts for 80.8% of the variation in the items) and the high Cronbach’s alpha value of 0.85 indicate that the PBQ consists of one substantive factor/dimension. Strong correlations between the total PBQ score and the conduct sub-scale (Spearman’s correlation coefficient (rs) = 0.67) and total difficulties score (rs = 0.59) of the SDQ indicate convergent validity. This study suggests that the PBQ is a reliable measure, and provides some evidence of validity. Further work is needed to test the PBQ in an older, more diverse populations and to measure sensitivity to change.

BACKGROUND: a number of studies demonstrate that children who are younger within their school year have poorer academic attainment and are more likely to have special educational needs. Few, however, have considered the impact relative age may have on child mental health, behaviour and happiness in school. METHODS: This paper utilized data from the Supporting Teachers and Children in Schools study (2075 pupils aged 5 to 9 years from 80 primary schools) to explore the relationship among relative age, behaviour and happiness in school. Behavioural and emotional development was assessed by using the teacher-reported and parent-reported Strengths and Difficulties Questionnaire and the Pupil Behaviour Questionnaire. Children's happiness within school was assessed by using the How I Feel About My School Questionnaire. RESULTS: Relatively younger children had higher Total Difficulties scores on the Strengths and Difficulties Questionnaire than their peers. There was a mean increase per 30-day decrease in relative age of 0.09 (95% CI: 0.03 to 0.16; p = 0.007) in teacher-reported and 0.08 (0.001 to 0.16; p = 0.05) in parent-reported scores. There was little evidence of a relationship between relative age and children's behaviour and happiness in school. CONCLUSIONS: for children with complex difficulties, being relatively young for their school year may be an additional stressor that may undermine mental health.

Investigating infants' numerical ability is crucial to identifying the developmental origins of numeracy. Wynn (1992) claimed that 5-month-old infants understand addition and subtraction as indicated by longer looking at outcomes that violate numerical operations (i.e. 1+1=1 and 2-1=2). However, Wynn's claim was contentious, with others suggesting that her results might reflect a familiarity preference for the initial array or that they could be explained in terms of object tracking. To cast light on this controversy, Wynn's conditions were replicated with conventional looking time supplemented with eye-tracker data. In the incorrect outcome of 2 in a subtraction event (2-1=2), infants looked selectively at the incorrectly present object, a finding that is not predicted by an initial array preference account or a symbolic numerical account but that is consistent with a perceptual object tracking account. It appears that young infants can track at least one object over occlusion, and this may form the precursor of numerical ability.

© 2015 SEBDA Children identified with special educational needs (SEN) and behavioural difficulties present extra challenges to educators and require additional supports in school. This paper presents views from special educational needs coordinators (SENCos) on various strategies used by educators to support children identified with SEN and problematic behaviours. The data were collected from telephone interviews with six SENCos from the UK’s South West Peninsula. The SENCos were invited to participate because their school was participating in a cluster-randomised trial of a teacher classroom management course (Incredible Years). Using thematic analysis to analyse the data, this paper illustrates strategies deemed by SENCos to be successful in the support of children identified with SEN. The management strategies generated by participating SENCos were then mapped onto those taught as part of the classroom management course for comparison. Findings indicate that strategies from the training programme appear to be appropriate for children identified with both SEN and behavioural difficulties.

BACKGROUND: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. METHODS: in this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. FINDINGS: Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. INTERPRETATION: We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. FUNDING: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

BACKGROUND: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial. OBJECTIVES: to establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action. DESIGN: Single-blind, parallel, individual randomised controlled trial. SETTING: UK general practices. PARTICIPANTS: Adult patients with a diagnosis of recurrent depression and who were taking m-ADM. INTERVENTIONS: Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action. MAIN OUTCOMES MEASURES: the primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities. RESULTS: in total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation. CONCLUSIONS: There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26666654. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula and will be published in full in Health Technology Assessment; Vol. 19, No. 73. See the NIHR Journals Library website for further project information.

BACKGROUND: Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. A recently developed treatment, mindfulness-based cognitive therapy (MBCT), shows potential as a brief group program for people with recurring depression.This trial asks the policy research question; is MBCT with support to taper/discontinue antidepressant medication (MBCT-TS) superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant medication (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? an explanatory research question also asks whether an increase in mindfulness skills is the key mechanism of change.The design is a single-blind, parallel randomized controlled trial examining MBCT-TS versus m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT-TS with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. RESULTS: Depressive relapse/recurrence over two years is the primary outcome variable. Analyses will be conducted following CONSORT standards and overseen by the trial's Data Monitoring and Safety Committee. Initial analyses will be conducted on an intention-to-treat basis, with subsequent analyses being per protocol. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre- and post-treatment and a qualitative study of service users' views and experiences. CONCLUSIONS: If the results of our exploratory trial are extended to this definitive trial, MBCT-TS will be established as an alternative approach to maintenance antidepressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches. TRIAL REGISTRATION: Trial registered 7 May 2009; ISRCTN26666654.

One of the major areas of research into early cognitive development concerns infants' ability to understand number, given that it leads into later numerical and mathematical competence. Accordingly, there is considerable research on this topic and there is a large body of research suggesting that infants have a least some ability to discriminate between small number sets and large number sets. This chapter begins by describing the evidence for two types of representations of number-one for small item sets, the other for large-together with evidence that these systems are modality-general. This is followed by evidence suggesting that infants may sometimes be responding to continuous variables that are found in displays of discrete items rather than number per se. It then turns to the main focus of the chapter, which is whether infants can add and subtract, or whether their purported arithmetical abilities can be explained in lower-level perceptual terms. It is in this context that the relative contributions of information-processing perspectives are compared with other theoretical views on our understanding of infants' numerical abilities.

BACKGROUND: Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. We need to develop psychological therapies that prevent depressive relapse/recurrence. A recently developed treatment, Mindfulness-based Cognitive Therapy (MBCT, see http://www.mbct.co.uk) shows potential as a brief group programme for people with recurring depression. In two studies it has been shown to halve the rates of depression recurring compared to usual care.This trial asks the policy research question, is MBCT superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and, secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? an explanatory research question asks is an increase in mindfulness skills the key mechanism of change? METHODS/DESIGN: the design is a single blind, parallel RCT examining MBCT vs. m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT plus ADM-tapering with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. Depressive relapse/recurrence over two years is the primary outcome variable. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre/post-treatment and a qualitative study of service users' views and experiences. DISCUSSION: If the results of our exploratory trial are extended to this definitive trial, MBCT will be established as an alternative approach to maintenance anti-depressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches. TRIAL REGISTRATION NUMBER: ISRCTN26666654.

After a brief familiarization period to either one or two toys 5-month-olds gave a clear preference for perceptually novel displays, suggesting that replicable findings of greater looking at an unexpected arithmetic outcome in addition/subtraction experiments cannot easily be attributed to simple familiarity preferences.

BACKGROUND: Comprising of both organisational and patient level components, collaborative care is a potentially powerful intervention for improving depression treatment in UK primary Care. However, as previous models have been developed and evaluated in the United States, it is necessary to establish the effect of collaborative care in the UK in order to determine whether this innovative treatment model can replicate benefits for patients outside the US. This Phase III trial was preceded by a Phase II patient level RCT, following the MRC Complex Intervention Framework. METHODS/DESIGN: a multi-centre controlled trial with cluster-randomised allocation of GP practices. GP practices will be randomised to usual care control or to "collaborative care" - a combination of case manager coordinated support and brief psychological treatment, enhanced specialist and GP communication. The primary outcome will be symptoms of depression as assessed by the PHQ-9. DISCUSSION: If collaborative care is demonstrated to be effective we will have evidence to enable the NHS to substantially improve the organisation of depressed patients in primary care, and to assist primary care providers to deliver a model of enhanced depression care which is both effective and acceptable to patients.