Completed projects

As part of a larger project looking at paediatric acute care sponsored by PenARC, we are investigating the prevalence and pattern of children’s admissions to hospital for mental health concerns.

Main contact: Vashti Berry and Tamsin Newlove-Delgado

Website: Paediatric acute care project

E-SEE (Enhancing Social and Emotional health and Wellbeing in the Early Years) is a community-based Randomised Controlled Trial (RCT) and economic evaluation of the Incredible Years Infant and toddler (0-2) parenting programme. The E-SEE study aims to find out if the Incredible Years programme benefits the wellbeing of parents and their babies, in particular, social and emotional aspects of child development.

The study is being conducted across four sites in the UK and we are interested in finding out whether this programme is more helpful than services that are already available to families in their area. The process evaluation for this study is being led by the University of Exeter. The process evaluation aims to understand whether the Incredible Years parenting programmes are acceptable and practical interventions to use with carers of young children under two years of age. It also aims to explore the aids and barriers to successful delivery of the programme/s.

Main contact: Siobhan Mitchell 

Website: E-see trial

The CATCh-uS project focussed on what happens to young people with Attention Deficit Hyperactivity Disorder (ADHD) when they are too old to stay within children’s services.

The mixed method design has three study streams;

1. surveillance study with nine-month follow-up to find out where, if anywhere, patients transferred to:
2. a mapping study to identify and describe services for young adults with ADHD and
3. a qualitative study to explore key stakeholder experience of transition from child to adult services.

Findings

CATCh-uS found that very few of those who need ongoing support for their ADHD successfully transferred to adult services, with an even smaller proportion experiencing optimal transitional care. The mapping study found that adult ADHD service provision was patchy and even among dedicated services, few provided the whole range of recommended treatments.

CATCh-uS was funded by the National Institute for Health Research Health Services and Delivery Research Programme. The project officially finished in September 2019, and the NIHR report is currently in production. The interactive map of adult ADHD services, now hosted by the UK Adult ADHD Network. Other outputs from the project including videos and links to papers are available from the project website. 

Main contact: CATCh-uS

If you would like to find out more about the STARS project, please check out our STARS project details.

For more information about the 'How I Feel About My School' (HIFAMS) measure used within STARS, please visit the HIFAMS webpage.

If you have any queries about the STARS study please contact us at:

Email: stars@exeter.ac.uk

Tel: 01392 722978

Tweet: @IY_STARS

Children and young people who have psychiatric disorders may continue to be affected by their symptoms over time. We have a good understanding of the course of many disorders, such as ADHD, anxiety and depression over childhood and adolescence- many of them improve with time, whereas others are chronically impairing.

Less is understood about why children with one disorder might develop a different kind of psychiatric condition as they get older. In this project, we are exploring what predicts a new type of disorder emerging when children already meet criteria for one or more psychiatric disorders: this is sometimes called “heterotypic persistence”. We are using information from over 1000 children to explore the child and family factors that might help us to understand who is most at risk of having a new type of disorder, so that we can help clinicians to identify and treat those who are at most risk.

Main contact: Dr Abby Russell and Dr Tamsin Newlove-Delgado

This project uses data from the CATCh-uS ADHD project to better understand the educational experiences of young people with ADHD. Many young people and their parents were interviewed about their ADHD and their experiences of moving from child and adolescent mental health services, to adult mental health services as part of the CATCh-uS study. They also discussed lots of aspects of education which were not the main focus of the initial project.

In this study, we are making the most of this extra information, and using a method called Thematic Analysis we are exploring these education experiences. We hope to be able to make practical recommendations for school staff working with children with ADHD as a result of the findings.

Main contact: Dr Abby Russell  

This project involves a systematic review and meta-analysis providing detailed evidence on gender differences in ADHD in two developmental stages, from a global epidemiological perspective.

We include epidemiological studies that provide gender estimates in childhood or adolescence to assess if these differences may relate to methodological issues (study and sampling design, diagnostic measure and impairment criteria, type of informant) or reflect actual differences in prevalence, perhaps related to ADHD subtypes, age range or cultural differences by region in the world.

Knowledge of cross-cultural differences will improve current understanding of the risk and protective factors in the aetiology and course of the disorder. Findings may facilitate targeted prevention and intervention in both educational and clinical contexts.

Main contact: Maria Tejerina-Arreal

In this research prioritisation project, we are working in collaboration with schools and networks in Devon and Cornwall to understand what research questions are relevant and of importance to young people who have experienced trauma or early adversity, their educators and those who work in this field. The project consists of a survey where these groups are asked to put forward research questions, then a prioritisation exercise to rank the ideas and questions in terms of how important they are considered to be. School lesson time will be used to identify young people's priorities and perceived importance, alongside a school staff focus group.

Main contact: Dr Abby Russell

Parent engagement refers to parents’ participation in supporting their child’s learning (academic attainment and related learning outcomes), whether at home, in school or via home-school connections and wider community collaborations.

School-led activities to engage parents can focus on parenting, communicating, volunteering, family learning, decision-making and collaboration with the community. It is widely recognised that parent engagement in children’s learning is important but schools often struggle to know how best to engage parents, particularly those from disadvantaged backgrounds.

This project funded by EEF aimed:

1. To synthesise the best available international evidence on parental engagement in children’s learning, focusing on:
   • effective parenting practices that are associated with positive learning outcomes at different stages of children’s development
   • what schools and early years settings can do to promote and support these activities, particularly for children from disadvantaged backgrounds
2. To describe what schools in England are currently doing to support parental engagement and show how far this practice matches the current evidence.

The focus was on practices that specifically support improvements in children’s academic attainment and related learning outcomes, supplemented by other outcomes known to impact on learning (e.g. behaviour). The review covered early years to secondary school (3-16 years).

Part (1) of the study involved searching relevant databases using key terms to identify relevant systematic reviews and, for aim 1 (b), more recent randomised controlled trials or quasi-experimental design studies (since the focus is on robust causal evidence of impact). These were critically appraised and data pertaining to key questions was extracted (e.g. nature of parent engagement, effect on outcomes, insights into aspects of implementation). The review data was synthesised narratively; where the included studies were suitable, a quantitative analysis was also conducted.

Part (2) entailed a survey of a quota sample of ≥100 schools in England regarding what they are doing to engage parents in children’s learning, including how they target their efforts. This was supplemented by c.20 semi-structured interviews with head teachers and school leads identified via the survey, together with international experts on the subject. The analysis explored how far existing practice matches what the evidence suggests is effective.

Read the final report for this project here.

E-mail: v.berry@exeter.ac.uk

Abby Russell’s PhD research, funded by the University of Exeter Medical School

Attention deficit/hyperactivity disorder (ADHD) is commonly reported to be more prevalent in children from socioeconomically disadvantaged backgrounds. I explored in more detail the association between socioeconomic disadvantage and ADHD. Socioeconomic status (SES) is an umbrella term used to capture the economic and social resources that individuals or families have. It includes things like education, income, poverty and housing ownership.

The PhD project involved six studies, starting with a systematic review in order to evaluate existing published evidence, which was followed by a qualitative study that explored educational practitioners’ conceptualisation of the causes of ADHD. A series of three analyses utilising existing data from thousands of children born in 1990 and 1991 who have been followed up by researchers for many years. This cohort is called the Avon Longitudinal Study of Parents and Children (ALSPAC). We explored which measures of SES were associated with a research diagnosis of ADHD and what might explain this association, and whether timing, duration or changes in exposure to financial difficulty impact on the SES-ADHD association. In the final study, we explored whether SES-health associations in general are likely to be due to epigenetic differences.

Existing literature provided evidence that an association between SES and ADHD is commonly detected. The facet of SES most predictive of ADHD was mother-reported experience of difficulty affording basic necessities (financial difficulty), which was associated with an increased odds of a research diagnosis of ADHD of 2.23 (95%CI 1.57, 3.16). Exposure to financial difficulty between birth and age seven was associated with higher levels of ADHD symptoms across childhood, of around 0.78 points on the Strengths and Difficulties Questionnaire Hyperactivity subscale (95% CI 0.54, 1.00, p<0.001) compared with peers without financial difficulty, whereas later exposure to financial difficulty was not associated with ADHD symptoms. In addition, we found tentative evidence that different patterns of SES exposure are associated with different levels of ADHD symptoms, with those consistently low SES having symptom scores 0.41 points higher than those in difficulty (95% CI 3.46, 3.57, p<0.001). We did not find strong evidence that low SES impacts on epigenetic profiles across childhood.

These findings add to emerging evidence of an association between SES and ADHD that has implications for theory and policy. This highlights the importance of recognising and treating ADHD when children have impairing levels of symptoms. The associations we found appeared to be explained by family psychosocial stressors impacting on neurodevelopment through pathways related to the home learning environment.

We concluded that SES should be considered a small but significant contributor to the risk of ADHD, similar to identified risk genes and gene-environment interactions, all with small but cumulative impact on the risk of developing ADHD. As educational practitioners believe ADHD that is diagnosed, but perceived to be caused by the environment, is a misdiagnosis, further work is needed to determine whether this impacts on referral or treatment of disadvantaged children. This will ensure those who would benefit from treatment for symptoms of ADHD do not miss out.

E-mail: A.E.Russell@exeter.ac.uk

In this project we are conducting a series of studies to explore whether biological mechanisms such as activation of the immune system, puberty or epigenetics have a role in causing self-harm. Currently, we do not understand a lot about what puts someone at risk of self-harm or suicide. We do know however that adversity in childhood is one of the most robust predictors of later self-harm or suicide. Adversity includes indicators of child maltreatment such as abuse, and household dysfunction such as witnessing domestic violence.

In this 2-year project funded by the Medical Research Foundation and Medical Research Council, conducted at the University of Bristol, we explore in more detail the relationship between adversity and self-harm, and investigate different biological mechanisms that might explain this relationship. We are also exploring the genetic similarities and differences between young people who report self-harm with no suicidal intent, or with suicidal intent in order to better understand whether these are two different types of behaviour or whether one is a more ‘severe’ form of the other. This project is currently wrapping up (as of July 2020).

Main contact: Dr Abby Russell

We are a research team based at Egenis, and part of the Child Mental Health Research group. Our research explores the role that diagnosis plays in society and in medicine, using diagnosis of autism spectrum disorder as a case study. On the way, we aim to celebrate and value the abilities and attributes of the neurodiverse community.

Main contact: Email Exploring Diagnosis

Website: Exploring diagnosis website

Twitter: @ExDx_UoE

Parent carers face increased risks of mental and physical health problems. They often prioritise the health and wellbeing of their children and their caregiving responsibilities, sometimes to the neglect of their own needs. Many parent carers don’t feel empowered to look after their own health. They may feel too tired or stressed to engage in healthy behaviours, or feel guilty about taking time for themselves. However, poor health of parent carers can have negative consequences on their wellbeing and on their children and families.

The Healthy Parent Carers programme aims to improve health and wellbeing among parents of children with additional needs and disabilities through:

Promoting greater empowerment, resilience and confidence of parent carers
Taking small steps that are associated with better health and wellbeing
Encouraging setting achievable goals and taking a problem-solving approach
Providing information through a group programme face-to-face or online

The Healthy Parent Carers programme was inspired by and developed together with parent carers from the Family Faculty in the Peninsula Cerebra Research Unit (PenCRU) based in the University of Exeter Medical School. We have recently completed a feasibility study to test whether the intervention can be delivered in community settings and whether a randomised controlled trial design is feasible. We are now running an implementation study to identify barriers and facilitators to implementation of the programme with two national charities, Council for Disabled Children and Contact, and to create an implementation plan that can be replicated at scale nationally.

Main contact: Gretchen Bjornstad

Website: healthyparentcarers.org

Our external partners are:

• Council for Disabled Children
• Contact

Using a participatory approach, we have co-produced three short films with the help of neurodivergent artists, The Art of Autism and Production Company, Calling the Shots. The films were designed to raise dialogue about autistic adults’ experiences of diagnosis and how the notion of neurodiversity has influenced their lives.

Sometimes I Think I’m Better invited autistic adults to explore the notion of Neurodiversity and what it means to them. This film is accompanied by animation created by the artists. In My Head and Heart follows the four featured autistic artists asking them what art means to them with snippets about the process by which they create their art. The State of Being Different features the voices of autistic adults reflecting on what it is like to receive an autism diagnosis. This film is accompanied by animation created by the artists. If you wish to read more about each of our featured artists, view our artist biographies page

Main contact: Jean Harrington

Website: Exploring diagnosis: exdx films

Twitter: @ExDx_UoE

In partnership with the Devon Partnership NHS Trust Research and Development teams and Devon CAMHS, we are conducting a project gathering ideas from service users and professionals involved in CAMHS to be turned into potential research projects. Young people with experience of CAMHS will prioritise the research questions. These questions will help us to develop new research that is relevant and important to the people who know the service best.

Ideas that are submitted will go into a prioritised repository in CAMHS for Trainee Clinical Psychologists to access when they undertake their service evaluation project as part of their training and for ChYMe researchers to access for development of new projects or areas of research.

This project was inspired by a young service user asking whether there was a link between CAMHS waiting times and inpatient admissions; a fantastic example of how research can be user-led.

Main contact: Gretchen Bjornstad

Our external project partners are:

• Devon Partnership NHS Trust
• Devon CAMHS – Children & Family Health Devon