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New relationships, new funding, and a new approach towards assessing young children

17 September 2020

Photograph of child sat on the floor doing an activity with a psychologist

Cardiff University’s Neurodevelopment Assessment Unit is paving the way for the future of child behaviour assessments and providing much-needed support to families, schools and children. With the approval of a new UKRI COVID-19 grant, its valuable work continues within the context of the current pandemic.

Nestled amongst a sea of concrete buildings, Cardiff University’s Neurodevelopment Assessment Unit (NDAU), just off busy Park Place, has been quietly welcoming children and their families for the last three years.

Professor Stephanie van Goozen is a biological psychologist working at Cardiff’s School of Psychology. She is one of four women who started the NDAU, and her passion for this area of research is palpable.

As we meet online, she props up her glasses, and leans into the camera, ready to unpack the project in her own words.

“From a research perspective, we know that most mental health problems start early in life – depression, eating disorders, ADHD and established adult mental health problems. We know that the onset of these behaviours usually happens early in life, and we also know that doing something sooner is much better for children and can prevent problems from arising later on. Most research focuses on older groups because it is easier to explain things and children are more ‘testable’ as they get older because of their verbal development. But by working with children aged 4 – 7, we’re reaching them at a critical stage, while they are still developing important skills.”

After working in the Netherlands and coming to Wales, Stephanie discovered that research into emotional and behavioural problems in very young children wasn’t an area getting a lot of attention or receiving a great deal of funding.

She explains that young children need to develop processes and skills for dealing with stress, mental health issues and adversity, and they need these tools to help them at school and to build friendships and resilience.

She also explains that, although some parents can get a referral to a GP, there are very few options available to parents who are concerned about their child’s behaviour and development.

Building new relationships with schools and parents

In school, children are developing their social skills and Stephanie believes that intervening early with the help of school staff is much more cost-effective and can have better long-term effects than intervening later in life.

“Teachers are very good at identifying when children are having problems. That’s why we set up the working-referral relationship with the schools and it’s how the NDAU started. We saw this opportunity in Wales and knew that we had the clinical insight and knowledge and could focus on younger kids.”

This is at the very core of the NDAU: working with schools, conducting thorough research and assessments, and providing guidance for individual children and ongoing support for emotional, cognitive and behavioural problems. Combine this with generous funding from the Waterloo Foundation and the team has created a very effective system of assessment and research.

“We assess the children, interview the parents and make a very broad profile of how the child is developing, focusing on social, cognitive, behavioural, emotional issues and the kind of processes that we think are important in the development of mental health problems. We then write a report based on these assessments and that report goes back to the school with advice on what they can do. They then know what the main needs and problems of the children are and also their strengths. Often you can work with a child’s strengths in order to achieve a change in behaviour.”

The NDAU has helped 300 children and families since it was first opened and, from interview information and referrals, the researchers have discovered that many of the children are on pathway that is likely to lead to mental health problems.

“We have a database of how these children are functioning and the issues they’re facing. Part of our funding is used to provide an educational psychologist who gives recommendations for how the school can help these children.”

Developing a new approach to assessment

Stephanie is keen to move towards a new system that focuses less on diagnosis and more on the aspects of behaviour that lead to a diagnosis.

“There’s a new system we need to move towards where people should forget about giving a diagnosis because that label implies a single solution. In very few cases is there a single problem with a single solution. We need to focus on what children’s actual problems are, for example difficulties with empathy or attention. That is exactly what we are doing in the NDAU. We are working within this new framework and focus on problems and processes that can be influenced and supported, such as memory problems or problems with impulsivity and language.”

“What we do is we build towards this new approach. We don’t give parents or teachers a diagnosis, but we give them an overview and a profile of how their children function in terms of these processes: cognitive, emotional, verbal ability, etc. These children come for five or six hours of assessment so we can gather very comprehensive, rich data to help us identify issues and understand why children experience and display problems.”

With these assessments, Stephanie believes parents and schools can better tackle these issues pragmatically and potentially achieve better outcomes for everyone.

“Children can be better helped in a school context, especially at a time when they are developing important language, cognitive and relationships skills and are learning about emotions in themselves and in other people.”

Although it’s common for psychologists to use an individual approach, the NDAU is unique because of its focus on detailed assessments, providing parents with a rare opportunity to access this kind of support.

“The NDAU is unique because of our resources. You don’t normally have access to six hours of assessment by an educational or clinical psychologist!”

New funding and new possibilities

Since the initial funding from the Waterloo Foundation, the NDAU has been approved for UKRI funding for a COVID-specific grant in July 2020.

“I’m very grateful to the Waterloo Foundation as they had faith in the project from the very beginning. Their funding allowed us to establish the Unit, to find out whether this type of assessment was feasible and worked. We need charities like the Waterloo Foundation because that is how new, innovative research comes about. I don’t know of many organisations you can go to and say ‘we have an idea, can we try it out?’. They were integral in getting this started.”

As a result of the start-up support from Waterloo, the NDAU’s database is now incredibly detailed and has led to the success of further funding by UKRI.

“We are the only research unit in the UK with such an extensive database of children with emerging problems and that means that this is a unique opportunity to understand what COVID is doing to the most vulnerable families. That was the strength of our proposal. We are able to monitor how children cope over the coming year and we have the data to find out what factors help children and families cope, and who is struggling the most.”

Stephanie and her fellow researchers at the NDAU are now conducting video interviews with as many as of the 300 families as possible before they return to school and will continue to assess them over the year, conducting another in-depth interview at the end of the next academic year.

“We will have three waves of data – pre-COVID, during COVID, and post-COVID. We will be able to identify how well different families are coping, and what the factors are to explain this.”

Stephanie also hopes to use some of the funding to set up a website and provide schools and families with online support and practical guidance.

“Hopefully, with UKRI funding, we can set up a website with resources, training options, information and video links. We want to develop this so that, while parents are waiting for their child to be seen by a doctor or psychologist, they have access to resources that should help them.”

Stephanie’s enthusiasm for the project has only grown with time and she’s looking forward to being able to welcome more children, with social distancing measures in place, through the door of the NDAU building this year.

Propping her glasses up once more, moving away from her desk and smiling, she’s already envisioning big plans for the future.

“I wish we could do more! But I see lots of possibilities and opportunities to make a significant and long-lasting change with this research.”

This article was originally published on the Cardiff University alumni blog.

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