We are the Association for Child and Adolescent Mental Health, or ACAMH for short, and this is ACAMH Learn. Welcome to the Mind The Kids Podcast. Let's imagine a child's world, both ordinary and miraculous, where everyday moments, like reaching for a spoon, playing tea party, or taking those first wobbly steps not just milestones, but clues to a bigger story about how language unfolds. This episode is called building blocks how genes, motor skills, and family shape language. I'm Mark Tebbs. I'm your host for today. I've spent my whole career working in mental health, from frontline service delivery to Director of Mental Health Commissioning. I'm currently chief executive of Charity, a trustee for mental health organisation, a career coach. And I'm delighted to be hosting these podcasts because we get to speak to clinicians and academics at the forefront of children and young people's mental health. Today I'm joined by Dr. Beate Pourcain and Dr. Ellen Verhoeff from the renowned Max Planck Institute for Psycholinguistics in the Netherlands. They are at the cutting edge of research into what helps children learn to communicate, revealing how genetics, motor skills, and the magic of social play all combine to open up the world of words. Today's episodes go deep into their recent JCPP Advances study, which followed more than 6,000 children and families will explore that developmental cascade, which is how early motor achievements, like sitting, crawling, or using a spoon are part of a gateway that leads to imaginative play, social connection, and everyday language. Beate and Ellen will unpack not just the science and surprises in their data, but the joy and complexity of how children grow and why language learning is always personal, shaped by both biology and the environment. So let's get started. Beate, Ellen, welcome. It's a pleasure to be speaking to you. Thanks, Mark. Grateful to be here. It's wonderful to have this invitation. It's wonderful to be here. Yeah, I'm really looking forward to it. So, look, let's start with some introductions. It'd be great to know a little bit more about you, maybe where you're working, your research interests. So, Ellen, do you want to start us off? Yeah. So I'm Ellen Verhoeff, and I'm a postdoctoral researcher at the Max Planck Institute for Psycholinguistics, which is a world-leading research institute that's devoted to interdisciplinary studies of the science of language and communication. And specifically, I'm a postdoctoral researcher in Beate's group, of which I'm sure she will tell you a bit more about when she introduces herself. So the group is called the Population Genetics of Human Communication Group, and I'm specifically interested in understanding the genetic influences that contribute to early life development, a particular language, and also whether these then also relate to measures that we assess later on in life, such as cognition or neurodevelopmental conditions. And in practise, this means that I really enjoy it to sit behind my computer and analyse large data sets with statistical tools. OK, brilliant. I love that little summary. Yeah, I'm a senior investigator at the Max Planck Institute for Psycholinguistics, and I lead there the Population Genetics of Human Communication Group. And we study common genetic variation to gain a better insight into the processes shaping language and social development, reaching from infancy to adolescence. And we want to better understand how these processes also relate to mental health and education, and well-being that are very important to most people. And to address these questions, we apply advanced statistical methods, and we really investigate large data sets, mostly population-based cohorts, but sometimes also clinical cohorts. And we conduct, for example, large genome-wide analysis to better understand the factors contributing to children's social behaviour. That's a large study of ours. Or the processes that influence when infants begin to utter their first words, to learn language. This is also the case in our latest work, where we study in depth the processes that might even lie before the utterances of the first words using methods that were developed in my group. OK, brilliant. So let's turn to the paper. So the paper is, as I understand, it's an investigation into language development in a developing body. So could you just start by giving us a little bit of an overview of what you were setting out to try to achieve? So if you're asking what inspired this research, it started quite a while ago. So a few years ago, we started working on the developmental origins of genetic factors that underlie language and literacy development. And that really started with the first word utterances, but also toddler language abilities and how they really relate to mid-childhood language reading and cognitive abilities. And this work was also published in the Journal of Child Psychology and Psychiatry and in PLOS Genetics in 2020 and 2021. And we showed there that the genetic foundations of these kind of mid-childhood reading cognitive abilities, age 10 years about it, are quite diverse. And they involve at least two independent genetic contributions that really emerge at very different developmental stages during the very early development. And this raised the question, if you have already such a diverse architecture, what are the developmental processes that lie even before the first utterances? And we began looking deeper into the precursors of infant language development, including very early infant motor, but also social milestones that contribute to a developmental cascade that eventually also includes language acquisition. Language development happens at different stages and you were looking at what was the precursor processes behind that variation. That is absolutely correct. Yes. This is what we would do. Got it. OK. Ellen, did you want to add anything to that? Yeah. No. So I think the developing body aspect comes a bit from the fact that we know that children develop in many different developmental domains at the same time during early development. So it's logical to think that there might be links between these domains and that it's not only language that develops, but that, for example, social or motor development that's happening at the same time may have an impact also on how children acquire language. So to give you some more concrete examples, we all know, of course, children, most typically developing children, acquire gross motor skills, such as sitting and independent walking, already during the first year of life, which is then followed by more fine motor skills, which helps them to explore objects. But at the same time, children also develop socially. So they are more and more able to engage in child caregiver interactions while they are also developing language. So language development is actually already starting in utero, but we often see the first real words being produced around the first birthday. But yeah, a lot has happened in various developmental domains before the first word. So here, we really wanted to look at the precursors and at the same time put it in the perspective of what's going on in early development, also in other developmental domains. Dive a little bit into that cascade theory in a moment. I just wanted to, before we go into that, just be really useful for you to let us know what was the research gap that you were aiming to address with the study? So what was known before the study, and what were you trying to achieve, or what was the gap you were trying to address through this work? We have, really what Ellen just outlined, this different developmental processes, where we have an approximate age once these processes really arrive. So to give you a little bit more of some details, it's that we have these gross motor skills that children acquire the age of about six months. And then they start independent walking at about 12 months, followed by some fine motor skills, like pincer grabs at the age of about 14 months. And once these children learn to adapt their motor behaviour, such as being able to move an arm to point to something, the infants can learn to use their motor behaviour selectively, so they can point to some things. And this helps to initiate really social interactions. Carers may look, carers may say, oh, the baby wants something. And at the same time, now the infant engages in these social abilities. For example, we have joint attention skills. We have interactive play at about of eight, of nine months. And in parallel, the children really engage into language. So the emergence of word understanding about six to nine months. You see that these processes are very much interlinked. And also, the first spoken words that arise at the age of 10, 15 months. So using genetic skills, we really wanted to see what we can do to better address the hypothesis in the literature that these developments are not independent, are interlinked and related, and we try to disentangle the developmental processes that exactly contributing to these kinds of developmental cascades that eventually, of course, result in language learning. And because these infant motor and social processes may enable children to initiate, but also to really change the quality of social interactions, they may lead to learning opportunities. They may in turn lead to language learning. So we ask these overarching questions, what are the genetic influences underlying infant and toddler language skills that are already shared with these very early infant motor or self-care symbolic actions that were mentioned even before that? And what are the underlying patterns that we may see according to very different hypotheses? And maybe Ellen can let you a little bit more about what kind of study design we used to address these questions. Yes, of course. So the way that we approach this question is by studying data from over 6,000 children from the Avon Longitudinal Study of Parents and Children. And this is a pregnancy cohort that has been asserted in the UK, especially in the Bristol area, in the early '90s. And then parents were asked about the children's motor, symbolic and self-care actions, and language development at various time points. So these parents were basically asked to fill in questionnaires that were derived from standardised psychological instruments. And on top of that, we also had the DNA of these children available to study. And an important aspect of our study design here is that the inclusion of the measures-- the measures that we included were inserted longitudinally, but the details that we studied for motor behaviour were collected at an age of six months, followed by performance on self-care and symbolic actions, which was collected at 15 months. And then we also included a variety of language measures that were assessed between 15 and 38 months. OK. So could you just tell us a little bit more about the measures that were used in the study? Yeah. So if we look at the motor achievements at six months, these resemble more like gross motor skills. And you can think about questions like, can your child already keep their head up on their own? Can it roll over? Can it sit? Can it crawl? Things like that. If we look at the self-care and symbolic skills, it's things like stirring a cup without actual liquid being in it. Does your child-- can it get dressed? Does it brush its hair? So it's more of these type of activities. And then for the language measures that we studied, we looked at measures that were basically reflecting the number of words a child speaks or understands. So out of, I think, over 100 words, parents had to take, does your child say and/or understand this word? And on top of that, we also had some measures reflecting more grammatical abilities, such as did your child already start to combine words or does it use certain past tense forms? OK. So can we just go a little bit back to that core question that you're trying to study and then how you went about studying it in your statistical modelling and analysis. Thanks for that. Yeah, that's a really important aspect of our study. And Ellen alluded a little bit already to the developmental cascade. This is really when she really mentioned this, that, for example, a child can learn how to eat with a spoon. So the child must be physically be able to hold a spoon and move it towards the mouth. This is a motoric aspect that needs to be mastered before the child can engage in any of this activity, what we discussed shortly before. So there has to be first a kind of-- an ability that has to be mastered before the next one can occur. And Ellen may also be a little bit more telling you about it. But one of the aspects that I would like to highlight here is the aspect of a gateway that we came across. And this is an aspect that is going beyond the hypothesis really of the developmental cascade. So if you think about how children develop, we could just think about that children share the abilities they learned before with the next abilities they learn later. And for instance, some shared motor abilities, they may have relevance how children produce speech because they used similar abilities of control, how these muscles are controlled. And this is a prerequisite simply to learn language. But on the other hand, a cascade may involve very different mechanisms. It may involve what we call a gateway. And here, these motor abilities enable children to participate in a social interaction. For instance, they can crawl, sit, reach out, and this helps to initiate the interaction with the parents and caregivers. And this provides learning opportunities. So the abilities that the children had, the motor abilities to engage in these social interactions are actually not the learning abilities that made them-- enable them to interact, play, and learn but they were necessary so that kids or infants could really have these social interactions. They initiated them, they pointed to them. And through the social interactions, they developed social skills, especially social learning skills, which might be very, very different from the very early motor abilities. And only these skills enabled them to really progress with social and effectively language learning. So these are the two types of patterns we really wanted to see and we used genomic methods to do it. But maybe Ellen can tell you a little bit more about how we did it and what we tried to find. Yeah. So we indeed try to find evidence for this hypothesis that actually comes from developmental psychology by studying genetic data. So what we do is that we know about the genetic differences between these children, and we also know about the difference that occurs, for example, in the number of words they produce at a certain age. And we can then use a type of study which we call an association study, where we actually see whether there is a relationship between the differences in the DNA and the differences that we see in the number of words a child speaks. And we don't do this only for the number of words child speaks, but we did this also for the motor and for the self-care and symbolic actions. And then using some of the tools that Beate developed, we can actually look at these influences for more than one measure at the same time. So we can't only see is there a particular relationship between the genetic differences and the differences in the number of words, but we can also look at are these the same genetic differences that influence motor skills, or are these the same genetic influence that are related to self-care and symbolic actions? That comes with saying that what we did is an association type of study, so we can't claim any causality based on our findings. And we also would like to know that our findings do not imply that every single child has to follow this developmental route to acquire language. So we know that there exists large individual differences in the way that children learn things. And here, we just sort evidence for a way that children could acquire language by studying data from this large group of children. OK. I want to check my understanding on a few things because we covered a lot there. So are you saying that the idea of a gateway is that children need to progress and achieve a certain milestones, or typically achieve certain milestones before they progress to the next stage? Would that be an accurate description or not? It would be a fairly accurate description. We cannot, of course, exclude that it is strictly only in this one order, because everything has also a interactive effect. You engage a child to a point more if it is rewarding to point. If you have an adult who just says, oh, look, the little one is pointing. So you get a-- it makes sense that I'm actually pointing to things because I may get the ball or the muffin, or whatever is in my reach a little bit quicker if I do so. But in general, yes, these processes need to develop in some kind of developmental order. This is the order that we also would expect and have also implemented in the study to make sure that we really only capture the processes that lead from an earlier stage to a later stage, and not the other way around. And when we do this, as Ellen has said, we use genetic tools. These are in the way we investigate them, not the tiny variants in the DNA. This is not a single gene because we studied nearly about 500,000 sites jointly, and we studied especially those sites where humans differ from each other. These are called genetic variants. And they can explain quite some proportion of the variation in humans. And these might be the variation underlying in early languages, personal social motor of development, about up to 20%. And this is the actual variation that we capture with our methods. And then we can ask whether they are really partially influenced by the same genetic variation. This is what we detect with our methods. And these shared genetic effects can be studied with statistical methods that are related to a technique called structural equation modelling. And this is also presented in our work. And these genetic influences reveal structures. And based on these structures, we can say our genetic influence is similar to our non-genetic influences. Are they similar across the traits? And this is how we actually disentangle then these shared genetic influences underlying motor, social, and language outcomes by enforcing also this developmental order, which Ellen alluded to previously. It'd be, I think, good to move on to more of your results. So what were your key findings, and what surprised you? So I think the key finding and what we really try to do here is to see whether we could disentangle these developmental processes leading up to language development. And what we actually found is that there are two sets of genetic influences that play a role. One is related to gross motor behaviour assessed at six months. And we saw that these influences are also important for development of self-care and symbolic actions. And I think this makes a lot of sense because if you want to learn how to eat with a spoon, you need to be able to hold the spoon, move it towards your mouth in a quite sophisticated manner to make sure that you don't spill all the food. So I think that makes sense. But we also saw that there's another set of genetic influences related to this type of self-care and symbolic actions. And this set was actually the set that also linked to language development. So we saw little evidence for these more motoric influences on language development, but we saw more evidence for another type of genetic influences related to self-care and symbolic and language development. And the way that we interpreted that here is that this may reflect some sort of social learning as the type of activities that we looked at, again, pointing towards the example of learning how to eat with a spoon, often takes place in a social interaction with a caregiver or a parent, which comes with a lot of language input as well. And then maybe Beates can tell you a bit about the surprise. We were actually looking at the very early language measures. Based on the current literature, we had assumed that these very early language measures would indeed share already quite strong and detectable links also to this social motoric and the language measures at 15 months, and later on. But these very early measures may capture a very early stage of motor abilities, which may indeed be distinct. And often in the literature, it seems to be like a continuous cascade, but it wasn't. We could extract, actually, the influence from these more social abilities that we also measured that may reflect the more social learning abilities at this stage. And we could see that only those, irrespective of the very early measures, were related indeed to language learning. That being said, that means also at this later stage, children may have developed fine motor skills that we would have not captured by the very early motor abilities, but it is in the literature quite common to assume that there is a continuation and to see that also these later motor abilities and social abilities on their own carried the majority of the link to language was indeed a very surprising finding for us. We know that these symbolic actions that are independent of the gross motor abilities are strongly related now to the infant vocabulary measures, and we can induce that they may actually be the consequence of social interactions, because what we indeed find at these very, very early measures is that they are not really a symbolic play of a child as we would expect at the age of maybe three months. We are talking about an age about 15 months children learn these abilities, both the cultural abilities, like to eat with a spoon, or to hold a phone, or make choo choo train that mark the beginning of social play, mark the beginning of social imagination. And as such, we can fairly confidently deduce that these abilities must have been learned within the context of a caregiver because they are not part of our natural behavioural repertoire. And this is really that these kind of abilities were linked to language learning that make the big difference in our study. Yeah, Ellen, do you want to add anything on this part? What might be important to mention that the self-care and symbolic actions that we studied are also quite culture-specific. So while eating with a spoon might be very typical in the UK, it may be less prominent in other cultures. So to see whether this is really a universal aspect and whether really the social learning is playing a role, we would really like to see these results replicated in also more diverse data sets. Yeah, really important. Can I just-- again, it'd be really useful to just check my understanding. Is there a way of describing that as an example that really brings it alive to a lay audience? That might be tricky. We used statistical techniques that asks, can you provide a measure for all the genetic variation that's available at the age of six months? And like a subtraction, we subtract this out from all the genetic influences that contribute to the pretend and social and cultural skills at the age of 15 months. We remove it and we have the ability, through that split, to look at the remainder of the social abilities that we discovered or defined through this procedure at the age of 15 months. And that's enabled us to look at both of these influences separately. And this was the point where we could see how the patterns to do subsequent measures then could be emerge. And we saw also in our work that these were quite strong. And we think that they are fairly reliable because we know that motor abilities at the age of six months, they cannot be reverse influenced by something like language learning at the age of 15 and 36 months later on. There is no way that we could have this reverse process happening. And what gave us an additional some confidence is that when we looked at the non-genomic patterns, which can be dissected exactly in the same way, we found quite strong similarities. That means we are capturing processes that both in the genetic factors, but also the other, mainly environmental factors are pretty similar. And this gave us additional confidence that the processes that we induce, and I have to say, they are not causal. These are association patterns, but that they are reliable. I think Ellen mentioned this also before. But through this kind of consistency, we gain more confidence by using a simple association study. I hope that answer is a bit-- maybe Ellen, you get it-- Yeah, and the fact that we found evidence for these two independent genetic sets of influences that are important, that does not preclude that it's still one developmental mental cascade. It only means that within this developmental cascade, there are multiple distinct processes that contribute to it. So you can't say, OK, if as soon as you-- if you have these motoric skills, then you will automatically acquire language, because you will also need another type of skills to build further once you are able to participate in the social learning settings. You need something else than motor to be able to build on it and learn language basically. Does that help? That does. That's good. Brilliant. So I'd like to turn a little bit to the implications. So I guess one of the reasons for studying language development is to better understand those kind of variations. So does this study shed any light on why there would be variations in language development? I think it does shed a bit of light on why there are differences in language development because we see that this is partially due to environmental differences in, for example, how children grow up. They have different parents. They do different types of activities. They go to different schools. But there's also a part that's due to differences in their DNA. However, as Beate mentioned before, the type of behaviours that we studied here are very complex. So we studied the differences across, or I think nearly 500,000 positions in the DNA together. So we can't really say it's this tiny thing in your DNA that matters really for how fast you acquire language. It's a lot of very tiny effects together, which then also come on top of a lot of different effects that come from the more environmental circumstances, which playing together will explain why one child acquires language maybe a bit faster than another child. And here, we did not really aim to pinpoint what the exact factor that drives these differences, but we rather looked at overall patterns, contributing to processes to get a better insight into, where should we look? What are the important developmental milestones early on in life that can contribute? Where can we focus on in that aspect? Beate, did you want to-- I saw you poised. Maybe just a short note as well. What Ellen already said is that, first, yes, we use these methods to gain some understanding of how groups of children develop. They are not really able to pinpoint on a developmental progress trajectory, as we call it, for an individual child. And this is something that we really need to stress here because we cannot predict it. Our genetic methods do not explain enough to be able to do that. But we do can better understand what these processes are. In fact, these genomic methods are just another angle to carry out developmental psychology. But we can look a tiny bit more under the hood because as our genomic processes here, they are not causal. We reflect behaviour as we would do in an observational study, but we dissect it in genomic and nongenomic influences. Through that comparison, through the disentanglement of these patterns, we can better understand the processes that lie underneath. But these processes may only partially be biological. They may capture developmental processes far better and then we can pinpoint it was a single gene. As Ellen alluded, we cannot really point to a single gene using these methods. What we do here is, really, we look at the importance of social interaction and social learning. And that is an idea that has been many years ago proposed by Vygotsky. And this is the importance for social interaction and an aspect that has been actually also reported by other studies who really work with children, especially collaborators of ours who have also been on the study, such as Professor Evan Kidd. And he can tell you a little bit more just to tell you that these kind of studies showed very, very similar aspects that we also highlight, which really focus on the social interaction that stands at the beginning of learning. So yeah, it'd be great to-- Beate, if you could expand that a little bit, because I guess there'll be parents and carers who are interested in how do they support their child to thrive and develop language. I don't know if you could, whoever, you could add anything to that kind of question. Yeah, sure we can. We are researchers working with secondary data. We do not work with children, and I really need to say this. And as such, we have association moments. We do not really have the nature of the social interaction in our study. We see the consequence. Yes, the children can do it. Obviously, they could pick up or pretend they had a telephone receiver, but we didn't see them learning that. We only see the outcome of that. We know however how these processes work. Ellen mentioned this a little bit earlier. They are acquired through close social interaction moments, typically involving shared attention, where parents says, no, we call you. We call each other. And we have a focused on language output. And our co-author, Professor Evan Kidd, has shown that such symbolic play, like pretending to cook spaghetti, now we are cooking our meal today, or drinking tea with a Teddy bear. Everybody has a tea party. And this can have a really positive effect on language proficiency compared to more functional play, like, we're doing a jigsaw, which is not really in this kind of very interactive, almost mimicking interaction with the child that requires this close attention and joint attention between a mum and her kid. So, more generally, it has indeed been shown that social interaction is highly beneficial. And it's also called child-centred social interaction because the social measures have been studied here, are really fulfilling this aspect in the way that we know that they are learned. We also provide additional evidence for this kind of claim that social learning is one of the central aspects that may also influence language learning. Yeah, brilliant. Thank you. And I guess there will also be part of the audience that are clinical working with children with developmental disorders or speech delays or autism. I wonder whether the research also sheds any light on language acquisition in those children. We use the AllSpark sample. As this was a cohort that was based on all pregnancies in a certain period of time in the UK, it did not specifically focus on children with certain types of challenges in life. So it's representative of the population, but it didn't especially include children with autism or speechless. Of course, there are a few children that ended up getting later on experiencing such difficulties, but the cohort is not really focused on these type of children. Also, when we look at children that encounter speech problems or are diagnosed with autism, there are very large differences between these different-- between these children. So it makes it very difficult to generalise and talk about things that would work for all of them, for example. So I think in order to really make statements about language development in these type of groups, further work is needed. Yeah, sure. That makes absolute sense. I'm just-- this might be some of your personal reflections rather than the strictly about the study. But I'm just wondering also about the kind of broader implications. So I'm wondering whether this study influences or shapes your thoughts around early childhood education programmes or policies. Is there anything from this study, from your broader research, that we could or should be doing better? Indeed. We have now identified developmental links. And of course, the question pops up, what does it mean? What is it good for? Where shall we go next? Now, it is good to really highlight that we are coming from our researcher perspective. So we do know about the evidence for developmental links now between these motor, social, and language measures. And also, we know that both genetic and environmental influences relate to these kind of underlying structures, but we do need now an intermediate step. And that is really that our research needs to inform the next step that would lead indeed to an intervention. But this would need intervention and causal studies before we can claim that they really make a difference. And as we said before, and also Ellen highlighted, we have no causal association. We have no causal links. We have associations. There could be still a reason why children do it, and it might not be consistent with a causal chain that we presume. So why we show that these associations refer to developmental pattern, we cannot infer causality and these intermediate step of interventional causal studies are needed. But what we can do is we can highlight for future studies that it is important to study the role of social interaction in very early infancy, and in particular for the outcome of how children learn language. And this is really important to better understand how this social learning process works. And this can be done already now. Although, going to intervention policies and education policies would be, at this stage, too far-fetched. But it is really highlighting, again, the research also of our colleague Evan Kidd, who mentioned that really symbolic play, this doing things together between parents, children, caregivers in a nursery, and the children really has an effect about the language proficiency that children then develop during the next months, years that are to come. So yeah, that would be maybe taking it a little bit slower. Yes, I hear that. Do you have any further research in the pipeline? Is there anything that you're currently working on that you'd be able to share? Yeah, of course. We are researchers doing always something that drives us, that itches and say, we need to better than that. So that's a never-ending story. And I love the discussions, especially with Ellen, when we just sit there together and really think, oh, what does it mean actually? So one research question usually leads to many more, many more areas that we could explore. So for instance, based on a genetic similarity of the language measures with the cultural learning and pretend measures that we've observed at the age of 15 months, this has, of course, an implication about how we can study language emergence at a large scale. And we carry out multiple studies also within the EAGLE Consortium, which is a large consortium that combines many population-based studies where we can pull forces together to better understand the factors underlying language acquisition using a genetic approach. When we have so much more power, we are talking about tens and thousands-- ten thousands of children, we have also a better ability and power to pinpoint the actual biological causes, which we call genome-wide association signal, which would be actually candidates for true biological contributions that we can then try to disentangle in more depth. So one aspect really considers the joint study of social and language development, given their developmental links. And in addition, what we noted as well is that we have indeed quite some similarity between the genetic and the non-genetic factors. Having that similarity bears, of course, the question, is there a kind of correlation? This is something that has been brought up also recently in the literature that we call gene environment correlation. And this is also an aspect that we would really like to investigate further because this may capture how parents share, of course, their genetic factors with children create the rearing environment of their children. And this is another aspect that I would love to investigate further together with Ellen because, yeah, it really builds to the research that has been carried out now for several years in my group. We're coming to the end of the podcast. I just wondered whether each of you have got a final take-home message for our listeners. Maybe we could encourage people to participate in research in general, also genetic studies because without people participating, allowing us to use the data of their children, these studies would never have been possible and we would really not be able to gain such insights. So we are really thankful for them and also really hope that they will continue to make these efforts also in the future. Maybe I would like to add play with your children, enjoy the time together. Whether it now causal or not, it has many good effects. Whether it relates to language or not, you really enjoy the time together. Brilliant. Two lovely final messages. Thank you so much for your time today. Super interesting conversation and lovely speaking to you. It was indeed a pleasure. Thanks so much. Thank you. I really enjoyed that. I was a bit worried about understanding that kind of complex data, but Beate and Ellen framed it so well. It was really easy to follow. So thank you. Thank you them for that conversation. And it'd be great if you could leave a comment, a review, a suggestion, and share with colleagues. It really helps us. If you have an ACAMH Learn account, which is free, then you can join at www.A-C-A-M-Hlearn.org and you'll be able to get a free CPD, CME, certificate for listening to any of the podcasts. Next week we'll be trying to distinguish hypomania in adolescence with Dr. Georgina Hosang of the Queen Mary University of London in a really fascinating discussion. [MUSIC PLAYING]