We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Hello there, and welcome to Mind the Kids. I'm Dr. Jane Gilmour, Honorary Consultant Clinical Psychologist and Child Development Programme Director at UCL. And I'm Umar Toseeb Professor of Psychology at the University of York, focusing on children and young people's mental health and special educational needs. In each episode, we select a topic from the research literature and in conversation with invited authors. Sift through the data, dilemmas and debates to leave you with our takeaways for academics and practitioners. Today, we'll be discussing the experiences and outcome of young people with mild intellectual disabilities MID. This episode is called children with MID. A multifactor intervention offers best protection. Let's talk everything that I'm interested in. So cohort studies neurodevelopmental conditions mental health and academic attainment combined with some amazing sets of analyses. So I'm very excited that we're talking about this particular study because like I said, it aligns with lots of stuff that I'm interested in. And also, I think it's central to lots of the stuff that the listeners of this podcast are interested in. So it covers lots of different topics. I was really impressed with the analysis of the paper as well. I was multiple imputation. Yes, sensitivity testing. Yes, using survey rates. Yes, so it was really, really nice. And it was because I had a colleague email me recently and they said, oh, we've written this paper and done this analysis. Can you just read through the analysis to make sure if we've done it OK. And we're just not that confident with the analysis. And I read it and I was like should be very confident with this analysis. This is amazing. Like you've covered everything that you should be covering and more. And that's what I felt about this paper where I was like, oh no, you've not cut any corners here. You've tested everything you should have tested before you done the analysis. You've accounted for attrition. You've accounted for the differences that might exist in the population level and applied weights. So I was like, yeah, this is good. And the topic is interesting too. So that's why I'm excited about this conversation. And it makes you and it's big data. It's cohort studies. It's got something there that I know it's all your favourites. It's just it's like what's the word. Oh I can't think of-- Smorgasbord. Smorgasbord, that's exactly the right word. Tell me-- and I think you're right not to go into too much detail in terms of methodology, but if you were going to say the best thing about this paper as you read it and define that for somebody who's never been involved in any of these methodology or whatever, what is the best part of this paper and why? What would you say? I think it's the fact that it aligns so nicely with my interest. So we're thinking about risk and protective factors at the population level. And then also how they apply differently to a specific group within that population. And it's not just we're looking at this one thing and it relates to this other thing whilst controlling for this one other thing. We're looking at lots of these things, how they relate to these other things in these two different populations from this overall population. And I think that was-- where I think it that was what was nice about it. But I think it was because the framework within have in your research approach, you have this template for how you do research and how you write papers and everything. And I think this aligns so well because I was like, yeah, risk and protective factors. Check. Looking at the difference between two different groups. That's why I do cohort studies. That's why I do all of this stuff. There was just so many of those things that I was like, yeah, I could have definitely been on if it wasn't already written, this is exactly the kind of paper I would want to write. That's very validating. Well, look, I love this paper too, but for different reasons. It wasn't about the survey weights as valid as they might be. I love the paper because it was solution focused and action orientated. And, I like a to do list. And it was also very grounded in a real world problem if you like. And I think that's what you're getting at in terms of the variables that the paper explored. So just in terms of terminology, we're looking at mild intellectual difficulties or MID. So that would normally be describing children who have got an IQ measure between 50 and 70. But for a formal diagnosis if you like, they'd also have functional impairment academic social or practical issues. And so one comment that really struck me as I read this paper was that the majority of young people who have an IQ between 50 and 70 will be in mainstream schools. And I hadn't appreciated these data and it really reflected an experience that I'd had in a study that I was looking at in terms of looking at kids who had behavioural difficulties, and I was doing school visits, and I would go into the school classroom, assess the kids, and I measured IQ as part of the protocol. It wasn't the point of the study, but it was part of the protocol. And we found that the vast majority of young people who had behavioural difficulties were in the MID range and they had no formal identification of that, no accommodation for that or provision. And so it really made me think about how these young people are managing without that being signposted at the very least. And so this paper really gives us some clear and data-driven action points. So I thought it was fantastic. I'm really looking forward to getting in a bit more detail with our guest. I just want to pick up on something you said there about many of these kids are just like you said, most of these kids are in mainstream school, and I wish I could say something because we just had a meeting this morning with the founder about this. So we've done this piece of work about something that's related to behaviour and mainstream schools and the severity of difficulty or the level of need that the child has. And there's some really interesting things about whether the severity of need is matched to the type of school provision and what impact that has on the child's subsequent outcomes. So watch this space. There will be more on this, and it builds on the work that we're going to talk about today. Wonderful I will be reading that with some keenness. I have to say, it's really important stuff. To bring the guest in. Let's welcome her in. Today, we're joined by Dr. Foteini Tseliou from the University of Cardiff in the UK. Foteini is the lead author of the paper Factors Associated with Better Emotional, Behavioural, and Educational Outcomes in Children with Mild Intellectual Difficulties published in JCPP advances. Welcome Yeah. Nice to see you both. Excellent. Well, let's start with just some definitions. So you've heard me and Jane having a brief little chat there about why we're excited about this paper. And we've mentioned terms like mild intellectual difficulties. And I think I also referred to it as intellectual disability. And what do those terms mean and what term will you be using in this conversation? So yeah, yeah, it's a great starting point because there's a lot of slightly similar terms being used and can be very confusing when reading across papers. So when we talk about intellectual disability, we're referring to significant limitations in cognitive and functioning. So especially how someone thinks and learns and but also in adaptive behaviour. So which are the everyday skills we need for independence like communication and social skills and self-care. And formally intellectual disability is diagnosed when someone has an IQ below 70 and significant difficulties with adaptive functioning beginning in childhood. And that roughly affects about 2% to 3% of the population. But in our study, we focus on a broader group of children with mild intellectual difficulties, or MID, I might call that for short. And these are children who have cognitive abilities like borderline to mild impairment range. So that would be like 50 to 75, like you mentioned before. But we might not meet the full criteria for a formal intellectual disability diagnosis. And in our two cohorts we can talk about it later. It was roughly like 4% to 5% in both cohorts. So we're looking at a consistent 4% to 5%. And it's important that the majority of them are in mainstream schools as we saw from our data. And these are children that may face many similar challenges with those diagnosed disability. So that would be higher rates of mental health problems, behavioural difficulties, educational struggles, and even social challenges. But they're often less visible in the system and may not receive the same level of support. And that's why we thought it was very important to have this broader definition and talk about those people that are not usually the primary focus. Yeah, and what I like about this is that-- and this-- I think this is a recurring theme in terms of what we talk about. Lots of difficulties exist on a continuum, and I think that a lot of the time what we're saying is, just because somebody doesn't meet the diagnostic threshold for a given difficulty, it doesn't mean that they are not struggling and don't need support. And it seems to me that's what you're describing there is a similar thing, but for intellectual disability, because the prefix of mild suggests that they are not quite reaching the threshold or the cohort for it to be categorised as an intellectual disability in that sense of the phrase. But there are some indicators that these children are experiencing some difficulties. So we should be investigating what those are. And I mean, it's really interesting what you're saying about looking at these children who have a higher risk of mental health difficulties and behavioural difficulties. And then we look at IQ and find that they are, in this borderline range or MID range to what degree we might say, well, I would have a challenge in terms of my mental health or I would express my struggle in a behavioural difficulty. If I were being asked to engage with a curriculum and my cognitive ability was at a certain level, I think there is something about an IQ which can be somehow misappropriated, if you like. But actually knowing a child's IQ is so important because it's got such high explanatory value. And you can say immediately, well, of course, there will be a reason why this young person is struggling, because the content is not designed for a young person who may have a variety of different vulnerabilities within that lower IQ level. So I think the humanity behind an IQ test, if you like, is somehow neglected. I was just going to add to that point where I'm not an expert on IQ and intelligence. I just want to start by saying that I was reading some literature on IQ last year. I think it was. And what was really interesting about the argument that they were making in that paper was we might not necessarily know or agree with what IQ is testing or the IQ tests are testing. But what we do know is they explain a lot for some part it might not matter what we're actually testing, but it's whatever it is, it has good predictive value. It tells us a lot about that child's functioning or their engagement, whatever else it might be. So yeah, we might not know what it is testing and we might not agree on a definition of what IQ is and what intelligence is. But we do know that those standardised tests of IQ predicts lots of stuff. Well, I just wondered, what do children with mild intellectual disability look like in the classroom? So if we've got teachers listening to this, I understand the group is not homogeneous. There will be lots of variation and differences within that group. But what I'm trying to get at is it obvious that these kids are experiencing difficulties, or are these the kind of kids who will slip below the radar. And you wouldn't think that they're experiencing difficulties and their intellectual difficulties might present as behaviour, or they might present as emotional problems, or they might present as a lack of friendships, or poor peer relationships, or is it that no people, the teachers know who these kids are. So yeah, like you mentioned, it is quite tricky because children with mild intellectual difficulties can present quite differently from one another. But there are some common patterns that you can focus on, especially for teachers and parents. So academically it would typically be children working below their peers, so they might struggle to keep up with the pace of instructions, maybe have difficulty retaining information, or need some concepts to be explained, either multiple types or in different ways. And again, they might have some specific issues like reading, writing, mathematics. This can all pose different challenges. But it's not just about academic performance, because we've seen that these children often have difficulties with executive functioning like planning, like organising, managing time, or doing multiple steps and instructions with multiple steps and tasks that perhaps might seem straightforward to their peers might be overwhelming for them. And from our data, we also found that the children with mild intellectual difficulties had lower self-esteem and a more external locus of control, meaning they were less likely to feel like they had agency over what happened to them. So it's not purely cognitive that we need to focus on. It's also about how they see themselves, basically, and their sense of control, which can compound to the classroom challenges they are experiencing. And also socially. You might notice that they might be struggling to pick up on social cues. They might have difficulty making and maintaining friendships, which is very important, or being more vulnerable to peer victimisation or bullying. There might be, due to this or other reasons, there might be more isolated when they're playing either in the playground or even in the classroom later on. And not because they don't want friends, but because the social world, might be more complex and challenging for them to navigate. So that's another aspect. But like, what's crucial to remember is it's not that they aren't trying. They're working incredibly hard, but facing some cognitive barriers that aren't always visible as we mentioned. And we found that those are very big variability in their experiences. So some children with intellectual difficulties with good quality relationships and positive outcomes, which tells us that with the right support and environment, these children can thrive in the school and wider settings. So it's not one thing that you can pinpoint. And so many of those, the first hypothesis for an educationalist would be, for example, I know many young people who fit the profile, who might not engage with work at all because it's better. In some ways. This is not a conscious thought, but it's better not to engage with the work at all if it's an overwhelming task. And so they may become somebody who's difficult or problematic or conduct disorder. And in fact, that's not the best way to understand their behaviour. So I really appreciate the way that you've given that portfolio of different expressions of MID and how that might look in a classroom because it's so valuable. It could be a variety of different difficulties and different expressions of that. And our challenge is how to address that. Yeah, very interesting. Just to unpack that a bit more. So you've described the associated challenges and what those differences might look like in the classroom. But if we were thinking about diagnostic labels and neurodevelopmental conditions, specifically, what other neurodevelopmental conditions can intellectual disability but also mild intellectual disability co-occur with. And I ask that because I know that for developmental language disorder as a condition, I think if the IQ is below a certain threshold, they can't have developmental language disorder, then it's categorised as something else. And I wondered whether there's those kinds of exclusionary criteria that apply to intellectual disability and whether it can and can't co-occur with other the neurodevelopmental conditions. So again, there is an association with neurodiversity. And in our data we did briefly look at specifically hyperactivity as a way of looking into neurodevelopmental problems like ADHD. It is a bit tricky because in cohorts you're always limited by the variables you have unfortunately, as you know, but we do know that there's a especially with neurodevelopmental problems and behavioural difficulties. So yeah, it's quite heterogeneous groups because even within that race we're talking about it's not a specific group. It's quite the cognitive ability. It's quite as a continuum. So you cannot really compare like to children. If you met one case, another case, another student would be different. But yeah, overall there is a link with developmental problems. Thank you. And if we move on to think about this risk and protective factors framework. So the paper is about risk and protective factors. I just wonder if you could give us a definition of what risk and protective factors are. And then specifically, I was working about 10 years ago with a colleague who was like, protective factors are not the same as promotive factors. And he explained it to me. And then I didn't remember obviously. We Are 10 years later and I've still got I'm not quite sure I understand the difference. So if it's possible. And you do know the difference and you're able to explain it, could you explain the difference between promotive and protective factors? So yeah, one way to think about it is that risk factors are things that increase the likelihood of poor outcomes, while protective factors, which is the term we're using, are things that can buffer against those difficulties and basically promote resilience and positive development. So in our study specifically we looked at both individual family, but also social domains trying to look at overall all as much as we could. Service factors might include things like adverse childhood experiences, poverty, peer victimisation, or even some early behavioural problems, whereas protective factors work in the opposite direction. So that would be including positive peer relationships, supportive family environments, a good school experiences like being physically active, and the child's own strengths in terms of pro-social trait, pro-social behaviour. And what's very important is that we weren't just interested in whether these factors exist. We wanted to know whether they work in the same way for children with mild difficulties compared to those without. And what we found was encouraging because there was no evidence that these factors operated differently depending on cognitive ability, because they were the same protective factors that helped children with intellectual difficulties and those without. But the challenge is that children with mild intellectual difficulties are significantly less likely to experience these protective factors in the first place. So, for example, earlier cohorts of children that were born in the '90s in the urban area of the UK, 78% of children with out mild intellectual difficulties were physically active, whereas 64% with mild Intellectual difficulties were. And in another example, in the later cohort, which were children born in the Nordies, the gap was even bigger. It was like 55% versus 35% And it's also around these three times as many adolescents with mild intellectual difficulties lacked good peer relationships compared to their peers. It's not that the different things help. It's that the children mild intellectual difficulties need more support in accessing the same protective factors their peers can benefit from across different areas. It seems so-- that's such an important piece of intervention information. And the fact that as I understand it, although this is not my area of expertise, there is the literature that exists, is actually not doesn't address this well at all. And this is one of the reasons that your paper is so important, and that this MID group have been neglected in terms of looking at protective factors and that the positive aspect of what could protect their outcome has been neglected. I'm really enjoying the way that you described risk and protective factors because of course, sometimes risk and protective factors could be either end of a continuum, if you like. So poverty as compared to advantage. But sometimes those protective factors are standalone. And I think the way that your paper described these was really important. I wanted to ask a question about thinking about risk factors, if you referring to the extensive literature and less risk factors and talking about ACEs. So the emerging literature and it's fairly I think it's a fairly confidently described. So Rebecca Lacey's group, for example, talk about this. So that although additional ACEs will have an additional effect, the way that they influence one another can be more nuanced. So there can be interactions, and so on. And your data showed that peer relationships in particular had an important protective factor. Could you say a bit more about that? Is there an implication that there's some interaction there? What are your thoughts? It's a key subject. But in terms of what we found in the paper, what research on adverse childhood experiences is showing that not all that experience ACEs have the same impact, and their effect might vary depending on the child's characteristics, but also the wider context. So it's similar for protective factors. And we're learning that they basically don't operate in uniformly. So our findings specifically on peer relationships were the most consistent result across both cohorts. So it was peer relationships, especially the quality, was the single most robust and protective factor we identified in both cohorts that we looked. So those born in the '90s and the Nordies, I was higher quality relationships in adolescence especially, were consistently associated with better emotional and behavioural outcomes for children with a MID. And the effect sizes were substantial, as we saw a reduction of around two points of emotional problems in the scale that we were looking at associated with good relationships, which is quite significant. And what is interesting is that this appears to be an especially important protective factor for children who are already quite vulnerable. So good peer relationships don't just make children feel better in the moment, they can provide opportunities for social skill development, emotional support, a sense of belonging, validation. So it's quite complex. And for children with mild intellectual difficulties, specifically who might struggle socially, as we mentioned, having one or two good friendships can be very important in transformative during adolescence, where they're developing their social skills more. Another point to make is that it mirrors what we see in terms of differential effect of ACEs. So it was only about 82%, 84% of adolescents with mild intellectual difficulties that had good peer relationships, whereas those without it was more like 93%, 94%. So meaning that roughly more adolescents with mild intellectual difficulties lacked good quality peer relationships. So the thing that will help the most is the thing that they're least likely to have access, which points out an important intervention target as well, especially in the school setting, which could be. Thank you. I have a question about how some of these risk and protective factors might be more or less important for different outcomes. So you're interested in mental health outcomes and then you're also interested in educational outcomes. What did you find? Because it seems that from my reading of it, some things are more important for one outcome. And some of the things that are more important for the other outcome. What did you find and what does that tell us? Yeah, so yeah, that's another important point because we might need it in the case of many different approaches for supporting mental health versus academic achievement, although there's an overlap. So what we found was reassuring but more complex because looking at the full cohorts, the same individual family and social factors that predicted better mental health and behaviour also predicted better educational outcomes. There wasn't a clear divide where certain factors only mattered for academic success and others just for emotional well-being. When we focus specifically on children with mild intellectual difficulties, individual predictors were harder to detect for educational attainment on their own, partly because of the smaller sample sizes and wider confidence intervals due to that, but we looked at the cumulative picture accumulating multiple protective factors predicted better outcomes across all the three domains. So emotional, behavioural, and educational. And that's a very important finding. And it makes sense when you think about it. Because a child who is anxious or maybe depressed or struggling behaviorally is going to have a harder time engaging with learning. And also, a child who is consistently failing academically may experience low self-esteem, more frustration, and that might lead to behavioural problems. So the factor that stood out more strongly about both mental health and educational outcomes was, as I mentioned earlier, peer relationship quality. So that practically means that we don't need completely separate approaches. So interventions that address the whole settings peer relationships, the family environment, school experiences are likely to benefit both emotional and well-being and academic progress. So when we invest in more social emotional learning, or perhaps something more targeted at schools like bullying prevention, or peer support programmes, so that might be more effective. And we shouldn't think of this as taking time away from academic surgery. Basically, it supports academic success in the whole continuum. You mentioned cumulative effect. So you're thinking about these things cumulatively and how they build up. So from a risk factors framework I understand that as in the more of the risk factors you have, the poorer your outcomes are. And I imagine from a protective factors framework, it's the more of those protective factors you have, the better your outcomes are. Is there a saturation point at which the number of risk factors stops making a difference. If you've experienced 10, then after 10, like your outcomes are the same as if you experienced 20, for example. And the same for positive and protective factors. Is there a point after which there's a saturation and more is not better. So that's one thing we wanted to look at whether is it one or two key protective factors or does having multiple sources have an additive effect. What we found supported the accumulative predictive model, which is the more protective factors a child has. Again, that can be quite broad. It could be like family relationships, peer relationships, good school experiences as well that we looked at or physical activity, the better outcomes they have. And this effect accumulated with multiple sources of support being considerably better than just one or two. And in terms of the numbers among children with mental health difficulties, those who had six or more childhood protective factors had positive outcomes at rates of about 33% in ALSPAC in those born in the '90s and almost like 46% to those born in the zeros. So compare that to children with fewer than three factors or positive outcomes dropped to virtually zero especially in the older cohort. But also in the later cohort. It was like 3% to 4% So it was quite the big significant difference. And for the adolescent factors because I was talking about child factors, but for adolescents-- but factors, it was a similar pattern, going from roughly 48% of positive outcomes for those with the most factors versus 6% to 16% for those with the fewest. So it's quite a big range. And that can look a lot of implications, as it basically tells us that even if a child is struggling in one area, those protective factors elsewhere can make a difference. So, for example, if peer relationships are difficult, having a strong family environment or good school connections can compensate to a degree. And we also found something that is more concerning is that the children with mild intellectual difficulties were less likely to have multiple protective factors in place. So they were more likely to be experiencing difficulties across multiple domains like realistic problems and intellectual difficulties. And this can create a cumulative risk situation. That's the mirror image basically of cumulative protection. So in terms of practical implications, as you mentioned, which is quite important, is that interventions need to be more comprehensive and coordinated, as we can't focus only in one area and expect it to be enough for the child, but instead what we need to think about building protective factors across multiple domains at the same time and recognising that even small improvement in some areas contribute to protective portfolio of factors that can help these children thrive. Yeah, it is quite complex. Yeah, I mean, but I'm really struck by the thing that you said right at the beginning, which is the headline in there. The thing that matters most is the thing that they're least likely to have, which is the peer relationships. And you've talked really helpfully about some practical implications in educational centres and for families, if we're thinking about how families might understand these data. So, for example, if I were a parent of a child who is MID, I might make it my priority to help them culture friendships. I might get in the car and take them to a play date. Because actually understanding that and culturing and fostering relationships outside the home as well, might be actually one of the best ways to foster their outcome. I don't would you agree with that or how would you communicate the implications for a family perhaps? One key thing is for-- especially for families, is to keep in mind that while they cannot exchange their child's cognitive abilities, they can influence their outcomes through the quality of peer relationships and support they provide. So again, being an advocate for the child in school and helping them build friendships, addressing their needs and creating a more supportive home environment, it can all make a difference. A real difference to the child and the families should also know that their children's struggles aren't about the lack of effort, or bad parenting, because there are real challenges that require understanding and proper support. And basically outcomes are not predetermined by IQ is one positive thing that we found because around a third of children with mild intellectual difficulties study, they showed positive outcomes across the board, which tells us that there's a huge room for growth with the right support is in place. Also, what you've just described there. In terms of that, not everyone with a mild intellectual disability will experience the negative outcomes, because I think sometimes when we talk about negative outcomes, we seem to just focus on the bad. And actually lots of children will do fine, whatever group we're looking at, like, and I can talk with developmental language disorder where a lot of the time we say, oh, they're more likely to experience mental health difficulties. But then when you look at it, a large proportion of them don't. And then when you look at the whole population of children with DLD, it's only a small number of kids or a smallish number of kids that actually go on to have a diagnosable condition. So I think that we just have as researchers, we have a tendency to focus on what's going wrong, and then we seem to focus on that, but then we lose sight of the fact that there are lots of kids who even within the group that we think is doing badly or having poor outcomes, lots of that group is actually doing fine. A great thing about this paper is that the protective factors that are linked to a better outcome work for these children. They work for children who do not have an MID. So it's a rising tide lifts all the boats. And I take your point about it being a fairly small proportion who may have difficulties. Implication is that all of the outcome, all of the young people will have a better outcome with these protective factors in place. So that I mean, I think that's the wonderful thing about this paper. It's really very, very useful indeed. I think that might be a good time for us to wrap up the conversation. I think it's a nice point to end on. So I'd just like to say thank you so much for that conversation. I think that it was really nice because it touches on lots of stuff that I do, but also that message that we're ending on, which is there are lots of things that work for children with and without mild intellectual disabilities. And actually it feeds into that universal provision argument where we should just be implementing some of these things in schools, for example, where it would help everyone, not just the kids who we think are the ones that are struggling the most. Yeah, so basically, like with the I would say briefly the right support children with mild intellectual difficulties, but also their peers can achieve positive outcomes in emotional well-being and behavioural, but also education. The key point is that this requires recognition and resources and commitment to inclusive support across all settings where these children learn and grow up. That's the key point. Thank you. Thank you. Thanks so much for that. It was great. Thank you. So, Umar, I know how excited you were to have a discussion about that paper. Was it everything that you hoped for or more. Yes no, it absolutely was. And again, when I was reading it, I was like, yeah, this is going to be a nice discussion. And it was. And I also have two thoughts that I'd like to just share that we didn't have time to go through with the guests. The first one was that finding about peer relations being important for both mental health and educational outcomes. And I think it speaks to well the importance of peers in childhood and adolescence. B the importance of relationships in general for children who might have any sort of neurodevelopmental condition. And we are doing a project on children who experience various difficulties during childhood and their outcomes in young adulthood. And we did a co-production group with parents, and teachers, and the young people themselves. And we were like, what outcomes shall we investigate. And as researchers, our interests were, oh, mental health outcomes, or educational outcomes, or health service use, or those kinds of things, income, employment. And the parents were like, I just want to know if my kid's going to be safe and whether they're going to have good friendships and caring relationships. And I was like, oh, we are so, removed from the realities of what goes on because we're like, we're so in that let's look at education, let's look at employment. Let's see how productive these people are. But actually for some of the parents, it was like, we're just interested in whether they're going to be safe and whether they're going to have good, strong relationships. And we know that relationships are the capacity to form relationships is the single most greatest predictor for a long, healthy, and happy lives. So if you can form relationships, you will be protected. The question here, and I think the discussion we were having really got at the heart of this, the question is actually, if you are happy and settled and have a relationship in school and at home that is fulfilling, you will do better educationally as well. And I think getting that across, the idea that, a settled, safe brain will be able to engage in the cognitive stretching material that might be presented in school is actually quite a challenging one, because if you said, well, the best way to change educational outcome would be to do a peer and social relationship programme in this school. It might be a difficult message to get across, but it does seem to be the case. And these data are certainly another reason why it seems to be the case, or certainly it's supported by these data, put it that way. Yeah, it's a good point though. Should we go to your clinical takeaway. And then we'll go to my academic one. Yeah, so I mean, this really made me think a lot about the so-called ordinary magic phrase of an Marsden's data. I'm sure you've come across this, but it's one of the most powerful data sets. It's longitudinal data set looking at how children might develop resilience. And that the thesis was resilience doesn't mean necessarily that you bounce back exactly to where you would have done, if the challenges hadn't been there. But it means that your trajectory is not as affected because you have resilience. And interestingly, an Marsden's data showed that IQ was a protective factor. So of course, these young people do not have that because they're vulnerable in this area. But the ordinary magic thesis is secure relationships. And supportive schools and communities are key in developing resilience and will protect outcome. And so that really made me consider and think about the ways that we can embed these processes and interventions in young people day-to-day. So I guess my take, my takeaway would be a positive outcome would occur by using the existing social and community systems. So in other words, you're increasing the intensity of the existing systems in order to improve outcome. And we know what protects young people in general. And these data underline that for many more young people, we need to use Marsden's power of the ordinary to improve outcome. Thank you. My academic takeaway is a bit off script really, so it's less of a-- oh, this is what I think we learned from this is more of something that occurred to me as a gap in the literature based on the conversation that we've just had. So there was a part where the guest talked about the ACEs literature and the cumulative effect, and how ACEs have different effect, depending on the developmental stage. And we discussed this on a previous podcast with Bushra Forough from the University of Bristol, and she looked at whether experiencing adverse childhood experiences was the timing and the duration of them, and the developmental stage affected the outcomes. And I'd like someone to flip that on its head and do it the other way. Where do positive childhood experiences influence outcomes differently depending on the timing, duration, and developmental stage. And I know for a fact those data exist in these cohort studies. I'm quite sure it's in ALSPAC. I'm quite sure it's in Millennium Cohort Study, so I think it's more of a challenge to be like, if this study hasn't already been done, can somebody do it-- Sitting down asking someone to do it. Umar there's one person, by the way, who I think is pretty well. What's going to happen is-- one day, one day it's going to be like, I'm going to be sitting around and I'll be like, actually, I've got a quiet afternoon, maybe previous analysis and do it because realistically, I think once you've cleaned the data sets and organised your do files for Stata or whatever it is, it's really not difficult to run someone else's because once you've cleaned it all and you've got all your variables in order, it's just about creating the analysis and running it. And so, yeah, no, I think it's a challenge for someone else to do it before I get bored of my life and then be like, what can I do? And I'll do more work. Yeah, but I think that's exactly right because I think the fact that the data set looked at peer relationships and that both prepubertal and post-pubertal. And then we think about the outcome that positive peer relationships for those young teenagers and in mid teenage years was the greatest predictor. We know that makes sense in terms of the neuroscience. Developmentally peer relationships are the most important. It's a fundamental brain drive to be integrated with your peer group in the teenage years. So it really does make sense. I think you are sitting on a beautiful paper and there is no one to blame but yourself. Just get on, crack on. Get it done. OK, let's call it a day there. Join us again next week, and we'll be speaking to Doctor Constantine Drexel about the relationship between sleep and adolescence internalising symptoms. [MUSIC PLAYING]