Sunday, 11 January 2015

A Review of 'Brainstorm' - a whirlwind encounter with the teenage brain

I love science and the communication of science in new and interesting ways.  My daughter and I love theatre.  I am a developmental speech and language therapist, researcher and parent.  My daughter is a teenager.  Islington Community Theatre's production 'Brainstorm', a youth theatre drama explaining the neuroscience behind the teenage brain and teenage behaviour looked set to tick all the boxes.

Brainstorm is a collaborative production with Islington Community Theatre, Park Theatre, the Wellcome Trust and the National Theatre Studio.  The result of 2 years of creative theatre making and workshops and with the involvement of leading neuroscientist Professor Sarah-Jane Blakemore (UCL), this looked like an exiting and innovative production.

Each of the teenagers made their entrance onto the stage with a typical teenage exclamation or grunt and proceeded to play with their mobile phones.  We were reminded that many people think of teenagers as a 'crap version of an adult'.  This production was to show the audience that it is not really like that.  Right from the first scene, the importance of the teenage brain in this story was given centre stage.  How the brain develops during the teenage years explains why they behave the way they do.  Members of the audience were informed that teenagers' behaviour is part of their development and is just the way it should be.  The performers pointed out that their brain is 'not broken' but 'beautiful'.

The setting of the production was the teenagers' own bedroom, which acted as a metaphor for many features important to teenage development; an expression of emerging independence and identity, a sanctuary and an illustration of the brain itself.  Another key prop in the production was the mobile phone, a device to which this generation of teenagers appears to be permanently attached.  Images from the cast's mobile phone screens were projected up onto the wardrobe to illustrate parts of the message.  This was an innovative way of communicating the story through a medium which is a fundamental part of the modern western teenager's identity.

The cast did a great job of explaining the neuroscience behind the teenage brain, behaviour and development.  Our brains are made up of no less than around 85 billion brain cells called neurones, which are connected together with synapses.  Teenagers have many more connections than adults so everything is connected together.  This was illustrated in the drama as the teenager's own bedrooms, messy and chaotic, full of everything.  As we develop, the connections or synapses that we use are reinforced and the ones that we don't die away, a process known as pruning.  The bedroom analogy was used again to illustrate pruning in the brain as the teenagers found a special place for their really useful or loved items, and cleared the less useful stuff away.

Other features of brain development also explained teenage behaviour.  The prefrontal cortex 'just behind your forehead' is the part of the brain responsible for reason and rational behaviour.  This part of the brain takes a long time to develop and is not fully developed in the teenage brain. The limbic system, that is the part of the brain responsible for emotions, risk taking and reward, is highly sensitive during the teenage brain.  The performers illustrated this as the limbic system shouting at them to take risks and handing out sweets, while the underdeveloped prefrontal cortex whispers in the background 'can you hear me?'

The production explored key aspects of teenage life, hopes and dreams for the future, relationships with friends and parents and the teenagers' emerging sense of self; 'you want me to be you but I am not you'.      The performers gave a candid account of themselves and their experiences which was both life affirming and moving.  A particularly powerful scene was introduced as 'brain scan', and involved the performers answering questions about themselves by turning on a lamp.  The anonymity of responses the randomly placed lamps gave enabled the teenagers to be open in their answers to challenging questions such as 'have you lied to your parents today?', 'does the thought of sex scare you?' and 'have you ever been drunk?'

The confidence, energy and potential of the teenager was demonstrated through the voices of these young actors.  Their vulnerability and need for understanding and support from their parents was also clearly communicated, particularly in the final scene where each performer shows a written message of love to their parents, something that they 'could never say'.  One key theme that was reinforced throughout the play was that brain development is not a 'one-off'' event, like starting your period.  It takes a long time.  'That's important.'

This production was a truly unique way to communicate the neuroscience of the teenage brain to a wider audience.  Using the voices of teenagers themselves made it even more powerful.  They understood and owned the science behind their own development.  The combination of these two aspects of communication resulted in a clear, powerful and relevant message.

I have always had an interest in the theatre and how it can be used to inform and educate.  I am also very interested in exploring ways in which scientific discoveries can be communicated to a wider audience (for more of this see my previous blogs on my experience of the Cheltenham Science Festival).  Living on the south coast my family is a long way from   Finsbury Park in North London.  I wanted to see this production for myself, but given that my daughter loves drama, I thought it might be an opportunity for her too to be exposed to a new field of science through a medium she loves so she and I travelled to North London for the Saturday matinee performance.  Brainstorm did not disappoint, in fact it far exceeded expectations.  I was surprised by the sheer energy of the cast, young people aged between 13 and 17, giving graphic, emotional but authentic portrayals of their experiences as teenagers.

It would be amazing to see such an innovative performance given a wider audience, perhaps at a major UK science festival such as Cheltenham or the British Science Festival.  Whatever the future of this venture, however, one thing is clear; Islington Community Theatre should be proud of a truly unique production.

Friday, 2 January 2015

Debunking parenting myths: The tale of the incompetent parent, the fiendish forward facing buggy & the developing child.

The poem 'This be the verse' by Philip Larkin starts with "they f*&!k you up, your mum and dad, they may not mean to but they do". It is true that parents are going to get some things wrong, but are they really messing things up quite as much as the media would have us believe?

Last week the UK's Daily Telegraph - education section published an article claiming that child communication development was being damaged as a result of parents' use of forward facing buggies.  The argument followed that forward facing buggies do not facilitate face to face interaction and conversation.  The claims were made by Gail Larkin, president of the National Association of Head Teachers.  You can read the article here. This might be worrying were it not for the fact that there is no evidence that these claims are true. 

In my fifteen year career as a speech and language therapist and now as a researcher into early language development these scare stories blaming parents are not new.  This article could well have been written back in 2005 when the National Literacy Campaign authored a paper entitled Why do many young children lack basic language skills? as part of it's "Talk to your Baby" campaign.  Or it might have been written back in 1995 after a groundbreaking study by Betty Hart and Todd Risley in the United States highlighted the relationship between parental talk to children and child language development.  Similar articles expounding the failings of parents were written in June 2003 , August 2003 and 2004.

It is valid to be concerned about child language development.  Communication through language is a vital skill, necessary for successful social, emotional, academic and ultimately economic wellbeing.  It is also valid to question what influences child language development and seek to optimise the environment children grow up in to support their acquisition of language.  We do know that there are a significant minority of children who genuinely need support due to difficulties with learning to communicate.  The sad fact is that despite this being a fascinating and valuable area of study, some newspaper articles such as the latest in the Daily Telegraph appear to be interested in going no further in this debate than blaming parents for the problem.  In this particular case, to make matters worse, the claims were not valid and were not based on a shred of credible evidence.

Following a brief discussion with other professionals interested in child development on Twitter I felt it necessary to debunk the myths in this latest article that have been reported as fact.  In order to make the claim that forward facing buggies are damaging child language development you need to establish a number of factors based on evidence; first, you need to agree there is evidence that children's communication skills have deteriorated over the last decade, second, that child language development is caused by parents not talking to them enough, third you then need to establish that parents are talking less than they used to, fourth and finally you would need to establish that forward facing buggies cause parents to talk less, and this effect is large enough and lasts for a long enough duration to have an overall effect on parent input to children.

In this blog I have explored these questions with reference to the evidence we currently have;

1.  The article claims that, in general, children's language has deteriorated.
I have heard this concern consistently throughout my clinical experience, and yet there is no empirical evidence to support it.  In areas of social deprivation there does appear to be a higher prevalence of language delay than in more affluent areas (see for example Locke et al; 2002 and the Hart and Risley study cited above), but this factor should not be generalised to a blanket concern about all children, and there is no evidence of change over time.  The only way to be sure that language skills have deteriorated is to compare cohorts of children at different points in time and there have been no such studies reporting a deterioration of language skills.  In fact, in 2003 in response to this very same concern an article in the UK's Times Educational Supplement uncovered 2 unpublished cohort studies, which indicated that, if anything, children's language levels had improved over that previous decade (you can read this article here).

Given this factor, the two further claims in the article that I challenge below are in essence moot points.    Let us explore the claims, however, to see if they might shed light on how we can help children who do present with language learning difficulties.

2.  The article claims that parents are having fewer conversations with their children.
Gail Larkin postulates that, in addition to forward facing buggies, this is because parents are spending too much time talking on their mobile phones or chatting to friends at the school gate.  This issue needs to be broken down to two distinct questions, a; are language learning difficulties caused by a lack of parental talk? and b; are parents actually talking less to their children than previous generations?

a; Are language learning difficulties caused by a lack of parental talk?
There is evidence that children from different families do experience a wide variety in the quantity of language that they hear from their parents.  This has also been found to be related to the child's language development (again see Hart & Risley, and Hoff and Naigles; 2002 for examples of this research).  It is also generally established that the language children hear forms part of the language learning mechanism and so as a clinician I would always advise parents to talk to their child through everyday routines to support child language acquisition. How effective this advice is is a topic for another blog, however, and whilst there is a relationship between parent language input and child language learning, Dorothy Bishop (Professor of Developmental Neuropsychology; University of Oxford) highlighted recently in her blog that as these studies on parent talk and child language learning are based on correlations a cause and effect relationship has not been established.  It may be that a third factor is influencing both parent language input and child language development.  For a more comprehensive discussion on this matter, read Dorothy Bishop's blog here.  The point to be made in this discussion is that, attractive as the proposal may be, there is as yet no evidence that child language learning difficulties are caused by lack of parental talk.

I suppose professionally I find this the most difficult question to address.  Something is going on between parent talk and child language learning, and much more research needs to be carried out in this area, as it is clearly a potential area of value to the speech and language therapy profession.  It is important, however, to be aware of what we know and what we don't yet know, and not to jump to conclusions.  In any case, the argument put forward by the Telegraph does not rest on this fact alone.  If anything, it states the claim that parents are talking less to their children than previous generations.  Let's explore that question, therefore, in a little more detail.

b; Are parents actually talking less to their children than previous generations?
Whilst there is evidence of a wide variety in the amount of language children hear across a population, there is no evidence that the amount of language children hear has changed within a population over time.  On the contrary, the research I have carried out with families in Portsmouth city, UK, reveals a similar distribution of parent talk across the population to that carried out by Hart and Risley in the early 1990s. Other studies have also reported similar distributions over the years, including the Hoff and Naigles study cited above and a recent study of parents in the US by Weisleder and Fernald; 2013.  There is no evidence that parents in general are talking less to their children than previously.

3.  The article claims that forward facing buggies are to blame for the decline in children's language skills.
Again this is not a new concern but was raised in the noughties (around 2005) by the National Literacy Trust's (NLT) 'Talk to Your Baby' campaign.  The NLT commissioned a study at Dundee University exploring the effect of forward facing buggies on parent-child interaction.  The buggies were already being blamed, however, for poor parent-child interaction in a Talk to Your Baby Conference in 2004 before the research findings were reported (see page 3 of conference report here).  To see if there had been any further developments leading to the latest newspaper article I carried out a quick review of the literature.  It yielded 1 review in 2011 (Topping et al) and 1 subsequent empirical  study (Blaiklock; 2013).  The Dundee study was not published in peer reviewed literature but a study report was published by the National Literacy Trust.  No study provided any evidence of a negative effect on child language development.  Effects on parental interaction were at best inconclusive, sample sizes were too small to have any confidence in the outcomes.  The fact is, in terms of empirical evidence, we are a long way from any claim that forward facing buggies are damaging child language development.

To conclude; should parents be forced to fork out on expensive buggies on the grounds of the Telegraph article?  Furthermore, should the media continue to fuel parental guilt based on the opinions of one person?  Whilst debate is to be encouraged in order to support child language development, rather than basing judgement on opinion let's have an informed inclusive discourse based on evidence.

The daily Telegraph has a much wider readership than this blog ever will, so journalists have a duty to report a balanced view of a topic, and there are moves to report science more objectively through the efforts of Sense about Science and The UK's Science Media Centre.  Unfortunately much needs to be done in the field of child learning and development before poor parenting myths are put to bed.