On early life experiences and long term outcomes, with Louise Marryat

Louise Marryat is a quantitative sociologist at the University of Dundee who specialises in using routinely collected data from health and education records, as well as birth cohort studies, to explore the pathways that children take throughout childhood and how services can support them to reach their full potential.

You can find out more about Louise's work by following her on twitter here.

The paper discussed in this episode is:
Marryat, L, and  Frank, J. Factors associated with adverse childhood experiences in Scottish children: a prospective cohort study.  BMJ Paediatrics Open 3.1 (2019).

Many thanks to Naomi Meiksin for editing the transcript for this episode. 

Transcript

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Intro 0:09

Oh, it is recording. I see the little figure. Okay, great . And I will do my little spiel and then I'll introduce you. Nice. Okay. Here I go.

Sue 0:16

Hi, I'm Sue from the Salvesen Mindroom Research Center at the University of Edinburgh, and I'm recording another episode of our podcast called psychologiCALL. And this is a kind of a little podcast that we've created to try and contribute to the rest of the conversations people are having at the moment about child and adolescent development and wellbeing and learning. And just talking to researchers in the field about , um, work that they've been doing, that seems relevant to those conversations. So today's psychologiCALL is with Louise Marryatt, who is , uh , based at the school of health sciences at the University of Dundee, where she is a Baxter Fellow, and she's going to talk to me about a paper which is called "factors associated with adverse childhood experiences in Scottish children, a prospective cohort study". Hello, Louise . How are you doing?

Louise 1:12

Hello. I'm very well, thank you.

Sue 1:14

Thank you for coming on the podcast.

Louise 1:16

You're welcome.

Sue 1:17

Um , so why don't you start by telling me what you sort of discovered in this bit of research, looking at adverse childhood experiences?

Louise 1:28

So in this bit of research, we wanted to look at whether we could identify adverse childhood experiences in a current population of Scottish children and , um , we were looking at the birth cohort data up to the age of eight. And we found that we could , um , we could find a lot of these adverse childhood experiences within the data. And we found that actually around two thirds of children had experienced at least one adverse childhood experience, so 1/8 by the age of 8 years. That's pretty high compared with a lot of the other studies that we've seen. So around 10% had experienced three or more ACEs. We also found that , um, that, that wasn't uniform across the population. So some children were more likely to experience ACEs than others, and there were a range of factors that were, that were associated with that. But one of the really key ones was about household income. So children who had the lowest incomes were about 10 or 11 times more likely to have experienced the highest levels of ACEs. So four more ACEs than children , um , in more affluent groups. So a real disparity there.

Sue 2:40

Wow, that's really very stark, isn't it? Those sorts of figures are really quite shocking. Um, so, and maybe just for people listening , um, I should say that , that, you know, maybe the question I'm about to ask might produce some upsetting answers. So there's just a little trigger warning for anyone who's listening . Um, but , um, Louise, could you tell us a bit about what, what an adverse childhood experience is? You know, what constitutes, an ACE according to the definitions that you used in your research?

Louise 3:15

Yeah, so ACEs , this sort of phrase was coined in the late 90s by a group in the United States. And they looked at data that was held by a health insurance company for adults. And they looked at , um , whether what the most common sort of adversities that those people were experiencing. Um, and they, they came up with this , this scale. Um, we managed to , um, look at 7 out of the 10 of these commonly used ACEs and they cover quite a range of things. So they go from a sort of range , um, of sexual, emotional, and physical abuse. Um, they look at neglect , um, but they also look at a range of other things. So whether your parents , um, have mental health problems or substance misuse problems, whether there was a domestic violence in the household , um, whether you had a parent in prison. Um , but also whether your parents ever divorced or separated. So there's , there's quite a wide range of , um, of different sorts of ACEs. We managed to look at seven of those , as I say, the ones that we couldn't get a grasp of were - there were no questions around emotional abuse or physical neglect , um, within the data we were looking at. And there were a few instances where sexual abuse was mentioned, but actually they were, there were so few that we couldn't really do anything with those data.

Sue 4:41

Mm mm mm. Which is, you know, a nice phenomenon, I suppose, to have so few examples , but , um -

Louise 4:48

Absolutely, yeah.

Sue 4:49

Yeah. So tell me a bit more about the data that you were using. Was this one particular cohort study that you were working on? Yeah, so we were looking at the Growing Up in Scotland , um, birth cohort , um, and their first birth cohort. So they now have two birth cohorts. These were children who were born in Scotland in 2004 to 2005. And there were about 5,000 of them in that first round of data collection, the first sweep, which was about 10% of children in that year. And it was, it was meant to be a representative sample , um, covering the whole of , um , whole of Scotland. Um, and those children have been followed up for the first five years. Their families were interviewed every year. Um, and then since then , um, it's been every couple of years. Um, and initially that was , um, asking , um, primarily the mother , um, or another parent in the household about the child. Um, and then as the children have aged, they've started to be asked questions, but the data we were using, so we were using data up to the age of eight and that was all parent reported data. But you said interviews rather than questionnaires, was it? Because obviously, you know, the the stuff that you're looking at is pretty sensitive information, and I can imagine parents might have some , um, reluctance to share some of that kind of information. So, you know, an interview might get quite different responses than a questionnaire would.

Louise 6:19

Yeah, you're right. And , um , so the way that , um, that the Growing Up in Scotland study (which is known as "GUS") , um , operates is that a lot of it is done by , um, computer assisted personal interviewing. So , uh, an interviewer will go into the family's house , um, in traditional times, obviously not COVID times, and , um, and ask survey questions, but face-to-face , and the interviewer would input the results into the computer. But within that, because there are, as you say, some very sensitive questions , um , within , um , every interview that's conducted there's a series of self-completion questionnaires. So at that point in the interview, the interviewer hands over the computer to , um , whichever parent or carer is completing the questionnaire that year and they then fill in the data themselves. And a lot of the questions that we're looking at are in that self completion , um , section. But also they, weren't, not all these questions weren't asked every year and that relationship gets built up with a family. So often you have the same interviewer going back to the same family year after year and those relationships and that trust is really built up over time. So for example, the domestic violence questions weren't in until about sweep six, I think. So by that point, there was a lot of trust there , um, in, in the study and in that relationship with the interviewer as well. Um, so I think you, you probably tend to get , um, more honest, more open answers through that as well.

Sue 7:55

Mm mm . And so you've, you've obviously flagged right at the beginning there, the way in which , um, kind of income bracket was related to frequency of ACEs. And so, you know, for this kind of research, I can imagine it's important to try and get , um, a really good , um, uh, population kind of representative sample in your cohort and to be able to capture various kind of potentially relevant , um, demographic elements. And so I just wonder, you know, it's , it's something that we talk about a lot in research that we end up with very sort of middle-class samples that tend to have, you know , more years of education, higher income, tend to be, you know, white - limited range of ethnicities, that sort of thing. So is GUS quite a good cohort in that respect? Are you able to , um, explore lots of dimensions in that cohort?

Louise 8:57

So the benefits of using this sort of birth cohort data as oppose to a lot of the original ACE studies, we're looking back retrospectively from adulthood into childhood so you , you, you lost a lot of that richness of the data about children's circumstances. I mean, you had a bit of data about where people had ended up , um, but you didn't know much about , um, their demographic background , um, and, and studies like GUS, do have a lot of that richness of the data, but they do also suffer from the same issues that many cohort studies , um , suffer from. So, the sample does have an over-representation of more affluent households. Um, and despite , um, the interviewer's best efforts, they tend to lose more children , um, from the more deprived households as the study goes on. Now to some extent they are able to account for that in the weighting , um, of the data and particularly that , um , attrition, so losing people over time, differentially, they can account for, because they know so much about these families. It's more of an issue in that first , um , sweep . Um, but it is a bit more balanced in that first sweep as well because of the sampling. Um , so and , um, yeah, I think that that's, that's an issue in most cohort studies. And that the, I think one of the few cohorts studies where they've managed not to do that is the Duniden cohort in New Zealand. And that's because they go to the extent of sort of, if you've moved to the UK, they will fly you back to New Zealand for you to take part. It's quite an amazing feat, but obviously a much smaller sample as well. Um , but most, most cohort studies do suffer from that sort of issue.

Sue 10:46

Yeah. Yeah. And so I suppose with this kind of effect, because as you say, you've got , um , slightly under-representation of people in lower income brackets , for example, and then also, you know , um, likely higher attrition of people from those groups. So they're more likely to drop out of the study, you know, obviously , um , circumstances will be more challenging. And so, you know, the sort of resources to stay , um, up to date with the research team and to give the research team time will be more limited perhaps for those families. Um, so, so would that suggest that if anything, the, the estimates that you extract from the cohort would tend to be a bit of an underestimate of the prevalence of ACEs? Is that -

Louise 11:36

Yeah, absolutely, trhat's what we've concluded is that yeah. If anything, the true picture is likely to be worse , um , within, within the Scottish population, which is really saying something, really.

Sue 11:48

Yeah, yeah. And were you able then, because this is a , um, a long-term longitudinal cohort, as you said. And so those children are being followed up. So were you able to look at the kind of , um, consequences of those early adverse childhood experiences for the children as they grow up? So is that something you've looked at?

Louise 12:11

So that's something we're moving on to do. So we we've just submitted another paper , um , which is looking at adverse childhood experiences and actually looking at , um, the positive childhood experiences along with that, because a lot of the criticism around ACEs is if there's such a deficit approach , um, that we've been looking at what positive childhood experiences , um, using various scales, we can identify within the data as well. Um, and this is if the children obviously have now aged as well. So we're looking at both faces and , um, PCEs as they're called (positive childhood experiences) up to age 12. Um, so that's showing some differences , um , over time as well. We've started to look at outcomes. That's part of a wider project looking at , um, obesity. Um, and then there's a separate paper looking at , um, predictors of preadolescent obesity as well. Um, and that is showing a relationship with , um , ACEs , um , which doesn't seem to be , um, accounted for by poverty or education or anything else that we've looked at. Um, so there there is, there does seem to be , um, an additional separate effect of ACEs on obesity. Um, and we're hoping to go on to look at both ACEs and PCEs in relation to psychological outcomes in adolescents as well, but that's a bit of work for the future at the moment.

Sue 13:39

Well we'll have to get you back on the podcast when you're ready to talk about that as well. So this might be a bit of a technical question and perhaps a bit hard to explain, but I'm going to ask it anyway, and I'm sure you'll , you'll , you'll kind of guide me through it. I'm just thinking about the fact that I would imagine that these kinds of adverse childhood experiences might quite often cluster together. Right? So , um, for example , um, domestic violence, and I think you mentioned that a parent going to prison would also be classed as an ACE. And so you can imagine scenarios in which both of those things would , um , occur in the same family. So how did you go about sort of pulling apart the way that , um, each individual adverse experience might have an impact, but also the way they might sort of cluster together in that way in, in a particular family , um, in a particular situation?

Louise 14:40

I think that's a really interesting question. The way that the ACEs have been , um , sort of set up to operate , um, is that actually, it doesn't matter which ACEs you're looking at. Um , it it's purely a summing of the ACEs. Um, and , um, and so, and then the there's said to be a magic number, that if you reach 4 , um , then that's sort of predictive of the poorest outcomes in terms of a range of physical and mental health outcomes. Um, but with, within that, it doesn't really matter which of those there are, but as you say , there are clusters and that's something we've started trying to disentangle a little bit in our followup work. Um, and there certainly seem to be some sort of gateway factors. So , so some factors that if you have , um, if I say - and I think I'm right in saying that having a parent in prison is one of those - that if you have a parent in prison, you are far more likely to have experienced other , um, adverse childhood experiences. And I think domestic violence was another one that you were far more likely to have experienced , um, other adversities as well. So , um, we haven't, we haven't particularly looked at clustering, but we've, we've sort of to started to look at those gateway , um, variables a little bit. Um, yeah. Which is, it's very interesting. There's far more of a spread. When you look at the positive childhood experiences - they don't seem to be so clustered or to have that sort of gateway approach.

Sue 16:19

Yeah . So what -give me some examples of some positive childhood experiences. What would be on the list there?

Louise 16:26

Um , so that's, that's a good question. I should have looked at that paper before we chatted! [laughs].

Sue 16:37

Sorry! [laughs].

Louise 16:37

Um , so the positive childhood experiences and there's , there's a range of different , um , scales that , um, that have been , um, sort of explored. Um, they're less well-developed than the ACEs approach. Um, but , um, they tend to look at , um , things like whether a child has , um, someone outside their family that they can go to , um, to, to speak to that they trust. Um, where , um, do they have at least one caregiver with whom they felt safe? Um, there's some that have , um, feelings about belonging in school. Um, that's , that's not something we've been able to explore in our data. Um, but there , there are a range of approaches and some of the scales that exist also take into account positive demographic factors , um, as well. But it's a lot about the sort of physical and, and particularly the emotional support that a child has access to. Um, and that sort of attachment theory , um , approach really about having one significant person in your life that you can rely on, um , seems to have been the thing t hat, that has, has had an impact when people have looked at outcomes, the little bit of research t here's been around that.

Sue 17:58

So interesting actually hearing you, I'm glad I put you on the spot, though I'm sorry. But I think , um, you know, I suppose I was starting to feel a little bit worried that positive childhood experiences would just be the absence of adverse childhood experiences. You know, just , just the reverse opposite, but actually you can imagine that, with those examples that you're giving it would be possible to have experienced a number of adverse childhood experiences from that list and also simultaneously you have had those positive ones, which I find very uplifting, you know, because I think it , it makes me feel a greater sense of hope in terms of, you know, how we can , um, work in the future to improve things for children.

Louise 18:45

Yeah, yeah, you're right. And that's exactly what we found is that the , an absence of one doesn't mean that there's going to be a presence of the other or vice versa, but a lot of children do seem to have both. Um, and what we need to do now is to move on, to look at how they both separately affect , um, outcomes. We found that there wasn't a relationship for example, between , um, positive childhood experiences and pre-adolescent obesity, but perhaps that we shouldn't expect that because the, sort of the mechanism for that , um, I'm not, I'm not sure that there's a mechanism for that in sort of theore - theoretical background. But when you're looking at more psychological outcomes, mental health outcomes, then perhaps we are likely to see , um, an, a separate impact of positive childhood experiences, but we will have to wait to see!

Sue 19:40

And so what do you think is the kind of take home from this, you know, for , um, for the researches of the future, or maybe for practitioners, you know, how should we be , um, taking account of adverse childhood experiences? You know, let's say in a, in a teacher, for a teacher in a primary school, for example, you know, what , what would be your message for them?

Louise 20:04

I mean, I think there's, there's been a huge amount of , um, raising awareness of ACEs among sort of teachers and the police and all sorts of different professions. Um, which I think has been a real positive , um, and sort of looking at the reasons behind children and adult's behaviours, and rather than looking just at the behaviours themselves. Um, and I think that plays out here in the , the original , um, ACE work poverty and deprivation was very much brushed over , um, because the feeling was that actually this was a relatively affluent group of adults they were talking to and yet they've experienced lots of ACEs. And I think our paper shows that, well , that's true - while there are ACEs, ACEs are found across the board - actually, they are still concentrated amongst the children who are experiencing various other demographic adversities as well. Um, and I think, I think that's , we found that really important to , to keep in mind that actually that there are still definitely some groups of children who need more support , um, and who will be experiencing , um , more adversity in their lives. And I think that's really important to, to keep in mind.

Sue 21:23

Yeah , that's really important. Um, so before we wrap up, thank you so much Louise, it's been a really fascinating conversation. Um, we, I think we have various early career researchers and PhD students and so on who listen to the podcast and I wondered if you had any pearls of wisdom that you would be able to share with them?

Louise 21:44

I think this is probably the toughest question you've asked [laughs]. But I think , um, I'd say for , um, I mean, one of the best things that I've done has been just applying for things that you possibly don't think you have a chance of getting on , or perhaps seem a little bit off the wall. Um, so an example of this was that I applied, it was about this time of year, and I put in a very quick application to the, there's a British council research link scheme between Iran and Scotland and I ended up going to Iran and that actually became my first piece of work, that I was , um, a PI on. Um, with very small bits of funding, but it developed out of that , um , with this international team. And, and I think things like that, you never quite know where they're going to lead. And it's similar , I'm doing the European crucible at the moment, um , and just being put in a room with people from vastly different backgrounds, but actually finding some really interesting connections and sparking different ideas off each other. It's been really great. Um, so I think, I think that's a key thing. Um, the other thing I would say, and I think I got told this a lot though I was never quite sure how to go about it, was , um , to get a really good mentor. Um, and I'd been trying to get some mentoring for a while, three sorts of the university schemes and so on and not having much luck to be honest. Um, and then eventually someone, someone at Edinburgh Uni actually , um , came and , and did a presentation and said , just email people, email people who you have - who have the same values as you. That is more important than being from the same subject background or the same , um, or a particular level. Email, people who have the same values as you , um, in terms of, in life in their work , um , what is meaningful to you and ask them if they would mentor you. Um, and that's, that's what I did. And I've ended up with a really good mentoring experience from that, which has been just so helpful in terms of talking about different career directions and different options and different opportunities. Um , so that, that would be my other piece of advice, I think.

Sue 24:01

Oh, fantastic advice, Louise! And I think that's so useful because you're right. We do often say, I say p eople all the time, get yourself a mentor, b ut, but you're right - it's not so clear how to go about it. And I definitely, I mean, I think t hese s orts of, u m, you know, u m, blind date style schemes are very, you know, it's great that they exist and they're very well-intentioned, but you're right, it's, it's a bit of a gamble. U m, and that value matching is a lovely way to think about it. I think that's really, really valuable advice. Thank you so much.

Louise 24:36

You're very welcome!

Sue 24:38

Well, I think we should draw to a close because we do try, we , I keep saying that this podcast is bite-size and then I just get too interested in what people are saying, but it's been absolutely lovely to talk to you, Louise . Thank you so much for your time and your expertise. That was fascinating. Um, for anyone who's listening, you'll be able to find out more about the work that we've talked about, and about Louise, by following the links in the podcast description in your podcast app or on our Buzzsprout page. Thank you so much, Louise. Bye!

Louise 25:10

Bye!

Outro 25:14

Okay. We did it. I thought that went quite smoothly!