Childhood sleep problems are highly prevalent and the importance of adequate sleep quantity and quality in child development has been well documented. The most common area of difficulty associated with young school-age children is bedtime resistance, where the child typically refuses to go to bed or attempts to delay bedtime with repeated requests. Current behavioural approaches used to address such difficulties typically involve the use of extinction techniques, which aim to minimise parental attention after bedtime. Research has shown that these techniques have led to a reduction in problem behaviours, but the emotional difficulties that parents face during the initial phase of the intervention have led to the exploration of alternative techniques. This review explored the potential use of a Social Story™ intervention (a short personalised story designed to teach a child how to manage their own behaviour during a specific situation) to help children with their bedtime problems. Current literature has shown that Social Story™ interventions have a good level of treatment acceptability, with supporting evidence provided for their use with both typically developing children and those with an Autistic Spectrum Disorder (ASD). Only 2 studies however have investigated the use of Social Stories™ within the specific area of children’s bedtime problems (Burke, Kuhn & Peterson, 2004; Moore, 2004). The empirical paper reports a study that investigated the use of a Social Story™ intervention with a community sample of 6 children who found it difficult to settle at bedtime. Results replicated previous findings, demonstrating a reduction in the frequency of disruptive bedtime behaviours for all 6 children associated with the introduction of the Social Story™. Treatment effects, however, were not maintained on all measures at the 6-month follow-up and results from an objective measure of sleep behaviours (actigraphy) produced mixed findings.

Breast milk is acknowledged and recommended as the best food for babies by the World Health Organization. However, globally the proportion of mothers who breastfeed is still low and this is particularly the case in Thailand. The aim of this study is to improve women’s ability to breastfeed. A two phase study was designed. Phase I was to better understand women’s experiences and breastfeeding support needs, which formed the development of the ‘Breastfeeding Support Package’. The package, which consisted of the tool and leaflets, was to be administered by the nurses with the postpartum women. Phase II aimed to explore mother’s and nurses’ experiences following the use of the package. A pragmatic qualitative approach was used throughout. A government hospital in Bangkok, Thailand, was the setting for this research. Purposive sampling was used to recruit the participants for both phases of the study. In Phase I, semi-structured interviews of 17 mothers who visited the Family Planning Clinical, post-delivery, were undertaken. Thematic analysis was used to examine the data. For phase II, three groups of participants were involved: five participants from phase 1, five postpartum women and five nurses working on the postpartum ward. Telephone interviews were used to assess face validity to the tool while semi-structured interviews were used to investigate mothers’ and nurses’ experiences regarding the use of the package. Three themes that contributed to women’s experience of breastfeeding were ‘knowledge and attitude towards breastfeeding’, ‘practicality’ and ‘support’. Three themes that contributed to ‘women’s needs of breastfeeding support’ were ‘knowledge’, ‘attitude’, and ‘practice’. The use of the package could open a ‘platform to communication’ regarding women’s needs and act as a ‘platform to support’ for nurses. The postpartum women were able to better communicate their needs regarding breastfeeding support with the nurses, as well as receiving the support they required. The packaged worked well with present conditions and environment at the postpartum ward of the hospital.

Earlier studies have shown that individuals whose mothers were diabetic when they were in utero, have an increased risk of early obesity, and impaired glucose tolerance (lGT) and type 2 diabetes in adult life. This study was designed to test whether adiposity, glucose tolerance and insulin concentrations are altered in Indian children born to mothers with gestational diabetes (GDM), and are related to maternal glucose and insulin concentrations in pregnancy even in the absence of GDM. 830 pregnant women attending the antenatal clinics of the Holdsworth Memorial Hospital (HMH), Mysore, India underwent an Oral Glucose Tolerance Test (OGTT) at 30+/-2 weeks. 674 of these women delivered at HMH. Detailed anthropometry was performed on the offspring at birth, and annually thereafter. 585 mothers returned with their offspring at 5 years of age for detailed investigations including OGTT for glucose and insulin concentrations, bio-impedance for fat estimation and blood pressure measurement. OGTT was administered to mothers and fasting plasma glucose and insulin concentrations were measured in fathers. The Mysore babies were small compared to UK neonates, but the deficit varied for different body measurements. While birthweight (-1.1 SD) was considerably lower, crown-heel length (-0.3 SD) and subscapular skinfold thickness (-0.2 SD) were relatively spared. At five years, subscapular skinfold thickness was larger than the UK standards (+0.23 SD, p<O.OOl) despite all other body measurements being significantly smaller. Findings at 5 years were similar in comparison with another standard, based on Dutch children. At 5 years, girls in the cohort had higher insulin concentrations and were more insulin resistant. Body fat was the strongest predictor of glucose and insulin concentrations independent of other body components and parental characteristics. Newborns of the mothers with gestational diabetes were larger in all body measurements than control neonates (born to non-GDM mothers and non-diabetic fathers). At one year, these differences had diminished and were not statistically significant. At five years, female, but not male offspring of diabetic mothers had larger subscapular and triceps skinfolds (P=O.Ol) and higher 30- and 120-minute insulin concentrations (P<0.05) than control females. Even in the control offspring maternal insulin area-under-the-curve was positively associated with 30-minute insulin concentrations, after adjusting for sex and maternal skinfolds (P<O.OOl). Offspring of diabetic fathers (n=41) were lighter at birth than controls; they showed no differences in anthropometry at five years. In conclusion, Maternal GDM is associated with adiposity and higher insulin concentrations in female offspring at 5 years. The absence of similar associations in offspring of diabetic fathers suggests a programming effect of the diabetic intra-uterine environment. With increasing levels of obesity and IGT among Indian mothers, these effects may be contributing to the rise of type 2 diabetes in India. Our continuing follow-up aims to study the long-term effects of higher maternal glucose concentrations in the absence of GDM.

This study explores the role of a specialist centre in responding to actual or suspected childhood sexual abuse. Children, families and professionals from several agencies are required to navigate an intricate journey when abuse is suspected to have occurred. Through the application of case study research methods in which a specialist centre forms ‘the case’, the complexities of the journey are explored. The literature review highlights the emergent nature of ‘knowledge’ about specialist children’s centres. To inform the research study, papers that focus on children and families’ experience of the multiagency response, the rate of positive medical findings on examination and their relationship with criminal justice outcomes are examined. The available literature relating to the nursing role in responding to child sexual abuse is also reviewed. This case study comprises three data sets: 1) Sixty children (0-17 years) who attended the Centre following suspected sexual abuse were ‘tracked’ to ascertain reasons for referral, type of examination undertaken and outcomes in terms of health status, social care input and criminal justice actions. 2) Semi structured interviews with 16 professionals (paediatricians, nurses, police officers and social workers) in which their perceptions of the centre were explored. 3) Analysis of patient and parent/carer satisfaction questionnaires. Medical examination rarely confirmed abuse had occurred and only 13% of cases were pursued within criminal justice systems. However, 66% of children had an identified health need that required professional follow up. Interviews demonstrated that professionals believed the Centre provided a ‘child friendly’ facility that enhanced multiagency co-operation, but challenges associated with the principles of multiagency working were identified. Patient questionnaires demonstrated positive views of the care received by those who completed them. Findings from the three data sets are presented as the child’s journey through a complex series of events in a case study ‘story’. The study demonstrates the way in which professionals may be distracted by the medico-legal demands of the ‘system’. Children’s active participation in decision making should be promoted when actual or suspected abuse has occurred and a combined approach by multi-agency professionals, based on the individual needs of each child, is advocated not only during attendance at the specialist centre but also during a follow up period. Where abuse is not confirmed, children may benefit from continued care from health professionals. Nursing has the potential to adopt a greater leadership role in achieving the required change.

Aims: To examine the interaction of maternal factors (body composition, physical activity, diet and cigarette consumption) with childhood factors (body composition, diet & physical activity) in the determination of bone mineral accrual by aged 6 years, assessed by a) bone densitometry b) hip structural analysis c) pQCT measurement of the tibia in children born to mothers from the Southampton Women‟s Survey. Methods: Children were recruited at 6 years old from the Southampton Women's Survey. Their mothers‟ diet, lifestyle and anthropometry had previously been characterised before and during pregnancy. The children underwent measurement of bone mass by DXA, including hip structure analysis (HSA), and by pQCT at the tibia. Physical activity was assessed by accelerometry (Actiheart) for 7 continuous days. Diet was assessed using a validated food frequency questionnaire and detailed anthropometric data was also collected. Results: There were 530 children who attended for a DXA scan. Of these, 148 also underwent pQCT assessment. Increased childhood height, weight and milk intake were associated with increased measures of bone size; increased physical activity levels and greater lean mass were positively associated with increased volumetric BMD. Fat mass was negatively associated with volumetric BMD. Whilst maternal height, weight, exercise in late pregnancy and pre pregnancy calcium intake were associated with increased bone size in the offspring, this association was removed after adjusting for childhood factors suggesting that maternal body composition and lifestyle may predict the child‟s body composition and lifestyle. On assessment of growth patterns in this cohort, children were who born small tended to remain small at aged 6 years. Increased catch up growth was associated with increased maternal height and total milk intake at aged 3 years. Rapid weight gain during childhood was associated with maternal smoking during pregnancy. Conclusions: We have demonstrated that maternal and childhood factors influence bone mineral accrual and bone strength, in the developing child. Whilst many important maternal determinants measured (such as physical activity levels) were shown to influence the corresponding determinants in the offspring, other factors such as maternal cigarette smoking were shown to have persistent independent effects on post-natal growth and body composition.

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder of childhood and manifests as symptoms of developmentally inappropriate inattention, impulsivity and hyperactivity. Although numerous deficits have been identified in ADHD, one of the most consistent findings is that patients with ADHD are more variable in the speed of their reaction time (RT) responses on neuropsychological tasks than control children. In 2008, the default-mode interference hypothesis of ADHD was introduced by Sonuga-Barke and Castellanos as a biologically plausible account of this increased within-subject variability in ADHD. This hypothesis suggests that some patients with ADHD might not effectively attenuate low frequency resting brain activity from rest to task and that these low frequency oscillations may then intrude onto task performance and cause periodic attention lapses. These periodic attention lapses would manifest as increased variability in RT data. The present thesis provided the first test of this hypothesis using DC-EEG. We assessed the power in very low frequency EEG bands (< .1 Hz) during rest and during goal-directed task performance in two samples. First was a sample of adults who self-reported either high- or low-ADHD scores, and second was a clinic referred sample of adolescent boys with ADHD and age- and gender-matched controls. We found that in both samples, low frequency EEG was generally attenuated from rest to task, but the degree of this attenuation was lower in ADHD or inattentive participants compared to controls. We also found that periodicity was evident in RT data, and that there was synchrony between low frequency fluctuations in RT data and low frequency EEG. These findings provide some initial support for the default mode interference hypothesis. The findings also highlight the potential involvement of low frequency electrodynamics in attentional processes and in the pathophysiology of ADHD.

This research utilised a multi-method approach to investigate risk factors that could lead to the development of psychopathology in institutionalised children in Saudi Arabia. Chapter 1 provided a cultural context for understanding reasons that lead to institutionalisation and attitudes towards these children. Chapter 2 outlined previous research that considered the negative impact of institutionalisation on development and Chapter 3 considered several frameworks that could explain adverse outcomes in this population. Chapter 4 presented a qualitative study that highlighted, following interviews with institutionalised children and their carers, that symptoms linked to externalising and internalising difficulties, as well as reports of behaviours to conceal their social status, were evident in children. The subsequent empirical chapters explored the presence of symptoms of psychopathology in institutionalised children compared to non-institutionalised peers, after having translated key questionnaires (linked to measurements of externalising and internalising symptoms, as well as self-concept, shame, stigma, and aggressive behaviours (Chapter 5)). Chapter 6 found some evidence for perceptions of stigma in children, their carers, their teachers, and other teachers who had less familiarity of working with these groups of children. Chapters 7 and 8 used theoretical frameworks to demonstrate that children’s reported perceptions of stigma were associated with symptoms of depression and anger, and that this relationship was mediated for depression and anger by children’s reports of their feelings of shame (Chapter 7). In addition, it showed that social information processing models had some utility in understanding links between elevated reports of aggressive behaviours in children with endorsements of hostile behavioural response to hypothetical peers via increased interpretations of ambiguous (benign/hostile) hypothetical actions as hostile (Chapter 8). Chapter 9 summarised how these findings fit with and extend previous research. In addition, it suggested how the findings could be used to intervene to deliver educational interventions to reduce the negative attitudes towards the institutionalised children and to provide specialised training for individuals who work with children and adolescents in institutional care, and society more broadly.

This thesis investigated the relationship between sleep disturbance and neuropsychological functioning in healthy, typically developing children and children with cystic fibrosis (CF). Three research questions were examined in this thesis. The first examined whether sleep disturbance is associated with specific deficits in executive functions or an overall deficit in executive functioning. The second research question examined the relationship between sleep disturbance and behaviour problems. A final research question examined whether sleep disturbance, in the absence of hypoxia, affects executive functioning in a comparable way to sleep disturbance associated with hypoxia. The first study demonstrated that global executive function (GEF) was significantly lower in healthy children with higher sleep disturbance. Sleep disturbance was not associated with individual performance on executive function tasks. The second study also examined sleep and executive function in healthy children using a revised battery of neuropsychological tests. Compared to children with low sleep disturbance, children with high sleep disturbance had significantly lower GEF and lower processing speed. Both sleep quantity and sleep quality predicted GEF however sleep quantity explained an additional unique proportion of the variance. The third study examined sleep in children with cystic fibrosis. When dichotomized into high and low sleep disturbed groups, neither GEF nor processing speed was significantly different between the two groups. The sleep and neuropsychological functioning of children with CF was compared to the healthy, typically developing children from Study 3. There were no significant differences between children with CF and healthy controls on any sleep measures or executive function performance. Nine children with CF underwent one night of polysomnography. A further aim of Study 3 was to examine whether neuropsychological deficits were greater if in the presence of both high sleep disturbance and nocturnal hypoxia. Executive function deficits were worse in children with nocturnal hypoxia, irrespective of whether they had high or low sleep disturbance. In contrast, processing speed deficits were more evident in children with high sleep disturbance, irrespective of whether they had nocturnal hypoxia. A consistent finding throughout this thesis was that children with higher conduct problems have increased sleep disturbance (measured using parent report and actigraphy). These findings have implications for children’s development; future research examining the effects of sleep disturbance on executive function should consider whether these effects are irreversible.

No description available.

A detailed review of the literature revealed that children report mixed views towards ADHD and medication. They are also reported to experience a lack of control over their symptoms and in turn, report a reliance on medication to control behaviours. Research into children’s sense of self is conflicting, where studies reveal poor self-image, but other work confirms an inflated sense of self. In addition, differences between adult and child perceptions of ADHD exist, and are explained by the Attribution Bias Context (ABC) model which describes the nature of informant discrepancies. Gaining a greater understanding of children’s perceptions of ADHD is important in identifying and implementing effective interventions for children and their families. This qualitative study explored 5 children’s perceptions of ADHD through interview and drawing. Children’s teachers were also interviewed in order to explore discrepancies. Analysis of the data revealed a grounded theory of internalisation of the ADHD label for children, and difference for teachers. Children were found to experience ADHD emotionally, in on/off conditions, as a medical disorder, with external locus of control and as part of their self/identity. Medication was felt to control their behaviour. Teachers described children’s ADHD using a medical discourse and strengths were identified as attributes which are present in the absence of ADHD symptoms. Results are discussed in terms of similarities and differences between adult and child perspectives, and only some of the data supports the predictions of the ABC model. Implications of the findings are discussed in terms of academic and applied settings, and future research directions are considered with particular reference to exploration of the process of internalisation of the ADHD label.