This thesis presents the work completed over the course of the author’s doctorate of clinical psychology, and consists of two volumes. The first volume includes three chapters, the first of which is a systematic literature review and meta-analysis of the prevalence of insomnia in clinical and non-clinical populations of children and adolescents. The second chapter is an empirical paper exploring the relationship between sleep problems and daytime challenging behaviour in children with Autism Spectrum Disorders. The final chapter is a document summarising chapters one and two for the purpose of public dissemination. The second volume constitutes each of the five clinical practice reports completed over the course of the doctoral training and will be available online in December 2026.

The literature review explores the relationship between parenting and the development of narcissism with a specific focus on the role of overindulgence. 13 empirical studies were identified for the review, 2 of which were unpublished. A quality assessment was completed for each study. The papers are examined for the strength of their findings and the constructs they purport to measure are considered in relation to each other and overindulgence. A distinction is drawn between ‘healthy’ and ‘unhealthy’ narcissism. Overall, both types of narcissism were found to be associated with low levels of parental monitoring and higher levels of overvaluation. Healthy narcissism was also associated with higher levels of warmth and empathy whereas unhealthy narcissism was associated with parental coldness, less empathy and harsher treatment. However, all individual effects were rather weak. Overindulgence remains rather unexamined in a reliable way in relation to narcissism, despite claims to the contrary. Clinical and research implications are discussed. The empirical paper comprises a cross-sectional questionnaire-based study investigating associations between parental illness perceptions of their child’s ADHD, with coping styles, wellbeing and stress levels of those parents. Forty parents of children with ADHD participated. Higher parental stress levels and reduced wellbeing were associated with greater perceived consequences for parent and child, higher emotional responses for parent and child, a longer expected duration for ADHD and more perceived symptoms of ADHD. Coping was also related to several illness perception domains and levels of general wellbeing and stress. Problem-focused coping was associated with positive effects and dysfunctional coping was associated with negative effects upon wellbeing and stress. The combination of several domains of perceptions with coping strategies explained moderate to large amounts of variance in stress and wellbeing.

Barnhälsovården i Sverige ska vara en resurs för alla familjer med barn upp till skolåldern. Syftet med studien var att undersöka hur adoptivföräldrar respektive biologiska föräldrar upplevde kontakten med barnhälsovården, vilka förväntningar de hade på barnhälsovården samt vilka olika insatser de blivit erbjudna. Dessutom undersöktes om föräldragrupperna hade olika behov när det gällde kontakten med barnhälsovården och hur de upplevde att deras behov uppfyllts. Studien är av kvalitativ design och intervjuer har genomförts både individuellt och i grupp med biologiska föräldrar och adoptivföräldrar. Resultatet visar att adoptivföräldrar förväntade sig och erbjöds färre insatser från barnhälsovården än biologiska föräldrar. En stor skillnad mellan grupperna var hur snart de träffade distriktssköterskan efter hemkomst med sitt barn, och hur ofta de besökte barnavårdscentralen. Biologiska föräldrar kunde bygga en förtroendefull relation med distriktssköterskan genom en tidig kontakt och täta besök i början. Adoptivföräldrarna saknade den möjligheten och upplevde dessutom att distriktssköterskan hade bristande kunskap om adoption och adoptivfamiljer. Tillsammans resulterade detta i att adoptivföräldrarna sällan sökte hjälp för annat än medicinska problem på barnavårdscentralen. Att adoptivföräldrarna erbjöds färre insatser skulle kunna bero på att barnhälsovårdens fokus låg på adoptivbarnets ålder vid hemkomst snarare än på familjens behov. / Child health services in Sweden are aimed at all families with children aged 0-6. The aim of this study was to investigate how adoptive parents and biological parents experience their contact with child health services, their expectations concerning the child health services and to what measures they had been invited. Furthermore it was investigated if the parent groups had different needs of the child health services and their experience of how these needs were supplied. The study has a qualitative design and individual interviews as well as group interviews have been conducted with biological parents and adoptive parents. The results show that adoptive parents expected and were offered less than biological parents from the child health services. There was a big difference between the parent groups in how soon they first met the district nurse after the family had returned home with their child, and how often they visited the child health centre. The biological parents could build a trusting relationship with the district nurse because they had an early start and frequent visits. The adoptive parents lacked this possibility and also felt that the district nurse lacked knowledge of adoption and adoptive families. Because of this the adoptive parents rarely sought help from the child health centre with other than medical problems. That the adoptive parents were offered less than biological parents were could depend on the focus of the child health services on the adoptive child´s age when the family returned home rather than on the needs of the family.

It is well known that, in Western countries, people of all ages and both sexes are becoming ‘fatter’ in general. In a ‘healthy’ population, we arbitrarily consider cut-offs to be that 10% of people should be ‘overweight’ and 5% ‘obese’, as there is limited evidence that these cut-off points are related to ill-health. However, we are seeing a dramatic rise in the numbers of people in each of these categories. The mechanism behind weight gain is energy-imbalance. At energy-balance for adults - i.e. where weight is expected to remain stable over time, we know that: energy intake (EI) = energy expenditure (EE) This equation is far less straightforward than it first appears. The first important issue is that EE has several different components (e.g. resting EE). The second issue is to do with measurement - how do we measure energy intake and energy expenditure? Another is down to physiological differences between people - how do things vary between individuals and do they differ systematically between males and females, adults and children? The above equation applies to adults, but we know that children and adolescents actually require a positive imbalance for healthy growth - what is not known is what degree of positive imbalance is healthy. This thesis is particularly concerned with energy-balance and imbalance during puberty, at which time the human body goes through extreme changes. We investigate how these changes are measured, and how energy-imbalance and the modelling thereof must change across this time. We will show that the proportions of children who are overweight and obese are higher than we would expect; commonly used models for body composition are not in agreement; commonly used models for resting energy expenditure are not in agreement; children do not need a high energy-imbalance for normal growth; and those girls with early menarche are more likely to become overweight than their counterparts.

No abstract available. / Thesis (M.Med.)-University of Natal, 1981.

The first twelve months operation of a five-bed rehydration unit at Osindisweni Hospital is described and data related to admissions presented. Osindisweni hospital is situated in a rural area north of Durban and has approximately 300 general beds with 60 000 outpatient attendances per year. A profile of children admitted to this unit was obtained and results are analysed according to the objectives of this study. The main findings of the study showed that 269 children were admitted to the unit during the study year and the majority of children were black African children, below three years of age, coming from rural areas. The children presented with acute diarrhoeal dehydration mostly of mild to moderate degree and were normally managed by oral rehydration therapy. Eighty-four percent of these children were successfully managed on the rehydration unit and only 13,7% received IV fluids. The majority of children requiring transfer to the ward had either persistent dehydrating diarrhoea or other complications such as malnutrition or septicaemia. No child died on the unit and no child died as a result of dehydration but 4 children died later as inpatients on the children's ward. The mortality of children admitted to the unit was therefore 1,5%. One hundred and nine patients were followed up (41,6% of questionnaires) and of these only 76 (69,7%) actually came for review the others presenting for other illnesses or else interviewed on the wards after transfer. However, most of these children had either no or minor complaints on follow up. Seventeen and a half percent of children were below the 3rd centile for age on discharge. Children with marasmus and/or kwashiorkor were not admitted to the unit. The availability of health care was poorly assessed but indicated a general lack of facilities for the rural population served. Also it was noted that the principles of G.O.B.I. had been poorly taught at Osindisweni in the past, particularly growth . charts. Mothers received health education on the unit and were found to have a good understanding of G.O.B.I. after their stay on the unit. On the whole the unit was well accepted by the mothers. It is thought that this short-stay oral rehydration unit offers a more appropriate and more cost effective alternative to previous methods of in-patient management of children with diarrhoeal dehydration and that it offers an excellent opportunity for health education. / Thesis (MMed)-University of Natal, Durban, 1988.

Background: This thesis sits within the arena of weight status during and after childhood acute lymphoblastic leukaemia (ALL), with a particular focus on the prevalence of unhealthy weight status amongst (ALL), Saudi and UK populations. Each chapter in the thesis explores different aspects of unhealthy weight status in ALL which had been highlighted as gaps in the literature at a conference in Puebla, Mexico, at the end of 2006. A summary of each study is given below. Study 1: Background: This study estimated prevalence of unhealthy weight status and metabolic syndrome (MS) amongst Saudi survivors of standard risk ALL. Methods: We recruited 56 survivors, mean age 13.4 years (SD 4.1), a mean of 9.1 years (SD 4.1) post-diagnosis. The BMI for age was used to define weight status relative to national (Saudi) and international (Cole et al., International Obesity Task Force (IOTF), World Health Organisation (WHO), and Centre for Disease Control and Prevention (CDC)) reference data. We measured body composition by dual energy X-ray absorptiometry (DXA), waist circumference, blood pressure, lipid profile (HDL-C, Triglycerides), fasting glucose and insulin. Results: According to international definitions based on BMI for age, around half of the sample had unhealthy weight status. All of the approaches based on BMI for age underestimated over-fatness, present in 27/51 (53%) of the sample according to DXA. Prevalence of MS was 7.1% (3/42 of those over 9-years old) and 5.4% (3/56) by applying the International Diabetes Federation (IDF) definition and National Cholesterol Education Program Third Adult Treatment panel Guidelines (NCEP III), respectively. However, MS by the NCEP III definition was present in 19% of the overweight and obese survivors and 7.1% of the sample had at least two of the components of MS. Conclusions: Unhealthy body weight and over-fatness may be common amongst adolescent Saudi survivors of standard risk ALL, though overweight and obesity may be no more common than in the general Saudi adolescent population. Defining weight status using BMI underestimates over-fatness in this population, as in other populations. Study 2: Background: Underweight, overweight, and obesity at diagnosis may all worsen prognosis in childhood ALL, but no studies have estimated prevalence of unhealthy weight status at diagnosis in large representative samples using contemporary definitions of weight status based on BMI for age. Methods: Retrospective study which aimed to estimate prevalence of underweight, overweight, and obesity at diagnosis for patients with childhood ALL on three successive UK treatment trials: UKALL X (1985-1990, n 1033), UKALL XI (1990- 1997, n 2031), UKALL 97/97-99 (1997-2002, n 898) .The BMI for age was used to define weight status with both UK 1990 BMI for age reference data and the IOTF definitions. Results: Prevalence of underweight was 6% in the most recent trial for which data were available. Prevalence of overweight and obesity was 35% in the most recent trial when expressed using IOTF definitions; 41% when expressed relative to UK 1990 reference data. Conclusions: Even with highly conservative estimates >40% of all UK patients with ALL were underweight, overweight, or obese at diagnosis in the most recent trial for which UK data are available (UKALL 97/99, 1997-2002). Study 3: Background: This study tested the hypothesis that overweight/obesity at diagnosis of childhood ALL was related to risk of relapse. Methods and results: In a national cohort of 1033 patients from the UK there was no evidence that weight status at diagnosis was related significantly to risk of relapse: log ranks test (p value= 0.90) with overweight and obesity as the exposure (n 917); individual (p value= 0.42) and stepwise (p value= 0.96) proportional hazards models, with BMI z score as the exposure (n 1033). Conclusion: The study does not support the hypothesis that overweight/obesity at diagnosis impairs prognosis in childhood ALL in the UK. Study 4: Background: In the sample of Saudi patients recruited to study 1 we compared DXA whole body and lumbar spine bone mineral density (BMD) using manufacturers software with a body size correction which derived bone mineral content (BMC) for bone area and Apparent bone mineral density of lumbar spine (BMADLS). Methods and results: The survivors of ALL were from Saudi Arabia (n 51, mean age 13.5 years). With no corrections, 29 patients (57%) had lumbar spine BMD z score < -1.0 and 21 (41%) had whole body BMD z score < -2. After correction, by using BMC for bone area method only 6 (12%) had lumbar spine BMC z score <-1.0 and 4 (8%) had whole body BMC z score <-2. By using BMADLS method, 18 (35%) had BMC <-1.0 and 6 (11%) had BMC Z score <-2. Conclusions: Correction for body size seems essential to accurate interpretation of DXA bone health data in adolescent survivors of ALL. The three correction methods provided different conclusions, but bone health remains a concern after treatment for ALL.

Study 1: Aims: Compare the uniaxial MTI/CSA accelerometer and the biaxial Actiwatch accelerometer against direct observation of total physical activity and minute-by-minute physical activity in 3-4 year olds. Methods: MTI/CSA-7164 and Actiwatch accelerometers simultaneously measured activity during 35-45 minute sessions of structured play in 78, 3-4 year olds. Rank order correlations between accelerometry and direct observation were used to assess the ability of the accelerometers to assess total activity. Within-child minute-by-minute correlations were calculated between accelerometry output and direct observation. Results: For assessment of total activity MTI/CSA output was significantly positively correlated with direct observation (r 0.72, p<0.001), Actiwatch was not (r 0.16, p>0.05). Conclusion: The present study suggests that for epidemiological assessment of total physical activity in young children the MTI/CSA-7164 provides greater accuracy than the Actiwatch. Study 2: Aim: To cross-validate the 1100 counts/ minute cut-off for the assessment of sedentary behaviour in an independent sample of young children using the MTI/CSA accelerometer. Methods: A previously developed cut-off for MTI-CSA accelerometry output (validation study) in 30 healthy Scottish 3-4 year olds, was cross-validated against direct observation in an independent sample of (n = 52) healthy Scottish 3-4 year olds. Results: In the cross-validation study sensitivity was 83%: 438/528 inactive minutes were correctly classified. Specificity was 82%: 1251/1526 non-inactive minutes were correctly classified using this cut-off. Conclusion: Sedentary behaviour can be quantified objectively in young children using accelerometry.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.