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<p>  </p> <p>Dyadic play interactions are a cornerstone of early development and difficulty engaging in sustained synchronous interactions are linked to later difficulties with language and joint attention. For children at elevated risk for autism spectrum disorder (ASD), it is unclear if early difficulties in synchronous exchanges could inform later diagnoses. As part of a prospective monitoring study, infant siblings of children with ASD (high-risk group) or typical development (low-risk group), and their mothers completed a standardized play task. Play interactions for infants were evaluated to: (1) assess if early difficulties with social responsiveness or synchrony proceed ASD diagnoses within the first year; (2) explore whether repertoires of observed synchronous behaviors distinguish ASD-risk; and (3) examine whether the unfolding rates of synchrony and responsiveness over continuous time highlight ASD-risk differences. </p> <p><br></p> <p>By 12 months, distinct mean-level differences in synchrony and responsiveness by risk status were observed. Higher synchrony and responsiveness totals were also positively associated with infants later language and cognitive scores and negatively associated with ASD symptom severity (Chapter 2). Although, dyads utilized mostly comparable repertoires of observed synchronous and responsive behaviors, regardless of group membership (Chapter 3). And lastly, the overall rates of unfolding synchrony and responsiveness were fairly stable throughout the interaction. However, distinct patterns by ASD-risk and developmental outcomes were evident (Chapter 4). Ultimately, the encompassed studies did not consistently find robust ASD-specific differences. However, these studies did demonstrate the applicability of advanced methodologies to provide relevant contextual/dyadic elements (beyond the field’s norm of mean-level totals), particularly for infants with non-autism developmental concerns. Future research should build upon these studies to assess synchrony and responsiveness growth curves that extend beyond 12 months of age, as well as utilize behavioral coding approaches that systematically capture both synchronous and asynchronous exchanges.</p>

Adolescent depression is a major public health problem, which is associated with educational problems, long-term psychiatric illness and suicide. One major source of stress during adolescence is peer rejection. In this thesis, I investigate the nature of the relationship between peer rejection and adolescent depression. In a review of longitudinal and experimental studies, I describe a bi-directional relationship between peer rejection and depressive symptoms. I then outline how genetic, cognitive and neural vulnerability may modify the effects of peer rejection on adolescent depression. Finally, I introduce five empirical chapters which test these hypotheses using different methodological approaches. The first study is a molecular genetic analysis of a sample of adolescents with and without a diagnosis of mood disorder. I report an interaction between diagnostic group, environmental stress (though not peer rejection specifically) and 5HTTLPR genotype on symptoms of anxiety, which supports the role of genetic factors in modifying the relationship between environmental stress and adolescent mood disorder. The second study is a behavioural study of negative attention biases in a typically developing sample of adolescents. I report a negative attention bias in adolescents with low (versus high) self-esteem. Although the data do not support a causal role for attention biases in adolescent depression, such biased cognitions could also moderate responses to peer rejection, maintaining affective symptoms. A final set of three fMRI datasets investigates how neural circuitry may influence depressed adolescents’ responses to peer rejection at three distinct stages: i) expectation of peer feedback, ii) the receipt of peer rejection, iii) emotion regulation of peer rejection. Data show distinct behavioural and neural differences between depressed patients and healthy controls during expectation and reappraisal of peer rejection, although heightened emotional reactivity immediately following the receipt of peer rejection did not differentiate behavioural or neural responses in adolescents with and without depression.

Les défis rencontrés dans les soins en santé mentale dans un contexte clinique interculturel sont nombreux, en raison, notamment, des différences de perceptions et de la stigmatisation culturelle de la maladie mentale (Hwang, Myers, Abe-Kim, & Ting, 2008; Alegria, Atkins, Farmer, Slaton, & Stelk, 2010). Les soins infirmiers en santé mentale ne semblent pas toujours adaptés aux besoins particuliers des adolescents et leur famille issus d’origines culturelles diverses (Alegria, Vallas, & Pumariega, 2010; Dogra & Vostanis, 2007; McKenzie et al., 2009). La pratique de soins infirmiers dans ce contexte est très peu documentée dans les écrits scientifiques pour nous permettre d’adresser en profondeur cette problématique. Le but de cette étude de cas multiples, tel que préconisée par Stake (2005), est de décrire la pratique de soins infirmiers en pédopsychiatrie dans un contexte clinique interculturel. Le cadre de référence de cette étude est celui des six volets de compétences requises pour l’infirmière en santé mentale et en soins psychiatriques émis par l’Ordre des infirmières et des infirmiers du Québec (2009). Les résultats de cette étude qualitative proviennent de l’analyse descriptive d’entretiens individuels (n=7) auprès d’infirmières en pédopsychiatrie qui ont accompagné au moins un adolescent et sa famille dans un contexte clinique interculturel. Les données issues de ces entretiens ont été validées lors de deux entretiens de groupe où un cas prototype, composé à partir des données issues des entretiens individuels, a été soumis à la discussion. Les résultats de cette étude révèlent des perceptions de la pratique de soins infirmiers dans un contexte clinique interculturel et des interventions privilégiées par des infirmières. Des recommandations pour la pratique, la formation et la recherche en sciences infirmières ont été formulées. / The challenges in mental health care in an intercultural clinical context are numerous, notably, because of the differences in perceptions and cultural stigma of mental illness (Hwang, Myers, Abe-Kim, & Ting, 2008; Alegria, Atkins, Farmer, Slaton, & Stelk, 2010). Nursing practices in mental health don’t always seem suited to the specific needs of the adolescents and their families from culturally diverse backgrounds (Alegria, Vallas, & Pumariega, 2010; Dogra & Vostanis, 2007; McKenzie et al., 2009). The practice of nursing in this context is poorly documented to address this issue in depth. The purpose of this multiple case study (Stake, 2005), is to describe the practice of nursing in child and adolescent psychiatry in an intercultural clinical context. The six areas of expertise required for the mental health nurses and psychiatric nurses describe by the Quebec Order of nurses (2009) were used as framework. The results of this qualitative study were obtained from descriptive analysis of individual interviews (n=7) with child and adolescent psychiatric nurses who accompanied at least one teenager and his family in an intercultural clinical context. The data from these interviews were validated in two group interviews, where a prototype case, made from data from the individual interviews, was submitted to discussion. The results of this study indicate perceptions of nursing practice in an intercultural clinical context and preferred nursing practices. Recommendations for practice, education and nursing research were made.

The purpose of this thesis was to examine associations between parenting and child callous-unemotional (CU) behavior in a high-risk sample of children aged 2-9 years. First, a narrative review examined the construct of CU behavior, focusing specifically on definitions and measurement of the affective and interpersonal dimensions of psychopathy, and their applicability to youth. Second, a systematic review examined evidence from 30 studies that had investigated associations between dimensions of parenting and CU traits. Studies were classified as testing one of five different research questions. Third, five different empirical studies tested various research questions pertaining to associations between parenting and CU behavior. Data from mother-child dyads N = 731; 49&percnt; female) were collected from a multi-ethnic and high-risk sample, and included multi-method observed measures of parenting. Study 1 found that observed harsh and positive parenting predicted child CU behavior from ages 2-4, controlling for earlier child behavior and various demographic covariates. Study 2 employed a moderator design, and found that harsh and warm parenting were more strongly related to the conduct problems of children with high versus low levels of CU behavior. Study 3 tested cross-lagged simultaneous and reciprocal effects models, and found that parental warmth (observed and expressed by parents in speech samples) uniquely predicted child CU behavior versus conduct problems. Study 4 tested the factor structure of Inventory of Callous-Unemotional Traits (ICU; Frick, 2004), finding support for a three-Bifactor structure. Finally, Study 5 found that parent-child affective interactions at ages 2-3 predicted CU traits at age 9, over and above general behavior problems. Taken together, the results of this thesis suggest that CU features are more malleable than previously thought. In particular, aspects of parental affect and warm parenting behavior appear to be important key targets of investigation for future empirical and intervention studies.

Introduction: Prenatal maternal depression is associated with an increased risk of psychopathology in childhood. The understanding of the mechanisms underlying this association is limited. Further, despite high rates of prenatal depression in the developing world, no research investigating this issue exists from these settings. Objectives: The primary objectives of this thesis are to study the association between prenatal maternal depression and the following early offspring outcomes in a non-smoking, non-alcohol consuming prenatal sample from rural, South India: Foetal stress responsivity, measured through foetal heart rate (FHR). Infant stress responsivity, measured through infant cortisol response to immunisation. Infant temperament. Methods: 194 pregnant women from Solur, India were assessed for depression. The first 67 mothers with elevated symptoms of prenatal depression and the first 66 controls underwent FHR monitoring to study foetal stress responsivity. 58 mother-infant dyads returned at 1.5-3 months post birth. Infant salivary cortisol was measured before and after immunisation. Information on infant temperament and maternal postnatal depression (PND) was also collected. Results: Twenty nine mothers (14.9%) met a diagnosis of major depression during pregnancy while 67 (34.5%) had elevated symptoms of prenatal depression. Whilst there were no linear association between prenatal depression and foetal responsivity, a curvilinear (U shaped) association existed with the foetuses of mothers with very high and very low levels of prenatal depression having elevated stress responses compared to those with moderate levels of prenatal depression. Prenatal depression predicted infant cortisol responsivity independent of PND (B=13.08, p=0.02).The relationship between infant cortisol responsivity and prenatal depression was also U shaped. There was no association between prenatal depression and infant temperament. Conclusions: This is the first study from the developing world investigating the relationship between prenatal depression and offspring outcomes. It provides evidence suggestive of the programming influence of prenatal depression on the developing offspring.

Therapeutic Day Treatment (TDT) is a community-based mental health treatment program regulated and funded by the Department of Medical Assistance Services (DMAS) in the Commonwealth of Virginia. This case study sought to understand how DMAS regulatory changes impacted the implementation of the TDT program in the Commonwealth between fiscal years 2004 and 2011. In an effort to respond to this question, sources of qualitative and quantitative data were collected including: TDT fee-for-service data, regulations in the Community Mental Health and Rehabilitative Services manual guiding the implementation of the TDT program, and structured interviews with eight key stakeholders who interface with the TDT program. The fee-for-services analysis found that there was a 269% increase in fee-for-service expenditures between fiscal years 2007 and 2011. The analysis of the regulations found DMAS added language to provide greater clarity to the existing regulators. Some of these changes include the implementation of the PA process with KePRO as well as the VICAP process. Additionally, staff requirements changed and paraprofessionals were no longer able to provide TDT programming. Caseload limits were also set for TDT programming. Four themes emerged through the analysis of the structured interviews. These themes include: 1) fraudulent practices and misuse of TDT services, 2) regulatory oversight, 3) cost containment, and 4) evaluation. Implications focused on the areas of policy, practice, and research by suggesting further research studies focusing on TDT and policy, offering the foundation of a more comprehensive theory focusing on policy implementation, and lastly the researcher provided a logic model for the TDT program in an effort to propel evaluation research forward.

O trabalho artístico infanto-juvenil é a temática que norteia a presente pesquisa. Dentro desse tema, observa-se uma discussão ampla na doutrina sobre a sua validade e qual a forma jurídica da prestação de serviços quando a atividade é exercida por crianças e adolescentes. Para enveredar por esta problemática, traz-se como suporte metodológico a abordagem dedutiva e técnica de pesquisa bibliográfica. O texto esta dividido em capítulos, onde se abordam os distintos assuntos que confluem para os objetivos pretendidos. São eles: evolução das regras jurídicas de direito do trabalho e defesa da exploração do trabalho das crianças e adolescentes, importância do estudo das artes para o ser humano em desenvolvimento e legalidade dessa prática, e, por último, a inclusão dessa discussão no ordenamento jurídico pátrio. A conclusão a que se chega é que, de acordo com as regras jurídicas aplicáveis atualmente, é válido o trabalho infanto-juvenil artístico, desde que cumpridas as normas legais em vigor. / The artwork juvenile is the theme that guides the present research. Within this theme, there is a broad discussion on the doctrine on which the validity and the legal form of the service when the activity is carried out by children and adolescents. To embark on this issue brings up as methodological support the deductive approach and technical literature. The text is divided into chapters, which deal with the different issues that converge to the desired goals. They are: the evolution of legal rules of labor law and defense of labor exploitation of children and adolescents, the importance of the study of the arts to the developing human and legality of this practice, and, finally, the inclusion of this discussion in the legal paternal. The conclusion reached is that, according to the applicable legal rules currently valid work juvenile art, provided it fulfills the legal provisions in force

Made available in DSpace on 2016-03-22T17:26:51Z (GMT). No. of bitstreams: 1 aline.pdf: 736058 bytes, checksum: b2b92b8350307484b0194e6d060e9276 (MD5) Previous issue date: 2012-09-25 / This study raises a policy analysis dedicated to the treatment and care to children and adolescents in protective measure considering aspects of this process of institutionalization in front of the ECA. Therefore, search reference in the institution of the state, family and social policies focusing on the organization of social assistance policy and the process of implementation of the laws that regulate protection programs to children and adolescents when it comes to protection policy. The revitalization of this work uses as a reference the exploration of movements of everyday reality of a welcoming institutional member of Own Network organized by the Municipality of Porto Alegre in an attempt to understand through the discourses that mobilize this everydayness, the effectiveness of the law. As an aid in this journey, the theoretical perspective of Michel Foucault approach responds to the multiplicity of relationships agencied this reality / O presente estudo suscita uma análise da política destinada ao atendimento e a atenção a criança e ao adolescente em medida de proteção, considerando aspectos do processo de institucionalização no presente frente ao ECA. Para tanto, busca referência na instituição do Estado, da família e das políticas sociais enfocando na organização da política de assistência social e o processo de implementação das leis que normatizam programas de proteção a criança e adolescente em se tratando de medida de proteção. A dinamização deste trabalho utiliza como referência a exploração dos andamentos da realidade cotidiana de um espaço de acolhimento institucional integrante da Rede Própria organizada pela Prefeitura Municipal de Porto Alegre na tentativa de entender através dos discursos que mobilizam esta cotidianidade, a efetividade da lei. Como auxílio nesta travessia, a perspectiva teórica de Michel Foucault atende à aproximação da multiplicidade de relações agenciadas nesta realidade

Made available in DSpace on 2016-03-22T17:27:20Z (GMT). No. of bitstreams: 1 carla.pdf: 989808 bytes, checksum: f66fec6e9cc0c95cfcef1bb4544b18af (MD5) Previous issue date: 2014-03-31 / Starting from the viewpoint that the demand served by the Guardian Council is woven complexity, the present study deals with the insertion of crew by the Guardian Council as a possibility to enhance the protection of the rights of children and adolescents without harming the democratic nature of that organ. For it was explored the reality of two Guardianship Councils with different scenarios in order to understand how the idea fosters in each space. As an aid in this passage, the paradigm of complexity Edgar Morin serving complementary interactions of various orders of the realities was used. From the findings of the research it was found that the problems of families served by the agency require counselor preparation function as specific knowledge and surroundings of advocacy in vogue. In this sense the counselor training, investment in the infrastructure of the councils, the election process enhancement and the priority in public investment are important aspects to be considered when thinking in the improvement of protection. Inserting a crew showed aggregate this context , the moment that can help with specific formal knowledge in cases that require it , as well as work on the issue of qualification of safety advisers for the purpose of achieving greater effectiveness in action / Partindo da ótica de que a demanda atendida pelo Conselho Tutelar é tecida de complexidade, o presente estudo trata sobre a inserção de equipe técnica junto ao Conselho Tutelar como possibilidade de aprimorar a proteção dos direitos da criança e do adolescente sem trazer prejuízo à natureza democrática do referido órgão. Para isso foi explorada a realidade de dois Conselhos Tutelares com cenários distintos, a fim de perceber como a ideia fomenta em cada espaço. Como auxilio nessa travessia, foi utilizado o paradigma da complexidade de Edgar Morin que atende as interações complementares de diversas ordens sobre as realidades. A partir dos achados da pesquisa constatou-se que as problemáticas das famílias atendidas pelo Conselho Tutelar demandam do conselheiro preparo enquanto conhecimentos específicos a função e os entornos da defesa dos direitos em voga. Neste sentido a capacitação dos conselheiros, investimento na infraestrutura dos conselhos, aprimoramento do processo eletivo e a prioridade no investimento público são aspectos importantes a ser considerados quando pensa-se no aprimoramento da proteção. A inserção de uma equipe técnica demonstrou agregar neste contexto, no instante que pode auxiliar com o conhecimento formal especifico nos casos que o exijam, assim como trabalhar a questão da qualificação dos conselheiros com o fim de alcançar a maior efetividade da ação