The Neuromatrix of Pain is a comprehensive theory that has been designed to account for a majority of mediatory processes that influence pain perception, yet one aspect that does not appear to have been explicitly considered as a predominant factor in the research is that of biological sex, despite several articles and reviews that have highlighted the importance of it. Originating as an examination of anticipatory processes, this thesis evolved to examine how males and females experience pain differently in social contexts, and possible neurometabolic differences that may account for these disparities. From the social approach, we examined the experimenter gender effect, which demonstrates that the experimenter’s sex alters pain perception. Not only were the results concurrent with previous literature, but it was demonstrated that the presence and gender of an additional observer also influences pressure-pain threshold (PPT), predominantly in males; the observer effect could operate as either an extension of the experimenter effect, or a facilitating factor to it. It was also found that, in females, the personality trait Openness correlated significantly with PPT, which may reflect previous findings of females’ coping mechanisms. From the biological approach, proton magnetic resonance spectroscopy (1H-MRS) was used to examine the neurometabolic concentrations in the insula of healthy males and females based on findings in clinical populations. While the results were not replicated, it was found that there was a significant difference between glutamate concentrations between males and females in the anterior insula (A.I.), and also that glutamate in the A.I. also correlated significantly with PPT in males. These findings demonstrate and support evidence for how males and females adopt differential anticipatory mechanisms to predict and limit potential tissue damage. Overall, this thesis provides evidence for gender differences in pain perception that holds implications for both the experimental and clinical fields of study.

Organisms are required to perceive, process and remember a wealth of visual information from the environment to guide behaviour during spatial navigation. However, our knowledge is limited regarding how the brain encodes and reconstructs in memory, spatial and non-spatial properties of objects in scenes. For example, how are object locations, arrangements and identities encoded and represented across core scene-selective regions? How does the identity of a focal entity influence memory for the spatial extent of a scene? This thesis used functional magnetic resonance imaging (fMRI) and behavioural approaches across 4 independent experiments to investigate these themes. Empirical Chapters 1 and 2 employed fMRI repetition suppression (RS) to examine how activation across scene-selective regions differed in response to spatial (object Locations and Arrangements) and non-spatial (object Identities) conditions. Results revealed no effect of RS in any ROI, considered to reflect the type of task used (inversion detection). The second fMRI experiment employed a novel task, where participants responded to multiple changes between scenes. Results showed a significant effect of RS in two regions, but no dissociable effects between conditions. In two behavioural chapters, we extended these themes by using boundary extension (BE),to investigate whether memory for the spatial extent of a scene is influenced by the type of entity (object/person). Results revealed that BE was observed in both experiments for objects in scenes (in line with previous research), but not for people in scenes. Further analyses demonstrated that this effect might reflect the increase in attention assigned to people compared to objects, possibly to predict their future actions/behaviours. Together, this body of research provides insight into the mechanisms that drive RS during scene encoding, and identifies that possible differences in saliency associated with people and objects may mediate how the spatial extent of a scene is encoded and subsequently remembered.

Applied Behaviour Analysis (ABA) uses our understanding of the science of behaviour to address issues of social significance (Baer, Wolf & Risley, 1968). One example is the support and education of children with autism, and there is a growing evidence base for the effectiveness of behavioural interventions with this population (Lai et al., 2014; Eldevik et al., 2012). However, getting evidence from research into practice is not straightforward (Rycroft-Malone, 2004). Translational or implementation science is the basis of this thesis. Two models from translational science (Rycroft-Malone, 2004; Fixsen et al., 2005), identify four factors critical to the successful implementation of evidence-based practice: core knowledge and skills; organisational processes which embed these into practice; consumer involvement in, and perceptions of the selection and evaluation of practices; and the wider national policy and regulatory framework. Using a range of research methods, this thesis explores these factors in relation to ABA as an intervention in the support and education of children with autism. Chapters include a description of the development of a competence framework for ABA (Chapter 2) and an example of a practical application of the framework – identifying ways of measuring staff competence (Chapter 3). Chapters 4 and 5 are both based upon and describe the first study in the UK to attempt to identify and quantify the use of behavioural interventions amongst a sample of UK parents and their beliefs about ABA; and Chapters 6 and 7 outline in two separate papers, the first study in the UK to explore the perceptions and experiences of commissioners of services in the support and education of children with autism. The findings from these studies are discussed in relation to theoretical models of implementation. The implications of these for the field of behaviour analysis are outlined and recommendations for further study are made.

Although the role of the cerebellum has historically been associated with motoric function, more recently it has become clear that the cerebellum also has a role in many cognitive functions, such as learning, perception, verbal working memory and emotion. Of particular interest to this thesis is how the cerebellum is involved in predictive language processing. Studies employing transcranial magnetic stimulation to examine the role of the cerebellum in language have primarily indicated that it is in some way associative or predictive, and have used methodologies that principally rely upon associative priming. The aims of this thesis are to: a) replicate previous findings as regards the role of the cerebellum in associative as compared to categorical priming, but with stimuli where the categorical relationship is controlled for across both types (namely, opposite pairs as compared to categorical pairs), and to determine whether these behavioural modulations are reflected in language specific event-related potentials that index language prediction, b) examine whether the role of the cerebellum in associative priming extends to backward priming, whose models imply a differing process as compared to forward priming, and c) examine whether the predictive or associative role of the cerebellum in language can be extended to more complex sentences and how modulation of this function affects later language specific event-related potentials that index language prediction. In Chapter 4, the opposite stimuli, and not the categorical, displayed a priming effect. This was reflected by the phonological mismatch negativity wave, implying that this task required only phonological access to be completed. There was no effect of the cTBS, possibly because this task did not require semantic access. This indirectly supports the literature that suggests the cerebellum plays a role in semantic prediction. In Chapter 5 I show for the first time, beyond fMRI activation, that the left cerebellar hemisphere is actively involved in backward priming. Modulation of the left cerebellar hemisphere through cTBS selectively enhanced backward as compared to forward priming, indicating that the cerebellum has a role in backward priming that is localized to the left cerebellar hemisphere. Additionally, this finding provides a potential explanation for the presence and mechanism of short stimulus onset asynchrony backward priming. Finally, Chapter 6 shows that modulation of right cerebellar function through cTBS results in easier processing of incongruent endings of highly predictable sentences, as indexed by the N400 event-related potential. I hypothesise that the effect of cTBS exhibited here is caused by modulation of the process through which errors are fed back in order to update cerebellar internal models. For the first time, we have shown that modulation of cerebellar predictive language function impacts upon later electrophysiological measures, and that this method might be an effective way to further elucidate the role of the cerebellum in language. Overall, this thesis supports the evidence that the cerebellum is involved in predictive language function, and that it applies a similar set of computations or internal models here as it does in motoric function and other cognitive functions. Additionally, we have proposed mechanisms through which cTBS may be affecting these internal models attributed to the cerebellum.

BPD is a severe and chronic psychological disorder associated with high rates of completed suicide and enduring disability. Standard DBT is an evidence-based, multi-modal psychotherapy for BPD which includes individual psychotherapy, group skills training, between-session coaching, and therapist consultation. DBT is effective for reducing many difficulties associated with BPD and can also transfer successfully into the community, yet important practice-relevant questions remain. The work in this dissertation involves four separate studies relating to ways DBT can be delivered in the community and exploring who is likely to respond to DBT. The studies draw on treatment outcome data from a total of 140 patients with a diagnosis of BPD collected over several years by community-based DBT teams involved in a multi-site, practice-based research network (PBRN). In Chapter 2, encouraging outcomes are reported from a small evaluation of standard DBT delivered to a cohort of 18-25 year olds with a diagnosis of BPD in a new young adult only DBT programme. Chapter 3 describes an expanded investigation of this young adult only DBT programme, mainstreamed as an early intervention initiative for 18-25 year olds presenting to community services with a diagnosis of BPD. Better outcomes are reported for the young adult programme compared to similar aged young adults in general adult DBT, suggesting advantages for this age-specific mode of delivery, possibly due to group cohesion. In Chapter 4, largely similar outcomes at six months are found for a rationalised, standalone group skills training adaptation of DBT when compared to standard (i.e. all modes) DBT, with some unexpected advantages for standalone group skills on hopelessness and difficulties in emotion regulation. Treatment conditions are not equivalent due to non-random allocation and the exclusion of higher risk patients from standalone skills, but findings offer support for the usefulness of standalone skills among lower-risk patients with a diagnosis of BPD who are willing to accept a group-only intervention when delivered by experienced DBT therapists. In Chapter 5, patient variables are investigated as predictors of outcome following one year of standard DBT for BPD. Gender, employment status, post-traumatic stress disorder (PTSD), and baseline suicide ideation are reported to be associated with change or recovery on borderline symptom severity and general psychopathology. Overall limitations of the dissertation, such as measurement problems, failure to formally assess treatment fidelity, and the inclusion of only completers in the analysis, are discussed in Chapter 6. In addition, several areas for future research are identified: the benefits of PBRNs, group cohesion as a factor in outcomes for DBT, and further study of young adult DBT under randomised trial conditions with longer term and wider follow-up.

Learning by observation is a natural way of acquiring new skills. Previous research suggests that physical and observational training share a similar neural basis. However, it remains poorly understood to what extent observational training affects neural representations of the acquired skill and what factors influence the training effect. Employing a keypress sequence learning paradigm and brain imaging, brain stimulation, and behavioural methods we investigated three parallel questions to help to provide a more comprehensive and integrative perspective on motor skill learning through observation and how it compares to previous findings on learning by doing. In Study 1 (Chapter 2) we investigated whether action observation establishes movement-sequence-specific neural representations that become more distinct with observational practice as reported in a previous physical practice study. In Study 2 (Chapter 3) we investigated whether non-invasive brain stimulation could facilitate observational practice effects, as stated for learning through physical practice. Finally, in Study 3 (Chapter 4) we examined whether individual differences in learning through observation could be explained by the same cognitive abilities and personality characteristics as in learning by physical practice. Overall, across the three studies, we found that same as physical practice, the observational practice provides behavioural benefits on motor skill acquisition. Furthermore, same as physical performance, action observation establishes distinct sequence-specific activity patterns in premotor and parietal brain areas. However, unlike following the physical practice, the sequence-specific activity patterns did not become more specialised following observational practice. Moreover, unlike with physical practice, anodal transcranial direct current stimulation over primary motor cortex during observational practice provided no benefits for motor skill acquisition through observation. Also, it appears that cognitive processes play a different role in learning by observation than in learning by doing. Perhaps although deliberate cognitive processes are involved in observational learning, the limited aspect of hypothesis-testing makes observational learning itself more implicit than explicit in its nature.

Over a century of research into prism adaptation (PA) has provided many insights into general sensorimotor functions including plasticity and the role of prediction. More recently, the therapeutic value of PA for conditions relating to right hemisphere dysfunction such as hemispatial neglect, and to body schema related conditions such as complex region pain syndrome, have generated a wealth of new knowledge – and more questions (Chapter 1). This thesis examines a cross-section of PA effects: sensorimotor adaptation in healthy participants and cognitive after-effects in a neurological population as well as a group of participants with a virtual lesion. Chapter 2 reports that PA does not induce an after-effect shift in a visual straightahead judgment task, while it does induce after-effects in other tasks which are attributable to a change in state estimates of eye position in the orbit. The results suggest that PA prompts complex changes within ocular proprioception and indicate that the assumption of linear additivity of PA sensorimotor after-effects is a concept requiring re-examination. An increase in priming following both right-shifting and left-shifting PA in patients with a left hemisphere lesion provides a first demonstration of the rehabilitative potential of PA for left hemisphere dysfunctions. Intriguingly, this result also widens the possible candidate mechanisms through which PA facilitates cognitive after-effects (Chapter 3). Finally, this thesis explores the potential influence of the cerebellum in the cognitive after-effects of PA (Chapter 4). It reports, for the first time, that neurodisruption of the right cerebellar hemisphere increases and left cerebellar stimulation decreases word association priming. The results indicate that the two cerebellar hemispheres conjointly schedule the facilitation and inhibition of associative priming. Taken together, the novel findings reported here suggest that previous theoretical stand-points need to be revised and provide a new framework for understanding the relationship between sensorimotor adaptation, cerebellar function and hemispheric interactions in human cognition.

Parents can face many new challenges in bringing up children with many now accessing the internet for general parenting support and advice. Much is known about patterns of parenting that support children’s positive development and a lot of research has demonstrated the effectiveness of parenting programmes to support parents of high challenge children. These interventions teach positive parenting skills, including relationship building, play, positive reinforcement and emotional regulation generally taught through discussion, training in observation skills and positive role modelling. The growing evidence for the effectiveness of teaching parents positive parenting strategies has demonstrated the potential of such programmes to improve the mental health and well-being of both parents and children. However, there is relatively little evidence-based information on parenting available in general. Many of the available programmes target children at-risk of developing conduct problems or families living in high-risk areas (e.g. Flying Start areas), meaning that the majority of parents do not have access to evidence-based information. Universal parenting programmes have the potential to promote positive child well-being and prevent future mental health problems. Advantages of a universal provision include (1) providing support for parents whose children do not have problems but who are concerned to parent their children in ways that provide them with the best outcomes, (2) facilitating access to evidence-based information for parents who are facing common everyday parenting challenges, but not currently in receipt of services, (3) impacting on societal norms by promoting positive parenting more widely, and (4) encouraging positive child development. The COPING parent (COnfident Parent INternet Guide) programme is a web-based universal programme that presents evidence informed parenting principles to support all parents in establishing positive relationships with children and promoting their children’s Evaluation of the COPING parent programme well being and development. This thesis reports on the development and evaluation of the programme in a randomised controlled trial with intervention and wait-list control conditions. Chapter 2 is a review of universally available parenting programmes, based on social learning theory principles, that were either offered to a universal population or included universal goals i.e. development of parenting skills and promotion of child developmental outcomes. This review highlighted the need for more research to establish the effectiveness of universal programmes on promoting positive parenting skills and child development. This leads to chapter 3, which is a review of web-based interventions for behaviour change, both behaviour in general (such as weight-loss and smoking) and parenting behaviour are included. This review highlighted the need for further evaluations of web-based parenting interventions and associated attrition challenges. Chapter 3 discusses the many challenges, which parents can face, and how these challenges can compromise parenting, child behaviour and parent-child interactions. Chapter 4 contains a brief review of interventions created using the LifeGuide software and a detailed description of the development of the COPING parent programme. Chapter 5 is a published paper (Owen & Hutchings, 2017) reporting our feasibility study that was conducted to gain user feedback from an early version of the programme. Feedback suggested modifications that included adaptations to enable the programme to be accessed by tablet users; an option to look back over previously completed chapters, the inclusion of more video examples of positive parenting and text message reminders to address engagement. Chapter 6 is the published protocol paper (Owen, Griffith & Hutchings, 2017) providing details of the methodology of the main trial. Chapter 7 is the main outcomes paper, and reports the findings from the evaluation of the programme, limitations and suggested improvements. The COPING parent web-based universal programme was effective in increasing observed praise and reducing observed indirect commands for parents who completed at least one chapter of the programme, however trial Evaluation of the COPING parent programme challenges included low engagement, high attrition at follow-up and softare challenges. The final chapter of this thesis provides a summary of the research findings and discusses implications, strengths and limitations and future directions. This was the first evaluation of the COPING parent online universal programme, an intervention for all parents of children aged 3-8 years who have an interest in learning more about positive parenting strategies. Findings from the main trial were promising and suggest that an online universal programme can significantly increase the positive parenting skills that are associated with good child outcomes for some parents. This thesis has highlighted the importance of providing all parents with the opportunity to access evicence-based support and further develop their parenting competencies in order to promote children’s development.

Positive Behavioural Support (PBS) is a multicomponent framework designed to address the multiple factors that influence an individual’s behaviour, with a focus on improving quality of life (Kincaid et al. 2002). PBS, in the UK, has largely been implemented by peripatetic community teams, in developmental disability (DD) services. High prevalence of challenging behaviour in individuals with DD (Jones et al. 2008) is a result of the interaction between vulnerability, environmental and impact factors (Hastings et al. 2013). This thesis will attempt to expand existing knowledge on all three of these aspects in relation to PBS as an intervention model. The thesis begins by presenting a total population study regarding the prevalence of challenging behaviour (chapter 2). This study investigates the associated correlates of challenging behaviour, and is the first study to consider the cumulative association of these correlates and propose ways to measure cumulative risk. Chapter 3 considers an impact of challenging behaviour – the high incidence of psychotropic medication use - and explores prescribing patterns associated with various topographies of challenging behaviour. In chapter 4, population data from the Behaviour Problems Inventory – Short Form (Rojahn et al. 2012) are used to estimate norms, clinically significant change and reliable change statistics. This chapter also provides guidance through examples on how this information can be used in research and clinical practice to enable practitioners to evaluate behaviour change in a more robust manner. Chapter 5 is an evaluation of outcome data from a peripatetic PBS service and, for the first time in research, considers statistically meaningful behaviour change (utilising evidence from Chapter 4), quality of life and social validity impacts. Finally, in chapter 6, findings from the four empirical studies are discussed in relation to theoretical implications. Implications for further research and practice in the field of PBS are proposed in chapter 6.

As humans, we share a strong desire to interact with other people. This strong motivation to engage socially directs our attention to social signals, guides us to participate in behaviours that help us to establish, maintain, and enhance our relationships with others, and allows us to enjoy social interactions and to find them rewarding. However, the Social Motivation Theory posits that individuals with Autism Spectrum Disorder may have deficits in social motivation, which may lead to difficulties in social interactions and communication. This thesis employs several methods (including behavioural, psychophysiological and neurological) to investigate social motivation in the typical population, and examines how autistic traits influence the reward value assigned to social stimuli. Specifically, this thesis investigates social motivation in relation to an important type of social stimulus, namely biological motion, which has not been the topic of research investigating social motivation. The first empirical chapter (Chapter 3) presents a behavioural experiment that investigates the reward value of biological motion, and how this value changes as a function of autistic traits among the participant sample. The following chapter (Chapter 4) comprises two eye-tracking experiments aiming to address how viewing biological motion affects attention and arousal. The final empirical chapter (Chapter 5) employs functional magnetic resonance imaging (fMRI) to examine brain regions involved in the anticipation of social reward or social punishment in a task where participants work to either receive positive feedback or avoid negative feedback. As a whole, this thesis sheds valuable new light on questions surrounding social motivation, such as whether individuals find a broad conceptualisation of social stimuli rewarding and whether the perceived reward value of social stimuli is influenced by autistic traits. The findings from this work have important implications for developing a greater understanding of social motivation and human social behaviour more broadly.