The behavioural symptoms of autism spectrum disorder (ASD) are thought to reflect underlying cognitive deficits/differences. Single cognitive deficit models of ASD have attempted to reduce the varied behavioural symptoms of the disorder to a single underlying cognitive deficit. However, there is a need to move on from these single cognitive deficit accounts of ASD. Therefore, the main focus of the thesis is to explore the potential for a multiple cognitive model of ASD using the predictions of the fractionated triad account. The data that is examined in the thesis originated from the Twins Early Development Study (TEDS) where one or both children met diagnostic criteria for ASD. A subsample of adolescents took part in the Social Relationship (SR) study. Overall, 181 adolescents with a diagnosis of ASD and 73 unaffected co-twins were included in the SR sample, plus an additional 160 comparison control participants. The findings in this thesis do not support a strong version of the fractionated account of ASD, in which distinct causes at the genetic and neural levels relate to distinct deficits at the cognitive level, and are associated with distinct symptoms of ASD at the behavioural level. There were some selective relationships between cognitive atypicalities and the behavioural symptoms of ASD, but these differed depending on the diagnostic symptom measure used. A weaker version of the fractionated theory is supported in which multiple cognitive deficits characterise ASD, and these cognitive deficits relate to distinct symptoms, as in the strong version, but a single cognitive deficit can explain more than one symptom domain, and more than one cognitive deficit can explain a single symptom domain. General interpretations are discussed using the framework of the fractionated triad theory of ASD. The limitations of the current thesis and potential future research are also considered.

The beliefs and conceptualisations that individuals hold about mental health needs is an important precursor to the coping responses that occur. This study is a cross-cultural comparison, investigating causal attributions and coping responses for depression experiences adopted by South Asian groups settled in England, and the differences on these dimensions when compared to a White indigenous group. A self-report, anonymous questionnaire method has been used, with postal return. Participants have been drawn from 7 places of worship across the Midlands and Southern Derbyshire, giving the study a non-clinical, community focus. Despite the South Asian group indicating a lower incidence of depression, at least a proportion were able to report having sought help for depression from their GP. However, unlike their White group counterparts, the South Asian coping response did not extend beyond the primary care level. A shared conceptualisation of depression was found between groups. Contrary to expectations, there were similarities between groups at the level of definitions for depression and causal attributions. Many of the predictions for Asian coping responses were overturned. Whilst a generally external set of attributions was observed for both groups, this did not preclude the anticipated use of active and emotion focused coping strategies. These findings are discussed in view of the religious background of participants, and the potentially buffering influence of religious beliefs. For Asians in particular, there may be value placed on the minimisation of personal distress, such that depressive symptoms are tolerated for longer, and remain undetected by primary care services. Potential barriers to help-seeking are also discussed, with a focus on service user and services alike. The findings convincingly remind practitioners of the danger of making assumptions about communities, on the basis of cultural sterotypes.

Conventional cognitive-behavioural models of eating disorder have a restricted focus in (a) affording primacy to weight and shape, and neglecting food and eating variables, (b) concentrating on the content of cognition and neglecting process dimensions, (c) primarily considering detriments of symptomotology rather than functionality. This thesis aimed at (a) eliciting dimensions of meta-cognitive eating disordered thinking, and (b) developing a psychometrically valid and reliable questionnaire. Study 1 involved a clinical sample (n = 20) of patients, all satisfying DSM-IV criteria for eating disorders. A semi-structured interview elicited dimensions of meta-cognition associated with food- and eating-related cognition. These statements were thematically categorised and independently rated by two raters. Inter-rater reliability was high (r = .82). A new questionnaire was developed on the basis of the derived categories. Study 2 involved a large sample of current dieters (n = 264). These participants completed the new questionnaire and six other questionnaire measures. The results of study 1 yielded 12 conceptually distinct dimensions of meta-cognitive beliefs. In study 2 a factor analysis reduced these dimensions to four factors: monitoring threat of eating ( = .84), abnormal self-inferences ( = .88), displacement of problematic thinking ( = .77), intrusive interference with cognitive functioning ( = .87). The new questionnaire (a) demonstrated good psychometric properties, (b) measured conceptually distinct variables, (c) distinguished between individuals on a number of dimensions of eating psychopathology. Primary indices of eating psychopathology were predicted by two of the factors. The findings of these studies vindicates the assertion that meta-cognitive appraisals of food- and eating-related cognition are important in eating disorder. Clinical research implications are discussed and therapeutic recommendations for the inclusion of meta-cognitive components in treatment are offered.

The onset of choreiform movement disorder is the most widely used indicator for diagnosis of the onset of Huntington's disease. Research in recent years has investigated the possibility that onset of the disease may occur prior to this and is manifest in the form of cognitive impairment, but has been unable to identify the nature of this. Several previous studies have implied that attentional function may be affected. This study employed a more specific and sensitive test battery than had previously been used in this area to investigate the possibility that attentional function was impaired in presymptomatic gene carriers. Eight carriers and fifteen at-risk non-carriers of the gene were recruited via the genetics services that had tested them for the gene. Two gene carriers were excluded from the analysis since they showed symptoms of movement disorder. These groups were compared in terms of response latency and errors on six sub-functions of attention: alertness, attentional set-shifting, inhibition of unwanted responses, integration of information from different sensory modes, divided attention, and vigilance. The two groups were of widely, differing ages so a covariate analysis taking this into account was performed. Attentional set shifting and the integration of information from different sensory modes were found to be significantly impaired. The two symptomatic participants were compared qualitatively with other participants and appeared to have more impaired performances than either group. The limitations of the study and its' implications clinically and for future research are discussed. This study offers the possibility that impairments in attention can be detected and that a more specific and sensitive testing procedure can be useful.

The literature review aimed to systematically review social cognitive abilities in young people with borderline personality disorder (BPD) features. Three electronic databases were searched and ten met the inclusion criteria. Through the quality appraisal, the studies were found to be weak overall. Across the studies, social cognition was assessed using various measures. The participants included both nonclinical and clinical populations. All studies rated BPD features through standardised, reliable measures. Findings were mixed. Studies demonstrated that individuals with BPD features had certain social cognitive deficits but the deficit findings differed across the papers. Further research is required to clarify the social cognitive abilities in young people with BPD features. The aims of the research were to explore inpatient CAMHS staff experiences of young people with a label of emerging personality disorder. An IPA methodology was employed and six inpatient CAMHS nursing staff were interviewed. Three super-ordinate themes and nine subthemes were found across the data that enabled convergence and divergence within their accounts. Findings are discussed with reference to psychological theory and past research findings. The clinical implications and future research recommendations are discussed. The critical appraisal is then presented.

Gender dysphoria is the distress experienced because of the disparity between an individual’s psychological gender and sex assigned at birth. Some individuals that experience gender dysphoria pursue medical and psychological interventions and transition. This thesis examines the impact of gender transition. Literature review: Sexuality is a multifaceted construct that may be influenced by our gender identity. The current thematic review appraised and synthesised findings from seven qualitative articles. Two main themes regarding ‘re-negotiating previous ‘norms’’, and ‘establishing identity’ were generated. The quality of the articles suggested there is scope for improvement when conducting qualitative research in this area. Empirical report: The empirical study examined psychological wellbeing during cross sex hormone transition. Cross sex hormone transition aims to alleviate distress experienced as a consequence of gender dysphoria. The study adopted a mixed methods approach to determine if there was any statistical change in psychological variables over time, and to supplement this with an understanding of the experiences that were occurring. A total of 60 questionnaires were completed and the data were examined using descriptive, correlation, multiple regression, and paired sample t-test analysis. A total of two individuals participated in a photo elicitation interview and discussed their experience of their psychological wellbeing during cross sex hormone transition. The quantitative findings suggest that prior to starting cross sex hormone transition, individuals experience statistically elevated rates of anxiety, and depression, and lower self-esteem. Interpersonal functioning and self-esteem predicted variance in anxiety, and interpersonal functioning predicted variance in depression. Over the course of cross sex hormone transition there were statistical improvements in self-esteem and body dysphoria. The qualitative findings revealed super-ordinate themes of: discovery; self-protection; and critical stance and responsibility. Critical appraisal: The critical appraisal details the research journey and learning points that occurred. Issues relating to both personal and professional development are considered.

Chronic illnesses such as epilepsy, have been shown to have detrimental effects on both psychological adjustment and coping behaviour. Using the process model of coping, these effects were investigated in a patient group of 36, 16-21 year olds with epilepsy. The patient group were compared with a control group of 31 of their peers with regard to both their psychological adjustment and how they coped with making the transition to adulthood. In order to further test the process theory, a comparison was made between how the patient group coped with making the transition to adulthood and how they coped with epilepsy. The relative importance of the perception of illness and condition characteristics to psychological adjustment and coping was also considered in the patient group. Participants completed a postal questionnaire which contained measures of psychological adjustment (self esteem, affect, self efficacy) and an adolescent coping questionnaire. Results showed that the patient group exhibited significantly more non productive coping than the control group. The control group exhibited significantly more problem solving coping and displayed a significantly more problem solving bias than the patient group. No differences were found between the patient and control group on measures of psychological adjustment. However, psychological adjustment was found to be associated with coping response in the patient and not the control group. Some differences were found in the cross-situational coping response within the patient group. Perception of illness, in particular, acceptance of illness, had more influence on the psychological adjustment and coping behaviour of the patient group than condition characteristics. The clinical and theoretical implications of these findings are discussed and the limitations of the study acknowledged.

'Drop-out' is a problem common to many mental health services. Within services for anorexia nervosa the issue is even more problematic given that the disorder has a potentially fatal outcome. Research suggests that approximately 50% of patients drop-out prematurely from treatment services for anorexia nervosa and there has been a concerted effort over recent years to try and understand and overcome this concerning phenomenon. This research set out to investigate the possible reasons for drop-out from services for women diagnosed with anorexia nervosa. An additional aim was to investigate the personal significance of anorexia nervosa and the impact that treatment has on changing this. This research investigated the reported experiences of 8 women who had previously attended a local specialist eating disorders service. The participants were asked to provide a narrative account of their experiences of treatment which was then followed up in an interview. One participant was only able to provide a narrative account and 3 participants preferred to be interviewed without providing a written narrative. The information obtained from the narratives and interviews was analysed using a social constructionist revision of grounded theory. A central theme of control emerged which was affected by interactions with the wider social system. The accumulative battle for control between the anorectic and others (such as family, friends and professionals) appeared to result in the act of dropping out as the treatment approach, timing and context recreated the setting conditions of lost control. The orga.nisational and clinical implications of this model are discussed in the light of existing conceptualisations of drop-out and anorexia nervosa.

Studies of the aetiology of Autism Spectrum Disorders (ASD) have been limited so far due to the rare nature of samples allowing detection of the total genetic and environmental influences. Most studies to date point towards strong genetic influences. However, two recent reports found that shared environmental influences mattered more than genetics. The first two empirical chapters of this thesis describe a set of innovative analyses designed to provide new evidence on the aetiology of ASD, and to make sense of the existing contradictory evidence. The new evidence comes from the Social Relationships Study (SRS). For the first time, a single model was fitted to data recognising the Broad Spectrum as an ASD subgroup. The results revealed strong genetic influences and little support for shared environmental factors. The second empirical chapter reports on the first meta-analysis of ASD twin studies to redress which familial effects are more important: genetic or shared environmental factors? Again, the results showed the importance of strong genetic influences. Moreover, the strength of shared environmental factors was dependent on the prevalence values used to correct for selecting individuals on ASD affection status. These results re-affirm that ASD is under strong genetic influences and that detecting shared environmental factors may be a statistical artefact. The second half of this thesis deals with the aetiology of associated psychiatric difficulties in autism, the study of which has gained significant momentum in the last decade. To extend this work, the third and fourth empirical chapters utilise data from the SRS as well as data on autism traits from the Twins Early Development Study (TEDS). Similar aetiology profiles were found for comorbid Emotional symptoms and Hyperactivity across the two samples. However, the aetiology of comorbid Conduct problems differed and appeared to be dependent on the severity of autism manifestations. This could possibly be explained by the fact that these problems are conceptualised differently in children with ASD and those with milder manifestations. There are two main implications of the findings from this thesis for future research. First, the next-generation sequencing studies ought to increase their efforts to include samples across the whole autism spectrum as the genetic risk is very likely to be shared across clinical cases, those showing Broad Phenotype and individuals with mild autistic behaviours. Second, validation is needed of the observed relationships of comorbid psychiatric difficulties in ASD, using independent cohorts; such data are important for the future design of ASD-appropriate comorbidity measures and interventions.

A dominant social cognition model has construed the central socio-communicative impairments in Autistic Spectrum Disorders (ASDs) as deficits in understanding others’ minds- what other people know, intend, believe and feel. Difficulties for individuals with ASD have been well documented on “Theory of Mind” (TOM) tasks designed to tap these skills (Boucher, 2012). Recently however, research has shifted toward exploring how individuals with ASD understand their own minds, and to look at the cognitive mechanisms involved in thinking about “the self”. The present thesis is situated in the context of this emerging self-referential cognition (SRC) research, including its close connection to social cognition. This thesis explored the quantitative and qualitative differences in neurotypical (NT) adolescents and those with ASD in generating self-images (e.g. concepts such as I am a female, I am a footballer, I am kind) through use of novel fluency tasks (the ‘I Am’ and ‘(s)he is’ tasks) based on the Twenty Statements Test (TST; Kuhn and McPartland, 1954). Relationships between these tasks and social cognition (TOM measures) were also explored. The results indicated that both NT adolescents and those with ASD exhibited a self-reference effect (SRE), generating more statements about themselves than other people. The magnitude of the SREs was found to be significantly related to several TOM measures such as performance on the Mind in the Eyes task of emotion recognition. Moreover, the ASD group produced significantly less personal attributions across all fluency tasks, but a similar number of social and physical attributions, compared to the NT group. This mirrored emerging findings that indicate a specific deficit in psychological but not physical self awareness in ASD (e.g. Williams, 2010). Additionally, the ASD group were found to make significantly fewer spontaneous social stereotypes on the (s)he is tasks, such as the “Beauty is Good” stereotype, a finding which contrasts with previous research showing preserved social stereotyping in children with ASD (Fonesca et al, 2011). The theoretical and clinical implications of these findings for individuals with ASD are discussed with reference to the “absent-self hypothesis” (e.g. Frith, 2003). Additionally, the promising utility of fluency measures in capturing important aspects of SRC are also noted, including suggestions for further research.