There is an abundance of research on the aetiology and maintenance of child sexual offending and many factors have been proposed as being influential, including distorted cognitions. These are the focus of this study, in particular, the underlying implicit theories thought to generate them. Ward and Keenan (1999) hypothesised that child sexual offenders hold five distinct implicit theories which account for the majority of their cognitive distortions, and which they use to make predictions about the meaning of children’s behaviour and underlying desires and intentions. These include Children as Sexual Beings, Nature of Harm, Uncontrollability, Dangerous World and Entitlement. However, it is unclear at the present time whether child sexual offenders with a mental disorder have similar or different cognitions which may have influenced their offending. This aim of the current study was to explore this. Semi structured interviews eliciting cognitions were carried out with 12 adult male high secure child sexual offenders. Content analysis indicated that the majority of the cognitive distortions exhibited by this sample of men could be categorized within Ward and Keenan’s (1999) five implicit theories. Evidence of a possible new implicit theory representing deviant sexual interest in children, Children as Sexually Attractive, was also found. Additionally, child sexual offenders whose offending appeared to be associated with intimacy deficits were not felt to be adequately captured under the Dangerous World implicit theory, and the theme of ‘Lonely World’ was felt to be more suitable to represent this group of men. Diagnosis did not impact upon the presence of implicit theories although content differences were found. Participants with a diagnosis of personality disorder (n = 5; 100%) more commonly articulated cognitions associated with the Children as Sexual Beings implicit theory and reported deviant sexual interest in children. In comparison, participants with a diagnosis of mental illness reported beliefs associated with the Uncontrollability implicit theory (n = 5; 100%), and only two men made reference to symptoms of their mental illness. 2 These preliminary findings appear to support previous studies identifying cognitions and personality as risk factors to sexual offending in men, irrespective of diagnosis. It can be concluded from this that psychosis alone is not a sufficient motivator for sexual offending and cognition appears to play an influential role. This is particularly relevant to those with a mental illness as the majority of research into their sexual offending up to now has mostly focused on the role of psychosis. In terms of assessment and treatment, these findings primarily suggest that implicit theories should be addressed in therapy rather than focusing solely on their surface level cognitive distortions, regardless of diagnosis. Further research is necessary in order to advance understanding of implicit theories in child sexual offenders with a mental disorder before any treatment and assessment tools can be adequately developed. Additionally, future research will build on the limited theories and typologies, particularly for those with a mental illness, which in turn should help to advance the assessment, formulation and treatment of these offenders.

Background: There is evidence to suggest that maternal depression is associated with suicide-related behaviour in offspring; however pathways contributing to risk remain unclear. The aim of this thesis was to investigate mechanisms of the association between maternal depression and offspring suicidal ideation and attempt in a general population sample. Methods: Data were utilised from a population-based birth cohort, the Avon Longitudinal Study of Parents and Children. Maternal depression symptoms were assessed on 10 occasions from pregnancy to child age 11 years. Offspring suicide-related behaviour was assessed at age 16 years. Latent class growth analysis was used to derive trajectories of maternal depression symptoms. Pathways mediating risk between maternal depression and offspring suicide-related behaviour were then examined using structural equation modelling. Results: Five distinct classes of maternal depression symptoms were identified (minimal, mild, increasing, sub-threshold, chronic-severe). Compared to offspring of mothers with minimal symptoms, the greatest risk of suicidal ideation was found for offspring of mothers with chronic-severe symptoms [OR 3.04 (95% CI 2.19, 4.21)], with evidence for smaller increases in risk for offspring of mothers with sub-threshold, increasing and mild symptoms. The pattern of findings was similar when examining risk for offspring suicide attempt. The majority of the association between maternal chronic-severe depression and offspring suicidal ideation was explained through maternal suicide attempt and offspring psychopathology. However, there was also evidence for indirect effects via both the parent-child relationship and peer victimisation. Conclusion: Findings from this thesis highlight that risk for suicide-related behaviour should be considered in offspring of mothers with sustained depression symptoms, even when symptoms are below clinical levels. Suicide prevention efforts in offspring of depressed mothers should be targeted at offspring with psychopathology and offspring whose mothers have made a suicide attempt. Interventions aimed at improving the parent-child relationship, or reducing peer victimisation may also be beneficial.

This thesis aims to provide a broad overview of topics relating to desistance factors and strength-based approaches to working with male sex offenders. It incorporates diverse methods, including a systematic review, an empirical study, an individual case study, and a critique of an actuarial risk assessment. Following an introductory chapter, Chapter 2 presents a systematic evaluation of 15 studies reporting on the relationship between denial or minimisation of offending and recidivism by adult male sex offenders. The highest quality studies (n = 5) do not find a consistent relationship between these variables. Some support for the view of denial as a protective mechanism against recidivism is found. Four studies exploring categorical denial find no relationship between denial and recidivism, lower recidivism rates by categorical deniers. Higher recidivism rates are found for low static risk and intra-familial offenders in categorical denial. In Chapter 3, predictors of belief in sex offender redeemability are explored in participants working or volunteering with sex offenders, and participants not working or volunteering with offenders. For those working or volunteering with sex offenders, stronger redeemability beliefs were predicted by being less punitive, younger and having a professional role which involved delivering treatment or working with sex offenders in a therapeutic capacity. For participants who did not work or volunteer with offenders, belief in sex offender redeemability was predicted by being less punitive, male, younger and endorsing more situational (rather than dispositional) explanations for sex offending. For female participants, those working or volunteering with sex offenders were less punitive and held stronger redeemability beliefs than females who did not work or volunteer with offenders. This difference was not found for male participants. Chapter 4 describes a strength-based approach to the assessment, formulation and treatment of an adult male sex offender with an intellectual disability in a prison-setting. The client was deemed to have responded positively to the strength-based treatment approach and progress was made in addressing his treatment need relating to offence-supportive attitudes, antisocial peer network and coping skills. Treatment need remained in relation to sexual interests and intimacy deficits. Positives in the strength-based approach included the use of the ‘success wheel’ to encourage focus on pro-social goals, encouragement to develop an adaptive, pro-social identity and the positive impact on the client’s motivation for change. However, restrictions resulting from the prison setting and standardised framework were highlighted in terms of their impact on strength-based practice. Chapter 5 critiques the Risk Matrix 2000 actuarial assessment tool for use with intellectually disabled sex offenders. It finds limited empirical support for using the Risk Matrix 2000 with this population and raises concern that high stake decisions are made based on information from this assessment. Further research to explore its reliability and validity for use with this client group is recommended. The Assessment of Risk Manageability for Intellectually Disabled Individuals who Offend Sexually is highlighted as an assessment tool with stronger empirical support in terms of predictive validity. It is found to be a more ethically defensible tool than the Risk Matrix 2000, given its holistic consideration of strengths in addition to deficits. Chapter 6 concludes that the thesis achieves its overall aims of developing understanding of desistance factors and strength-based approaches to working with sex offenders. A model is developed which proposes several mechanisms through which the desistance process is enabled or impeded for sex offenders. This model incorporates consideration of denial, staff and public attitudes about sex offenders, community reintegration, social capital, self-identity, static risk, supervision, strength-based practice and treatment effectiveness. Future research is recommended to empirically test this model, through further exploration of the potential protective function of denial for sex offenders, exploration of additional variables explaining variation in redeemability beliefs and exploration of the effectiveness of strength-based approaches to assessment and intervention for sex offenders.

There is a well-established association between thinking and doing and so it is no surprise that thinking about violence can be associated with risk of violent behaviour. Violent thoughts are recognised as a treatment target in many offender treatment programmes, yet given the multi-faceted nature of violent cognition and absence of integrating theory of violent offenders’ cognition it can sometimes be difficult to assess and treat the cognition that is associated with violent behaviour. This research project aims to explore Violent Thoughts and Fantasies (VTF) in a clinical and forensic client group. The thesis begins with a review of violent cognition and related constructs. A systematic review then highlights the role of violent cognition at various stages in the offending process. The main empirical study uses qualitative methodology to explore VTF amongst a sample of mentally disordered offenders detained within a high secure hospital. The thematic analysis yielded four super-ordinate themes which included ‘part of who I am’, ‘emotional regulation’, ‘aware of the need to be careful’ and ‘thinking to doing, to thinking, to doing’. Violent thoughts and fantasies appeared to be integral to one’s self concept and functioned to sustain the individual in some way, depending on individual need. A range of functions of VTF were identified using functional analysis and these included: emotional regulation, dealing with provocation and using VTF to plan or guide violent offending. Consequently, there continues to be a need to carefully assess and manage these experiences as the link between thinking about violence and acting in a violent way continues to be a likely possibility. Clinical implications are directed towards a thorough assessment of VTF, with particular emphasis on assessing the underlying function of VTF and supporting offenders to find alternative ways of addressing the need that the fantasy currently fulfils.

This thesis provides an investigation into the presentation and treatment of childhood maltreatment in adolescents, with a key focus on adolescents with developmental disabilities (DD). A range of methods, including an empirical study, a systematic review, a single case study and a critical evaluation of a psychometric assessment were used to explore this field. The empirical study explores the presentation of childhood maltreatment in a cohort of adolescents with and without DD, within a specialist inpatient setting. The systematic review investigates the effectiveness of psychological treatments for adolescents with a history of childhood maltreatment. The case study explores the effectiveness of an Adapted Sex Offender Treatment Programme (ASOTP) at reducing the risk of sexual re-offending, for a male adolescent with DD and a history of childhood maltreatment. The critical evaluation of the Trauma Symptom Checklist for Children (TSCC) (Briere, 1996) focuses on evaluating the reliability, validity and applicability of the measure for use with adolescents in secure psychiatric settings. The preliminary results of the empirical study found no significant differences between both groups for the dependent measures, however data trends suggested that adolescents with DD display a higher frequency of problematic behaviours. They also displayed some trauma symptoms and emotions more frequently compared with adolescents without DD. The findings of the systematic review were unclear due to methodological issues and bias, however the review showed that Cognitive Behavioural Therapy was not effective at reducing depression but Attachment Based Family Therapy may be an effective intervention for reducing depression and suicidal ideation in adolescents. The case study found that the ASOTP was not effective at reducing the Client’s risk of re-offending. The Client did not engage well with the work and the reasons for this are discussed in relation to the Client’s history of maltreatment and development of personality disorder traits. In the critical evaluation of the TSCC, it is recognised that the TSCC is a strong measure of trauma, however it has not been validated or standardised for use with children/adolescents with DD. The thesis concludes that there are many avenues of research about maltreated adolescents with DD which need to be explored. This research field needs to be substantially developed before clinicians can reap the beneficial clinical implications of the research.

Tracing Autism is about neuroscientists’ on-going search for a brain-based biomarker for autism. While much recent sociological work has looked at the ‘cerebralization’ of such diverse diagnostic categories as depression, bipolar disorder, psychopathy, addiction, and even autism itself, surprisingly little light has yet been shed on the mundane ways that researchers in the new brain sciences actually think about, reason through, and hold together neurological accounts of complex and emerging diagnostic entities. Situating itself within a series of interviews with neuroscientists who work on the autism spectrum, one of the most enigmatic, recalcitrant and unresolved categories of contemporary neuroscience, Tracing Autism is an attempt to fill this gap. The key argument is that while this work might be seen as a process of gradual ‘neurobiologization’ or neuromedicalization,’ talking to autism neuroscientists reveals a practice much more complex, much more ambiguous, much less monolithic, and also much less certain, than the sociological literature yet fully realizes. The thesis shows how autism neuroscience works by tracing its way across some very different and ambiguous commitments – carefully negotiating the space between the biological and diagnostic definitions of autism, the hope and disappointment of neuroimaging technology, as well as the intellectual and visceral commitments of laboratory research. Locating itself within a recent turn to theorising the entanglement of cultural and biological phenomena within scientific spaces (Barad, 2007), and joining with a growing literature that wants to take neuroscience seriously (Wilson, 2004), Tracing Autism shows how the complex work of autism neuroscience picks its way across social deficits, neurobiological substrates, psychological theories, disappointing machines, and loving scientists. Tracing Autism is the story of an intellectual and affective complexity that has come to define autism neuroscience; but it is also the story of the care, seriousness and novelty with which neuroscientists talk about their work.

There is an increasing emphasis on the importance of parental voice in education, and specifically within the realm of Special Educational Needs (SEN). For parents whose children have been identified as potentially having Autistic Spectrum Disorder (ASD), their story may have begun long before there is professional involvement. There appears to be a dearth of qualitative research into parental experiences prior to their child’s ASD assessment. Therefore, this research explored the narratives of two parents whose children had been referred for an ASD assessment. Within a social constructivist, relativist paradigm, narratives were collected through in-depth interviews that enabled a detailed inductive analysis of each of the unique stories. Findings are discussed in relation to the analysis and related theory, research and policy. The limitations of this research and implications for future projects and Educational Psychology (EP) practice are also discussed, including how reflection on issues of power, hermeneutics, ontology and epistemology may be pertinent to EP practice.

A large number of patients with epilepsy have drug-resistant seizures. Therefore, there is a need for the development of new therapies. The purine nucleoside adenosine is an endogenous anticonvulsant that acts to supress neuronal excitability via adenosine A1 receptors. The aim of this thesis was to investigate whether manipulating ATP bioenergenetics and importantly adenosine levels had any effects on activity-dependent release of adenosine and seizure activity. ATP bioenergetics and adenosine levels were manipulated by pre-treating rat hippocampal slices with a combination of the sugar backbone of ATP (D-ribose) and the free purine base adenine (RibAde) and the phosphate buffer creatine. The role that the adenosine A2A receptor plays in relation to epileptiform activity was also investigated. Biosensors were used to measure the real-time release of adenosine. The K+ channel blocker 4-aminopyridine (4-AP; 50 μM) in Mg2+-free medium was the model used for inducing spontaneous bursting epileptiform activity. Additionally, homocysteine thiolactone (HTL) was used to “trap” intracellular adenosine to test if extracellular adenosine measured with biosensors, is released as adenosine per se and if this had any effects on seizure activity. I show that during bursting epileptiform activity, the amount of adenosine released is increased in RibAde slices compared to creatine and untreated (control) slices and increased the time between seizures compared to both creatine and control slices. No differences was found between creatine and control slices. My data also suggest that adenosine A2A receptors may partially contribute to seizure activity. HTL reduced adenosine release in a burst-dependent manner and also increased the frequency of seizures. HTL influenced the intensity of bursts in control but not RibAde-treated slices. This thesis provides evidence for the beneficial role of the ATP precursors ribose and adenine on reducing seizure activity and will hopefully contribute to ongoing attempts to establish adenosine-based epilepsy therapies.

Introduction Depressive rumination is a type of repetitive thought with deleterious effect on mental health. Depressive rumination is associated with deficits in the control of working memory and has been shown to be a robust predictor of onset and severity of a depressive episode. Consequently, a number of therapeutic approaches for depression endeavour to remediate depressive rumination either directly or by proxy in an effort to alleviate depressed mood and to prevent relapse. Maintenance of depressed mood has been argued to be the result of a deficit in the ability to regulate depressiogenic cognitive structures. This review investigates which of these structures are targeted by current psychotherapeutic interventions. Method A computerised search using key words was conducted on a number of academic databases to identify peer-reviewed articles documenting the efficacy of treatments of depressive rumination. Additional references were obtained through the references section of relevant articles and chapters. The resulting articles were arranged thematically under their respective intervention within two broad groups: interventions aimed at restructuring cognitive content and behavioural interventions. Results Results identified evidence for both cognitive interventions, such as cognitive therapy, metacognitive therapy and mindfulness therapy, and for behavioural interventions, such as distraction, aversion behavioural activation and graded exposure. Discussion Current therapeutic treatments of depressive rumination appear to privilege interventions targeting the reappraisal of cognitive content and the disruption of activation of mood congruent cognitions, whilst omitting to directly remediate the structural deficit in cognitive inhibition of depressiogenic thoughts. Treatments such as cognitive remediation therapy can target such structural cognitive deficits. The article proposes that future research needs to investigate the effectiveness of such interventions for the treatment of depressive rumination and depression.

This thesis is presented in two volumes; the research component (Volume One) and the clinical component (Volume Two). Volume One presents three research papers focusing on understanding interventions and change processes for people with severe and enduring mental health problems. The first paper is a meta-analysis evaluating the use of Acceptance and Commitment Therapy for people with severe and enduring mental health problems. The second is an empirical study examining the role of shame and psychological flexibility in the relationship between mental health and substance use in people with severe and enduring mental health problems. The third is a report written to disseminate the research findings to the research participants and health care professionals. Volume Two consists of five clinical practice reports (CPRs); CPR 1 formulates a lady presenting obsessive-compulsive disorder, CPR 2 is a service evaluation, CPR 3 presents a single case experiment evaluating a cognitive-behavioural intervention for a man diagnosed with obsessive-compulsive disorder, CPR 4 presents a case study of a compassion-focused intervention, and the abstract of CPR five, an oral case presentation, presents a case study of a man presenting with psychosis.