This thesis is concerned with two different accounts of how speakers coordinate conversation. In both accounts it is suggested that aspects of the manner in which speech is performed (its disfluency and its rate) are integral to the smooth performance of conversation. In the first strand, we address Clark's (1996) suggestion that speakers design hesitations, such as filled pauses (e.g. uh and um), repetitions and prolongations, to signal to their audience that they are experiencing difficulties during language production. Such signals allow speakers to account for their use of time, particularly when they experience disruptions during production. The account is tested against three criteria, proposed by Kraljic and Brennan (2005), for evaluating whether a feature of speech is being designed: That it be produced with regularity, that it be interpretable by listeners, and that its production varies according to the speaker's communicative intention. While existing literature offers support for the first two criteria, neither an experiment with dyads nor analyses of dialogue in the Map Task Corpus (MTC; Anderson et al., 1991) found support for the third criterion. We conclude that, rather than being signals of difficulty, hesitations are merely symptoms which listeners may exploit to aid comprehension. In the second strand, we tested Wilson and Wilson's (2005) oscillator theory of the timing of turn-taking. This suggests that entrainment between conversational partners' rates of speech allow them to make precise predictions about when each others' turns are going to end, and, subsequently, when they can begin a turn of their own. As a critical test of the theory, we predicted that speakers who were more tightly entrained would produce more seamless turn-taking. Again using the MTC, we found no evidence of a relationship between how closely entrained speakers were and how precisely they timed the beginning of their turns relative to the ends of each others' turns.

There is evidence of a high incidence of language difficulties (LD) amongst boys with externalising behaviour (EB); however we still have little understanding about why they co-occur. This 3 part study investigates aspects of this relationship framed within a biopsychosocial model and with a focus on pragmatic language skills and social cognition. Firstly, this study seeks to replicate recent research that has indicated a close association between pragmatic language skills and EB. It is the first study to consider the strength of this association while controlling for other variables known to commonly co-occur with LD and EB: aspects of the child’s ability (word decoding and nonverbal cognitive skills), and aspect of their environment (parenting stress, maternal education and family set up). Secondly, this study furthers our understanding of the social cognitive and friendship skills of boys with LD, in both areas through investigating reasons for variance in ability. A better understanding of an LD population feeds into our understanding of EB due to the high proportion of boys with EB who have coexisting LD. Thirdly, this study measures social cognition of boys EB while accounting for the role of LD, thus investigating whether difficulty with these tests is associated with the high rate of LD in this population. Previous studies have not adequately considered this. Method: Boys aged 8 to 11 years receiving additional support in school were assessed for LD and EB and two groups (not mutually exclusive) were identified: boys with LD (n=31) and boys with EB (n=35). A control group of typically developing boys matched for age and SES were also identified (n=42). For part one, participants completed assessments of language skills, word decoding and non-verbal cognitive ability. Teachers completed a checklist to provide a measure of pragmatic language skills. Parents completed questionnaires to provide measures of parenting stress, family set-up and maternal education. For the second and third part of the study participants’ social cognition was assessed and parent and teachers completed a checklist for measurement of emotional and behavioural difficulties including friendship skills. Results and discussion: In the first part of this study, all variables measured were found to be significantly associated with EB, as would be expected within a biopsychosocial model in which many factors interact with each other in the development of EB. However, particularly close associations were found between pragmatic language skills and EB (replicating previous research in this area), followed by language skills. This indicates a close and specific association between communication skills and EB, even when other closely associated variables are accounted for. In part two, amongst boys with LD, different social cognition assessments were found to be associated with different aspects of communication skills. One was most closely associated with structural (particularly expressive) language and the other two with pragmatic language. This indicates that they are tapping different constructs and highlights the difficulty using a proxy to give an indicator of social cognition; it is not easy to assess. Variability in friendship skills of boys with LD was not associated with any aspect of communication skills. Significant correlations were found with two of the social cognition test scores only. This is at variance with research indicating a link between friendship and receptive language skills. In part 3, the EB group scored significantly lower than the Control group in tests of social cognition, however EB was not found to be linked with social cognition score. Only boys with LD (with or without EB) scored significantly lower than the Control group. This has implications for previous research into the social cognition of boys with EB which has not fully considered the high proportion with LD and the extent this may be contributing to their low social cognition scores. Implications for practice and future research are discussed.

This study investigated verbal pragmatic skills in Saudi Arabian children with attention deficit hyperactivity disorder (ADHD). It examined quantitatively the verbal output, turns, topic related skills, and interlocutor impact in the children with ADHD compared to age-matched typically developing (TD) children. Also, a qualitative approach was used to investigate the mother-child interaction in children with ADHD compared to TD children with respect to conversational contributions and repair by the mother and the complexity of responses from the child. Another goal of the study was developing an audio-visual language sample database for Saudi Arabian Arabic speaking children. The participants were twenty 4-5 year old Saudi boys. Ten were typically developing and ten had a diagnosis of ADHD. A 30 minute sample of speech during free play was collected from each child in conversation with an unfamiliar adult interlocutor and a 15 minute sample of speech was collected during free play with a familiar interlocutor (the mother). All sessions were recorded on DVD using two video cameras. Transcription and coding systems were used to analyze the data. Comparisons were made between the TD children and the children with ADHD using quantitative and qualitative techniques. The results of the quantitative study showed that children with ADHD have a reduced verbal output with respect to total number of words, total number of verbal turns and average number of words per turn compared to typically developing children of similar age. Also, participants with ADHD showed a significantly higher topic initiation to topic maintenance ratio compared to TD participants in the sessions with the unfamiliar interlocutor. No significant effect of interlocutor was found. The results of the qualitative study revealed that verbal skills are more challenging for children with ADHD relative to their unaffected peers which is presented by more frequent “no verbal response” than TD participants and use of more single word productions during their interactions with FI. However the incidence of “mazes” did not differentiate the children with ADHD from TD children. The mothers of children with ADHD were found to be more directive in conversation, to use "what" and "yes/no" questions more frequently and they had a greater tendency to use non-verbal cues. The differences were interpreted as evidence of the negative effect of the core behavioural characteristics of ADHD on verbal pragmatic skills and the presence of weak discourse skills in children with ADHD compared to TD age-matched children. The results also reveal the importance of investigating mother-child interaction variables in an attempt to understand the effect of parental style on the verbal skills of the children with ADHD. We have at this stage no means of telling whether the reduced verbal productivity is merely a by-product of non-linguistic core behavioural characteristics of this disorder or whether it stems from a core linguistic pragmatic deficit which is (or can be) an integral part of the disorder itself. The clinical implications are that very careful attention is needed in assessing children with ADHD to determine the nature and the extent of their language-use difficulties. Language-use difficulties exhibited by children with ADHD may be associated with a lack of social competence, which will be reflected in their conversational skills. The analysis provides the speech language pathologist with information that could assist them, by giving them a better understanding of children with ADHD, which would lead to more comprehensive assessments and more effective intervention and parent training programs.

Psychopathy is a personality disorder, the boundaries and content of which lack clarity and consensus. Researchers and clinicians tend to agree on one key aspect: affective hypo-responsivity. Recent evidence suggests that this disposition may be specific to certain features of psychopathy, and that affective deficits may be specific to aversive stimuli. Recognising that existing tests of emotion processing in relation to psychopathy have tended to rely on facial affect recognition, the present work delineated emotion processing into several components which were assessed in relation to the psychopathy dimensions broadly labelled primary and secondary psychopathic traits. Use of the same pictorial stimulus set allowed for an examination of processing of affective cues in terms of categorisation of affect, physiological response assessed through pupillometry, and influence on behaviour. Emotion experience was assessed through self-report. This approach allowed an examination of whether deficient threat reactivity is consistently found across the different manifestations of emotion. Moreover, by assessing psychopathy in terms of primary and secondary psychopathic traits, the generalisation of threat deficits across the variants could also be examined. Recognising the existing debate regarding the content of psychopathy, the present work also utilised two alternative measures of the disorder, the Psychopathy Checklist: Screening Version, and the Triarchic Psychopathy Measure. Assessing components of emotion processing in relation to the psychopathy dimensions within a sample of 94 adult male offenders revealed the specificity of threat deficits in relation to PCL:SV Factor 1. Contrary to hypotheses, physiological reactivity to affect was intact for offenders high on primary psychopathic traits. For offenders high on secondary psychopathic traits, affective responses across the components were intact but an atypical pattern of autonomic activity was found. Assessment of multiple components of affect therefore allowed a more subtle pattern of psychopathic emotion processing to emerge and highlighted the multifaceted nature of psychopathy.

South Asian women in the United Kingdom have shown higher rates of self-harm compared to their white counterparts and Asian men. However, only a few studies have attempted to use in-depth exploration on an individual level to understand the reasons behind this. The empirical study aimed to explore the subjective experience and meaning of self-harm from South Asian women’s perspectives. It sought to appraise how they understood and made sense of their experience and the factors contributing to their self-harm using a qualitative phenomenological methodology. Five South Asian women, representing a non-clinical sample, were interviewed and their accounts were analysed using Interpretative Phenomenological Analysis (IPA: Smith, 2008). Four master themes, highlighting the women’s experiences of self-harm, their understanding of the contributory factors, and their opinion of support services, emerged. In line with previous research, the study found self-harm to be a method of emotional regulation and a logical response to the distress these women faced in their lives. However, new meanings and understandings specific to South Asian women were also discovered. For instance, self-harm was perceived by these women as a friend; in other words, as a means of compensating for the loss of a visible companion in their lives. Self-harm’s covert style was acknowledged as a significant means of surviving within the context of South Asian culture. Most pertinent and embedded in the study’s findings was the concept of Family honour, otherwise understood as the South Asian cultural code of conduct and law of ‘Izzat’. The concept was recognised as a subtle yet pertinent and underlying influence behind why the women chose to self-harm. These findings have not been produced by previous research, bringing forth novelty to the field. Furthermore, self-harm was experienced as a double-edged sword; this was considered to maintain and perhaps explain the increased rate of suicide following self-harm in this population. Participants’ experiences and opinions of support services were also taken into account. Their suggestions and experience helped the study inform clinical practitioners working with South Asian women to approach interventions differently. Limitations to the study and recommendations for future research have also been outlined.

Epilepsy affects over 450,000 people in the UK and there are over 50 epilepsy phenotypes; genetic generalised epilepsy (GGE) account for up to 30% of seizure types. It is established that GGE and other neurological disorders are, in some cases, caused by channelopathies within post-synaptic inhibitory neurotransmitter systems such as GAB A (epilepsy) and Glycine (hyperekplexia). GAB A is the primary inhibitory neurotransmitter in the brain and is synthesised from glutamate by GAD65 and 67, and is released from the pre-synaptic nerve terminal into the synaptic cleft, where it binds to post-synaptic GABA receptors and initiate neuroinhibition. This inhibition is removed by post-synaptic GABA transporters (GAT1 and GAT3) that uptake GABA back into the cell for re-packaging in presynaptic vesicles or breakdown by transamination. Abnormalities in this system have been linked to diseases including anxiety, psychosis, Parkinsons’s Disease and epilepsy. GABAergic animal models have demonstrated a tendency to seizure, including GABA transporter and enzyme models in relation to epilepsy. Given the above, the aim of this study was to identify GGE causing variants in four GABAergic genes. GGE patient samples (n=101) were recruited from 3 global centres and screened for variations in GAT1, GAT3, GAD65, GAD67 using high-throughput LightScanner analysis and bi-directional Sanger sequencing. Control population studies («=480) were carried out and analysis of online databases to determine the frequency of variants. Twenty novel or very rare variants were identified in 48 patient samples representing a detection rate of 6.8%, where a clustering of phenotypes included a predisposition towards absence seizures. The biological consequences of these variants were predicted using three online predictive programmes, multiple phylogenetic alignments and 3D structural modelling. Mutation expression constructs were prepared and expression levels were validated by immunocytochemistry. Functional characterisation of these variants will hopefully improve genetic diagnosis in GGE and determine causality of GABAergic absence seizures.

This thesis is organised around three chapters. Each examine patterns of cognition that can lead some people toward or away from the various stages of suicidality; thoughts, plans or attempts to die. Chapter 1 presents a systematic review of the literature, examining the relationship between optimism and suicidal ideations. The emerging evidence-base suggests the existence of a weak to moderate negative relationship; as levels of optimism increase, so the strength of suicidal thoughts are weakened. The studies reviewed also indicate that the utility of optimism is more evident in terms of its moderating or mediating effect on other prominent variables such as hopelessness and life-stressors. The clinical significance of these findings are discussed and suggestions for future research considered. Chapter 2 details an empirical investigation of Rudd’s Suicidal Belief System (SBS) and its role, alongside other psycho-social factors, in formulating a risk prediction model of suicidality. The study adopted a cross-sectional design, employing a range of psychometrically valid self-report measures. The sample population consisted of 114 participants, representing a control group: ‘Nevers’; and three different levels of suicidality: ‘Thinkers’; ‘Planners’; ‘Attempters’. Principal Axis Factoring confirmed the existence of Rudd’s underlying SBS. That is, a pattern of cognitions characterised by a pervasive sense of hopelessness; that life was ‘unbearable’, problems were ‘unsolvable’, and the suicidal person was ‘unlovable’. Analysis of Variance suggested that the intensity of these cognitions were strongly differentiated by depression severity, though the causal nature of the relationship between cognitive and affective states was difficult to determine. Binary Logistic Regression helped formulate a tentative risk prediction model of suicidality, organised around the traits of hopelessness, low resilience, and neurotic personality-type. Clinical implications of the findings are discussed, alongside suggestions for future research on patterns of suicidality and cognition. Chapter 3 recounts my reflections on the research process and its influence on my personal and professional development. This discussion is framed around Beck’s cognitive triad; reflections linked with my ‘self’, the world in which I live and work, and my future-outlook.

The thesis explores developments in the treatment of eating disorders (EDs) and the experiences of men living with an ED. The first chapter is a systematic review of a transdiagnostic cognitive behavioural model of treatment for EDs (CBT–E). Following database searches 15 studies were included for review. Results highlight that CBT-E appears to be an effective treatment option, with an indication that results transfer to clinical settings. Strengths and limitations of the included studies are discussed and implications for practice are considered. Areas for further study are recommended. The second chapter is a qualitative study investigating men’s experiences of developing and living with an ED. Interpretative Phenomenological Analysis (IPA) was employed to facilitate an in-depth exploration into participants’ experiences. The ED taking control; the ED consuming their life; the conflict between letting go and holding onto the ED; and questioning of masculine identity were themes which emerged from participants lived experiences. Implications for clinical practice and directions for future research are highlighted. The third chapter presents a reflective account of undertaking the research project. Parallels between the experiences of participants and the researchers own experiences as a man are considered.

This thesis consists of three papers: a literature review, an empirical paper and a reflective paper. The systematic literature review examines the role of dissociation within eating disorders. Thirty-four articles meeting the inclusion criteria were identified through database searches and manual searches. The findings of these articles were reviewed and critically appraised. The evidence reviewed indicates that dissociation in people with an eating disorder diagnosis may have a number of roles. Individuals with an eating disorder diagnosis may use dissociation as a means of managing certain affective states and dissociation may also act as a means of separating oneself from eating disorder symptomatology. In addition, dissociation may play a role in the development of eating disorders in individuals who have also experienced trauma. Methodological limitations, clinical implications and future research recommendations are considered. There is a need for staff in eating disorder services to be aware of dissociation and to use or develop interventions which take this into consideration. Further research, using a wider variety of methodologies, is needed, in particular to further elucidate the relationship of dissociation to eating disorder symptomatology. The empirical paper is a qualitative exploration of the lived experience of dissociation in individuals with a diagnosis of psychotic disorders. Five participants were interviewed using semi-structured interviews. The transcripts of interviews were analysed using Interpretative Phenomenological Analysis. One super-ordinate theme emerged from the analysis. ‘Emotional impact of unsafe uncertainty’ describes the emotions evoked by dissociative experiences and the uncertainty that surrounds exploration of these experiences for participants. Themes are discussed and considered in relation to clinical implications. Further research is needed to more carefully consider the role of dissociation within psychotic disorders. Finally, the reflective paper discusses the author’s experience of the process of research and exploring experiences of dissociation in individuals with a diagnosis of psychotic disorders. This paper utilises an Acceptance and Commitment Therapy approach to support personal reflection and reflexivity.

This thesis consists of three chapters: a literature review, an empirical and a reflective paper. The literature review and empirical papers investigate adult social attachment dimensions in specific samples (those with high levels of ‘borderline’ traits, and professionals who work alongside these individuals). The literature review paper aimed to investigate the relationship between a specific operationalised definition of attachment (adult attachment dimensions) and ‘borderline’ traits. A quantitative analysis of the effect sizes between the variables as well as a narrative synthesis which considers inter-related variables were conducted. Both attachment dimensions were significantly related to ‘borderline’ traits, with ‘attachment anxiety’ having a stronger relationship. The results are considered alongside other intra- and interpersonal variables presented in the literature. A descriptive model of the literature is provided and the review, as well as the literature, is critiqued, with future research, clinical and policy directions suggested. The empirical paper investigated the effect of clinician attachment dimensions and their levels of ‘burnout’ on their endorsed response to a vignette of a client in crisis. The study employed a questionnaire survey design to measure attachment dimensions and ‘burnout’ constructs. Bivariate, point-biserial and partial correlations were used to test models where ‘burnout’ constructs mediated the relationship between attachment and endorsed ‘response urgency’ to the vignette. Greater levels of urgency among staff with high ‘attachment anxiety’ were suppressed by greater levels of ‘depersonalisation’. The findings are discussed in the context of previous healthcare and childcare research and the limitations of the research design. Recommendations for clinicians, policy makers and researchers are suggested. The reflective paper uses a repertory grid technique to explore the way I construe the role of researcher in clinical psychology. The grid was administered at two time-points and changes through the thesis research process are discussed with reference to my values and epistemological position.