This thesis focuses on early parenting interventions that aim to promote secure parent-child attachment relationships. Part 1 is a literature review that critically evaluates the evidence for the effectiveness of early parenting interventions in improving the maternal sensitivity of mothers with clinical problems. Twelve studies met the criteria for inclusion; the methodological quality of the studies was high. Mixed evidence was found for the effectiveness of these interventions on maternal sensitivity, particularly in depressed mothers. Further research examining the long-term impact of these interventions on maternal sensitivity in clinical populations and their effectiveness with different types of psychological difficulties is needed. Part 2 is a qualitative study exploring parents’ experiences of engagement and change in Minding the Baby (MTB), a parenting programme aimed at facilitating improvements in the reflective functioning of disadvantaged mothers. The study is part of a larger UK pilot study of the MTB programme and it was conducted in collaboration with another UCL Clinical Psychology Doctorate student (Grayton, 2014). In the study, semi-structured interviews were conducted with 16 mothers and three fathers currently participating in MTB. Parents described changes in their parenting skills, their confidence and their wellbeing. They valued the flexible, individualised and collaborative nature of the programme and the strong therapeutic relationships they had with their MTB practitioners. The findings suggest that tailoring parenting programmes to meet the specific needs of parents experiencing social adversity is particularly important in facilitating their engagement and change. Part 3 reflects on challenges in designing and conducting the qualitative study, and the ways in which these were addressed.

Part I of this thesis comprises a review paper which will contextualise the empirical paper that forms Part II of the thesis. Section A of the literature review offers the reader an introduction to the often-misunderstood phenomenon of malingering. Although avoided by psychologists perhaps due to its seeming incompatibility with the establishment of a therapeutic alliance (Rogers, 1997), the case for the importance of research into improving malingering detection methods is presented. The reader is then orientated to the contemporary understanding of malingering as an elected means of adaptation to circumstance, and this adaptational perspective is used to elaborate on what and how individuals might malinger. Whilst thinking about malingering might be interesting of itself, the aim of any malingering research must be to improve upon the accuracy of classification and detection methods. Section B of the review paper provides the reader with a summary of the development of methodologies and strategies used in the clinical assessment of malingering. This is presented with reference to the theoretical account of the malingering construct elucidated in Section A. Detection methods used in malingered mental illness and malingered cognitive impairment are presented independently, and the distinct domains in which these assessments tend to focus is emphasised. Specifically, individuals suspected of malingering mental illness are assessed predominantly in the psychiatric (not cognitive) domain, and although corroborative evidence of malingering on cognitive tests is routinely sought in order to augment classification accuracy, no cognitive tests have been developed specifically to assess malingered mental illness. This constitutes a gap in the research literature since feigning on tests of cognition among persons malingering mental illness has been repeatedly evidenced (e.g. Boone et al., 2002). Advances in the literature on malingered cognitive impairment (in the context of traumatic brain-injury) are presented and considered then, in the context of developing bespoke cognitive instruments for the assessment of malingered cognitive symptoms in the context of mental illness. Part II of this thesis constitutes the empirical study that was designed and executed in the aim of investigating the utility and validity of a test battery designed to assess malingered cognitive symptoms in severe mental illness. A three-group "fully controlled" simulation study is described, in which psychiatric inpatients, simulating malingerers and healthy controls (total n = 105), were administered a multi-method malingered cognitive symptoms test battery, comprising interview- and performance-based tasks. Established malingering tests were also administered in order that simulated malingering could be externally validated, and also so that classification according to the cognitive battery, could be compared with that according to 'gold standard' instruments. Tests of true ability and pathology were administered in order to explore the potential confound of true mental illness with malingering measures, and also so that the true symptom status of simulating malingerers could be quantified. Results demonstrate a high degree of precision of discrimination between simulating malingerers and their genuine counterparts on the basis of composite scores on the cognitive symptoms battery. Results also show that composite scores on the cognitive symptoms battery are not correlated with true pathology in genuine patients, estimated IQ and level of educational attainment. Part in of this thesis constitutes the critical review section in which qualitative information pertaining to the execution processes of the study is discussed. This information pertains mainly to the engagement of acutely mentally ill patients in this research, and also includes personal reflections on conducting a study entailing simulation.

Schizotypy is a personality dimension that maps on to symptom clusters found in schizophrenia. Schizotypy can help in investigating underlying cognitive processes that may be present in schizophrenia or that may indicate a greater vulnerability to schizophrenia. A current theory regarding the underlying information processing in schizophrenia is the context deficit hypothesis (e.g. Hemsley, 2005). Waters et al., (2004) found a difference in context memory between patients with schizophrenia and controls. This study employed an experimental design to investigate the role of context in memory. It compared 38 high scorers (one standard deviation above the mean) and 30 controls (mean and below) using the Schizotypal Personality Scale (Claridge and Broks, 1984) on a modified version of the Waters et al., (2004) task. The task was modified to raise the level of difficulty for the normal population. It also included self-report measures for possible confounding factors such as executive function (Hayling Burgess & Shallice, 1996), mood (HADS Zigmond & Snaith, 1983) dissociation and trauma history (Holmes & Steel, 2004). It was hypothesised that people with higher levels of schizotypy would score lower when integrating information in the memory task however, this was not supported by the results. Nor were there any significant relationships found between the possible confounding factors and the memory task. Several reasons for the lack of significant findings were discussed.

Background: Dementia in older adults with Down’s syndrome is common. People with Down’s syndrome often have specific cognitive deficits, affecting prefrontal, hippocampal and cerebellar regions. A cognitive assessment battery has been developed (called the Arizona Cognitive Test Battery, ACTB), which assesses cognitive function in these areas. These tests have not yet been validated in older adults with Down’s syndrome. Methods: This study aimed to assess the use of the ACTB in older adults with Down’s syndrome and establish its validity in testing for dementia. Participants with Down’s syndrome aged 45 and over were assessed. Participants took part in a 2-3 hour assessment which included tests on a touchscreen computer tablet as well as standard table-top tests. Results: 50 participants with Down’s syndrome were recruited. Of these, 19 had a diagnosis of dementia or possible dementia. Most participants were able to attempt most of the tasks, although some tasks had a large number of participants at floor. There were significant differences between the dementia and no dementia groups on CANTAB Simple Reaction Time, Verbal Fluency and Object Memory tasks. Conclusions: In general, most of the tasks in the ACTB can be used in older adults with Down’s syndrome and have mild to moderate concurrent validity when compared to tabletop tests and carer ratings, although this varies on a test by test basis. Although the ACTB can be used in older adults with Down’s syndrome, it has not been shown to clearly detect differences between people with Down’s syndrome who have early stage dementia and those who do not have dementia. Suggestions are made regarding which of the tests assessed in this study are most useful when assessing cognitive skills in older people with Down’s syndrome. It is hoped that this research will help in the development of appropriate cognitive tests for older adults with Down’s syndrome.

Family based linkage studies have confirmed that part of chromosome lq23.3 contains a susceptibility gene for schizophrenia. This region was investigated by tests of allelic and haplotypic association in order to fine map a specific gene in the lq23.3 region. Previously published studies claimed that the genes RGS4 and CAPON on lq23.3 were associated with schizophrenia. For this research thesis multiple markers were genotyped at the RGS4 and CAPON loci in a London based case control sample, no evidence for association was found. Therefore further fine mapping was carried out in the region between the RGS4 and CAPON genes. Allelic and haplotypic associations with schizophrenia were found with three microsatellite and four SNP markers within the serine threonine kinase (UHMK1) gene. A replication study using an Aberdeen based case control sample also found statistically significant evidence of allelic and haplotypic association between TJHMK1 and schizophrenia. Re-sequencing of the UHMK1 gene was carried out in those individuals who had inherited alleles and haplotypes associated with schizophrenia. Three genetic variants were found. Genotyping of the whole case control sample showed that these changes were not associated with schizophrenia. The previously reported associations between schizophrenia and RGS4 as well as CAPON could possibly be explained by linkage disequilibrium between UHMK1 and both CAPON and RGS4. Alternatively there could be two or even three susceptibility genes within the 700 Kb region. At present no potential aetiological base pair changes have been detected in any of the three genes. UHMK1 is known to be highly expressed in regions of the brain implicated in schizophrenia and was found to be significantly down regulated in mice treated with the antipsychotic drug Clozapine. Further confirmation of the involvement of this gene in schizophrenia is needed followed by further efforts to detect genetic variation in or next to the gene which has an effect on expression and function of UHMK1.

The hypothesis that empathy inhibits aggression and therefore that a deficit in empathy may underlie aggressive behaviour (Feshbach, 1978) was investigated in this review. Twenty empirical papers examining the association between empathy and aggression in children and adolescents were reviewed. The studies revealed inconsistent results, particularly in relation to children. Amongst the studies of adolescent samples, there tended to emerge a significant negative association between empathy and aggression. More recent studies, and studies employing measures of situational empathy, yielded the most consistent evidence for a negative association between empathy and aggression. Gender differences were rarely reported, but one recent study offered some tentative support for the notion of a differential association between empathy and certain forms of aggression in girls compared with boys. Clinical implications and directions for future research are discussed in light of the results of this review.

Aims: The use of emotion regulation strategies can reduce the intensity of negative experiences; event related potentials (ERP) specifically the late positive potential (LPP) is known to be sensitive to this reduction in adults. It is argued that individual differences play an important role in one‘s ability to regulate emotions. The current study aimed to explore neural correlates of emotion regulation in adolescents. The study aimed to replicate previous findings from studies on adult populations, to show that emotion regulation is associated with changes in the amplitude of the late positive potential (LPP) in adolescents. It also aimed to examine neural changes associated with emotion regulation as a function of age and explore age-related differences in the scalp localisation of emotion regulation in adolescents. The study also aimed to explore whether individual differences, specifically the quality of internal representations of relationships, can predict neural activity associated with emotion regulation. Method: Event related potentials (ERP) of 53 adolescents (12 to 17 years old) performing an emotion regulation task were recorded. The social cognition and object relations scale (SCORS; Westen, 1995) was utilised in a narrative interview to obtain data about the quality of mental representations of relationships. Results: The study confirmed that the use of emotion regulation modulated the LPP in adolescence early in the emotion generation process. A relationship between the changes in the LPP and the age of the participants has been established, indicating that emotion regulation became more effortless with age. The study found that the quality of mental representations of relationships was able to significantly predict LPP amplitude related to emotion regulation. Conclusions: The findings suggest that emotion regulation becomes more effortless with age, and that internal representations of relationships are closely implicated in the ability to regulate emotions.

This thesis comprises three parts. Part one is an overview and critique of the literature examining whether adolescent inpatient units are beneficial for young people. Part two presents the qualitative empirical paper, which explores young people's experiences of relationships with staff and peers on adolescent units. Finally, part three of the thesis will be presented and consists of a critical appraisal and reflection of the research process. This will involve discussing the challenges and dilemmas which arose when designing, conducting and writing up the research.

Background: There have been few longitudinal studies investigating the impact of coping on psychological morbidity in caregivers of people with dementia (CG), and those have conflicting or unreplicated findings. About a quarter of caregivers of people with dementia (CG) experience clinically significant anxiety, but anxiety is relatively neglected in this group.;Main Hypothesis: The relationship between burden at baseline (T1) and anxiety a year later will be mediated by more dysfunctional coping strategies, and less emotion-focussed and problem-focussed coping strategies at T1.;Methods: 126 people with Alzheimer's disease and their family carers were recruited, of whom 93(73.8%) were re-interviewed a year later. Sampling was designed to ensure that the participants were representative of people living in the UK with Alzheimer's disease in terms of dementia severity, gender and care setting. I used the Hospital Anxiety and Depression Scale to measure carer anxiety, and the Brief COPE to measure coping strategies, to explore our hypothesis that the relationship between carer burden and anxiety and depression is mediated by coping style.;Results: Using relatively fewer emotion-focussed strategies and more problem-focussed strategies mediated the relationship between caregiver burden and anxiety a year later, after controlling for potential confounders. Using fewer emotion focussed strategies also predicted higher psychological morbidity in general. More use of dysfunctional coping strategies mediated this relationship cross-sectionally but not on longitudinal analysis.;Conclusion: Carers who used more emotion-focussed coping strategies in response to carer burden were protected from having higher anxiety levels a year later, while those using problem-focussed strategies were not. Most current psychological interventions are based on problem-solving coping strategies, but our results suggest that a psychological intervention package to encourage emotion-focussed coping may be a rational approach to reduce anxiety in dementia carers. Studies are needed to test such interventions.

Heightened self-focused attention (SFA), a tendency to direct awareness to internal, self-referent information, has been implicated in a number of psychological disorders. This review concentrates on the theoretical and empirical validity of attempts to extend normative models of SFA (e.g. Duval & Wicklund, 1972 Carver & Scheier, 1978) to account for anxious states and anxiety disorders. It will be argued that existing models are too non-specific, with similar accounts having been put forward across different disorders, reducing the explanatory power of the framework. Therefore two novel distinctions will be put forward to attempt to meaningfully fractionate SFA. First, self-awareness may be directed to different parts of internal experience, in particular to body-state information or mental-state information, and therefore potentially maintain psychopathology in different ways. Second, a distinction can be made between the habitual tendency to engage SFA (or degree) and the precision with which this mechanism operates (or accuracy). Ways to validate these distinctions will be proposed and how such a model could potentially differentiate anxiety disorders from other forms of psychopathology considered.