Text in Afrikaans / Die doel van hierdie studie was om die aard van betekenisgewing in die identiteitsvestiging van adolessente met probleme, veral ten opsigte van die realiteit en by die aanleer van sekere lewensvaardighede, te ondersoek. Die ondersoek bestaan uit 'n literatuurstudie sowel as 'n eie empiriese ondersoek. Die betekenisgewingsfenomeen is vanuit 'n empiries-pedagogiese perspektief ondersoek, veral met die implikasies daarvan vir identiteitsvestiging. Die adolessent met probleme is geneig om op 'n onrealistiese wyse betekenisse aan sy verskillende relasies toe te ken. In kort bestaan die probleem daarin dat die adolessent met probleme nie oor die vermoe beskik om die eie 'self' objektief waar te neem nie. Die adolessent se gebrekkige insig en begrip van die realiteit lei dikwels tot irrasionele of onlogiese betekenisgewing. Irrasionele denkwyses veroorsaak by sommige adolessente gevoelens soos angs, vrees, emosionele opwelling, selfverwyt, minderwaardigheid en rigiditeit. Hierdie emosionele probleme manifesteer in 'n identiteitskrisis en word sigbaar in die adolessent se gedrag. Adolessente wat irrasionele betekenisse toeken en nie tot realistiese identiteitsvestiging kom nie, leef dikwels hulle probleme uit deur te steel, seksueel losbandige lewens te lei, dwelmmiddels te gebruik en selfs van die huis weg te loop. In die literatuurstudie is verder ook aandag gegee aan die volgende: • Terapievorme wat van toepassing is in die hulpverlening aan adolessente wat irrasionele betekenisse toeken, • Hulpverlening in groepsverband en • Kommunikasie in groephulpverleningsgebeure. Die empiriese ondersoek is 'n idiografiese ondersoek wat aan die hand van 'n model, volgens Dryden, wat gestruktureer en aangepas is, uitgevoer is. Die model is gebaseer op rasionele-emotiewe-terapie (RET) soos voorgestaan deur Ellis. Vyf adolessente is in die ondersoek betrek. Aan een adolessent is op individuele basis hulp verleen terwyl die ander vier adolessente groepshulpverlening ontvang het. Dit blyk uit die idiografiese ondersoek dat die model en werkswyse wat toegepas is, wel 'n bydrae kan lewer tot die wysiging van onrealistiese betekenisgewing by adolessente met probleme. Deur die hulpverlening verwerf die adolessent 'n lewensvaardigheid waardeur oorgegaan word tot realistiese betekenisgewing en -identiteitsvestiging. Uit die bevindinge van die ondersoek word enkele aanbevelings met betrekking tot verdere navorsing en praktykvoering gemaak. / The aim of the study was to investigate the nature of meaning attribution by which adolescents with problems establish their identity. The following aspects were focussed on: the reality and acquiring certain life-skills. The investigation comprises a literature study as well as an empirical investigation. An empirical-pedagogic perspective was used to examine the phenomenon of significance attribution and the implications thereof in establishing identity. The adolescent with problems tends to attribute unrealistic meaning to his various relationships. Briefly the problems exist because of the lack of ability to perceive the 'self' objectively. This inadequate perception of the adolescent with problems, causes him to attribute irrational or illogical meaning. The tendency of some adolescents, to attribute irrational meaning, causes feelings of anxiety, fear, emotional ebullition, self-blame, inferiority and rigidity. These emotional problems are manifested in an identity crisis and show in the actions of the adolescent. The adolescents, who attribute unrealistic meaning and who do not arrive at realistic self-definition, often act out their problems by stealing, living promiscuous lives, abusing drugs and absconding from home. In the study of literature the following aspects were also focussed on: • Types of therapy applicable in rendering assistance to the adolescent who attributes unrealistic meaning. • Group therapy. • Communication in group therapy events. The empirical research comprises an idiographic investigation, structured on an adapted form of Dryden's model. The model is based on rational-emotive therapy, (RET) as advocated by Ellis. five adolescents were used in this investigation. Individual therapy was given to one adolescent while the other four adolescents received group therapy. From the idiographic investigation it has become evident that the model and the procedure followed, can make a contribution to the adolescent with problems, in changing his tendency to attribute unrealistic meaning to his relationships. He can make successful use of the model as an acquired life-skill to attribute significant meaning in his efforts to arrive at a realistic self-definition. He is thus able to actualise his defined self. Based on the findings of this investigation certain recommendations, concerning further research, as well as counselling in practice, were proposed. / Psychology of Education / D. Ed. (Empiriese Opvoedkunde)

Young people within the youth justice system experience three times higher rates of mental health problems than the general youth population yet are one of the least likely groups to seek help. Very little theory or research is available within this population to explain these high rates of unmet need. This study aimed to develop a theory about the barriers and facilitators that Youth Offending Team workers experience when supporting young people to access mental health services. Eleven semi-structured interviews were conducted with participants; eight youth offending team workers, two young people and a mental health worker. Interviews were audio-recorded and transcribed verbatim before being analysed using “grounded theory”. This method was chosen to allow the in depth exploration of participants experiences and the development of theory within an under researched area. The results showed that Youth Offending Team workers appeared to play a crucial role in supporting a young person’s help seeking from mental health services. A preliminary model was developed which demonstrated the complex relationships between six identified factors which influenced this role. The study concluded that Youth Offending Team workers would benefit from more support, training and recognition of the key role they play in supporting young people to become ready for a referral to mental health services. Mental health services could be well placed to provide this. Clinical implications are discussed. Further research is needed to develop our understanding of what influenced the help seeking of this vulnerable population.

Culture can often influence how psychological distress is experienced and where help is sought. South Asians are the largest ethnic minority group in the United Kingdom (UK). This paper aimed to explore how second-generation South Asian adolescents make sense of their experiences of psychological distress and the meanings attributed to help-seeking. Semi-structured interviews were carried out with nine second-generation adolescents aged 13-19 years. Interpretative Phenomenological Analysis was employed. Five superordinate themes emerged from the analysis: feeling distressed, negative impact of family and cultural ideals on the self, connectedness to others, perception of help-seeking outside the family and intergenerational differences in help-seeking. The results indicated that help is sought from families when participants perceive they are able to relate to the source of distress. However, when there is a lack of understanding of distress, participants sought this from external sources of help. Professional help-seeking appeared influenced by the interplay between not meeting family ideals, intergenerational differences in understanding of distress and the stigma of seeking help. Clinical and research implications are discussed.

Bakgrund: I Sverige finns ca 35 000 personer diagnostiserade med schizofreni. Att insjukna i schizofreni innebär en livsomvälvande katastrof både för den som insjuknar och de närstående. Av de barn och ungdomar som drabbas av schizofreni får hälften ett livslångt handikapp. Deras föräldrar får ofta svårigheter med att möta sina barns lidande, bekymmer, att förstå deras förändrade livsvärld och den problematik som den psykiska störningen omfattar. Syfte: Denna litteraturstudies syfte var att beskriva föräldrarnas svårigheter hantera den uppkomna situationen och att förstå sina barns förändrade livsvärld och den problematik som den psykiska störningen innebär. Ett vidare syfte har varit att tydliggöra sjuksköterskans vägledande roll i denna process. Metod: En litteraturstudie med kvalitativ ansats som belyser föräldrarnas upplevelser av att ha ett barn med schizofreni. Resultat: Studiens resultat visar fem framträdande teman; Att inte förstå vad som händer med sitt barn, Moraliska och praktiska dilemman, Skuld och skam, Att som förälder sörja förlusten av det barn man en gång känt samt Vilken form av stöd/information söker föräldrarna? Slutsatser: Allvarlig psykisk störning orsakar ett stort lidande både för barnet som diagnostiserats och dess föräldrar. Det är en komplex situation för hela familjen och det ligger ett stort ansvar på vårdaren att vara öppensinnig i kommunikationen med denna patientgrupp och deras närstående för att kunna hjälpa och stödja.

To align the neuropsychological functioning of our adult euthymic patient group with that reported in previous studies on euthymic bipolar disorder (BD), we used a neuropsychological battery that examined sustained attention (Rapid Visual Information Processing Task), verbal memory (California Verbal Learning Task), executive functioning (Intradimensional-Extradimensional Shift Task, Barrett Impulsivity Task, and Framing Task), and emotion responsiveness/regulation (Positive Affect/Negative Affect Scales, Behavioral Inhibition/Behavioral Activation Scale, and Affective Lability/Affective Intensity Scales) in patients versus healthy volunteers (HV). Our results corroborated existing evidence of reduced sustained attention, impaired verbal memory and executive functioning, and abnormal emotional responsiveness and regulation in euthymic BD relative to healthy controls (Chapter 2). To investigate how abnormal development of brain function in BD leads to deficits in decision-making, motor inhibition, and response flexibility, we examined child and adult BD using a novel risky decision-making task, and used cross-sectional (age x diagnosis) functional magnetic resonance (fMRI) designs to examine neural activation associated with motor inhibition and response flexibility in BD relative to HV. During the risky decision-making task, adult euthymic BD patients were no different from healthy controls in their proportion of risky lottery choices over a range of competing lotteries. This matched behavioral performance was associated with similar prefrontal and striatal brain activation between the patient and control groups during response, anticipation, and outcome phases of decision-making (Chapter 3). These results are different from previous studies that have shown increased risk taking during decision-making in euthymic BD. Similarly, young BD patients were no different from age-matched healthy and patient controls in their pattern of decision making during the risky choice task. This was evidenced by a similar number of risky lottery selections over the range of changing expected values between the young BD group and control groups (Chapter 4). Using a cross-sectional, fMRI analytic design during the stop signal task, we found that child and adult BD showed similar behavioral performance to child and adult HV during motor inhibition. However, this matched behavioral performance was associated with abnormal neural activation in patients relative to controls. Specifically, during unsuccessful motor inhibition, there was an age group x diagnosis interaction, with BD youth showing reduced activity in left and right ACC compared to both age-matched HV and adult BD, and adult BD showing increased activation in left ACC compared to healthy adults. During successful motor inhibition there was a main effect of diagnosis, with HV showing greater activity in left VPFC and right NAc compared to BD (Chapter 5). These neuroimaging data support existing laboratory-based evidence of motor inhibition impairments in BD relative to HV, and indicate brain dysregulation during motor control is important to BD pathophysiology. A previous behavioral study showed impaired response flexibility in young BD patients relative to age-matched controls when using the change task. Here, we used the change task during fMRI to examine response flexibility in child and adult BD compared to child and adult HV. We found that patient and control groups showed similar change signal reaction times in response to change cues. However, this matched behavioral performance was associated with abnormal age group x diagnosis activations in brain regions important in signal detection, response conflict, response inhibition, and sustained attention. Specifically, during successful change trials, child BD participants showed frontal, parietal, and temporal hyperactivation relative to healthy children and adult BD, while adult BD showed hypoactivation in these regions relative to healthy adults. These novel fMRI findings during the change task indicate impaired neural activation during response flexibility may be important to the pathophysiology of BD development.

Children and adolescent psychiatric inpatients (n = 25) versus staff (n = 35) milieu perceptions were measured with the Ward Atmosphere Scale (WAS) Form K (Kids). The perceptions were compared with previous data collected in 1981, 1982, and 1984 on the same unit. The 1993 staff and patients continued to perceive the unit as a therapeutic environment despite recent restrictions on length of stay due to health care reform. The views of the staff and patients were found to be divergent but less so than in previous years. Additionally, the more seriously ill a patient was determined to be, the more negatively he or she perceived the environment. Differences in perceptions between day shift versus night shift and administrative versus non-administrative staff were also found and discussed. Staff perceptions versus their ideal conceptions were also investigated and compared with those of the 1984 staff. The 1994 staff was found to more closely approximate their ideals than the 1984 staff.

Background: Orphanhood is a major consequence of the HIV/AIDS epidemic in sub-Saharan Africa. There is little evidence concerning psychological problems for AIDS-orphaned children. This thesis explores the relationship between orphanhood status and mental health. It also examines mediating influences of environmental risk and protective factors, and interactions between factors, on children’s psychological problems. Methods: 1200 isiXhosa-speaking children were interviewed, using standardised questionnaires, in deprived urban settlements of Cape Town. A qualitative stage with 60 AIDS-orphaned children, 42 caregivers and 20 professionals explored participant perceptions of risk and protective factors. A quantitative stage compared 1025 AIDS-orphaned children to control groups of other-orphans and non-orphans. Data were analysed with t-tests, chi-sq, anovas, regression and log-linear analyses. The study took place in collaboration with Cape Town Child Welfare. Results: AIDS-orphaned children reported more depression (p<.001), peer relationship problems (p<.001), post-traumatic stress (p<.001), suicidal ideation (p<.05), delinquency (p<.001) and conduct problems (p<.001) than other-orphans and non-orphans. Anxiety showed no differences. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems. These differences remained when controlling for socio-demographic factors. A number of factors strongly mediated the relationship between AIDS-orphanhood and mental health. These include poverty-related factors (food, education and social security, p<.001). caregiving-related factors (caregiver illness, p<.001, excessive housework p<.001, being a streetchild, p<.001) and AIDS-related stigma (p<.001). Cumulative effects were also found. Food insecurity and AIDS-related stigma interacted to raise likelihood of disorder from 19% to 83%, and orphanhood status and bullying interacted to raise likelihood from 12% to 76%. Conclusions: This thesis shows clear evidence of heightened psychological problems amongst AIDS-orphaned children. It also indicates mediating factors and points to areas of possible intervention. The South African Ministry of Social Development plans to scale up the study to a national survey of AIDS-orphanhood.

Depression in adolescence is a major health problem, associated with poor psychological function and key risk factors both for later illness and suicidal behaviours. The antidepressant fluoxetine is commonly used in this population and it is shown to have a favourable benefit-to-risk profile. However, controversy still exists about the use of antidepressants in young people and there is little research focusing on underlying mechanisms of wanted and unwanted actions in this group. This doctoral thesis aims to investigate, for the first time, the acute effects of fluoxetine on emotional processing, using a combination of behavioural and neuroimaging techniques. The aim is to achieve a greater understanding of the mechanisms underlying fluoxetine use in depressed adolescents, in light of differences seen in their clinical presentation and response to antidepressant drugs. In the first study (Chapter Two), a single dose of fluoxetine was shown to decrease the recognition of anger in a sample of young adult volunteers, an effect not previously seen in acute studies of older participants. This effect may be particularly relevant for the treatment of adolescent depression, in which symptoms of anger and irritability are often prominent. Beyond this, fluoxetine was shown to increase the recognition of positive vs. negative facial information, and also exerted an anxiolytic-like influence, eliminating the emotion-potentiated startle effect. However, no influence was seen in measures of attentional vigilance to threat. In an attempt to overcome methodological limitations of this study, a paradigm was developed that is particularly sensitive to the detection of automatic biases towards threatening information (Chapter Three). Chapter Four describes a neuroimaging study with depressed adolescents, in which a single dose of fluoxetine was found to reduce amygdala activity in response to anger. Early changes in amygdala activity to fear correlated with decreased symptoms of anxiety and depression in the first 7-10 days of treatment. Chapter Five explores the effects of acute fluoxetine in a sample of high trait anger males. This study replicated the finding that fluoxetine acts to increase the recognition of positive information, whilst showing preliminary evidence for a reduction in attentional vigilance to angry faces. Overall, fluoxetine was found to decrease the processing of anger across studies. This effect was seen alongside a broader influence on positive vs. negative information and anxiolytic-like properties. Together, these results indicate that fluoxetine has direct effects on processes that are especially relevant to adolescent depression and suggest a potential cognitive mechanism for the efficacy of this particular antidepressant in adolescent patients.

Att barn blir utsatta för våld är i dagens samhälle inte ovanligt. Våld är ett komplicerat ämne att prata om med barn då barnen behöver lita på den som frågar, inte känna sig trängda och samtidigt åsidosätta sin lojalitet till en nära person för att våga berätta. Syftet med vår studie har varit att utifrån en triangulering, en kombination av kvalitativ och kvantitativ metod, undersöka hur yrkesverksamma inom barn- och ungdomspsykiatrin arbetar i kontakten med barn för att upptäcka om barnet utsätts för våld i hemmet och att uppmärksamma om eventuellt glapp finns mellan riktlinjer och verklighet. Undersökningen gjordes genom en enkät med 23 svarande som redovisas genom en deskriptiv analys av de kvantitativa frågorna samt en innehållsanalys av de kvalitativa frågorna. Resultatet visar att yrkesverksamma inom barn- och ungdomspsykiatrin idag frågar barn om de har utsatts för någon typ av våld när misstanke uppstår snarare än på rutin. Arbetsplatsens riktlinjer är bekanta för de flesta svarande och de vet hur de ska gå vidare om de får reda på att ett barn utsatts för våld. De yrkesverksammas upplevelser kring att fråga skiljer sig mellan olika typerna av våld och det är svårare att närma sig ämnet sexuellt våld än att prata om fysiskt våld. Trots olika svar på våra frågor kring att fråga om det förekommer våld i hemmet finns det ett genomgående tema: Det handlar om att fråga på ett sådant sätt att ingen känner sig trängd eller kränkt. / That children are exposed to violence is nothing unusual in the society of today. Violence is a complicated topic to talk about with children because the child has to trust the person who asks, not feel repressed and also, to tell someone about what has happened means to override their loyalty to a person close to them. The aim of our study has been, through a triangulation, a combination of qualitative and quantitative method, to investigate how the child and adolescent psychiatry work in the contact with children to discover if there is violence in the family, and whether they have knowledge of the workplace guidelines in the subject. The survey was conducted through a questionnaire with 23 respondents reported by a descriptive analysis of the quantitative material and a content analysis of the qualitative. The result shows that professionals in child and adolescent psychiatry today ask children if they have suffered any kind of violence when the suspicion arises rather than routine. Workplace guidelines are familiar to most respondents, and they know how they should proceed if they find out that a child is exposed to violence. The professionals' experiences on the issue differ between different types of violence and it is difficult to approach the topic of sexual violence than it is to talk about physical violence. Despite the various answers to our questions around the topic to ask if there is violence in the family, there is a consistent theme: It's all about to question in such a way that no one feels cornered or offended.

<p>Diagnosen Asperger syndrom är ett relativt nytt begrepp inom autismspektrumet. För bara 20 år sedan var syndromet relativt okänt världen över. År 1988 hölls den första internationella kongressen i London och där presenterades de första diagnoskriterierna av makarna Gillberg. Efter kongressen har ytterliggare tre kriterier uppkommit. Vi vill undersöka hur elever med Asperger syndrom uppfattar sin skolgång. Vi vill även undersöka hur lärare och föräldrar till barn med diagnosen upplever barnets skolsituation. </p><p>Vi har utfört en kvalitativ studie, där vi med hjälp av sju ungdomar med diagnosen Asperger syndrom, fyra lärare som arbetar med barn i behov av särskilt stöd och två föräldrar som har barn med diagnosen Asperger syndrom. Resultatet av intervjuerna visar att eleverna är väl medvetna om vad som krävs av skola och lärarna för att de ska känna delaktighet i undervisningen. Vår studie visar att regelbunden kontakt med hemmet är mycket viktigt för både barnet, föräldern och läraren. Denna studie ger tänkvärd information för pedagoger och föräldrar som antingen arbetar eller kommer i kontakt med barn med diagnosen Asperger syndrom.</p>