Many adolescents with type 1 diabetes (T1DM) have suboptimal glycaemic control, increasing the risk of diabetic complications. This thesis explores some of the causes, consequences and therapeutic options for adolescents with T1DM and poor glycaemic control. Insulin resistance occurs in T1DM and normal puberty and contributes to poor glycaemic control. The effect of rosiglitazone, an insulin sensitizer, in addition to insulin on the glycaemic control of adolescents with T1DM was tested using a randomized, double blind placebo controlled trial. Treatment with rosiglitazone did not improve HbA1c, however there was a significant reduction in insulin dose and adiponectin, suggesting improved in insulin sensitivity. Insulin sensitivity by euglycaemic hyperinsulinaemic clamp varied widely between individuals and there was no consistent pattern with rosiglitazone. Potential markers of insulin resistance in T1DM were examined. Total and high molecular weight (HMW) adiponectin levels were lower in children and adolescents with T1DM than controls. HMW adiponectin was significantly associated with other markers of insulin resistance, such as insulin dose, body mass index standard deviation score (BMI-SDS), age, pubertal stage and duration of diabetes. There is increasing evidence that insulin resistance may play a role in T1DM complications. The natural history and risk factors for the development of microalbuminuria was described using a retrospective cohort study of 972 children and adolescents. Most cases of microalbuminuria were transient. Apart from baseline albumin excretion rate, HbA1c and age at diagnosis, other predictors of subsequently developing persistent microalbuminuria included several markers of insulin resistance (higher cholesterol, BMI-SDS, and insulin dose). In addition to insulin resistance, there are many other factors that contribute to glycaemic control. The role of the variability in carbohydrate intake was assessed using questionnaires and food diaries. Although carbohydrate consumption varied by approximately 45grams each day, it had no significant correlation with HbA1c. The impact of socioeconomic status, quality of life and health care delivery is discussed by comparing glycaemic control of children with T1DM in three diabetes centres. A model for the factors associated with poor glycaemic control in adolescents with T1DM is proposed, and the challenges of research and clinical practice in this population are discussed.

This study compared the impact of instructional and improvisational music therapy approaches on the level of motor impulsivity displayed by adolescent boys who have Attention Deficit Hyperactivity Disorder (ADHD). Measures included numbers of errors made on a Synchronised Tapping Task (STT); and Conners' Rating Scales (Conners, 1997). Participants (n=13), aged 11 - 16 years, were enrolled in a special residential school. A combination of a multiple contrasting treatment and an experimental control group design was used. Students were randomised to three groups; control (Group A) and two treatment groups. Students in Group B received eight sessions of improvisational music therapy followed by eight sessions of instructional music therapy, while the order was reversed for Group C.There was no statistical difference between the impacts of the contrasting music therapy approaches on the level of motor impulsivity displayed by the students as measured by the STT and the Restless-Impulsive and Hyperactive-Impulsive Conners' subscales. However all students significantly improved on the STT across each phase of treatment and improvement was slightly greater during the instructional treatment periods for both groups. During these same periods teachers reported a small decrease in restless and impulsive behaviours. The results therefore cautiously imply that the instructional approach might contribute to a reduction in motor impulsivity in the classroom.Significant improvement on STT without the corresponding improvement in motor impulsivity suggested that increased accuracy on the STT might be attributable to progress in other developmental domains. Teacher report of significant improvement for treatment groups on the DSM-IV Total Subscale adds weight to this suggestion, and implies that combined music therapy approaches might have contributed to a reduction in DSM-IV symptomology in the classroom.Rickson's (2001) tentative suggestion that creative music-making might over-arouse students with ADHD was not confirmed. Students did make more errors when tested on the STT a second time on the same day but this was regardless of whether they had been involved in instructional, improvisational or no music therapy programme. It is possible that students who have ADHD are easily aroused by the general school milieu and classroom or music room interactions with peers.

Health-Related Quality of Life (HRQOL) is an important outcomes measure in cancer and there are specific issues depending on the site, stage, treatment and patient age. Although numerous instruments are available for cancer HRQOL, most are designed for adults, some for children, but none for adolescents and young adults (AYA) who have special age-specific concerns and poor improvement in survival compared with other age groups. An existing HRQOL instrument was modified to ensure its suitability for AYA, its validity, reliability and sensitivity were tested in Australians aged 16 to 25 years old diagnosed with cancer or a blood disorder. Varni’s PedsQLTM Measurement Model (13-18 year olds) was selected, modified then administered to families recruited from haematology/oncology clinics and wards at three Sydney Metropolitan Hospitals in person or by telephone. The Memorial Symptom Assessment Scale was used to categorise participants into groups reflecting sensitivity of symptom severity (slight, moderate and severe). The instruments demonstrated excellent internal consistency reliability, making them suitable for both group and individual comparisons. Clinical validity, construct validity, and discriminant validity were demonstrated by “known-groups” analysis, exploratory factor analysis and correlations, respectively. These new versions of the PedsQL Generic Core and Cancer Module are reliable, valid and sensitive measures of HRQOL in patients aged 16-25 years diagnosed with cancer or a blood disorder. The measures will soon be available for use as outcome measures in clinical trials and clinical practice with this age cohort in Australasia and internationally.

Adolescent depression affects up to 24% of adolescents before adulthood and is linked with serious outcomes. However as only 25% of affected adolescents in Australia receive appropriate assistance the prevention of adolescent depression has a high priority. Risk and protective factors exist in the individual, family, school and society, but the connection between these factors is often uncertain. Prevention at the individual level has been found to be successful but despite the importance of family factors there is little research into prevention at the family level. Because of the difficulty in engaging parents in preventive interventions it has been suggested that convenient, flexible delivery interventions may achieve better penetration. This study evaluates in two stages the Resourceful Adolescent Parent Program (RAP-P), a positively-focused family-based intervention for parents which has been developed to fill the need for a universal preventive intervention for adolescent depression. Firstly the study evaluates the theoretical basis for RAP-P by developing and testing models linking the family-based psychosocial risk and protective factors for teenage depression that are addressed by RAP-P, and the family systems factors underpinning these. No previous models linking these variables could be found in the literature. The study then evaluates two formats of RAP-P, one of three facilitated workshops attended by parents; the other a videotaped flexible delivery format for use at home, developed to overcome parents' poor involvement in preventive programs. Participants were 242 adolescents in Year 8 and 361 of their parents, recruited from eleven schools in Brisbane, Australia. Schools were randomly allocated to one of three conditions: workshop intervention, video intervention and control. Adolescents and parents completed measures at pre-test, post-test and 15 month follow-up. Based on the current adolescent depression literature and Bowen Theory, four models were developed, tested using structural equation modeling and confirmed after minor revisions. The first model examined links between adolescents' depression and the family based risk factors of parent-adolescent conflict and adolescents' negative perceptions of their parents' interactions with them, and the protective factor of parental attachment. Other models, based on Bowen Theory, examined the trans-generational transmission of differentiation of self from the adolescents' grandparents (generation 1) to the adolescents' parents (generation 2) and the effects of parents' differentiation and anxiety on the third generation adolescents' perceptions of their mothers, attachment and depression. The second part of the study examined the implementation and efficacy of the two formats of RAP-P. Predictions that the convenience of the flexible delivery format of RAP-P would result in better recruitment and lower attrition than for the workshop format were not supported, with the flexible delivery format encountering poorer recruitment and higher attrition. Predictions that parents' evaluations of both formats would be equally positive were not supported; the flexible delivery format was consistently evaluated less positively than the workshop format. However parents perceived both formats to be of similar benefit to them. Parents in the intervention conditions were predicted to exhibit better differentiation and lower anxiety than those in the control condition, resulting in their adolescents experiencing less intense conflict over fewer issues and appraising their parents more positively, and consequently exhibiting better parental attachment and lower levels of depression. The level of improvement was predicted to be related to the level of parental engagement in the interventions. However parents and adolescents in the intervention conditions did not show any positive effects of the interventions at post-test or follow-up. Parents who were engaged in the interventions and their adolescents similarly did not show any measurable benefits from the intervention. Thus this study has found support through modeling for the theoretical basis for RAP-P. Parents' feedback strongly supported the overall thrust and ethos of RAP-P and particularly of the workshop format, indicating that the intervention targeted the right factors in the right way. However the interventions did not achieve measurable improvements for parents or adolescents within the time frame of the study. With models supporting the appropriateness of the measured variables it appears that the potency of the intervention was insufficient. Finally the study found that the use of a flexible delivery videotape intervention did not achieve its goal of increased participation and was still very costly of resources.

Very little is known about the effects of paediatric traumatic brain injury (TBI) on prospective memory, the memory for future intentions such as remembering to post a letter in the morning or do homework. The main aim of this thesis was to redress that shortcoming in the literature. To investigate the effects of paediatric TBI on prospective memory as reliably and fully as possible, the study of children and adolescents with brain injuries was preceded by a developmental study. Given that the process of recovery from brain injury is imposed on the ongoing process of development, it is important to understand more about the normal developmental trajectory of prospective memory first of all. Study 1 compared the prospective-memory performance of 88 normally developing children, adolescents and young adults. The main task was computerised, and its design was influenced by a prefrontal-lobe model because prospective memory is believed to be mediated by the prefrontal regions of the brain. Variables associated with prefrontal-lobe capacity were manipulated: the cognitive demand of an ongoing task, and the importance of the prospective task. Results of Study 1 found that children remembered to respond to fewer prospective cues than adolescents or adults, but that adolescents and adults remembered similarly. Further, the differences between the children's performance and the adolescents' and adults' widened as the cognitive demand of the ongoing task increased. However, the effects of increasing the cognitive demand did not vary between the adolescents and adults. It made no difference to anyone's performance whether the importance of remembering the prospective cues was stressed or not. On the other hand, performance on executive functions, as measured by the Self-Ordered Pointing Task (SOPT), the Stroop Colour Word Interference Test (Stroop), and the Tower of London (TOL), which are also believed to be affected by prefrontal capacity, produced the same age effects as were produced on the computerised prospective-memory task. Further, performance on the SOPT and Stroop predicted performance on the high-demand level of the prospective-memory task. Study 2 compared 34 children and adolescents with TBI with the non-injured children and adolescents from Study 1 on the same tasks. Results revealed that overall those with TBI had poorer prospective-memory performance than their non-injured peers. However, a different pattern of impairment was evident in the children than in the adolescents. Specifically, the children with TBI performed similarly to their non-injured peers, but the adolescents with TBI were significantly worse than the non-injured adolescents. This trend was most noticeable as the cognitive demand of the ongoing task increased. Further, the age and injury effects were reflected in the performances on the executive-function tests, and the TOL predicted performance on the high-demand, prospective-memory task in those with TBI. Study 3 aimed to examine the ecological validity of Study 2, by investigating whether the impairments in prospective memory in young people with TBI measured quantitatively, were matched with qualitative data. Twelve parents of children and adolescents with mild to severe TBI were interviewed about whether or not their children's injuries impacted on their memory (retrospective and prospective) in everyday life. Results showed that in general most children suffered memory losses as a result of their brain injuries, and that prospective-memory loss caused particular hardships for the children and their families. Taken together, the results of the current research revealed that the development of prospective memory reaches a peak of maturity in adolescence, and that adolescents with TBI show greater decrements in prospective memory than adolescents without TBI, but that this pattern is not evident in children, where those with TBI were not significantly different from those without. These findings give support to the prefrontal-lobe model of prospective memory by showing that prefrontal maturity, which reaches a peak during adolescence, reflects the prospective-memory performance of healthy adolescents, and prefrontal injury, which is very common with TBI, shows the effects of deficits more during adolescence than in earlier years when the prefrontal regions are not yet fully developed. Study 3 showed that impairments in prospective memory that result from TBI translate into disabilities in the real world. As a follow up it is recommended that rehabilitation strategies be designed to assist young people with prospective-memory impairments adjust better to school and the demands of everyday living. The prefrontal-lobe model should guide the design of such strategies.

The investigations described in this thesis were conducted in order to increase the understanding of the relationships between physical activity, aerobic fitness, body composition, asthma, and asthma severity in children and adolescents. This was largely achieved by examining the aforementioned factors in a sizeable population of Melbourne school children and adolescents. However, during the course of the school-based testing, it became apparent that the severe asthmatic category was under-represented, typical of the current literature. Thus, effort was also directed at addressing this knowledge gap by examining a severely asthmatic cohort in a laboratory-based setting. The outcomes generated by these investigations can be summarised as follows: 1) In ‘school-tested’ youth aged 10 to 14 years, prevalence rates of overweight and obesity were 19.1% and 4.0%, respectively. Approximately 16% of participants also suffered from asthma. These rates appear to be representative of similarly aged children and adolescents within Australia. The latter observation also adds weight to the view that asthma prevalence has attenuated in recent years. In addition, overweight and obesity were more prevalent in asthmatics than non-asthmatics, supporting the proposed notion of an asthma-obesity association. 2) Asthmatic and non-asthmatic young people had comparable aerobic fitness and daily physical activity levels and the severity of disease did not influence aerobic fitness nor involvement in physical activity. Males possessed greater aerobic fitness and physical activity levels and had a lower percentage body fat compared to age-matched females, independent of asthma status (i.e. asthmatic or non-asthmatic). 3) There was a significant inverse relationship between aerobic fitness and markers of increased body fat among non-asthmatic children and adolescents, even after corrections to aerobic fitness were made for fat free mass. Differences in daily physical activity could only partially explain this association. In fact, the current findings suggest that decreased levels of daily physical activity are not the cause of the increased overweight/obesity prevalence among this sample, and that physical activity lacks a strong link to paediatric overweight/obesity in this population. These findings were also present in asthmatic youth. 4) Severely asthmatic youth, premedicated with bronchodilator, had aerobic fitness levels comparable to their non-asthmatic and less severe asthmatic peers. This finding indicates that severely asthmatic youngsters should be able to train at work intensities sufficient to bring about improvements in cardio-respiratory fitness without any added functional limitation due to their condition. In addition, a state of well-controlled asthma (as were the severe asthmatics in this study) afforded the participants the ability to engage in similar levels of physical activity as their non-asthmatic or less severe asthmatic peers. In agreement with data from the ‘school-tested’ asthmatics, a significantly greater proportion of severely asthmatic participants were overweight or obese in comparison to their non-asthmatic peers. These findings (i) highlight the association between aerobic fitness and overweight/obesity; (ii) suggested that decreased levels of daily physical activity were not associated with the increased overweight/obesity prevalence in a youth sample within Australia; (iii) emphasize that well-controlled asthmatic young people can undertake levels of physical activity and achieve cardio-respiratory fitness similar to that of their non-asthmatic peers, independent of asthma severity, and; (iv) indicated that asthma is either a risk factor for overweight and obesity or that overweight and obesity may precede asthma.

This study, conducted in a junior high school in Canberra, used naturalistic research methodology and idiographic data analysis. As the results obtained in the study were time and context specific, the object was to reveal the personal factors which affected the nature of the reading experience for individual research participants. The theoretical basis of the research was derived from Louise Rosenblatt's transactional theory and focused on the reading experiences of adolescents with whole class novels. Three research techniques were employed in the exploration of aesthetic reader responses to two whole class novels. The techniques: reading journals, small group discussions and creative written responses to the text were implemented sequentially and revealed different levels and stages of individual and group responses from the 'primary spontaneous' to a considered reflective response. Data was explored through the case study mode of analysis which included information relevant to the individual research participants and the study context. The research explored the integration of the individual's evocation of the text with the individual's awareness of self, text, literature and the wider social context. The research data concluded that the employment of classroom practices which focus on a full, individual transaction with a text promotes the development of critical awareness of and familiarity with the text. This sound understanding of the individual's evocation of the text forms a self-aware and firm basis for the development of active, engaged and critical readers of texts.

Resilience (positive adaptation despite exposure to risk or adversity) is a widely researched construct, yet it has not been examined systematically with Australian Indigenous adolescents despite their high level of risk. Indigenous adolescents experience disproportionate disadvantage and associated poorer health and well-being compared with their non-Indigenous peers. Thus the protective factors or predictors of resilience that ameliorate the negative effects of risk in this subgroup are important to explore. Adolescence is a critical period for examining resilience given the increased vulnerability to mental health problems during this time. Of interest to this thesis are the psychosocial predictors of resilience (protective factors), which act to ameliorate the negative effects of stress. Three widely established protective factors were examined: Coping skills, social support, and multidimensional self-concept. These protective factors were compared in a sample of 304 Australian non-Indigenous (n = 245) and Indigenous (n = 59) adolescents, aged 12-18 years. Using a methodological framework developed for this study resilience was assessed by examining stress (negative stressful life events and daily hassles) and adaptation (internalising, externalising and other mental health symptoms). Participants were classified into four resilience groups based on their stress (high or low) and adaptation (positive or negative): resilient (high stress, positive adaptation), negative expected (high stress, negative adaptation), positive expected (low stress, positive adaptation), or poor copers (low stress, negative adaptation). Results were examined separately for non-Indigenous and Indigenous participants. The two cultural groups were then compared. Results revealed that higher stress was strongly associated with more internalising, externalising and other mental health problems. The impact of daily hassles was a strong predictor of adaptation, particularly for Indigenous participants. Indigenous participants reported higher levels of stress and more negative adaptation than non-Indigenous participants. Three coping methods were examined: Solving the Problem, Reference to Others and Non-Productive coping. Solving the Problem coping was a strong predictor of positive adaptation and resilience for non-Indigenous adolescents but not for Indigenous adolescents. No cultural differences in Solving the Problem coping were revealed. Reference to Others was found to be a maladaptive coping method in relation to resilience. Non-Productive coping (e.g., avoidance and substance use) was also found to be maladaptive, and used more by Indigenous than non-Indigenous participants. Social support only predicted resilience for non-Indigenous participants in conditions of very high stress. Contrary to expectations, social support did not discriminate among the Indigenous resilience groups and no significant cultural differences were revealed. Self-concept was strongly related to resilience and positive adaptation for non-Indigenous participants, although not for Indigenous participants. Cultural comparisons, however, revealed that positive self-concept was associated with positive adaptation for both groups. While differences between non-Indigenous and Indigenous participants on several self-concept domains were revealed, the total self-concept of non-Indigenous and Indigenous participants did not differ. The results of this study revealed both similarities and differences in the relationships between the three predictors investigated and the resilience of non-Indigenous and Indigenous adolescents. The findings make some progress toward informing culturally appropriate interventions to promote and strengthen the resilience of Indigenous young people.

This thesis is comprised of two separate studies, the first of which set out to examine the Intimate Partner Abuse behaviour and attitudes of young Australian students. Intimate Partner Abuse (IPA) may be defined as a pattern of deliberate physical, sexual, or psychological abuse within a married, de-facto, dating, or courting relationship (Miller & Bukva, 2001: Victoria Health Promotion Foundation, 2004). Specifically, Study One aimed to explore the IPA attitudes of Australian students and examine the relationships between these attitudes with a view to provide theoretical guidance for understanding how negative IPA attitudes may be maintained. A total of 400 students (male = 99, female = 301) with ages ranging from 15 to 25 years (M = 19.38, SD = 2.04) participated in Study One. Participants completed the Conflict Tactics Scale - Revised (CTS2; Straus, Hamby, Boney-McCoy, & Surgarman, 1996), which measures the number of times respondents have experienced physic al and psychological abuse over the previous 12-month period. Attitudinal questionnaires were also completed by participants, including a measure of IPA victim blame and endorsement of IPA myths. Overall, rates of IPA among the present sample were consistent with those reported in overseas samples, with over 85% of women reporting being the victim of psychological abuse in the previous 12-months, and over 30% having been the victim of physical abuse. Lower scores on measures of victim blaming attitudes were associated with more positive attitudes towards women and less endorsement of IPA myths. These findings implicate the importance of addressing attitudes towards women and commonly held IPA myths within IPA prevention programs for young people. Study Two evaluated a brief educational program for Australian Technical And Further Education (TAFE) and high school students, which was selected and modified on the basis of a literature review of published program evaluations and the findings of Study One of this thesis. The program, titled Through New Eyes: Exploring the Hidden Dynamics of Domestic Violence (Hunter Women's Centre, 2003), aimed to inform the IPA attitudes of students and comprised of videos and discussion questions. A quasi-experimental pre-post design was used with a non-randomised experimental and control group. The program was evaluated using a questionnaire measure of participants' attitudes as well as their experience of the program. There were 98 students who consented to participate in Study Two, 48 (male = 26, female = 22) of whom fulfilled all the requirements of participation and were included in the results of the study. Participants' ages ranged from 14 to 25 years (M = 16.91, SD = 2.12). Several statistically significant desi rable changes were observed among participants of the program, however there were similar changes observed among control group participants. Study Two provides some support for the effectiveness of the Through New Eyes program in informing the attitudes of young Australians. However, it is recommended that future research evaluate this program in combination with skill building programs in order to assist students to translate attitudinal changes into behavioural ones.

<p>The aim of this thesis is to elucidate different aspects of Swedish adolescents’ use of alcohol and drugs and how society deals with problems related to their use. The subject has been analyzed in four studies. The first study was based on focus-group interviews with adolescents and aimed at elucidating the meaning of alcohol and intoxication for adolescents. The participants’ discussions contained two levels - one superficial (an ideal presentation of themselves) and one deep (which mediated cultural ideas of how to think and act). This is interpreted as a way to express the maturity process they are going through, at the same time as it symbolizes difficulties to unite external norms and values with their own need for devotion. The second study was based on project applications, evaluations and economy accounts for preventive work from 150 projects conducted by non-profit organizations. The results show that type of organizations and the methods used were based on tradition rather than on efficiency. These results are discussed in relation to growing demands for evidence based practice in the field of prevention. The third and the fourth study are based on the ADAD-interview (Adolescent Drug Abuse Diagnosis). In the third study, comparisons of different judgements concerning the extent of drug abuse among adolescents in institutional care, were made and results show large differences between the different judgements, concerning both occurrence and extent of abuse. In the fourth study, the significance of ADAD was discussed in relation to matching drug abusing adolescents to treatment institutions. The results show that only a limited number of institutions specializes on drug abusing adolescents and that a majority of the adolescents institutionalized for drug problems never visit an institution specialized on drug abuse treatment.</p>