To date, no research has explored the relationship between UK school experience and self-identity for young people with Autism Spectrum Disorder (ASD). Within this study, it is argued that identity is an adaptive process that utilises experience of the sociocultural context to generate a 'self'. Reviewed literature additionally suggests that school may be an important domain of identity development. Using a Narrative Orientated Inquiry (NOI) methodology, this research examines identity constructs within school experience narratives produced by young people who have a diagnosis of ASD. Participants were five mainstream secondary school (MSS) students (four males and one female) with a diagnosis of ASD (including Asperger Syndrome), sound expressive language skills and no additional diagnoses. Narrative Interviews (Mishler 1986a, 1986b) were conducted. Three interpretive perspectives, in accordance with NOI, were used to analyse transcripts: Separation of 'fabula' from 'sjuzet' (Hiles and Čermák, 2008); The Holistic-Content interpretive perspective (Lieblich, Tuval-Mashiach and Zilber, 1998); and Critical Narrative Analysis (Emerson and Frosh, 2004). Member checks were carried out. The stories imply that being a young person with ASD at an MSS can be restrictive and disempowering. Findings can be seen to support the proposed theory of identity, suggesting the relationship between school experience and self-identity for young people with a diagnosis of ASD may be an adaptive one, where school experience is the material subject to the process of identity. Findings appear to show that school experience may hinder, through restrictive systems and structures, or help the development of self-identity for young people with ASD. Where young people with ASD can experience free choice and receive support, not least through school staff empathy and understanding, findings suggest they may be aided in developing self-identity. Peer friendships may also potentially afford the opportunity for young people with ASD to learn about themselves, although further research is required in this area.

The ability to take another person’s perspective is highly important for social interaction. People with autism have particular difficulty with taking someone else’s point of view. This thesis aimed to examine whether people with autism are impaired at visual perspective taking and the processes which underlie this ability and how this could impact on social interaction. Chapter two examined body representation in children with autism and results showed no significant difference between these and the control groups in regards to performance. Chapter three investigated mental rotation and egocentric spatial transformations in adults with autism compared to typically developing (TD) adults. Results showed that participants with autism were slower but equally accurate in the mental rotation task and slower and less accurate in the egocentric task. Comparisons across tasks suggested that the participants with autism may have general differences in perception compared to typical people. The experiments in Chapter 4 examined level 2 visual perspective taking (VPT2) and the processes which underlie this ability in TD children. The results showed that in typical children VPT2 is driven by the ability to represent bodies from different points of view. Chapter five examined whether children with autism were impaired at VPT2 and whether the same processes predicted this ability in children with and without autism. Results showed that VPT2 in children with autism is predicted by mental rotation ability and not body representation. In the final experiment, level 1 VPT was examined in children with autism. Whilst previous studies have suggested that this ability may be intact in autism, the results of this chapter suggested otherwise. Overall it was found that people with autism have problems in perspective taking which could impact on their social skills.

This research examined relationships and positive growth in families of children who have a developmental disability. Chapter one is a critical review of the literature relating to positive growth in parents of children who have a developmental disability. Past studies have indicated that having a child with a developmental disability can be both stressful for parents and place increased pressures on their time, energy and resources. However, this review of more recent research about the experience of having a child with a developmental disability highlights the range of positive growth experiences parents undergo and some of the possible processes involved. Positive growth experiences reported included changes in parental perceptions of their growth, changes in belief systems, increased sense of coherence and increased hope. Resilience, reframing coping strategies, meaning-making and social support were all implicated in this positive growth process. Clinically, the value of strengths-based services for families emerged. Chapter two is an empirical study, focusing on the maternal experience of a family based Lego Therapy intervention amongst five families who have a child who is on the autism spectrum. Qualitative analysis of interview data resulted in themes of family specific factors (communication, new perspectives, deeper relationships), child-specific factors (impact of the child's ASD, child-specific developments) and intervention-specific factors (ambivalence about the intervention, time). Methodological· and clinical implications are discussed, alongside recommendations for future research. Chapter three is a reflective paper focusing on the individual differences to emerge amongst families and the clinical and methodological implications of this.

The possibility that seeing aggression on television and in video games might cause aggression in children is a public health concern. A systematic review found insufficient, contradictory and methodologically flawed evidence regarding this association in children with behavioural and emotional difficulties. It indicated the complexity of the subject, along with numerous gaps in knowledge. There are few studies based in clinical settings. This thesis reports a mixed methods pilot study that explored possible associations between aggression seen on television and in video games and reported aggression in children attending specialist outpatient Child and Adolescent Mental Health Services (CAMHS). Forty-seven children aged 7-11 years with behavioural and emotional difficulties, attending CAMHS, and their carers participated in a survey. Twenty children were purposively selected; they and a parent/carer participated in semi-structured interviews, which were analysed using the Framework Analysis Approach. Quantitative findings indicate that children exhibit various types of aggression, of varying frequency and severity. Qualitative findings reveal that children see aggression in multiple real and virtual settings. Children do not think their own behaviour is influenced by seeing aggression. Carers regard aggression as the result of a combination of inner and environmental factors, amongst which seeing aggression in real life has more impact than television/video games. Verbal aggression is often seen in real and virtual settings, frequently exhibited and strongly associated with poor peer relationships and low prosocial behaviour. There is currently no definitive proof of any association between seeing aggression on television and in video games and exhibited aggression in such children. This thesis makes suggestions for the undertaking of and methodology for future research, tackling the challenges of researching this field and hard to reach population. Carers, professional organisations and policy makers should consider the role of aggression, particularly verbal, that children see in both real and virtual environments.

Existing research indicates that typically developing children pass through predictable stages of fear development throughout their childhood. Evidence suggests that in general, children with disabilities experience more fears than typically developing children. Children with disabilities share similar stages of fear development compared to typically developing children, but at a delayed rate, with a more protracted course. Children on the autism spectrum experience higher levels of anxiety, compared to other children. Limited fear research in children on the autism spectrum suggests that they exhibit a unique fear profile compared to their peers, however, little is known about why this may be. Chapter 1 reviews published literature on fear development for typically developing children, children with physical and intellectual disabilities, and children on the autism spectrum. Chapter 2 presents an empirical study that investigates the relationship between sensory processing and fear profiles in children on the autism spectrum. The results support the notion that sensory experiences may account for a proportion of the unique fear pattern experienced by children on the autism spectrum. The thesis concludes with a reflective account that reviews the process of conducting internet-mediated research on children on the autism spectrum.

Borderline Personality Disorder (BPD) is a severe and chronic mental health disorder, affecting many areas of functioning including: affect regulation, impulse control, interpersonal relationships and self-image. Causal factors are only partly known due to a scarcity of prospective, longitudinal studies which enable one to delineate the time ordering of antecedents, and allow for tentative causal inferences. This thesis explored the developmental precursors of BPD symptoms at 11 years, using a British cohort sample, with assessments pertaining to the study child from pregnancy to 11 years of age. Three studies were conducted. Firstly, the predictive relationship between exposure to maladaptive parenting and subsequent BPD symptoms was explored within a child population, using a clinically relevant assessment of BPD symptoms. This association has been previously shown in a range of retrospective studies. Secondly, the role of peer victimisation in the development of BPD was considered. This study was designed to extend current aetiological models, which focus on parental rather than peer relationships. It was based on the recognition of a strong interpersonal core in the BPD symptom constellation, and the role of trauma experiences in the development of BPD. Finally, the third study was designed to consider how these two experiential factors (maladaptive parenting and peer victimisation) might magnify a predisposition towards dysregulation, eventually culminating in BPD symptoms. Data was obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC), which studied 6,050 children (43.1% of the total sample population), using questionnaire and interview assessments. Results revealed that, firstly, family adversity during pregnancy and suboptimal parenting, during early to middle childhood was predictive of BPD symptoms at 11 years. Secondly, peer victimisation during early to late childhood was predictive of BPD symptoms at 11 years. There was an especially strong dose response effect for severe, combined or chronic victimisation. Finally, those evincing stable dysregulated trait behaviour from 4 to 8 years were more likely to develop BPD symptoms, and this effect was especially strong for high levels of dysregulation. Consistent with the biosocial developmental model of BPD, the association was fully mediated by psychosocial risk factors (peer victimisation). Those with high levels of dysregulation were more likely to be victimised and, in turn, develop BPD symptoms. Further, the indirect associations were significantly stronger for BPD, compared to psychotic or depression outcomes. The strengths and weaknesses, along with practical and theoretical implications, and future directions are discussed in the final chapter.

Objective: Given the well-established association between epilepsy and sleep disturbance and the evidence suggesting the importance of sleep in memory consolidation, there is reason to investigate the relationship between sleep and rate of forgetting in children with epilepsy. This study aimed to investigate the relationship between sleep and forgetting in children with Genetic Generalised Epilepsy (GGE). Methods: Participants were 19 children with GGE (9-15 years old). Actigraphy, sleep diaries and standardised questionnaires were used to measure sleep over a week long period. Rate of forgetting was measured using neuropsychological tests at the beginning and end of the study week. Spearman’s correlation analysis was used to determine if poorer sleep was associated with poorer initial learning and rate of forgetting in verbal memory recall and recognition. Results: No association was found between sleep efficiency or duration and rate of forgetting. Measures of sleep disturbance were mixed, with sleep onset latency found to be associated with rate of forgetting on the Word Lists test. However, increased wake after sleep onset was associated with decreased rate of forgetting. Conclusions: Whilst there was limited evidence of a relationship between some actigraphic sleep parameters and rate of forgetting for verbal information, the results were mixed and likely biased by the small sample size. There is need for further research with a larger sample to establish the nature of the relationship between sleep and rate of forgetting in children with GGE.

Background: Adolescence is a time of significant psychological readjustment. A number of young people experience the transition to adulthood as challenging, however many are able to adapt without significant difficulties and thus demonstrate resilience. Aim: The aim of this study was to investigate the role of hope and resilience in relation to well-being in late adolescence in a sample of young people aged between 16 and 18 years. Method: A cross-sectional questionnaire design was utilised with a sample of 50 participants aged between 16 and 18 years of age and who were recruited from a college. Participants completed three measures relating to well-being, resilience, and hope. Findings: The results support the hypotheses that hope and resilience are related to well-being. High levels of hope are associated with high levels of well-being and hope is a significant predictor of well-being in young people aged between 16 and 18 years. Implications: Young people may benefit from accessing services that enhance their levels of hope and resilience and emphasise their existing strengths and resources in relation to negotiating the transition to adulthood.

Background: Insulin pumps have the potential to improve glycaemic control and health in childhood type 1 diabetes (T1D) but they require intensive monitoring and their impact on parental quality of life (QoL) is less well understood. Aims: To explore the views of parents who manage their children’s T1D with insulin pumps, with a particular focus on the impact of this method of insulin delivery on parental QoL. Method: A qualitative, cross-sectional study was conducted. Seven parents with a child aged 12 or younger with T1D, who have used the insulin pump, were recruited using purposive, volunteer sampling. Semi structured interviews were carried out and analysed using interpretative phenomenological analysis (IPA). Results: Four super-ordinate themes describe parents’ experiences adjusting to caring for their child using an insulin pump; ‘life before the pump’, ‘transition to the pump’, ‘life on the pump’, and the ‘perceived impact for their child’. Each super-ordinate theme comprised several sub-themes, and a concept that crossed all themes was ‘fluctuating feelings of control’. Conclusions: Parents were generally positive about using the insulin pump to care for their child with T1D, and most wished to continue with this method of insulin delivery. Parents faced challenges at particular times with the pump, but with support regained control over difficult aspects of pump use. Understanding parents’ experiences will assist diabetes teams to implement care practices centred on the needs of the family.

Background The literature suggests that working and long-term memory are impaired in paediatric brain tumour survivors (Robinson Fraley, Pearson, Kuttesch & Compas, 2013; Robinson et al., 2014). Survivors report difficulties remembering information they learned days before, including for school exams. Sleep and psychological problems can affect memory performance and may exacerbate memory difficulties in this population. Aims Assess learning and long-term memory in paediatric brain tumour survivors relative to healthy controls, and explore associations between memory, sleep and mood. Method A learning paradigm was used to teach verbal and visual material to an 80 percent criterion in ten young brain tumour survivors and ten matched healthy controls (sibling, cousin or best friend) aged between 11 and 24. A between-subjects design compared recall between groups at delays of 30 minutes and one week. Sleep quality (measured by Actigraphy), anxiety and depression were also assessed. Results Verbal learning was significantly impaired in brain tumour survivors relative to controls. There was very tentative evidence of increased visual forgetting in the tumour group, however definitive conclusions could not be drawn from results due to the study lacking power. Some participants had significant impairments in verbal learning or verbal and visual long-term memory, and others did not. Memory was not associated with sleep or psychological variables in the tumour group, although this may be due to the study lacking power. Discussion The variability in memory within the tumour sample emphasises the heterogeneity in the brain tumour population and the need for memory to be monitored in individuals. Education and occupational settings could offer further support to those that require it. Future research should assess memory after delays longer than 30 minutes and further explore how tumour, treatment, sleep and mood variables affect memory.