The main aim of this thesis was to improve our understanding of the development of early inhibitory emotions and emotion regulation from infancy, and the role of these emotions in early risk pathways. More specifically, this thesis investigated (1) the development of fearful temperament, its stability over the first 3 years of life, and its associations with later developing effortful control (EC) and guilt; (2) risk factors in infancy that predict later externalising psychopathology; and (3) the development of EC, and its associations with fear and guilt. Psychophysiological and observational measures were used, when available, to examine these emotional systems as well as their role in predicting later psychopathology. The thesis consists of 3 empirical chapters, investigating a sample of 70 typically developing children in a longitudinal, prospective manner. Behavioural fear was stable over time, but physiological fear peaked in year 2. Fearful infants continued to be fearful toddlers, and fear in infancy predicted fearfulness 2 years later. Fear and guilt were associated, and we showed for the first time that infant fear is a predictor of later developing guilt. EC increased from year 2 to year 3, showed inter-individual stability across time, and girls’ ability for EC surpassed the ability in boys. EC and guilt were not associated; however, EC and fear were associated in year 3, suggesting that early fear does not regulate later EC. This thesis identified two biomarkers in infancy for later psychopathology. A subgroup of toddlers with internalising problems displayed higher heart rate in infancy, whereas skin conductance arousal in infancy predicted aggressive behaviour in toddlers.

The aim of this study was to explore children's play, looking at developmental domains of play and gender differences in aggressive play. Chapter One reviewed existing literature on types and functions of play. Five developmental domains of play that incorporate types and functions were proposed, namely sensorimotor, cognitive, socio-communicative, imaginative/ creative and emotional. Chapter Two involved an observational study of children's play. An attempt was made to explore the existence and occurrence of the developmental domains that were proposed in Chapter One. Results suggested that the domains exist in this sample of children's play. Children statistically spent the most time in sensorimotor and imaginative/ creative play, compared to the other types of play. No statistical difference was found in gender with respects to time spent playing in the domains. Clinical implications are discussed. Future research is required to create more valid and reliable criteria for the domains and age-related norms. Chapter Three investigated gender differences in the duration of aggressive play. An observational study of children's play was carried out. The duration of time of aggessive play in each child's play was recorded and analysed. Results showed that boys displayed statistically more aggressive play than girls in this sample. Clinical implications are discussed. Chapter Four reviews the previous three chapters, looking at methodological limitations, observations of the research process and personal reflections.

Background: Compared with their term-born peers, school aged children born very preterm (≤32 weeks gestation) are at increased risk of inattention. It remains unclear whether the cognitive and neural mechanisms underlying inattention are the same in both very preterm and term-born children. Aims: The aim of this study was to determine whether the cognitive and neural mechanisms underlying inattention differ between term-born and very preterm children. Chapter 3 explored cognition, while Chapters 4 & 5 explored neural processing in terms of event-related potentials (ERPs) and frequency analysis of functional connectivity respectively, to identify mechanisms underlying inattention. Method: A sample of 65 children born very preterm (≤32 weeks gestation) aged 8-11 years was recruited. A comparison group of 48 term-born peers (≥37 weeks gestation) matched for inattention symptoms using the parent-rated Strengths and Weaknesses of ADHD and Normal behaviour (SWAN) questionnaire was selected for comparison. All children were asked to complete neurocognitive tests to assess basic cognitive processes, executive function and sustained attention. Electroencephalography (EEG) was recorded from a sub-sample of children (very preterm n=43; term-born n=40) while they completed a sustained attention task. The contingent negative variation ERP component and theta and alpha frequency changes following the cue stimulus were derived from the EEG as neural indices of response preparation. Similarly, following the presentation of cued and uncued target stimuli, the P1, P2, and P3 ERP components were derived from the EEG as neural indices of stimulus detection, stimulus categorisation, and evaluation of task-relevance respectively. Results: In both groups, more severe parent-rated inattention on the SWAN was predicted by poorer verbal and visuo-spatial short term memory, visuo-spatial working memory, and greater response time variability, and by smaller amplitude of the P2 ERP to uncued targets at the neural level. In children born very preterm only, slower motor processing speed, and smaller theta increases at the neural level, predicted more severe parent-rated inattention. Similarly, in term-born children only, shorter P2 ERP latencies to all targets predicted more severe parent-rated inattention. Conclusions: In sum, the cognitive and neural mechanisms underlying inattention in term-born and very preterm children were partially overlapping, but some mechanisms were unique to only one group. These results present candidate mechanisms that may be useful for the identification of children at risk for inattention, and as potential targets for intervention.

This study builds on existing research into the efficacy of universal Cognitive Behaviour Therapy (CBT) based programmes in schools in the promotion of Emotional Literacy and more broadly Mental Wellbeing. Previous research in this area has focused on CBT interventions delivered to targeted groups. In this instance, the focus was on CBT based universal, whole class intervention. The specific CBT intervention utilised the ‘Think Good Feel Good: A Cognitive Behaviour Therapy Workbook for Children and Young People’ (TGFG) resource (Stallard, 2002). The researcher was also able to take the opportunity to evaluate the possible additional impact of conducting CBT based interventions in parallel with the Social and Emotional Aspects of Learning (SEAL) programme. Initially, a pilot study was conducted with a single Year 5 child. The purpose of the pilot was to provide a guide as to the effectiveness of the resources to be used, to familiarise the researcher with those tools and principles of the study, and to provide meaningful feedback to aid in the fine tuning of the full research. The main research study was conducted in two schools within the local authority in which the researcher was a practising Trainee Educational Psychologist. Participants consisted of 85 Year 5 pupils (aged between 9 and 10). Measures were recorded before and following intervention using the Southampton Emotional Literacy Resource (SELR) and the Strength and Difficulties Questionnaire (SDQ). Data were collected from teachers, parents and the children. A fixed design was employed, with participants placed in one of three groups:  Experimental group 1 - One class (n=25) received CBT intervention alongside the SEAL programme over a 6 week period. The CBT intervention consisted of two one hour long sessions per week and was delivered by the researcher, with support from the relevant class teachers  Experimental group 2 - A second class (n=31) received only the CBT based intervention, for the same period and delivered in the same manner as with experimental group 1  Control group 3 - A group of 29 Year 5 pupils were also part of the study but received no intervention. Statistical analysis on the non-normally distributed dataset indicated that significant differences were found in some domains for experimental group 2 (CBT) compared to the control group (3). Further analysis indicated that these significant differences were as a result of positive change. Additionally, significant differences were found in some domains for experimental group 1 (SEAL + CBT) when compared with experimental group 2 (CBT alone). Further analysis indicated that these significant differences were as a result of negative change. The researcher suggests that the present study tentatively contributes to the growing evidence base for the potential effectiveness of CBT based interventions delivered within a universal framework regarding the promotion of emotional literacy and mental wellbeing. Findings lend some support for the use of CBT based interventions (i.e. the Think Good Feel Good resource) as part of the standard curriculum for Year 5 pupils, suggesting a possible positive impact on some areas of emotional literacy and more broadly mental wellbeing. Additionally, the study offers potential suggestions for future study along with implications and considerations for educational psychologists when undertaking therapeutic type work with children.

The promotion and development of resilience in children and young people has become increasingly the focus of many preventative and treatment interventions. This is informed by evidence that suggest that a high proportion of mental health difficulties start by adolescence and can have enduring consequences later in life. One of the psychological presentations that cause significant difficulties is personality disorder. Attachment theory has been connected to both resilience and personality disorders, however their interaction has not yet been studied. This thesis aims to bring together these concepts in an attempt to contribute to the evidence of developmental pathways to personality disorders and to resilience. Chapter one presents a systematic review of the association between attachment and personality disorders in children and adolescents. The findings of the review support the literature that has previously documented this association and confirms that attachment theory is a meaningful framework for the understanding of personality disorders in children and young people. Furthermore, it includes additional factors that may interact within this relationship. This has clinical and research implications that are discussed along with the limitations of the review. Chapter two contains an empirical paper that focuses on the interaction of resilience with attachment and personality disorder. Findings from this study support existing evidence that additional factors help explain the relationship between attachment and the development of personality disorders. Thus the empirical paper enhances the findings from the literature review. Chapter three offers an account of the author’s experiences of research, including reflections on personality constructs. It encompasses these reflections within the wider experiences of clinical training to finally consider these topics in the wider context of mental health services.

Objective: The purpose of this study was to develop and test psychometric properties of a Mealtime Interaction Clinical Observation Tool (MICOT) that could be used to facilitate assessment and behavioural intervention in childhood feeding difficulties. Methods: Thematic analysis of four focus groups with feeding and behaviour experts identified the content and structure of the MICOT. Following refinement, inter-rater reliability was tested between three healthcare professionals. Results: Six themes were identified for the MICOT, which utilises a traffic-light system to identify areas of strength and areas for intervention. Despite poor inter-rater reliability, for which a number of reasons are postulated, some correlation between psychologists’ ratings was evident. Healthcare professionals liked the tool and reported that it could have good clinical utility. Conclusion: The study provides a promising first version of a clinical observation tool that facilitates assessment and behavioural intervention in childhood feeding difficulties.

Aggression Replacement Training (ART) is a 10-week, multi-component intervention based in cognitive behaviour therapy (CBT), which aims to improve social competence. It has been applied internationally as part of offender rehabilitation (NOMS, 2010). However, more recent research has focused upon its application in school-based settings. The aim of the current research is to investigate the efficacy of ART when implemented in the UK with an adolescent sample in mainstream school settings. These sessions were facilitated by newly-trained staff from the Educational Psychology Service (EPS). A quasi-experimental design was employed to evaluate this initial pilot of the programme in one Local Authority. 41 participants across six settings were allocated to intervention (N=23) and wait-list control (N=18) conditions. The Social Skills Improvement System-Rating Scales (SSIS-RS), a multi-source measure, was used to assess the group member’s problem behaviours and social skills, with data gathered from teachers, parents and pupils themselves. The Sociomoral Reflection Measure-Short Form (SRM-SF) was also completed by the participants to ascertain their moral reasoning maturity. Non-parametric statistical tests demonstrated no significant improvements in the intervention participant’s social skills or problem behaviours. However, their moral reasoning ability did increase significantly from pre to post-test, achieving a large effect size (r=-0.64), which was not reflected in the data from the control group. In contrast to the quantitative findings, supplementary qualitative data gathered from the facilitators and group members involved in the ART programme demonstrated that all felt the intervention had resulted in positive outcomes for the young people. Factors which may have contributed to the success of the programme were also provided, including organisational support and group composition. Possible explanations for these findings, including methodological considerations and comparison with previous research are discussed and the implications of these findings in future practice and in guiding further research suggested.

Background: Caring for a child with a chronic health condition is often associated with high levels of anxiety, depression and stress (Burton et al., 2003). Demanding caring duties, a lack of time and social isolation create barriers for carers accessing mental health support. The internet may be useful way for carers to access psychological supports but to date no research has explored this. Aims: To identify common difficulties which carers face and adapt a pre-existing computerised CBT (cCBT) based course to reduce carer stress. To determine the feasibility of providing mental health support to carers through an online course and assess its potential effectiveness and accessibility. Methods: Focus groups and questionnaires completed by hospice staff provided information regarding common stressors encountered by carers. Thematic analysis (Braun and Clarke, 2006) was used to identify topics which were then used to adapt a pre-existing cCBT course which consisted of 6 primary modules and additional online materials/modules plus the offer of weekly email support for 6 weeks from a support worker to encourage use. A single arm feasibility trial of the tailored cCBT was conducted using carers of children with chronic conditions recruited through advertisements and local hospice staff. Participants were provided with access to the cCBT course for 6 weeks and received weekly personalised support emails. Self-report measures of anxiety, depression and daily functioning were measures at baseline and at post-treatment. Questionnaires administered online explored participant satisfaction and course use which were then analysed. Results: 19 hospice workers were recruited to complete questionnaires regarding common difficulties faced by carers. Several themes emerged from thematic analysis of the data including: physical and interpersonal difficulties, external pressures, time constraints, limited support, responding to the child’s illness and difficulties accessing appropriate care for their child. 29 carers were recruited to trial the online course, with 55.6% recruited through social media. 12 (30.8%) carers logged onto the course and 6 (15.4%) completed follow-up measures at 8 weeks post intervention. Of the participants that started the course only 2 (18.2%) completed all 6 course modules. Exploratory analyses showed no statistically significant differences in depression, anxiety or functional impairment. However, results indicated a general reduction in clinically significant anxiety symptoms and functional impairment. Satisfaction questionnaires completed by carers post-intervention indicated a high level of satisfaction with the course. Qualitative results showed that participants valued the email support they received and the flexibility that an online approach provided. Some carers still struggled to find time to complete the course and suggestions were made to amend the course to enable it to be accessed offline and on portable devices. Conclusion: Computerised courses may be an acceptable way of offering mental health support to some carers. Difficulties in retention and recruiting suggest that further adaptations to the course are needed to improve engagement (i.e. delivering the course via apps, or moving to stand alone course topics rather than a recommended course). Alternative methods of delivering psychological support should be explored to avoid excluding those who do not have internet access.

Attachment theory describes the importance of the child’s early relationship with the caregiver and insecure attachment has been identified as a risk factor for adolescent self-harm. Research presented in this thesis aims to further our understanding of this relationship by firstly exploring whether attachment impacts on self-harm via its effect on coping, secondly examining how peer attachment styles relate to self-harm and finally establishing what role attachment has in the repetition of self-harm and other related outcomes. Study 1, an online survey of 314 undergraduate students,revealed that attachment has an indirect effect onself-harm through coping. Higher quality of attachment was association with greater reliance on problem-focused (adaptive) coping, which in turn was associated with a decreased risk of having self-harmed. Furthermore, poorer paternal attachmentwas associated withlower appraisal of problem-solving skills, which in turn was associated with an increased risk of having self-harmed. Study 2 prospectively examined self-reported peer attachment as a risk factor for self-harm over 6-months amongst adolescents (n= 4508) in school years 8-11. Findings indicated that insecure attachment at baseline significantly predicted self-harm at follow-up, even after adjusting for baseline covariates (school year, gender, previous self-harm and levels of anxiety and depression). Lastly, study 3 hypothesised that insecure attachment would be associated with poorer outcomes over 6-months amongst adolescents aged 12-17 years who had self-harmed and been referred to Specialist CAMHS. Attachment styles were classified using the Child Attachment Interview: a validated assessment for young people. Compared to secure adolescents, those with insecure maternal attachment were more likely to repeat self-harm and showed less improvement in problem-solving. There were no differences between the groups in concordance with therapy. These findings provide novel insights into the relationship between attachment and self-harm and highlight the importance of considering attachment when planning treatment and assessing the risk of future self-harm.

Profiles of sleep disturbance and sleep quality of children with the specific neurodevelopmental disorders of Smith-Magenis syndrome (SMS), Angelman syndrome (AS), autism spectrum disorder (ASD) and tuberous sclerosis complex (TSC) and the relationships between behavioural and health characteristics, age and sleep were described in these groups. Interview data demonstrated that children with AS's sleep disturbance had a negative impact on both parents and children. A homogeneous sleep disturbance profile of severe night waking and early morning waking affected over 70% of children with SMS but more heterogeneous profiles were found for children with AS, TSC and ASD using cross-group questionnaire data comparisons and when compared to typically developing (TD) children. A heightened risk of sleep-related breathing disorders was identified for children with AS and SMS. Compared to TD children, children with SMS had significantly earlier morning wake times and children with AS and SMS had significantly earlier bedtimes according to actigraphy and sleep diary data. Increased daytime sleepiness in children with SMS was associated with increased overactivity and impulsivity. This thesis includes the largest samples of actigraphy data for children with SMS and AS to date. The importance of aetiology of intellectual disability in the profiling of sleep disturbance was evidenced. Areas for further assessment and intervention include sleep-related breathing disorders for children with AS and SMS and individualized assessment of circadian rhythm disorders for both groups.