No description available.

Developmental dyslexia is suggested to affect approximately 5-10% of the population (Habib, 2000). The most influential theory of dyslexia is the phonological-deficit theory of dyslexia (Liberman, 1973; Stanovich, 1988; Snowling, 2000). An alternative explanation is that visual deficits can lead to reading difficulties (e.g. Stein & Walsh, 1997). To date the findings are mixed regarding the extent of visual deficits within the dyslexic population. Whether these problems represent a cause, correlation or consequence of the reading difficulty also remains highly controversial. The data presented throughout this Thesis examined the possibility that reading difficulties, associated with dyslexia, are linked to poor binocular coordination. In three experiments binocular eye movements of adults, typically developing children and children with dyslexia were measured while they read sentences or scanned dot string targets. In these experiments findings of previous binocular studies were replicated. Specifically, fixation disparity was modulated by the amplitude of the preceding saccade and the fixation position on the screen regardless of whether fixations and saccades were targeted to dots or words. Additionally, during the dot scanning task adult’s binocular coordination was improved in relation to children’s, but no reliable differences were found between the three groups. Critically, a significantly greater magnitude of fixation disparity was found for dyslexic children compared to typically developing children and adults during the reading task alone. The existence of linguistically modulated differences in binocular coordination for dyslexic children is a novel finding. The patterns of results from the three experiments indicate that poor binocular coordination in dyslexic children is restricted to reading linguistic material. Clearly, this represents a stimulus specific deficit in regard to binocular coordination, for children with dyslexia.

The aim of this study is to develop a pain assessment scale for use during neonatal transport. Underpinned by the rights of the child to have appropriate assessment and management of pain and the important deleterious effects pain can have on the physiological stability of the neonate, this study utilises a qualitative consensus paradigm of enquiry to inform the content and structure a pain assessment scale specific to the transport setting. The study was conducted in three Phases, the first Phase consisted of a nominal group meeting with transport clinicians to ascertain their views on items to include in a pain assessment scale for transport. Phase Two utilised the Delphi technique to gain consensus from a large cohort of clinicians experienced in the field of neonatal transport on the content, structure and design of a transport pain assessment scale. Results of the first two Phases of the study were then applied to the adaptation of an existing pain assessment scale. Face validity of the newly developed Neonatal Transport Pain Assessment Scale (NTPAS) was then tested in Phase Three by semi-structured interviews with transport clinicians. Results of initial face validity testing suggested positive results in relation to feasibility and clinical utility of the scale, however further testing is strongly recommended. Currently there are no pain assessment scales developed for use in the transport setting, and little evidence on the effects of transport on pain and pain assessment. This study offers a unique approach in adding to the body of knowledge on neonatal pain assessment and facilitated the development of a scale adapted to transport. Further research is suggested to undertake psychometric testing of the scale and establish validity and reliability in the clinical setting.

Childhood aggression affects a significant number of children and represents the majority of referrals to child clinical services (Ford, Hamilton, Meltzer, & Goodman, 2007). There are substantial costs for the child, their family and society more generally if aggressive behaviour remains untreated (Shivram et al., 2009). Social-cognitive models of aggression have provided the theoretical framework for much of the research into childhood aggression over the past twenty years and formed the focus of clinical interventions (Crick & Dodge, 1994). A key finding from this research is that aggressive children have a tendency to attribute hostility to the intentions of others in ambiguous situations (Orobio de Castro, Veerman, Koops, Bosch and Monshouwer, 2002). The aim of literature review is to explore the factors that lead to the development of this bias. Limitations to extant literature and suggestions for future research are discussed. Although evidence from a number of studies demonstrates the effects of socialisation or peer contagion on children’s aggressive and anti-social behaviour (Prinstein & Dodge, 2008; Thornberry & Krohn, 1997), currently no studies have examined peer contagion effects on hostile attribution bias. The empirical paper describes a study investigating whether hostile attribution biases are contagious amongst adolescents in a community sample of boys and girls. Using a computerised ‘Chat-room’ experimental paradigm, contagion effects were demonstrated across two conditions (hostile and benign) with those exposed to hostile group norms showing greater contagion effects. Four possible moderators on the effects of peer contagion were explored; gender, dispositional levels of aggression, social anxiety and friendship style. The role of peers in the socialisation of hostile intent attribution styles and implications for preventative interventions are discussed.

No description available.

Working with people with learning disabilities can be stressful for direct care staff; as many as one-third of staff members in adult services experience stress levels indicative of a mental health problem. In addition to adverse effects on staff mental and physical health, staff stress can impact on the delivery and quality of services for people with learning disabilities. Challenging behaviour is recognised as a significant source of staff stress. Both adults and children with learning disabilities may display challenging behaviours including self-injury and physical aggression, the severity and frequency of which can be extremely distressing for staff exposed to them on a daily basis. This thesis explored psychological mechanisms which may explain how challenging behaviour impacts on the well-being of care staff. Chapter One reviews the evidence for the roles of negative emotional reactions to challenging behaviour and the psychological resources of care staff in the development of stress and burnout. Chapter Two investigates whether experiential avoidance, thought suppression and mindfulness, which has been found to be significant predictors of mental health outcomes outside of the learning disabilities field, provides a psychological mechanism for understanding the relationship between negative emotional reactions to challenging behaviour and staff well-being.

This review examines the research on the Picture Exchange Communication System (PECS), which has become a popular communication strategy for children with autism and other communication disorders. A growing body of research has shown that the system is a promising mode of communication. There is, however, a paucity of research that examines the conditions under which the PECS is used, specifically whether children use the PECS to make spontaneous requests. A lack of agreement currently exists over the definition of the term ‘spontaneity’ and so researchers of the PECS who do report instances of spontaneity may be basing the judgment on different patterns of behaviour. Skinner’s (1957) analysis of verbal behaviour and the continuum model of spontaneity (Carter, 2002,2003a; Carter & Hotchkis, 2002; Chiang & Carter, 2008) can be used to understand the development of self-initiated requesting behaviour. Both frameworks state that requests can only be considered as fully spontaneous if they occur without prompts from another person and when the desired item is not in sight. There is a lack of research that examines whether children are able to use the PECS to make requests under these conditions. Furthermore, this literature review shows that some children may be unable to use the PECS to request items not in sight because of the teaching conditions used and/or because the reinforcement practices of the community may be inefficient, and, therefore, ways of promoting spontaneity are considered.

No description available.

Fundamental movement skills (FMS) are a vital part of a child’s development, which allow them to advance on to more complex movements, resulting in them functioning successfully in their daily lives and when participating in sports and physical activity. Despite the importance of FMS, previous studies have routinely found children to have low competency levels. Further research on competency levels in this area is required, specifically among UK children, as data on FMS proficiency and FMS interventions is dominated by research from Australia and North America. As such, the aims of this thesis were to a) document the level of FMS competency of preschool children from a highly deprived area of Northwest England, b) determine the effectiveness of a six-week Active Play intervention on FMS competency among preschool children from a highly deprived area of Northwest England, c) examine the relationship between FMS competency, physical activity and weight status over a five-year period between preschool and late primary among children from a highly deprived area of Northwest England and finally, d) gain the thoughts and opinions of experts and practitioners in order to help inform the development of an appropriate intervention to increase the physical literacy of preschool children.

Disorders of sex development (DSD) are a diverse group of conditions in which there is variation from the typical chromosomal, gonadal, or anatomical developmental pathway. While much has been learnt about the genetic aetiology of many of these disorders, a significant proportion of cases remain without a definitive diagnosis. This thesis consists of a series of studies designed to look at different aspects of DSD in order to identify causes and develop better ways to assess and research these conditions in the future. Chapter 1 is an extensive literature review of normal sex development, models to describe the sex phenotype, steroidogenesis, steroid hormone structure and physiological role, classification of DSD, clinical uses of progestogens and determinants of foetal growth. An understanding of these diverse subjects is essential to consider the topics investigated. Chapter 2 presents the rationale for, and specific aims of, this thesis. Chapter 3 describes a study using the I-DSD registry, the largest international register of cases of DSD, to identify associated conditions co-occurring in DSD. 649 cases with documented consent were identified and analysed from the registry, with further information obtained from the reporting clinician where necessary. Associated conditions were reported in 168 cases (26%), overall, and when considered according to karyotype were reported in 112 cases of 46,XY DSD (24%), 27 cases of 46,XX DSD (22%), 19 cases of 45,X/46,XY (45%), and 6 cases of 45,X (75%). In 46,XY DSD, which represents the largest group of cases in the Registry, small for gestational age (SGA), cardiac and CNS anomalies were the most commonly reported associated conditions. This study strengthens the recognised association between SGA and non-specific 46,XY DSD. Additionally, the data indicate a possible association between genetically confirmed AIS and skeletal and renal anomalies. These results provide new research targets for cases in which the aetiology of DSD remains unclear. They also highlight the need for multi-disciplinary teams for management of these patients. Chapter 4 documents a clinical study investigating the association between hypospadias, one of the mildest conditions on the spectrum of DSD, and the measurement of anogenital distance (AGD). 88 boys had AGD measured under general anaesthetic during hypospadias surgery, alongside assessment of severity of hypospadias. Medical notes were reviewed for further information including birth weight, gestation and the presence of additional genital anomalies, as described by the external masculinisation score (EMS). Median AGD was found to be shorter in boys with severe hypospadias (63mm), than those with mild hypospadias (75mm) (p < 0.001). Additionally these boys were more likely to have lower birth weight SDS (-0.61) than boys with mild hypospadias (-0.42) (p= 0.013). This study is the first to show a link between severity of hypospadias, additional genital anomalies, and degree of AGD shortening. This supports the hypothesis that severe forms of hypospadias may be linked to inadequate androgen exposure in utero. Results also show that boys with more severe hypospadias have a lower birthweight, reinforcing the link between 46,XY DSD and SGA. Chapter 5 describes the use of a rat model to investigate the developmental effects of exposure to the progestogen medroxyprogesterone acetate (MPA) during the male programming window. It has been previously suggested that antenatal exposure to progestogens may be associated with DSD. In this study Sprague Dawley dams were injected with 75mg/kg or 150mg/kg of subcutaneous MPA on gestational days 14.5 to 18.5. Results showed that MPA exposure was associated with a shorter than normal AGD in male rats, and a longer AGD in female rats. Offspring of both sexes had reduced birth weight when exposed to MPA (control weight 5.99g, MPA 75mg/kg 4.58g, MPA 150mg/kg 4.72g). There was no evidence of an effect on internal reproductive structures, including testis weight. Chapter 6 describes studies using small vessel myography to investigate vascular function in the pregnant dams exposed to MPA in the previous studies. Low birth weight can be the result of altered vascular remodelling during pregnancy, leading to impaired placental function. It has previously been suggested that impaired placental function may be responsible for the combination of intra-uterine growth restriction and DSD. Uterine artery segments from animals exposed to MPA 150mg/kg demonstrated greater vessel wall thickness, and a trend towards an increase in internal and external diameter, with increased distensibility at higher pressures when compared to control segments. Wire myography showed that vasoconstriction in response to noradrenaline and NG-nitro-L-arginine methyl ester (L-NAME) was reduced following MPA exposure. These studies do not explain the causes of reduced growth in MPA exposed offspring. The responses seen are the opposite of those seen in animals with pre-eclampsia and hypertension, and may demonstrate the protective effect of progestogens in pregnancies complicated by these conditions. Chapter 7 draws together the findings of all the studies in this thesis, to reach overall conclusions. The common theme of an association between DSD and impaired foetal growth from all three branches of this work in discussed. The potential for further investigations in pursuing this work to strengthen conclusions and inform future practice is considered.