Background: Behaviour difficulties are one of the commonest problems for which parents seek professional advice. Behaviour difficulties in early childhood are associated with poorer educational and social outcomes in later life (Loeber & Dishion, 1983). The importance of early intervention and preventative work to support behaviour difficulties has been stressed in the literature and is a priority in the government’s strategy for promoting positive outcomes for children. It is now generally accepted that parenting programmes (PPs) are an effective mechanism for supporting children with behaviour difficulties. A review of the literature suggests that while there are numerous evaluations of PPs there is limited evidence of PPs that are successful outside of a clinic setting and even less evidence on particular aspects of PPs and how parents view them. Aims: The main aim of this research was to explore a community based PP (the Holding Hands Group Programme (HHGP)) in terms of both its outcomes and the perceptions of the parents involved. The aim of paper one was to investigate whether families who undergo the HHGP, notice any improvement in child behaviour, parental stress and parental confidence. A second aim was to compare the HHGP to the previously evaluated Holding Hands Individual Programme (HHIP). The aim of paper two was to examine the process elements of the Holding Hands Group Programme (HHGP), seeking new insights and a detailed descriptive portrayal of how parents experience the HHGP. Methods: The study utilised a pragmatic approach to evaluation, with mixed methods and differing methodologies. Paper 1 involved a fixed quasi-experimental design using a pre-test, post-test single group evaluation. Outcome data was gathered from 34 parental responses to a range of psychometric measures completed on each of three occasions. Paper 2 involved semi-structured interviews being carried out with 15 parents prior to, and on completion of, the HHGP. The interviews focused on parent’s experiences of the programme and what they liked/disliked. Results: Paper 1: At the start of the HHGP parents typically reported high levels of intensity of behaviour, behaviour that was a problem and stress levels. They also reported low levels of parental confidence. By the end of the HHGP parents reported significantly increased confidence and significantly reduced stress, intensity of behaviour and behaviour that was problem. These positive results were maintained beyond the end of the programme as indicated at follow-up meetings. The findings indicate that the HHGP was effective for all identified subgroups of the sample. These findings broadly mirror the findings of the evaluation of the HHIP, although results do show some significant differences between the HHIP and the HHGP. Paper 2: The interviews conducted with fifteen parents were analysed using a rigorous approach to thematic analysis to identify emerging themes. Six themes were identified from parental accounts: support, new knowledge, reconstructing, awareness, changes and interactions. Alongside these themes was a practical element about ‘what worked’. Prior to the HHGP parents gave detailed descriptions about the difficulties that they were experiencing with their child, were able to identify what they wanted to achieve through the group and seemed able to predict what might be useful to them. After the sessions parents discussed what they had gained from taking part and were able to give suggestions for what had caused any changes. Extensions and Implications: On methodological grounds it would be desirable to undertake further work with either a control group, or baseline wait list. A further extension would be to use a longer follow up period or to contact the current participants to see how this cohort is coping when they start school. This study relied on self report data, therefore future work could consider the use of videoing interactions. It would also be useful to extend the interview process to include the follow up period. The results of this study imply that PPs can be delivered effectively to groups in non-clinic settings, and this suggests a route to more cost-effective delivery of PPs. However, as the results indicate that the HHGP was not successful for all, it reminds us that practitioners need to be vigilant in attempting to identify those families that are not helped and flexible in trying to assist them in other ways - perhaps via booster sessions or through the use of self-guided written materials.

The problem with which this investigation was concerned was that of determining the efficacy of child-centered group play therapy with pre-kindergarten and kindergarten children with speech difficulties as an intervention strategy for improving specific speech problems in the areas of articulation, receptive language, and expressive language. A second purpose was that of determining the efficacy of child-centered group play therapy in improving self-esteem, positive social interaction, and in decreasing anxiety and withdrawal behaviors among pre-kindergarten and kindergarten children with speech difficulties. The experimental group consisted of 11 children who received 25 group play therapy sessions one time a week in addition to their directive speech therapy sessions. The comparison group consisted of 10 children who received only their directive speech therapy sessions. The Goldman Fristoe Test of Articulation, the Peabody Picture Vocabulary Test - Revised, and the Clinical Evaluation of Language Fundamentals - 3 were used to measure receptive and expressive language skills. The Burks' Behavior Rating Scale was used to measure symptoms of anxiety, withdrawal, poor self-esteem, and poor social skills as observed by parents and teachers. Twelve hypotheses were tested using ANCOVA and Eta Squared. Child-centered group play therapy was shown to have a large practical significance in helping children improve their expressive language skills. Child-centered group play therapy was shown to have a medium practical significance in increasing children's receptive language skills. Small sample size may have contributed to the lack of statistical significance as calculated by the analysis of covariance. Child-centered group play therapy was shown to have a small yet positive impact upon children's articulation skills and anxiety. Although not significant at the .05 level, these results indicate a slightly larger increase in articulation skills and a slightly larger decrease in symptoms of anxiety among those children who received group play therapy as compared to those who did not. Child-centered group play therapy was shown to have a mixed effect upon children's self-esteem, withdrawal behaviors, and positive social interactions. This study supports the use of child-centered group play therapy as an effective intervention strategy for children with speech difficulties to improve expressive and receptive language skill development.

It is of primary concern, both from the perspective of the individual and of society at large, to take measures to prevent the occurrence of a negative development amongst young people. The starting point of this dissertation is the notion that interpersonal interactions that occur between people contribute to a process of learning, thus focus is placed upon the pedagogic interactions between society's authorities and young people in trouble. How such interactions contribute to the process of learning regarding the young people, and what that learning entails, is seen as a vital pedagogic question. The overriding aim of the dissertation is to identify aspects of learning that occur during the interactions between society's authorities and young people in trouble, in order to contribute to an understanding of how such interactions can be developed in a constructive manner. The thesis is based on the theories of man as a social being, dependent on relationships and interaction for the process of knowledge. The empirical study includes interviews with teachers, social workers, police officers and young people. Vignettes have formed the basis of discussions about the measures and initiatives taken by society and the types of experience the young people feel the measures and initiatives have led to. Since an element of authority is a component of the relationship between the representatives of society and the young people, the concept of governmentality formulated by Foucault has been used in the process of analysis. Also von Wright's concepts of punctual and relational perspective have been used in this process. The purpose of this study is to attempt to determine what consequences the various perspectives taken in the interactions may lead to, in relation to the knowledge these young people develop about themselves and about society. The result shows that society's representatives among themselves have different views of young people in trouble. Young people's experiences of interactions with society's representatives argue for the fact that their backgrounds often direct the course of the interaction and its contents. Young people testify about irrelevant measures and initiatives taken by society; that they are subject to prejudice and that the principle of "equality before the law" is not observed. Their experience has led them to feel that they have less of human dignity. The dissertation ends up in a discussion about the prerequisites necessary, in order that pedagogic interactions between a person in authority and young people in difficulties may proceed from a relational perspective. The ability to take the young person's perspective would thereby be a central aspect in the discussion about what measures and initiatives taken by society are appropriate to change a troubled lifestyle.

Sväljningssvårigheter förekommer hos personer i alla åldrar, men är vanligast hos de äldre. Konsekvenserna av sväljningssvårigheter i form av undernäring och aspirationspneumonier bidrar till ökad ohälsa och stora samhällskostnader. Sväljningssvårigheter är inte en sjukdom i sig, utan är ett symptom av andra sjukdomar. Eftersom undernäring är vanligt hos personer med sväljningssvårigheter, bör sjuksköterskan ha kännedom om patienters erfarenheter av sväljningssvårigheter. Syftet var att beskriva patienters erfarenheter av att ha sväljningssvårigheter. Genom utförande av en allmän litteraturstudie framkom fyra teman: Erfarenheter av att sväljningssvårigheter ställer upp hinder för måltiden, Erfarenheter av begränsningar i det dagliga livet, Erfarenheter av att hantera vardagen och Den glädjelösa måltiden. Måltiden präglades av hostattacker, kvävningskänslor och att maten fastnade i halsen. Både det sociala livet och familjelivet begränsades. Patienterna hanterade situationen genom att undvika att dela måltider med andra. Patienterna kände ingen glädje av måltiden längre. Vidare forskning gällande allmänhetens attityd gentemot sväljningssvårigheter är av intresse. Ett framtagande av en konsistensanpassad meny för restauranger vore hjälpsamt för patientgruppen. / Swallowing difficulties occur in people of all ages, but is increasingly common in the elderly. Malnourishment and aspiration pneumonia are consequences of swallowing difficulties that lead to increase in ill-health and high costs for society. Swallowing difficulties are not an illness, but a symptom of other diseases. Since malnourishment is common in people with swallowing difficulties nurses should have knowledge of patients with experiences of having swallowing difficulties. The purpose of this study was to describe patients’ experiences of swallowing difficulties. Through the performance of a literature review four themes emerged: Experiences of swallowing difficulties hindering the meal, Experiences of limitations in daily life, Experiences of dealing with everyday life and The joyless meal. The meal was characterized by coughing, feelings of choking and food getting stuck in the throat. Social life and family life alike were limited. Patients handled the situation by avoiding eating with others. Patients no longer experienced joy in eating. Further research on public’s attitude towards swallowing difficulties are of interest. The development of a texture modified menu for restaurants would be helpful for this patient group.

Mit Einrichtung der Giftinformationszentren in der zweiten Hälfte des zwanzigsten Jahrhunderts konnten Ärzte erstmalig auf der Basis einer evidenzbasierten klinischen Toxikologie beraten werden. Parallel zu anderen medizinischen Fachgesellschaften wurden von den europäischen und nordamerikanischen Fachgesellschaften Empfehlungen bezüglich verschiedener Therapieformen der klinischen Toxikologie erarbeitet. Als Beispiele sind die Maßnahmen der primären und sekundären Giftentfernung und der Einsatz von Antidota zu nennen. Ob Ärzte den Empfehlungen der Giftinformationszentren folgen, ist bisher wenig untersucht worden. In einer prospektiven Untersuchung anhand von 206 Fällen wurde analysiert, ob und in welchem Ausmaß den Empfehlungen des GIZ-Nord gefolgt wurde. Darüber hinaus wurden Daten zu Alter und Geschlecht der Patienten, zum Vergiftungsmodus und zu den eingenommenen Noxen erhoben. Es wurden folgende Fragestellungen formuliert: 1. In welchem Ausmaß wird den Empfehlungen des GIZ-Nord gefolgt? 2. Gibt es Einflussfaktoren wie Alter und Geschlecht der Patienten, Vergiftungsmodus, die Noxengruppe sowie sprachliche Verständigungsschwierigkeiten der anrufenden Ärzte? 3. Wie hoch ist die Zufriedenheit der Ärzte mit der Beratung des GIZ-Nord? Die Fragen ließen sich folgendermaßen beantworten: 1. Empfehlungen zu diagnostischen Maßnahmen wurden in 89% der Fälle befolgt, therapeutische Maßnahmen zur primären Giftentfernung und den Einsatz eines Antidots betreffend in 74%, Maßnahmen zur sekundären Giftentfernung in 61% und spezifische therapeutische Maßnahmen in 66% der Fälle. Insgesamt wurde den Empfehlungen des GIZ-Nord in 64% der Fälle vollständig gefolgt. 2. Während das Patientengeschlecht und der Vergiftungsmodus “suizidal” keinen Einfluss auf ärztliche Compliance gegenüber den Empfehlungen des GIZ-Nord aufwiesen, waren Compliance-Unterschiede bezüglich des Patientenalters und der eingenommenen Noxen zu erkennen. Im Vergleich zu anderen Altersgruppen wies die Altersgruppe der 15-19-Jährigen eine mit 41% vergleichsweise niedrige Compliance auf. Ebenfalls wiesen sich Antiepileptika wie Carbamazepin und Barbiturate, die bei Vergiftungen einer komplexeren Behandlung bedürfen, als Noxengruppe mit geringerer ärztlicher Compliance aus. Eine auffällige Compliance-Differenz konnte bei sprachlichen Verständigungsschwierigkeiten ärztlicher Anrufer gesehen werden. Eine lückenlose Befolgung konnte in 70% der Fälle bei uneingeschränkter sprachlicher Kommunikation und in 13% bei sprachlichen Verständigungsschwierigkeiten aufgezeigt werden. 3. Eine hohe Zufriedenheit mit der Beratung durch das GIZ-Nord konnte in 97% der Fälle verzeichnet werden.

This outcome study investigates whether music therapy can improve the emotional well-being of adolescents who are at risk of exclusion or underachievement. Specifically, it addresses music therapy’s impact on students’ self-esteem, anxiety, attitude towards learning, behaviour and relationships with peers. The setting for the research was a mainstream secondary school and its federated special school for students with emotional and behavioural difficulties. Over nineteen months, a mixed methods design was used to observe change in students before and after music therapy. One group received twenty, weekly, individual sessions, and the other formed a wait-list group for comparison and then received the same treatment. At four different times during the project quantitative data were collected from students, teaching staff and school records, and qualitative data from semi-structured interviews with the students before and after their period of intervention. The study found that music therapy made a positive difference. The high level of treatment adherence (95%) of all twenty-two students confirmed music therapy’s appeal to this client group. The majority of teachers (58%) reported improvement in students’ social development and attitude overall, and for some mainstream students (56%) recognition of self-concept increased. The conviction with which students conveyed their positive experiences of music therapy was striking. The study supports the author’s argument for therapeutic support to be made available at secondary schools and promotes a student-centred approach, as exemplified in the thesis. It concludes that music therapy can be effective for youth at risk but requires more participants in subsequent investigations for it to be proved statistically.

Based in a sociocultural perspective the study aims at illustrating how teachers in mathematics perceive their possibilities of supporting students in mathematical difficulties and how their schools support the teaching practices to those pupils. The methodological approach is phenomenographic and data was collected in half structured interviews with ten professionals teaching mathematics to Swedish 13-16-year-old students from 10 different schools. The results show that, due to the heterogeneity in students’ achievements, teachers perceive the time a limiting factor to individualising and meeting the needs of every student. The findings also indicate that the designs of the schools’ supportive structures are governed by traditions and an individualistic perspective. Thus, ability grouping and supportive measures outside the classroom of ordinary teaching are common. However, the picture is dual. The interviewed teachers express a wish for inclusive teaching and teacher collaboration, promoting a common responsibility for a complex teaching situation. Yet, organisational obstacles and the schools’ scarce resources inhibit inclusion. Further, findings suggest that both the extent and forms of support provided to the mathematics teachers differ, ranging from almost non-existent to well-developed forms of collaborations in mathematics teams, co-teaching and supervision of special educators or head teachers in mathematics. Further training was the support teachers consistently found most important and demanded the most.

Stroke is one of the major causes of eating difficulties (EDs). It is one of the leading causes of death and disability and one of the most important factors contributing to health-care costs. There is a clear association between EDs after stroke and undernutrition, where studies have shown that structured screening of eating function among stroke patients can predict nutritional problems as well as need for subsequent institutional care. Reliable and valid instruments that can identify EDs exist, but there is lack of knowledge on how persons experience living with EDs after stroke. Stroke unit care is evidence-based and grounded in multidisciplinary collaboration and continuity of care. The overall aim of this thesis is to explore and describe EDs after stroke as represented by health care professionals in patient records (PRs) and transferred information, and as described by persons living with EDs after stroke. An additional aim is to explore methodological aspects related to the inclusion of persons with EDs and communication impairment in research studies. Both quantitative and qualitative methods were used. Two studies used descriptive designs (I, II), one an explorative design (III) and one applied a methodological discussion (IV). In one of the studies PR data were used (I), in another study data were derived from three sources: PRs, screening of patients and interviews with nurses (II). Persons with EDs after stroke participated in Study III while literature, empirical data and researchers' experiences served as the data in study IV. Data were analysed by categorisation of phrases (I), content analysis (II) and descriptive statistics (I, II), by qualitative analysis (III) and by processing of literature and empirical findings in two research groups (IV). The main findings from the studies on representation of stroke care in PRs (I, II) showed that, despite that >50% of patients in Study I and all patients in Study II had EDs, there were few signs of multidisciplinary collaboration dealing with this problem. Unsystematic screening for swallowing difficulties was routine, whereas screening for nutritional risk and EDs was lacking (I, II). Multidisciplinary discharge summaries proved to have low quality and entailed little information on patients' eating ability (I). The two EDs most frequently documented were swallowing and lack of energy to complete a meal (I,II). EDs were described in vague terms (I, II). In Study II, all patients had swallowing difficulties and most patients had lack of energy to complete a meal. The electronic information transfer tool held information on eating ability for most patients (II), but the nursing staff in residential home care perceived deficiencies in that information, even identifying several EDs not reported at discharge (II). Experiences from persons living with EDs after stroke were presented in one main theme: Striving to live a normal life, including three sub-themes: Abandoned to learn on one's own (little support from health care professionals to learn to handle eating), Experiencing losses (loss of eating functions and loss of valued activities) and Feeling dependent in mealtime situations (III). One major finding from the methodological exploration (IV) is that creative approaches and suitable methods for inclusion of participants with EDs and communication impairment into qualitative studies can be found in the fields of aphasiology and learning disabilities. Another major finding from Study IV is that researchers need good communication skills as well as knowledge in neuropsychology. A general conclusion is that screening for EDs should be routine in stroke care and that a multidisciplinary terminology to express EDs must be developed to provide accurate information transfer. Health care professionals need to enhance their knowledge in nutrition and provide support to stroke patients with EDs with the goal that they can eat and perform meal-related activities in accordance with their habits before the stroke. To gain access to the experiences of persons with EDs and communication impairment researchers need to test participatory approaches when planning for inclusion of those persons.

This study is a comparison of the verification sales of a self-rating sentence completion method for evaluating marital difficulties and the MMPI validity scales.

Stress is being linked increasingly to physiological, psychological, sociological, and educational problems. However, scant attention has been given to stress in recent reading research. This study investigated referral and evaluation statements and diagnostic data from parents, teachers, reading specialists, and counselors regarding signs of stress and potential stressors as factors in the reading difficulties of seventy-seven primary schoolchildren referred for evaluation at the pupil Appraisal Center (PAC) at North Texas State University between 1977 and 1984. Qualitative methods, specifically situational analysis, were employed to obtain a holistic view of each subject's reading difficulties. The researcher collected data from documented files at PAC. Data analysis via a categorical coding system produced thirty-nine stress related categories, organized under broad headings of family and school environment, readiness for reading/ learning, general stress reactions, and responses to stress when reading/learning becomes a problem.