Objectives: The purpose of this thesis was to identify risk factors for the development of mental health concerns in pre-teens and adolescents with Autism Spectrum Disorder (ASD), and in particular the role of early childhood ASD symptomatology in their development. Additionally, this thesis generated prevalence estimates for mental health concerns in Canadian adolescents with ASD. Methods: The parents of 390 individuals with ASD were invited to participate in a survey, either online or by mail. Sixty-seven parents completed and returned surveys. Kendall tau b correlation coefficients were calculated for the association between age at assessment with ADI-R and score in each domain. Prevalence estimates with 95% confidence intervals were generated, and the Kappa statistic was used to determine the strength of agreement between parent-reported diagnoses and clinical CBCL scores. Finally, bivariate analysis was used to determine if childhood ASD symptomatology was associated with mental health in adolescence, followed by logistic regression modeling to evaluate the effect of other possible risk factors. Results: Scores on two domains of the ADI-R were significantly associated with age at assessment, therefore, it was necessary to control for age at assessment with the ADI-R on these domains in the analysis conducted in Chapter Four. Forty-five percent of the study sample met case criteria for a comorbid psychiatric disorder. Anxiety, mood and attention-deficit disorders were the most common disorders in this sample. Early childhood ASD symptoms were not associated with the development of mental health concerns in adolescence. Family history and female gender were associated with the development of mental health concerns in adolescence. Conclusions: Nearly half of the individuals in our sample have been diagnosed with a psychiatric disorder, or are experiencing clinically significant symptoms that may be indicative of such a disorder. Our findings of discrepancies between parent-reported diagnoses and CBCL scores, indicates that many individuals in our sample are experiencing clinically significant mental health concerns, but do not have an official diagnosis. Finally, as has been reported previously, family history of mental illness and female gender were found to be associated with the development of a mental health concern in adolescence. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-10-14 11:06:50.53

Neuropsykiatriska funktionsnedsättningar är idag lättare att diagnostisera och det är vanligare att barn och ungdomar i skolan vet om att de lever med en diagnos som till exempel Attention deficit hyperactivity disorder (mer känt som ADHD), eller Aspergers syndrom. Trots att dessa diagnoser blir allt vanligare, finns det ett ökat behov för kunskapen om dem. Syftet med denna uppsats var att studera barn och ungdomar med neuropsykiatriska funktionsnedsättningar, och framförallt studera deras liv i skolmiljö. Att få mer förståelse för hur barn och ungdomar har upplevt skolan och relationen till sina lärare, men även hur de upplevt de hinder och möjligheter deras neuropsykiatriska funktionsnedsättning medfört var i fokus. Metoden i denna studie var semistrukturerade intervjuer med 6 ungdomar, deras föräldrar och lärare. Frågorna har handlat om hur ungdomarna sett på diagnosen, livet med den och även hur de klarat av skolgången med sin funktionsnedsättning. Resultatet visar att lärare behöver mer utbildning när det kommer till neuropsykiatriska funktionsnedsättningar Studien visar att barn och ungdomar med neuropsykiatriska funktionsnedsättningar har lättare att lära sig om de får göra praktiska saker. Att ta in mer praktiska moment i undervisningen skulle kunna förenkla för många av dessa barn och ungdomar. Informanterna har varit eniga om att kunskapen om neuropsykiatriska funktionsnedsättningar överlag är för låg. Familjen är en viktig del i ett barns säkerhet, men det betyder att föräldrar och syskon måste få veta hur de ska bemöta ett barn som lever med en neuropsykiatrisk funktionsnedsättning. Det är inte enbart i skolan kunskapen bör vara hög.

Previous research on Fetal Alcohol Spectrum Disorder (FASD) has identified common physical and behavioural characteristics associated with children who were prenatally exposed to alcohol. The research suggests that many individuals with FASD have experienced involvement with the law, and engaged in inappropriate sexual behaviour. However, there would appear to be a scarcity of research that identifies the life histories of individuals with FASD who have engaged in inappropriate sexual behaviour. Identifying risk and protective factors towards positive outcomes for people with FASD has both individual and societal importance. In order to better understand individuals with FASD, this research paper explores the common characteristics of FASD which may lead to inappropriate sexual behaviour, such as deficits in social skills, self-regulation, and executive functioning. Another important characteristic that is explored in the research paper is how FASD can present as an invisible disability, and the risk associated with treatment of individuals who may not be identified as having organic brain damage, specifically in the criminal justice system. As the research on FASD is limited, this paper also explores the characteristics associated with the general population of people who have engaged in inappropriate sexual behaviour, and people with disabilities who have displayed challenging sexual behaviour. The comparison of populations of people engaging in inappropriate sexual behaviour highlights the importance of the responsivity of interventions. Despite the diagnostic label of “paraphilia” attributed to those who have been convicted of sexual crimes, each individual is a complex being. Responsivity indicates each individual must be holistically understood in order to design services that encourage individual change.

Carisbamate (CRS) and lamotrigine (LTG) are anticonvulsants which act mainly on neuronal voltage-gated sodium channels, that have been shown to have antidepressant-like effects in animal models of depression. In vivo electrophysiological recordings were carried out following 2 and 14 days of CRS or LTG administration. Overall firing activity in the dorsal raphe, locus coeruleus and ventral tegmental area were decreased with CRS. Similarly, a decrease in the dorsal raphe was also observed with LTG. Despite these presynaptic decreases in firing activity, both anticonvulsants exhibited significant enhancement of serotonergic transmission in the hippocampus as demonstrated by increased tonic activation of postsynaptic 5-HT1A receptors. This may be attributed to the observed desensitization of the terminal 5-HT1B autoreceptors. This study suggests that the enhanced serotonergic effect may be associated with an antiglutamatergic effect, and may contribute to the antidepressant-like effect of CRS in the forced swim test and the antidepressant properties of LTG.

Cognitive models of obsessive-compulsive disorder (OCD) suggest that an ambivalent self-concept and dysfunctional beliefs play an important role in the pathogenesis of OCD. Early attachment experience is argued to be the main process through which such ambivalent self-representations develop. The current study investigated self-concept clarity, a broader construct than ambivalence, attachment security, obsessive-compulsive (OC)-relevant beliefs and their relation to OC symptoms. Forty four people who reported experiencing OC symptoms were compared to 34 individuals who reported no mental health difficulties. People who experienced OC symptoms exhibited significantly less self-concept clarity, less attachment security and higher levels of OC-related beliefs. Once levels of depression were controlled for, no significant relationship between attachment security and self-concept clarity was found in the OCD group. OC symptoms were not significantly correlated with self-concept clarity in the OCD group, although significant negative relationships were found between self-concept clarity and specific OC symptoms. Evidence was found to support the notion that OC-relevant beliefs mediate the relationship between self-concept clarity and OC symptoms, in addition to mediating the relationship between attachment anxiety and OC symptoms. Implications for attachment theory and cognitive models of OCD are discussed, along with clinical and research implications.

This portfolio thesis comprises three parts: a systematic literature review, an empirical study and a set of appendixes. Part one is a systematic literature review, in which the empirical literature relating to interventions for siblings of children with chronic illness and developmental disorder is reviewed. Siblings of children with such conditions have not been extensively studied within research and the review aimed to identify what interventions exist to support siblings in this area, to provide an overview of how rigorously these have been evaluated and to synthesise what findings have been documented with regards to the effectiveness of such interventions. An introduction to family and sibling research in this area is presented, followed by a rationale for why a review of intervention based literature in this area is considered to be a useful addition to the field. The paper goes on to specify the methods and search strategies used to identify suitable articles to meet the research aims and which satisfied set criteria for inclusion. Main findings are presented, conclusions made, and areas for further research identified. Part two is an empirical study of siblings of children with ADHD. Part one highlighted the paucity of research in the domain of siblings and developmental disorder. The cross-sectional study examines the level of empathy, self-esteem, and the sibling relationship quality factors of warmth/closeness and conflict reported by a sample of siblings of children with ADHD, and compares these variables to a sample of children who have siblings with no diagnosed disorders. The paper reports the between groups outcomes for these variables, along with an examination of whether children�s individual characteristics such as empathy and self-esteem predict reports of warmth/closeness and conflict, based on Furman and Buhrmester�s (1985) model of the determinants of sibling relationship quality. This is followed by an explanation of the clinical implications, the limitations of the study and consideration of further areas of research. Finally, part three is a set of appendixes to support the work in the previous parts of the portfolio thesis. It contains a reflective account of the research process and documents the experiences and lessons learned in planning, implementing and writing this document.

No description available.

Introduction: Autism Spectrum Disorder (ASD) is a behaviourally defined disorder characterised by impairments in three domains of social interaction, communication, and repetitive/restricted interests and behaviours (DSM-IV-TR; APA, 2000; ICD-10; WHO, 1992). Recent research suggests that this diagnostic triad may no longer fit as the best way to conceptualise ASD. Although not due for publication until 2013, a proposed revision of autistic disorder for DSM-V has merged three domains into two; i) Social/communication deficits and ii) Fixated interests and repetitive behaviours (APA, 2010). The aim of this study was to examine the structure of ASD symptom domains within the Adult Asperger Assessment (AAA; Baron-Cohen et al., 2005). Method: Confirmatory factor analysis was used to examine data from a clinical population of adults diagnosed with Asperger Syndrome (AS) and High Functioning Autism (HFA). Results: Analysis suggested that none of the theoretically-driven models were supported by the AAA data. However, it did highlight high correlations between social and communication factors (r > 0.9) within unmodified models. Discussion: The results of the analysis did not provide support for the move towards considering ASD as a dyad of ‘social-communication’ impairments and repetitive/restricted interests and behaviours, as none of the models were supported by the AAA data. The validity of the AAA as a diagnostic tool is discussed, as well as limitations and suggestions for future research. Conclusion: This study did not provide the evidence required to endorse a move towards the proposed DSM-V dyad. Further research to understanding the structure of autism symptoms could improve diagnostic and classification systems, and further studies of the genetic and neurobiological bases of ASD.

Background: Borderline personality disorder (BPD) is a psychiatric diagnosis characterized by emotional and behavioural instability, and impaired ability to maintain relationships. Previous research has demonstrated an association between BPD and insecure attachment style. It has been argued that BPD is a disorder of attachment, with insecure attachment being associated with inadequate capacity to represent mental states, or to “mentalize”. There is evidence that people with BPD are impaired in their capacity to mentalize in the context of attachment relationships. The term “mentalization” encompasses a broad range of processes including metacognition. There is a theoretical basis for metacognitive deficits in BPD. However, there is a lack of empirical evidence regarding the role of metacognition in BPD and its relationship to adult attachment style. Method: Participants with BPD were recruited from Community Mental Health Teams, Clinical Psychology and a Dialectal Behaviour Therapy (DBT) service within NHS Highland. A comparison group of participants without BPD were recruited from the Clinical Psychology service, having been referred for symptoms of depression. Both groups were administered the Relationship Scales Questionnaire (RSQ)(a self-report measure of attachment); and a short version of the Metacognitions Questionnaire (MCQ-30). Severity of clinical symptoms and current mood was assessed using the Clinical Outcomes in Routine Evaluation (CORE) and the Hospital Anxiety and Depression Scale (HADS). Results: Participants with BPD scored significantly higher than those without BPD on the attachment-anxiety and attachment-avoidance dimensions of the RSQ. The BPD group also endorsed MCQ-30 items more than the comparison group. There was a significant difference between the groups on the MCQ-30 total score and four of the five subscale scores. There were significant positive correlations between attachment dimension scores and metacognition subscales. The strongest associations were between attachmentanxiety and “uncontrollability and danger” and “need to control thoughts” subscales of the MCQ-30. Only metacognition was predictive of current mood and distress levels. Conclusions: The results of this study show that people with BPD report high attachment-avoidance and attachment-anxiety in their relationships, relative to a non-BPD, depressed comparison group. These findings are consistent with the existing literature regarding the profile of attachment in BPD. This study also found that people with BPD also have more maladaptive metacognitions than people with symptoms of depression. An association between self-reported adult attachment style and maladaptive metacognitiion was demonstrated in the present study. Maladaptive metacognitive strategies and beliefs potentially contribute to maintenance of depressed and anxious mood, as well as broader symptoms of distress.

This thesis is an exploration of Plato’s understanding of the power of disorder as it is presented in his cosmology, The Timaeus and in his predominantly religious work, Laws X. In the former work this causal force is presented as the disordering power responsible for the physical chaos prior to the generation of the universe, as well as for any residual disorder found within the cosmos after it has been ordered and is the antithesis of ‘nous’ or reason. In the latter work, however, Laws X, the causal force for disorder is now understood as a disordering power capable of endangering the soul, active long after the cosmos has been generated and itself, a ‘Soul’. What ultimately emerges is a dynamic theory of disorder and a metaphysics supporting that theory, weaving through, connecting across and separating apart these two works. In Part I, consisting of five chapters, I provide the Greek, an original translation and commentary on seven key passages from The Timaeus where Plato presents his ideas on disorder, both as an effect within the cosmos and as a causal power or force for disorder prior to its generation. In this regard, I look closely at Plato’s use of the Greek word &V&YK~ in its role as a disordering power, but which has also been commonly understood and translated as ‘necessity’. I contrast this with Plato’s understanding of the role which the ‘Demiurge’ or the ordering power of the cosmos has played, with its faculty of ~06s or ‘reason’ and its access to ideal ‘Forms’ or ‘ideas’ when ordering or generating the universe. In Part 11, consisting of four chapters, Laws X is similarly presented, providing the Greek, a translation (for the most part, that of A. E. Taylor) and commentary on eight key passages. Here I investigate Plato’s understanding of disorder as it pertains specifically to the ‘soul’ and of the soul’s relation to the disordering power(s) and to ‘evil’. In the final chapter a theory of disorder is proposed, in which an epistemology is outlined, an ontology is given and from which, it is argued, a metaphysics of disorder emerges.