Background/Purpose: ADHD is frequently associated with functional deficits across social, familial, and academic contexts (Pelham, 2005). Children with ADHD and internalizing symptoms typically experience higher levels of functional impairment compared to their counterparts with exclusively ADHD (Bishop et al., 2019). Positive parenting practices and child strengths have been found to play a protective role for children with ADHD (Healy et al., 2011; McCrimmon et al., 2018). This study aims to investigate the influence of internalizing symptoms on functional impairment for children with ADHD. Child strengths and parenting strengths have been examined to identify moderating effects of the aforementioned constructs. Methods: Data were collected in a community mental health centre using the Child and Adolescent Needs and Strengths questionnaire (CANS) and the Child Strengths and Difficulties questionnaire (SDQ). Participants included 209 children and their caregivers seeking mental health services between the ages of 5 and 11 with an ADHD diagnosis. To examine the moderating effects of parenting and child strengths, ordinary least squares regression models were tested using the PROCESS macro for SPSS (v3.5; Hayes, 2018). Results: Results suggest that levels of internalizing symptoms influence functional impairment in children with ADHD. Child strengths moderate the relationship between internalizing symptoms and functional impairment when internalizing symptoms are medium to high. Conclusion: Findings from this study demonstrate that facilitating child strengths can help moderate functional impairment for children who experience ADHD and internalizing symptoms.

No description available.

Objective. To examine associations among attention-deficit/hyperactivity disorder (ADHD) symptom dimensions (hyperactivity, impulsivity, inattention, and sluggish cognitive tempo [SCT]) and functional impairment among adults. The potential influence of co-occurring internalizing and externalizing difficulties, as well as self-reported executive functioning deficits, on these associations was also evaluated. Methods. One thousand eight hundred and ninety-four adults (58.8% female; 75.9% Caucasian; age: M = 36.24 [SD = 11.65] years) recruited from Amazon’s Mechanical Turk (MTurk) completed extensive questionnaire batteries assessing ADHD symptoms, co-occurring internalizing and externalizing difficulties, executive functioning deficits, and functional impairment across a range of domains. First, factor analyses were completed to identify empirically-derived functional impairment factors for use in subsequent analyses. Second, associations between ADHD symptom dimensions and functional impairment factors were examined via a path model. Third, multiple mediation analyses were conducted to evaluate the impact of ADHD symptom dimensions on functional impairment domains via internalizing and externalizing difficulties. Finally, additional multiple mediation analyses were completed to examine to influence of ADHD symptom dimensions on functional impairment via self-reported executive functioning deficits. Results. Factor analyses identified four overlapping but distinct functional impairment factors indexing general impairment, quality of life, romantic relationship functioning, and social support. Path analyses revealed significant associations between increased ADHD symptoms and higher general impairment, lower quality of life, reduced romantic relationship functioning, and decrements in perceived social support. Multiple mediation analyses indicated that ADHD symptom dimensions influence functional impairment domains via specific internalizing, externalizing, and executive functioning difficulties. Conclusions. The pattern of findings provides further support for associations between ADHD symptom dimensions and a range of functional impairments, as well as highlighting potential exacerbation of these effects in the presence of co-occurring mental health and executive functioning difficulties. Current findings may help to clarify the complex phenomenology of ADHD in adults, and carry implications for improving extant treatment approaches.

Posttraumatic stress disorder (PTSD) is associated with significant functional impairments and disruptions in cognitive functioning. Functional recovery and remediation of cognitive difficulties are oft over-looked treatment targets in this population, despite their significant contribution to the burden of PTSD to the individual and to society. Existing literature suggests that functional impairment and cognitive dysfunction may not respond to first-line treatments for PTSD. Thus, the focus of this thesis was to examine symptom dimensions associated with cognitive dysfunction and functional impairment among individuals with PTSD, and to investigate a novel approach to cognitive remediation, Goal Management Training (GMT), in this population. Study one in this thesis is a review in which we identified a strong relation between dissociative symptoms and neuropsychological functioning, transdiagnostically and among individuals with PTSD. The hypothesis that dissociative symptoms would be strongly related to functional impairment among individuals with PTSD was explored in study two. We found that dissociative symptoms mediated the relation between PTSD symptoms and functional impairment among a sample of military members, veterans, and first responders with PTSD. Study three identified that emotion regulation difficulties and dissociative symptoms most strongly predicted functional impairment among civilians with PTSD and high rates of exposure to childhood abuse and neglect. In study four we investigated the effectiveness of a cognitive training program, Goal Management Training (GMT), in improving cognitive functioning, clinical symptoms, and functional impairment among inpatients with PTSD. Participation in GMT was associated with improved cognitive functioning and increased ability to engage in goal directed behaviours when highly emotional. This thesis highlights the importance of assessing emotion regulation difficulties and dissociative symptoms in order to target functional impairment and cognitive dysfunction among individuals with PTSD. Moreover, it provides evidence for a potential treatment approach to ameliorate these difficulties. / Thesis / Doctor of Philosophy (PhD) / Posttraumatic stress disorder (PTSD) is a mental health condition that develops after exposure to a traumatic event. It is associated with reduced functioning in important areas of life, including social relationships, work performance, and self-care. PTSD is also associated with reduced cognitive functioning in areas such as memory, planning, and organization. This thesis focuses on examining variables that may be related to these difficulties, including specific symptoms such as difficulty managing emotions and difficulties remaining in the present moment (dissociation). We also investigate a treatment program, Goal Management Training (GMT), aimed at teaching skills to improve cognitive and daily functioning. By understanding what contributes to cognitive functioning and functional difficulties in individuals with PTSD and by providing evidence for a treatment that can improve these difficulties, we hope to improve the lives of individuals with PTSD.

With a growing ageing population decline in physical function has become a major public health issue, as it is associated with disability in later life. Recent evidence suggests that blockade of the renin-angiotension-aldosterone system may have a role in improving physical function in older people.We hypothesised that inhibition of the renin-angiotensin-aldosterone system with spironolactone would improve physical function in older people without heart failure. In a double-blind, randomised controlled clinical trial 120 participants, aged >65 years with functional impairment were randomized to receive 25mg spironolactone or placebo for 20 weeks. The primary outcome was the change in six-minute walking distance over 20 weeks. Secondary outcomes were change in Timed-Get-Up and Go test, Incremental Shuttle Walk Test, measures of health related quality of life (EuroQol health questionnaire and Functional Limitation Profile) and measures of psychological state (Hospital Anxiety and Depression Scale). Outcomes measures were repeated at 10 and 20 weeks.Participant mean age was 75 years (SD 6), 65/120 (54%) were male. Only 8/120 participants (6.6%) dropped out (5 from the placebo group, 3 from the spironolactone group). Of the 112 participants who completed the study 95% (106/112) remained on medication at 20 weeks. There was no significant change in six minute walking distance at 20 weeks with a -3.2 (95% CI -28.9, 22.5) metres difference between the spironolactone group related to the placebo group (p=0.81). There was however a significant improvement in quality of life at 20 weeks (a secondary outcome) with a rise in EuroQol EQ-5D score of 0.10 (95% CI 0.03, 0.18) in the spironolactone group relative to the placebo group (p=<0.01). There were no significant changes between groups in the other secondary outcomes. This trial found that spironolactone was safe and well tolerated, but did not improve physical function in older people who did not have heart failure. Quality of life improved, but the biological plausibility and possible mechanisms for this require further study.

Elöverkänslighet är ett officiellt funktionshinder. Enligt Socialstyrelsens Miljöhälsorapport 2009 uppger 3,2 procent av befolkningen i åldrarna mellan 18 och 80 år att de är känsliga/överkänsliga eller allergiska mot elektriska och magnetiska fält, vilket motsvarar drygt 200 000 personer. 0,4 procent uppger att de har svåra besvär. Detta motsvarar knappt 30 000 personer som får svåra sjukdomsliknande symptom som exempelvis yrsel, illamående, huvudvärk, sömnproblem och hudbesvär när de vistas i elintensiva miljöer som större delen av befolkningen inte besväras av. Avhandlingen består dels av teoretiska studier över radiofrekvent strålning och hur denna kan avskärmas, dels av en enkätundersökning för att undersöka hur landets kommuner, försäkringskassekontor och tre landsting bemöter dessa personer. Genom den arkitektorienterade forskningsmetoden ”research by design” har ett förslag på ett elfritt typhus, som även kan avskärma de högre frekvenserna från den radiofrekventa strålningen, utformats men ännu inte byggts. Utifrån enkätundersökningen framgår att personer med funktionsnedsättningen elöverkänslighet ytterst sällan får hjälp med den tillgänglighetsanpassning i bostaden de enligt svensk lag har rätt till. Avhandlingen visar på vad som byggtekniskt kan utföras för att förbättra boendemiljön för personer med funktionsnedsättningen elöverkänslighet. / Electrohypersensitivity in Sweden is an official functional impairment. According to The National Board of Health and Welfare’s questionnaire from 2009, 3.2 percent of the population aged between 18 and 80 answered that they are sensitive / hypersensitive or allergic to electric and magnetic fields, which represents just over 200 000 people. 0.4 percent said they have severe problems. This corresponds to nearly 30 000 persons who receives severe sickness-like symptoms such as dizziness, nausea, headaches, problems with sleeping and skin disorders when they are visiting electricity-intensive environments that are not bothering most of the population. The thesis consists of theoretical studies of radio-frequency emissions and how these can be shielded as well as a survey to investigate how the country's municipalities, social insurance offices and three county councils are receiving these persons. By the architect-oriented research methodology “research by design” a proposal for a type-building free from electricity, which also can shield the higher frequencies from the radio-frequency radiation, is designed but not yet built. The questionnaire survey indicates that persons with the functional impairment electrohypersensitivity very rarely receive the dwelling accessibility adaptation assistance they, according to Swedish law, are entitled to. The thesis shows what can be done by building construction to improve the living for persons with the functional impairment electrohypersensitivity. / QC 20111114

Magister Psychologiae - MPsych / The propensity to blush is typical of many individuals with social anxiety disorder (SAD). SAD is also associated with significant disability or functional impairment. The relationship between SAD, blushing and functional impairment is still not completely understood however. This study has focused on the association between the propensity to blush and reported level of functional impairment due to SAD. Data from thirty-eight (n=38) individuals with SAD, were collected via a larger study conducted at the MRC Anxiety and Stress Disorders Unit. Assessment tools include the Structured Clinical Interview for Axis I disorders – Patient Version (SCID -I/P), Social Phobia Inventory (SPIN) and the Blushing Propensity Scale. Demographic and clinical data were gathered and reported on. Spearman rank order correlations were used to determine relationships between variables, including blushing propensity, disability and symptom severity. Results were reported on and then discussed using the social attention theory. Limitations and recommendations were proposed in the final and concluding chapter. This study, as part of a larger study at the MRC Research Unit on Anxiety and Stress Disorders, has been approved by the Research Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.

Objective: To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services. Method:A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence. Results: Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical, or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk. Conclusions: Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions.

This work identifies and describes pathological skeletal changes associated with and attributable to acquired syphilis and which potentially caused functional impairment within eleven skeletal individuals recovered from five industrial-era London cemeteries. In eight (72.73%), functional impairment was likely or very likely, based on type and distribution of lesions across their skeleton. These impairments likely impacted the individuals’ ability to engage in various forms of physical activity, potentially limiting their economic potential. These results expand our still highly limited understanding of syphilis’s functional impacts within past populations, especially within industrial-era societies, querying longstanding characterizations of tertiary gummatous involvement as benign, while encouraging paleopathological investigations of the functional impacts of syphilis in past populations in which the disease was endemic, such as industrial-era England. Further, with syphilis rates on the rise globally, this information may be informative prognostically for present-day clinical cases of primary to tertiary stage undiagnosed and/or untreated syphilis.