In 1944 Hans Asperger, a Viennese physician, identified a neurological disorder which hinders a person’s ability to communicate and interact socially. Lorna Wing’s research reintroduced the disorder in 1981, but Asperger’s Syndrome was not recognized in the United States until 1994. This study, aimed at generating knowledge about the lived experience of individuals with Asperger’s, is grounded in hermeneutic phenomenology. The writings of Martin Heidegger (1962, 1971), Hans Gadamer (1975/2003), and Edward Casey (1993) provided the philosophical foundation that helped me to open up the phenomenon as I answered the question, “What is the lived-experience of individuals with Asperger’s Syndrome?” Van Manen’s (2003) six research activities served as a framework: (a) turning to a phenomenon which seriously interests us and commits us to the world; (b) investigating the experience as we live it rather than as we conceptualize it; (c) reflecting on the essential themes which characterize the phenomenon; (d) describing the phenomenon through the art of writing and rewriting; (e) maintaining a strong and oriented pedagogical relation to the phenomenon; and (f) balancing the research context by considering parts and whole. Individuals with “Asperger’s Syndrome” navigate the world in a manner that makes sense to them. These adults desire to build nearness in what has been coined a neurotypical world. Five adults with Asperger’s Syndrome were interviewed three times each, sharing their experiences in school, the workplace, and community, elaborating upon how they attempted to fit in with their neurotypical peers. They also shared strategies developed to build nearness and find place in the neurotypical society. Participants reported experiences such as wearing masks as a tool to gain insider status in the neurotypical world, and the sense of exhaustion this behavior involves. They described their experiences with terms such as “bully magnet” and “emotional traffic jam,” in illuminating the daily discomforts they face attempting to meet the expectations of social interaction. The experience of bullying particularly seems to have had a lifelong impact. Recommendations for further research include examining the effect of early diagnosis, and how early transition experiences contribute to social development. A study on the effects of bullying that Aspies encountered during their school years would also add valuable information to the literature. Finally, work is a significant part of every adult’s life. Recommendations for employers include exploring mentoring or natural supports to employees who disclose the disorder. Additional supports and resources would increase performance and job retention. / Ph. D.

Findings related to the adjustment of typically-developing (TD) siblings of children with Autism Spectrum Disorder (ASD) have been inconsistent, but suggest that most function well over time. The current mixed methods study investigated the relationship between family factors, especially disruptions to family routines, and academic functioning of TD siblings. Measures of family functioning, parenting stress, and parenting daily hassles were collected from parents (n = 20); an additional 19 families also completed semi-structured interviews (total n = 39). Teacher reports on classroom functioning (n = 25) and report cards were also collected. All parent participants (92% Caucasian, 90% married, 79% college-educated) had a child with an ASD diagnosis (80% male, M age = 11.74) and a TD child (62% male, M age = 10.31 years). Seventy-two percent of TD siblings (n = 18) had scores above the mean on the Academic Performance Rating Scale (DuPaul, Rapport, and Perriello, 1991), and 91% (n = 32) had grade averages of B or higher. Ninety-six percent (n = 24) of TD siblings had scores within the normative range on the Learning Problems and School Problems scales of the Behavior Assessment System for Children, Second Edition (BASC-2; Reynolds and Kamphaus, 2004). Daily hassles were not significantly correlated with any school measures for the TD siblings. Families with children with more severe ASD symptoms discussed greater frequencies of emotional outbursts in the child with ASD and missed social opportunities as a family. Families of children with externalizing behaviors may particularly benefit from targeted support. / Ph. D.

Yes / Most people living with dementia want to remain in their own homes, supported by family and paid carers. Care at home often breaks down, necessitating transition to a care home and existing interventions are limited. To inform the development of psychosocial interventions to enable people with dementia to live well for longer at home, we qualitatively explored the views of people living with dementia, family carers and health and social care professionals, on how to achieve and maintain independence at home and what impedes this. METHODS: We conducted an inductive thematic analysis of qualitative interviews with 11 people living with dementia, 19 professionals and 22 family carers in England. RESULTS: We identified four overarching themes: being in a safe and familiar environment, enabling not disabling care, maintaining relationships and community connectedness, and getting the right support. For people living with dementia, the realities of staying active were complex: there was a tension between accepting support that enabled independence and a feeling that in doing so they were accepting dependency. Their and professionals' accounts prioritised autonomy and 'living well with dementia', while family carers prioritised avoiding harm. Professionals promoted positive risk-taking and facilitating independence, whereas family carers often felt they were left holding this risk. DISCUSSION: Psychosocial interventions must accommodate tensions between positive risk-taking and avoiding harm, facilitating autonomy and providing support. They should be adaptive and collaborative, combining self-management with flexible support. Compassionate implementation of rights-based dementia care must consider the emotional burden for family carers of supporting someone to live positively with risk. / This work was supported by the Alzheimer’s Society (UK) and was carried out within the UCL Alzheimer’s Society Centre of Excellence for Independence at home, NIDUS (New Interventions in Dementia Study) programme (Alzheimer’s Society Centre of Excellence grant 330). This project is also part-funded funded by The National Institute for Health Research Applied Research Collaboration North West Coast (ARC NWC).

Item Response Theory (IRT) methodologies were employed in order to examine the Myers-Briggs Type Indicator (MBTI) for differential item functioning (DIF) on the basis of crossed gender and ethnicity variables. White males were the reference group, and the focal groups were: black females, black males, and white females. The MBTI was predicted to show DIF in all comparisons. In particular, DIF on the Thinking-Feeling scale was hypothesized especially in the comparisons between white males and black females and between white males and white females. A sample of 10,775 managers who took the MBTI at assessment centers provided the data for the present experiment. The Mantel-Haenszel procedure and an IRT-based area technique were the methods of DIF-detection. Results showed several biased items on all scales for all comparisons. Ethnicitybased bias was seen in the white male vs. black female and white male vs. black male comparisons. Gender-based bias was seen particularly in the white male vs. white female comparisons. Consequently, the Thinking-Feeling showed the least DIF of all scales across comparisons, and only one of the items differentially scored by gender was found to be biased. Findings indicate that the gender-based differential scoring system is not defensible in managerial samples, and there is a need for further research into the study of differential item functioning with regards to ethnicity. / Master of Science

<p dir="ltr">Compared to individuals low in schizotypal traits, those with elevated schizotypal traits present with social deficits and are at greater risk for developing schizophrenia-spectrum disorders and other forms of psychopathology. Ecological Momentary Assessment (EMA) is a powerful tool for understanding the real-world behaviors of schizophrenia-spectrum populations. Although studies have effectively utilized EMA to examine important aspects of social interactions (i.e., how often people interact [likelihood], the complexity of the content in these interactions [depth], and how much pleasure they derive from these interactions [enjoyment]) in people with schizophrenia, few have explored differences in social interactions using EMA across schizotypal traits (i.e., positive, negative, and disorganized). In this study, we used EMA to collect data from three universities. Our primary aim was to evaluate if positive, negative, and disorganized schizotypal traits in college students were significantly linked to individuals’ likelihood, depth, and enjoyment of social interactions in their everyday lives. Our secondary aim was to investigate whether affect and stress play a role in individuals’ likelihood, depth, and enjoyment of social interactions. Results revealed that negative schizotypal traits more strongly predicted social interaction depth and enjoyment compared to positive and disorganized traits. Contrary to hypotheses, positive affect was a better predictor of social interaction outcomes than negative affect and stress. Several notable interactions between schizotypal traits and affect also emerged. Overall, this study increases understanding of how schizotypal traits and affect impact daily social interactions. These findings may inform future research aimed at improving and individualizing interventions for social functioning deficits in individuals with elevated positive, negative, and/or disorganized schizotypal traits.</p>

Le raisonnement sociomoral (RSM) est une habileté essentielle durant l’adolescence, car elle guide les décisions sociales, facilitant le fonctionnement social. Quelques facteurs sociocognitifs et socioémotionnels semblent favoriser l’évolution du RSM, cependant leur contribution particulière reste nébuleuse, car ils ont été étudiés de façon isolée. Cette étude explore les habiletés associées au RSM mature chez les adolescents en santé, ainsi que la contribution spécifique des fonctions exécutives, en utilisant un outil écologiquement valide pour cette population. Nous avons détecté quatre contributeurs indépendants du RSM mature : l’âge, l’intelligence, la flexibilité cognitive et la fluence verbale, ainsi que des différences de genre concernant la maturité du RSM et la prise de décision sociomorale. Les résultats de cette étude contribuent à améliorer la compréhension du développement moral à l’adolescence et soulignent l’importance d’utiliser des outils écologiquement valides pour mesurer les habiletés sociales. / Sociomoral reasoning (SMR) is an important skill during adolescence because it guides social decisions, facilitating social functioning. A number of sociocognitive and socioemotional factors are likely to underlie the evolution of SMR abilities; however their relative contribution remains unclear given that to date their roles have typically been explored in isolation. This study explores the underpinnings of SMR maturity in typically developing adolescents and the specific contribution of executive functions using an ecologically valid tool for assessment in the adolescent population. We detected four independent contributors of SMR maturity in healthy adolescence: age, intelligence, cognitive flexibility and verbal fluency, as well as gender differences in SMR maturity and sociomoral decision-making. Taken together, the findings of this study contribute to better understanding moral development during adolescence and highlight the importance of using ecologically valid tools to measure social skills.

Evidências sugerem o envolvimento de um estado de inflamação crônica de baixo grau na fisiopatologia do transtorno bipolar (TB). Os estudos apresentados nesta tese tiveram como objetivo explorar o papel da inflamação crônica nos mecanismos fisiopatológicos do TB através da avaliação dos níveis séricos de proteína C-reativa (PCR). A PCR é um marcador de inflamação sistêmica comumente utilizado na prática clínica, sendo considerado fator de risco para várias patologias, incluindo câncer e doença cardiovascular. O primeiro artigo, através de um estudo de meta-análise, teve como objetivo avaliar o tamanho de efeito da associação entre níveis de PCR em pacientes bipolares nas diferentes fases de humor (n=730) comparado a indivíduos controles (n=888). Pacientes bipolares apresentaram níveis de PCR significativamente elevados em comparação ao grupo controle, com moderado tamanho de efeito (effect size, ES = 0.39; 95% IC, 0.24 – 0.55; P < 0.0001). Níveis de PCR foram significativamente maiores em pacientes maníacos (ES = 0.73; 95% IC, 0.44 – 1.02; P < 0.001) e em eutímicos (ES = 0.26; 95% IC, 0.01 – 0.51; P = 0.04). O segundo artigo se propôs a revisar dados da literatura relacionados a biomarcadores periféricos potencialmente implicados na progressão do TB. Pacientes em diferentes estágios do TB apresentaram níveis alterados de marcadores de estresse oxidativo, neurotrofinas e de inflamação, incluindo a PCR, o que reforça a hipótese da inflamação crônica exercer um papel importante na fisiopatologia do TB. Em seguida, considerando a abordagem multidimensional no TB, o terceiro artigo avaliou a reatividade emocional como uma dimensão relevante para caracterizar pacientes bipolares apresentando sintomas subclínicos de humor durante a fase de remissão (N=613). Apesar de todos pacientes estarem em remissão, a maioria deles (68%) apresentou reatividade emocional anormal (hipo ou hiper-reatividade emocional). Esse estudo avaliou, também, o funcionamento psicossocial nesses pacientes e os níveis de PCR ultra-sensível como um possível marcador objetivo de hiper-reatividade emocional no TB. Os pacientes com hiper-reatividade emocional, em comparação aos pacientes com hipo- ou normal reatividade emocional, apresentaram prejuízo cognitivo e níveis de PCR significativamente mais elevados (P < 0.001). Esses resultados provêm de um estudo transversal e, portanto, conclusões sobre causalidade dessas associações não podem ser inferidas, já que outros fatores, além dos níveis de PCR, podem também contribuir para o estado inflamatório crônico observado nesses pacientes. Em suma, os resultados desta tese sugerem que a inflamação crônica de baixo grau, evidenciada pelas alterações nos níveis de PCR, parece estar implicada na fisiopatologia e na progressão do TB. Novas intervenções terapêuticas com alvo em mecanismos inflamatórios e na modulação dos níveis de PCR devem ser priorizados em estudos futuros. / Evidence suggests that chronic low-grade inflammation appears to be involved in the pathophysiology of bipolar disorder (BD). The studies presented in this thesis aimed at exploring the role of chronic inflammation in the BD pathophysiological mechanisms by assessing serum levels of C-reactive protein (CRP). CRP is a marker of low-grade inflammation widely used in clinical practice, and a risk factor for cardiovascular and malignant diseases. The first article, a meta-analysis, aimed at evaluating the effect size of the association between CRP levels in bipolar patients (n=730) compared to healthy subjects (n=888). Overall, CRP levels were significantly elevated in patients with BD versus controls (effect size, ES = 0.39; 95% CI, 0.24 to 0.55; P < .0001). CRP levels were significantly higher in manic (ES = 0.73; 95% CI, 0.44 to 1.02; P < 0.001) and euthymic (ES = 0.26; 95% CI, 0.01 to 0.51; P = 0.04). The second paper aimed at reviewing the scientific literature regarding peripheral biomarkers potentially implicated in the progression of BD. Bipolar patients within different disease’s stages presented altered levels of oxidative stress, neurotrophins and inflammatory markers, including PCR. These findings reinforce the hypothesis of the potential role of the chronic inflammation in BD pathophysiology. Regarding the multidimensional approach in BD, the third article assessed emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms (N=613). Although all patients were in remission, most of them (68%) showed abnormal emotional reactivity (hipo- or hyper-reactivity). In addition, this study assessed the psychosocial functioning in these patients as well as the levels of high-sensitivty PCR (hsCRP) as an objective marker of emotional hyper-reactivity in BD. Patients with emotional hyper-reactivity had higher levels of PCR and cognitive impairment compared to patients with emotional hypo or normal emotional reactivity (P < 0.001). This was a crosssectional study of emotional reactivity, hsCRP levels and functional status in remitted bipolar patients, and no conclusions regarding the causality of these associations can be substantiated. Others factors could also be contributing to the chronic inflammatory state in these patients. In conclusion, the results of this thesis suggest that low-grade chronic inflammation, as evidenced by alteration in CRP levels, may be implicated in the pathophysiology as well as in the BD progression. Novel therapeutic interventions targeting inflammatory mechanisms and the modulation of CRP levels should be prioritized in future studies.

The purpose of this study was to identify school-based practices that lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth endorse as ways for high schools to provide social, emotional, and academic support to LGBTQ youth. A diverse sample of LGBTQ high school students (N = 18) from one large urban school district in a southeastern state participated in individual semi-structured interviews and/or small group brainstorming sessions. Eleven individual interviews were conducted to gather detailed accounts of a) supportive behaviors and policies that youth had experienced in their schools, as well as b) supportive behaviors and policies that were suggested as desired supports that had not actually been experienced. Participants' sentiments were coded based on the source of support (i.e., teachers, school mental health providers, administrators, policies, resources), nature of support (i.e., proactive, reactive), and social context of the support (i.e., impacting single students through one-on-one setting, impacting more than one student or groups of students). Three brainstorming sessions that included a total of 13 students were conducted to gather additional ideas from youth on ways for schools and school staff to provide support. Frequency counts of individual interview data indicated that teachers provided more experienced and desired supports than any other school-based source of support. Of the desired supports that participants had not actually experienced, Proactive Supports Impacting Groups were the most frequently described Support Type for teachers, school mental health providers, and administrators. Content Themes emerged within Support Types (e.g., Proactive Support Impacting Individuals, Reactive Support Impacting Groups) capture sentiments that were shared across multiple participants' responses. Data from interviews and brainstorming sessions were also analyzed together through a constant-comparative reduction process, resulting in 162 Specific Educator Behaviors/Policies corresponding to 8 Big Ideas of school-based supports for LGBTQ high school students: (1) Using Respectful Language and Interactions with Students; (2) Providing Comfort, Assistance, and Advice Matched to Student Needs; (3) Facilitating Connections with Community Supports; (4) Providing LGBTQ-Related Materials and Information; (5) Allowing and Supporting School-Based GSA and Pride Activities; (6) Addressing Professional Development, Human Resources, and School Culture Related Issues; (7) Implementing Policies that Address Bullying and Harassment of LGBTQ Students; and (8) Implementing Policies that Respectfully Account for Students' Diversity.) Pragmatic implications for teachers, school mental health providers, and administrators are discussed.

Le raisonnement sociomoral (RSM) est une habileté essentielle durant l’adolescence, car elle guide les décisions sociales, facilitant le fonctionnement social. Quelques facteurs sociocognitifs et socioémotionnels semblent favoriser l’évolution du RSM, cependant leur contribution particulière reste nébuleuse, car ils ont été étudiés de façon isolée. Cette étude explore les habiletés associées au RSM mature chez les adolescents en santé, ainsi que la contribution spécifique des fonctions exécutives, en utilisant un outil écologiquement valide pour cette population. Nous avons détecté quatre contributeurs indépendants du RSM mature : l’âge, l’intelligence, la flexibilité cognitive et la fluence verbale, ainsi que des différences de genre concernant la maturité du RSM et la prise de décision sociomorale. Les résultats de cette étude contribuent à améliorer la compréhension du développement moral à l’adolescence et soulignent l’importance d’utiliser des outils écologiquement valides pour mesurer les habiletés sociales. / Sociomoral reasoning (SMR) is an important skill during adolescence because it guides social decisions, facilitating social functioning. A number of sociocognitive and socioemotional factors are likely to underlie the evolution of SMR abilities; however their relative contribution remains unclear given that to date their roles have typically been explored in isolation. This study explores the underpinnings of SMR maturity in typically developing adolescents and the specific contribution of executive functions using an ecologically valid tool for assessment in the adolescent population. We detected four independent contributors of SMR maturity in healthy adolescence: age, intelligence, cognitive flexibility and verbal fluency, as well as gender differences in SMR maturity and sociomoral decision-making. Taken together, the findings of this study contribute to better understanding moral development during adolescence and highlight the importance of using ecologically valid tools to measure social skills.

The increased use of polytomous item formats has led assessment developers to pay greater attention to the detection of differential item functioning (DIF) in these items. DIF occurs when an item performs differently for two contrasting groups of respondents (e.g., males versus females) after controlling for differences in the abilities of the groups. Determining whether the difference in performance on an item between two demographic groups is due to between group differences in ability or some form of unfairness in the item is a more complex task for a polytomous item, because of its many score categories, than for a dichotomous item. Effective DIF detection methods must be able to locate DIF within each of these various score categories. The Mantel, Generalized Mantel Haenszel (GMH), and Logistic Regression (LR) are three of several DIF detection methods that are able to test for DIF in polytomous items. There have been relatively few studies on the effectiveness of polytomous procedures to detect DIF; and of those studies, only a very small percentage have examined the efficiency of the Mantel, GMH, and LR procedures when item discrimination magnitudes and category intersection parameters vary and when there are different patterns of DIF (e.g., balanced versus constant) within score categories. This Monte Carlo simulation study compared the Type I error and power of the Mantel, GMH, and OLR (LR method for ordinal data) procedures when variation occurred in 1) the item discrimination parameters, 2) category intersection parameters, 3) DIF patterns within score categories, and 4) the average latent traits between the reference and focal groups. Results of this investigation showed that high item discrimination levels were directly related to increased DIF detection rates. The location of the difficulty parameters was also found to have a direct effect on DIF detection rates. Additionally, depending on item difficulty, DIF magnitudes and patterns within score categories were found to impact DIF detection rates and finally, DIF detection power increased as DIF magnitudes became larger. The GMH outperformed the Mantel and OLR and is recommended for use with polytomous data when the item discrimination varies across items.