This research explores experiences and perceptions of mothers of adolescents and young adults (13-22yrs) with Additional Support Needs (ASN) in relation to stress, service provision and family and individual Quality of Life (QoL). A particular focus is the effect of having a family member with ASN who also has a diagnosis of Autistic Spectrum Disorder (ASD) or where the young person with ASN may have an ASD which has not been diagnosed. Mothers of young people from 4 groups were recruited: i) those with ASN and no ASD (n=41), ii) those with ASN and a diagnosis of ASD (n=18), iii) those with ASN, no diagnosis of ASD but with a positive score on an ASD screening measure (n=17) and iv) typically developing controls (n=17). The mothers of young people with ASN (n=76) completed standardised questionnaires about family and individual QoL, stress, service provision, child behaviour and presence and severity of ASD traits. Twenty two of these mothers also took part in a semi-structured interview about coping with issues identified as most stressful by them in the stress questionnaire. The mothers of typically developing young people (n=17) completed standardised questionnaires on individual and family quality of life and on the behaviour of their similarly aged son or daughter. Data collected via these questionnaires showed that increased severity of ASD was associated with increased maternal stress, which in turn was associated with decreased family and maternal QoL. Mothers of typically developing young people had significantly higher individual and family QoL scores than each of the three other groups. The findings from the interviews supported the questionnaire results and gave further insight into mothers’ life experiences. Mothers identified many perceived barriers to their child’s progress including: lack of support and lack of co-ordinated service provision. The results suggest that mothers of young people with ASN experience lower individual and family quality of life than mothers of typically developing young people. Parenting an adolescent or young adult with ASN is perceived as stressful and that the presence of behaviour associated with ASD is additionally stressful. Possible reasons for differences in quality of life outcomes amongst the study groups are discussed. Implications for adequate services and recommendations for future research are suggested.

The focus of this thesis is economic evaluations of programs and interventions regarding children and adolescents with mental health issues, victimization, and intellectual disabilities (ID). The first paper examines a potential link between mental health issues among adolescent and the class-size of the school class they are enrolled in. The class-size and schools’ financial resources is often at the center of policy debates. Our results suggest that there is no evidence that larger classes have negative impact on the mental health for adolescents in a Swedish context. The second paper investigate the societal willingness to pay (WTP) to reduce bullying in Swedish schools. The results suggest that the tax payers WTP is about 5 SEK and the societal is about 600 000 SEK per reduced bullying victim. This value of WTP could be used as a measure to evaluate different investments in anti-bullying programs and efforts to reduce the bullying in schools. The third paper estimates the cost-effectiveness of one recently introduced antibullying program, the Finnish KiVa program, one of the few evidence based programs in the world. Based on a decision-analytic model, the results indicate that the KiVa program is a cost-effective program that has a cost per reduced victim well below the WTP as estimated in the second paper as documented above. The fourth paper evaluates, from the municipality perspective, the effects of investing in a SE program compared to “business as usual” in order to increase the likelihood for gaining regular employment for the pupils with ID. The results indicate that it takes 9 years before breakeven is reached if investing in the SE program. The fifth paper conducts a decision-analytic economic evaluation of the SE program using simulations to assess the effects over the full life-course. The results suggest that from a societal perspective the program is cost-effective ten years after the investment and by then has generated a benefit of 17 000 SEK per individual.

Sexuell hälsa är betydelsefullt i alla människors liv. Personer med intellektuell funktionsnedsättning möter ofta barriärer som hindrar dem att uttrycka sin sexualitet. Personalen är outbildad inom området, därav använder sig av sin egen moral i bemötandet. Syftet med studien var att undersöka hur bemötande till sexualitet hos personer med intellektuell funktionsnedsättning, hos den bedömde ser ut. Påverkas bemötandet till sexualitet av graden av intellektuell funktionsnedsättning och self-efficacy av bedömaren? Sammanlagt deltog 96 socionomstudenter och 38 boendestödjare i en vinjettstudie med experimentell mellangruppsdesign. Vinjetten varierade i två olika betingelser. Deltagare fick ta ställning med hjälp av egengjorda skalor och en self-efficacy skala. Resultatet visar positivt samband mellan self-efficacy och pedagogisk kompetens hos bedömaren. I fråga om bemötandet i relation till sexualitet och graden av intellektuell funktionsnedsättning visades ingen signifikant skillnad. Förslag på framtida forskning är att undersöka hur skillnader ser ut beroende på kön hos den bedömde.

I denna systematiska litteraturstudie ville vi undersöka modern forskning kring kommunikation och delaktighet för elever med flerfunktionsnedsättningar och intellektuella funktionshinder. Ämnet delaktighet för elever med flerfunktionsnedsättningar som ingår i grundsärskolans inriktning träningsskola är ett komplicerat ämne att bearbeta. Elevernas olika förmågor, förutsättningar och svårigheter att uttrycka sig gör det svårt att få insikt i elevernas egna uppfattningar. Konsekvensen av detta blir att personer med flera funktionsnedsättningar ofta blir exkluderade från forskningen. Syftet med studien är att sammanställa forskning som handlar om kommunikation och samspel med elever med flera funktionsnedsättningar på tidig utvecklingsnivå. För att samla in data till vår litteraturstudie gjorde vi vår artikelsökning i Stockholms universitetsbiblioteks (SUB) databas-samling och denna studie omfattar 12 artiklar som berörde vårt ämne. Våra urvalskriterier var att artiklarna skulle handla om elever med flera funktionsnedsättningar och kommunikationssvårigheter samt vara kopplade till lärande och skolmiljö. Kvalitetsgranskning och metodanalys samt resultatanalys av dessa kvantitativa artiklar har dels redovisats i tabellform, som bilaga och ett mer omfattande resultat återfinns i löpande text. Det sammanfattande resultatet visar att omgivningens värdegrund och attityder samt pedagogers förhållningssätt är avgörande för elevernas utveckling och lärande. Undervisningen måste individanpassas utifrån elevernas förmågor och förutsättningar med tillgänglig AKK samt med stöd av partners och mentorer för att skapa de bästa premisserna för samspel och kommunikation.

A qualidade de vida de pessoas com deficiência mental vem sendo investigada, nos últimos anos, sob a perspectiva de seus cuidadores que, na maioria das vezes, são os próprios pais. Em pesquisas e, mesmo socialmente, não é prática comum dar voz a pessoas com deficiência. Sabe-se que elas são capazes de pensar sobre seus sentimentos e de expressá-los; são capazes de trabalhar e, independentes, morar em sua própria casa, constituindo uma família. Assim, este estudo teve por objetivos: conhecer a opinião de adultos com deficiência mental leve em relação a sua qualidade de vida e a opinião dos cuidadores a esse mesmo respeito; avaliar a sobrecarga gerada na vida destes cuidadores, pelo cuidar das pessoas com deficiência. Participaram desta pesquisa 15 adultos (20 anos ou mais) com deficiência mental leve, e seus respectivos cuidadores. As pessoas com deficiência responderam a um instrumento que avalia a qualidade de vida (WHOQOL-Bref) e a uma entrevista estruturada. Os cuidadores responderam, além destes dois instrumentos, a uma escala que avalia a sobrecarga ao cuidar, a Burden Interview. Os dados provenientes das escalas de qualidade de vida e de sobrecarga foram analisados estatisticamente, conforme indicação da literatura, enquanto aqueles resultantes das entrevistas foram analisados quantitativamente e também a partir do Sistema Quantitativo-Interpretativo. Após a análise dos dados em separado, os resultados foram comparados entre si. Para ilustrar alguns detalhes de participantes que se destacaram no grupo, realizaram-se dois estudos de caso, sendo cada um com uma pessoa com deficiência mental e seu respectivo cuidador. Comparando-se os resultados obtidos a partir de todas as avaliações realizadas, obteve-se que, de maneira geral, as pessoas com deficiência apresentam-se mais satisfeitas e seus cuidadores mais insatisfeitos cada um com sua própria qualidade de vida. As pessoas com deficiência que possuem idade superior a 27 anos mostraram-se mais insatisfeitas com o domínio das relações sociais. No caso dos cuidadores, ao avaliarem a própria qualidade de vida, os índices de insatisfação com o próprio bem-estar físico estão associados à idade elevada e também ao elevado número de anos em que exerce a função de cuidar. Isto se verifica principalmente entre os cuidadores de alta renda, porém, entre aqueles de baixa renda familiar, existe uma grande satisfação com o seu bem-estar físico e com suas relações sociais. Em geral, os cuidadores não demonstraram alta sobrecarga advinda da rotina de cuidados. Ao tratarem, através das entrevistas, de assuntos relacionados com a independência, sociabilidade e sexualidade, os relatos das pessoas com deficiência e de seus cuidadores se tornam um pouco distintos, demonstrando alguns conflitos, principalmente no que diz respeito ao último tópico. Conclui-se, por fim, que as pessoas com deficiência mental são capazes de falar de suas próprias vidas e apresentam uma visão positiva das mesmas, expressando seus sentimentos e pensamentos a respeito da realidade em que vivem, de maneira bastante concreta. E ainda, seus cuidadores não se sentem sobrecarregados como os de outras populações, mas possuem dúvidas e receios que podem ser amenizados com a ajuda de profissionais da Psicologia. / The quality of life of people with intellectual disability has been investigated lately, under the view of caregivers who are their own parents most of times. That is why people with intellectual disability are often socially neglected. It is known those people are able to think about their feelings and express them; are able to work and to live in their own home independently, and to create a family. Thus, the present study aimed: to known the opinion of patients with mild intellectual disability related to their quality of life; the opinion of their caregivers about people with disability quality of life; to evaluate the burdens of taking care of people with intellectual disability. Fifteen people with mild intellectual disability participated to the study, adults (over 20 years-old) and their respective caregivers. People with disability answered to an instrument that evaluates quality of life (WHOQOL-Bref) and to an interview. Caregivers, besides answering both instruments, were submitted to a scale that evaluates the burdens of care, a Burden Interview. Data from quality of life and burden scales were statistically analyzed, while data from interviews were quantitatively analyzed and so did by Quantitative-Interpretative System. After data analysis, outcomes were compared. In order to recover some details, two cases reports with intellectual disability and their caregivers were carried out. Comparing outcomes obtained from evaluations of quality of life of people with intellectual disability and their caregivers, those people with disability are generally more satisfied with their own quality of life and those caregivers are less satisfied with the quality of life of whom they take care. People with disability over 27 years-old were more unsatisfied with socializing. Caregivers, as evaluating their own quality of life, dissatisfaction with their own physical welfare are associated to elderly and also to spending years of caretaking, mainly among those better paid. However, among those worse paid there is a high satisfaction with their physical welfare and socializing. Caregivers generally dont feel very burdened on taking care. Issues such as independence, sociability and sexuality, report from people with disability and their caregivers were quite different, showing some conflicts, principally the latter one. In conclusion, people with intellectual disability are able to talk about their own lives and present a optimistic view, expressing their feelings and thoughts about reality they live in a very concrete way. Moreover, their caregivers do not feel overburdened, but actually they have some doubts and fears that might be diminished with aid of psychologists.

Objectives: The following thesis is presented within two separate pieces of work. A systematic literature review (SLR) aimed to evaluate the individual characteristics and psychometric properties of four dementia screening tools. These were the Dementia Questionnaire for People with Learning Disabilities (DLD) (Evenhuis, 2007), the Dementia Scale for Down Syndrome (DSDS) (Gedye, 1995), the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) (Deb et al, 2007a) and the Adaptive Behaviour Dementia Questionnaire (ABDQ) (Prasher et al, 2004). The empirical research (ER) aimed to evaluate the clinical utility and longitudinal accuracy of two of these tools; the DLD and the ABDQ in a clinical population with intellectual disability (ID) and Down syndrome (DS). Methods: For the SLR a comprehensive list of electronic academic databases were searched to identify studies which included information relating to the psychometric properties of the DLD, DSDS, DSQIID and the ABDQ. Information within the studies was then extracted and rated using two quality assessment measures. These were the Characteristics of Assessment Instruments for Psychiatric Disorders in Persons with Intellectual Developmental Disabilities (CAPS-IDD) (Zeilinger et al, 2013b) and the Qualsyst (Kmet, 2004). For the ER, a repeated measures MANOVA was used to assess change over time between two groups of people with intellectual disabilities and Down syndrome; one with dementia and one without. Results: In the SLR, 16 studies were identified and rated using the CAPS-IDD and the Qualsyst. Detailed information related to the dementia screening tools and quality ratings of the papers are provided. In the ER both the ABDQ and the DLD demonstrated a clear difference between those who develop dementia and those who do not, with those in the ‘dementia’ group exhibiting increasing scores over time. Conclusions: The SLR concludes that the evidence base for these dementia screening tools remain limited. The largest evidence base was evidenced for the DLD. The ER concludes that the ABDQ and the DLD are useful tools to differentiate between those who develop dementia and those who do not. Further analysis incorporating the exploration of individual component items of tools is recommended.

Lai Ching Ha. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 225-243). / Title --- p.1 / Abstract --- p.2 / Acknowledgments --- p.4 / Contents --- p.5 / Abbreviations --- p.10 / List of Figures --- p.12 / List of Tables --- p.15 / Chapter Chapter 1 --- Review on Inherited Metabolic Diseases --- p.18 / Chapter 1.1 --- Development of the concept of inherited metabolic diseases (IMD) --- p.18 / Chapter 1.2 --- Frequency of inherited metabolic diseases --- p.20 / Chapter 1.3 --- Molecular basis of mutations in inherited metabolic diseases --- p.22 / Chapter 1.3.1 --- Point mutations --- p.22 / Chapter 1.3.2 --- Small deletions and insertions --- p.25 / Chapter 1.3.3 --- large deletions or duplications --- p.26 / Chapter 1.4 --- Pathological consequences of protein defect resultingin IMD --- p.27 / Chapter 1.4.1 --- End product --- p.28 / Chapter 1.4.2 --- Precursor accumulation --- p.28 / Chapter 1.4.3 --- Unusual metabolites --- p.29 / Chapter 1.5 --- Heterogeneity of inherited metabolic diseases --- p.29 / Chapter 1.5.1 --- Genetic heterogeneity --- p.29 / Chapter 1.5.2 --- Variations of expression in different cells --- p.31 / Chapter 1.6 --- Diagnosis of inherited metabolic diseases --- p.32 / Chapter 1.6.1. --- Biochemical investigations --- p.32 / Chapter 1.6.2 --- Identification of accumulated or missing metabolites --- p.33 / Chapter 1.6.3 --- Direct analysis of enzymes and proteins --- p.34 / Chapter 1.6.4 --- Molecular investigations --- p.34 / Chapter 1.7 --- Treatment of inherited metabolic diseases --- p.40 / Chapter 1.7.1 --- Treatment at the clinical phenotype level --- p.41 / Chapter 1.7.2 --- Treatment at the metabolite level --- p.41 / Chapter 1.7.3 --- Treatment at the dysfunctional protein level --- p.43 / Chapter 1.7.4 --- Transplantation --- p.44 / Chapter 1.7.5 --- Gene therapy --- p.45 / Chapter 1.8 --- Inherited metabolic diseases in Hong Kong --- p.47 / Chapter 1.9 --- General Aim --- p.48 / Chapter Chapter 2 --- Study of Inherited Metabolic Diseases in Mentally Retarded Patients --- p.49 / Chapter 2.1 --- Introduction --- p.49 / Chapter 2.2 --- Aim --- p.52 / Chapter 2.3 --- Materials --- p.53 / Chapter 2.3.1 --- Standards --- p.53 / Chapter 2.3.2 --- Chemical reagents --- p.53 / Chapter 2.3.3 --- Derivatization reagents --- p.54 / Chapter 2.3.4 --- Major equipment --- p.54 / Chapter 2.4 --- Clinical materials --- p.56 / Chapter 2.4.1 --- Subjects --- p.55 / Chapter 2.4.2 --- Blood and urine samples --- p.56 / Chapter 2.5 --- Methods --- p.57 / Chapter 2.5.1 --- General biochemistry tests --- p.57 / Chapter 2.5.2 --- Metabolic screening tests --- p.57 / Chapter 2.5.3 --- Two-dimensional thin layer chromatography --- p.53 / Chapter 2.5.4 --- Identification of urinary organic acids by gas chromatography mass spectroscopy --- p.59 / Chapter 2.5.5 --- Amino acid analysis by high performance liquid chromatography --- p.66 / Chapter 2.6 --- Results --- p.71 / Chapter (A) --- Methodological Aspects / Chapter 2.6.1 --- Identification of urinary organic acids by gas chromatography-mass spectroscopy (GC-MS) --- p.71 / Chapter 2.6.2 --- Amino acid analysis by high performance liquid chromatography (HPLC) --- p.86 / Chapter (B) --- Patient Investigations / Chapter 2.6.3 --- General biochemistry tests --- p.107 / Chapter 2.6.4 --- Serum amino acid profiles --- p.113 / Chapter 2.6.5 --- Urinary organic acid analysis --- p.115 / Chapter 2.6.6 --- Case reports --- p.119 / Chapter 2.7 --- Discussion --- p.123 / Chapter 2.7.1 --- Identification of urinary organic acids by gas chromatography-mass spectroscopy (GC-MS) --- p.123 / Chapter 2.7.2. --- Amino acid analysis by high performance liquid chromatography (HPLC) --- p.130 / Chapter 2.7.3 --- Identification of inherited metabolic diseases (IMD)in an institutionalized mentally retarded patients --- p.136 / Chapter Chapter 3 --- Molecular Investigation of Maple Syrup Urine Disease --- p.140 / Chapter 3.1 --- Introduction --- p.140 / Chapter 3.1.1 --- Branched chain amino acids (BCAA) --- p.140 / Chapter 3.1.2 --- Metabolism of branched chain amino acids --- p.142 / Chapter 3.1.3 --- Maple syrup urine disease (MSUD) --- p.144 / Chapter 3.1.4 --- Classification of maple syrup urine disease --- p.146 / Chapter 3.1.5 --- Screening and diagnosis of maple syrup urine disease --- p.148 / Chapter 3.1.6 --- Treatment of maple syrup urine disease --- p.150 / Chapter 3.1.7. --- Branched chain a-ketoacid dehydrogenase complex (BCKDH) --- p.151 / Chapter 3.1.8 --- "Gene features of human E1α,E1β and E2 subunitsin branched chain α-ketoacid dehydrogenase complex" --- p.153 / Chapter 3.1.9 --- Molecular defects of the BCKDH gene complex --- p.156 / Chapter 3.1.10 --- MSUD in Hong Kong --- p.161 / Chapter 3.2 --- Aim --- p.163 / Chapter 3.3 --- Materials --- p.164 / Chapter 3.3.1 --- Source of skin fibroblasts --- p.164 / Chapter 3.3.2 --- Enzymes --- p.164 / Chapter 3.3.3 --- DNA markers --- p.164 / Chapter 3.3.4 --- Reagent Kits --- p.165 / Chapter 3.3.5 --- Primers --- p.165 / Chapter 3.3.6 --- Chemical reagents --- p.165 / Chapter 3.3.7 --- Nitrocellulose membrane --- p.166 / Chapter 3.3.8 --- Antiserum for Western blotting --- p.166 / Chapter 3.3.9 --- Radioisotopes --- p.166 / Chapter 3.4 --- Methods --- p.168 / Chapter 3.4.1 --- Preparation of buffers and solutions --- p.168 / Chapter 3.4.2 --- Agarose gel electrophoresis --- p.170 / Chapter 3.4.3 --- Preparation of native polyacrylamide gel --- p.171 / Chapter 3.4.4 --- Preparation of sodium dodecyl sulfate (SDS) polyacrylamide gel --- p.172 / Chapter 3.4.5 --- Preparation of denaturing polyacrylamide gel --- p.173 / Chapter 3.4.6 --- Branched chain α-ketoacid dehydrogenase complex enzyme assay --- p.173 / Chapter 3.4.7. --- Identification of the affected subunits in BCKDH complex of MSUD patient and her family members --- p.176 / Chapter 3.4.8 --- Screening of mutation in the BCKDH subunits by RT-PCR-SSCP --- p.178 / Chapter 3.4.9 --- Mutation analysis of whole cDNA fragments of Elα， Elβ and E2 subunits by ds DNA cycle sequencing --- p.184 / Chapter 3.5 --- Results --- p.188 / Chapter 3.5.1 --- Branched chain α-ketoacid dehydrogenase complex enzyme assay --- p.188 / Chapter 3.5.2 --- Identification of the affected subunits in BCKDH complex ofMSUD patient and her family members --- p.188 / Chapter 3.5.3 --- Screening of mutation in the BCKDH subunits by RT-PCR-SSCP --- p.192 / Chapter 3.5.4 --- "Mutation analysis of whole cDNA fragments of Ela, Elβ and E2 subunits by ds DNA cycle sequencing" --- p.204 / Chapter 3.6 --- Discussion --- p.210 / Chapter 3.6.1 --- BCKDH activity in the MSUD patient and her family members --- p.210 / Chapter 3.6.2 --- Investigation of the mutation sites --- p.212 / General Conclusion --- p.222 / Appendix --- p.224 / References --- p.225

The clinical needs of patients with epilepsy are often unmet for the following reasons: (1) the clinical diagnosis of epilepsy in a hospital setting is challenging and there is a lack of longitudinal data from the time-point of initial triage to help clinicians go through the diagnostic process; (2) epilepsy patients who develop refractory illness may encounter problems of localization and lateralization of their seizure foci and (3) the technology required in the delineation of epileptogenic zones and functional cortices may not be accurate enough to support the clinicians in their diagnoses. / The current thesis begins with the exploration of the epidemiology of suspected seizure patients in a hospital setting where patients with first seizure, epilepsy and non-epileptic events may present at the same point-of-care entry. We designed a longitudinal, prospective study examining patients presenting with “seizure-specific“ and “non-specific“ labels. Among 531 patients with “seizure-specific“ labels, 27(5%) had non-epileptic events and among 1170 patients with “non-specific“ labels, 58(5%) had a first seizure or epilepsy. In particular, first seizure patients were prone to misdiagnosis as up to 22% of these patients had an initial “non-specific“ label. Components of evaluation contributing to revision of diagnosis included retrieval of witness accounts, epileptiform discharges on electroencephalogram(EEG), short-term monitoring of patients with acute symptomatic seizures and panel discussion of cases. These may represent the first step towards a multimodal investigation of patients with epilepsy. / In the second part of the current thesis, we examined the prognosis of first acute symptomatic seizures (ASS), an important component of the seizure diagnosis under the hospital setting. We challenged the traditional school of thought that “ASS are not necessarily considered epilepsy as their potential to generate unprovoked seizure is low“. By following 105 patients with ASS, we found that first ASS was associated with status epilepticus (29.5%), multiple-onset (>1 seizure within 24h on day of presentation, 35.2%) and multiple aetiologies (22.9%) with a mortality of 30% at 2 years by the Kaplan-Meier method. By using seizure recurrences in the setting of a persisting or re-emerging acute symptomatic cause, we were able to demonstrate a risk of recurrence following an ASS of 32% at 2 years with epileptiform EEG being an independent predictor2. This information sheds light onto the fact that even ASS can be “refractory insofar as the acute symptomatic cause takes a long time to treat, is prone to re-emergence, or is irreversible. This may be seen as the second step towards a multimodal investigation of patients with epilepsy. / In the next part of the current thesis, focus was placed on the refractory epilepsy patients. A formal treatise on a specific modality of investigation, namely video electroencephalogram (VEEG) was presented. The clinical appearance of patients at the time of seizure was known as semiology, and this was systematically explored in a cohort of patients undergoing VEEG. By carefully examining the localizing value (which cerebral lobe) and the lateralizing value (which side) of the semiology, we discovered a new set of semiology which might point towards an epileptic focus in the medial aspect of the frontal lobe. The gold standard for seizure localization was used in this study in the assembly of the cohort. Only patients with an Engel Class I outcome, seizure localization by analysis of resection margins and/or intracranial implantation were selected. The first part of study involved 152 patients who underwent frontal lobe surgery and the second part involved 253 patients with non-frontal lobe surgery. All habitual seizures were analyzed by VEEG using a semiology checklist of 47 items during the early (electrographic onset to 10s) and late phase (rest of episode). Localization semiology was analyzed by Chi-square test with Bonferroni correction and cluster analysis when occurrence exceeded 10% in at least 1 region. Ictal body turning along the horizontal body axis was a statistically significant localizing semiology for the mesial frontal region (57%) from the first part of study. In the second part, we found that ictal body turning along the horizontal axis and semiology with physiological movement together gave a positive predictive value of 85.7%. This modality of investigation may serve as clinicians’ hypothesis towards the localization of epileptic foci. / Electroencephalography (EEG) forms an essential part of the multi-modal investigation of epilepsy. Modern-day EEGs are performed with surface electrodes attached to the scalp to capture the electrographic information at the time of seizure but this can be hindered by muscle artifacts which decrease the localizing power of the EEG. We began with the exploration of the “hypersynchronous states of intracranial EEG in which no muscle artifact would be present. A total of 100 focal onset seizure episodes were analyzed from 60 patients undergoing intracranial implantation4. A multivariate method was used computing the eigenvalue spectrum of the zero-lag correlation matrix of a short sliding window. We showed that there were clearly observable and statistically significant changes of the correlation structure of focal onset seizures. These changes indicated that the zero-lag correlation of multi-channel EEG either remained approximately unchanged, or especially in the case of secondary generalization, decreased during the first half of seizures. The correlation then gradually increased again before the seizures terminated. This development was qualitatively independent of the anatomical location of the seizure onset zone and it appeared to be a generic property of focal onset seizures. We concluded that the de-correlation of EEG activity was due to the different propagation times of locally synchronous ictal discharges from the seizure onset zone to other brain areas and the increase of correlation during the second half of the seizures may be causally related to seizure termination. / In the next part of our multimodal investigations, focus was made on how to use applied mathematics in procuring an accurate EEG interpretation from surface EEG. A mathematical model known as discrete wavelet transform (DWT) is a powerful tool which may help denoise the ictal EEG. It can be coupled with an absolute slope method as described in the last part of the thesis which enhances the determination of ictal foci. Twelve patients achieving Engel Class I/IIa outcome following temporal lobe surgery at 1 year were selected for EEG analysis5. The EEG signals were denoised with DWT, followed by computing the normalized absolute slopes and spatial interpolation of scalp topography associated to detection of local maxima. For localization, the region with the highest normalized absolute slopes at the time when epileptiform activities were registered (>2.5 times standard deviation) was designated as the region of onset. For lateralization, the cerebral hemisphere with the first emergence of normalized absolute slopes >2.5 times the standard deviation was considered the side of onset. As comparison, all the EEG episodes were reviewed by two neurologists blinded to clinical information to determine the localization and lateralization of seizure onset by visual analysis. The wavelet and absolute slope method improved the diagnostic accuracy for localization from 64% (16/25) to 84% (21/25). Similarly, the wavelet and absolute slope method improved the diagnostic accuracy for lateralization from 48% (12/25) to 92% (23/25). The comparison between the wavelet/absolute slope method and the visual analysis showed statistical significance for lateralization (p=0.0026, McNemar test). It was conceivable that coupling DWT with the absolute slope method helps clinicians achieve a better EEG diagnostic accuracy. / To conclude, findings of the present thesis open up an area of neuroscience to researchers and biomedical engineers in relation to multi-modal investigations of epilepsy patients, which may play an essential role in fostering our understanding of the epileptic brain, through which more accurate and precise treatment may be delivered to patients with epilepsy. / Leung, Ho Wan Howan. / Thesis (M.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 172-185). / Chapter Chapter 1 --- Understanding first seizures and epilepsy / Introduction- epilepsy, past and present --- p.(Page 17) / The burden of epilepsy --- p.(Page 19) / From first seizures --- p.(Page 19) / Scrutiny of clinical first seizure studies --- p.(Page 21) / Symptomatology of first seizures --- p.(Page 22) / Prognosis of first seizures --- p.(Page 23) / The question of managing first seizures --- p.(Page 29) / From first seizure onto refractory seizures --- p.(Page 30) / From drugs to surgery --- p.(Page 32) / Chapter Chapter 2 --- A treatise on epilepsy from the local perspective of Hong Kong / Local epidemiological data --- p.(Page 34) / Use of antiepileptic agents in Hong Kong --- p.(Page 36) / Epilepsy surgery in Hong Kong --- p.(Page 37) / Chapter Chapter 3 --- What are multi-modal investigations? / Semiology as a modality of investigation --- p.(Page 41) / Electroencephalography as a modality of investigation --- p.(Page 44) / Neuroimaging as a modality of investigation --- p.(Page 53) / Additional modalities of neuroimaging --- p.(Page 56) / Methods of ascertaining the functional areas of the cerebral cortex --- p.(Page 63) / The scientific future of multi-modal investigations in Hong Kong --- p.(Page 66) / Chapter Chapter 4 --- The triage of patients before multi-modal investigations can be applied / Method --- p.(Page 70) / Setting and patients --- p.(Page 70) / Results --- p.(Page 73) / Exploring how diagnoses were revised --- p.(Page 75) / Completeness of patient inclusion --- p.(Page 77) / Thematic considerations of current study --- p.(Page 77) / Chapter Chapter 5 --- Consideration of a special category in the process of triage / Patient cohort --- p.(Page 81) / Definitions --- p.(Page 82) / Statistical analysis --- p.(Page 87) / Results --- p.(Page 88) / Demographics and clinical profile --- p.(Page 86) / Mortality --- p.(Page 92) / Seizure recurrence using acute symptomatic seizure as outcome --- p.(Page 93) / Seizure recurrence using unprovoked seizure as outcome --- p.(Page 96) / Risk factors for recurrence --- p.(Page 96) / Progressive symptomatic seizures as a separate category --- p.(Page 97) / Thematic considerations of current study --- p.(Page 97) / Chapter Chapter 6 --- Analyzing semiology with video monitoring as multi-modal investigation / Study part I --- p.(Page 103) / Study part II --- p.(Page 107) / Results --- p.(Page 108) / Semiology in the early phase of seizures --- p.(Page 108) / Semiology in the late phase of seizures --- p.(Page 109) / Cluster analysis of mesial frontal lobe epilepsy syndrome --- p.(Page 110) / Clinical utility of ictal body turning along the horizontal axis --- p.(Page 111) / Thematic considerations of current study --- p.(Page 111) / Chapter Chapter 7 --- Applying mathematical models in the analysis of electroencephalogram / Methods --- p.(Page 118) / Results --- p.(Page 126) / Discussion --- p.(Page 132) / An unanswered question in epileptology --- p.(Page 135) / Chapter Chapter 8 --- Wavelet theories in the analysis of electroencephalogram / Methods --- p.(Page 141) / Results --- p.(Page 150) / Localization --- p.(Page 151) / Lateralization --- p.(Page 154) / Discussion --- p.(Page 156) / Study by Battiston et al --- p.(Page 157) / Study by Ursino et al --- p.(Page 158) / Study by Senhadji et al --- p.(Page 158) / Thematic considerations including limitations --- p.(Page 162) / Chapter Chapter 9 --- Strengths and limitations of current thesis / General --- p.(Page 163) / Specific --- p.(Page 164) / Chapter Chapter 10 --- Conclusions and future research directions --- p.(Page 166)

Rationale: Research has repeatedly demonstrated that people have difficulty understanding their interrogation rights, as presented in an orally presented police caution. There has been a limited amount of research into possible means of improving understanding, with the application of linguistic, listenability, techniques to caution wording proving most effective amongst students. Methods: This thesis systematically reviewed research exploring verbal caution comprehension amongst adults involved in the criminal justice system, to isolate possible predictors of performance. It then assessed understanding of the Scottish police caution amongst people with an intellectual disability and if this can be improved using a modified (listenability) version. Results: IQ and verbal comprehension appear to have a positive association with understanding. However, the reviewed literature tends to use broad inclusion criteria that may increase confounding variables and reduce opportunity to isolate further possible predictors. People with intellectual disabilities performed poorly in assessment of their understanding of the Scottish police caution, even when the modified version was used. This was despite every participant claiming they had understood. Conclusions: The thesis questions whether the use of a verbal police caution fulfils the intention of communicating interrogation rights as required by law. It suggests more research into caution comprehension is required, with more specific inclusion criteria, to help better understand variables that predict understanding. The relationship between verbal ability and IQ suggest efforts to improve comprehension should be directed to people who have challenges in these abilities, such as people with intellectual disabilities. This should ensure any improvements can benefit a greater number of people. The thesis' empirical study suggests the method found effective amongst students does not extend to people with intellectual disabilities.

Peer, staff, and faculty members who mentored college students with Intellectual Disabilities (ID) completed self-reflections and digital interviews, and participated in focus groups. The information was used to determine whether the mentoring experience affected their attitudes and beliefs regarding individuals with ID as well as whether mentor personal growth occurred as a result of participation in the mentoring experience. The research suggested that participants from all groups of mentees did experience a change in their attitudes and beliefs regarding those with ID. Those changes in attitude and beliefs were overwhelmingly positive. Peer, staff, and faculty mentors also reported many benefits from participation in the mentoring experience including but not limited to increased self-awareness and self-improvement. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection