Background: The onset of Inflammatory Bowel Disease (IBD) is highest during adolescence. The symptoms may make the essential developmental transitions associated with this stage more challenging and cause difficulties in psychosocial functioning. While previous research has compared adolescents with IBD to healthy controls, it may be more informative to take a developmental approach, examining psychosocial functioning within the early, mid and late stages of adolescence. Aims: The primary aim of this exploratory study was to investigate whether stage of adolescence has an effect on social functioning, body image and self-esteem in adolescents with IBD. The secondary aims were to determine whether stage of adolescence has an effect on mood, and whether demographic and disease factors have an effect on outcome measures. Methods: 63 adolescents aged between 11 and 17 years with IBD were recruited from a gastroenterology outpatient clinic. Each adolescent completed measures of social functioning, body image, self-esteem and mood. Demographic and disease information was also gathered. Outcome measures were compared between the three groups (early, mid and late adolescence) using parametric and non-parametric statistical tests. Results: There were no significant differences in any of the outcomes between the three groups. The only significant finding from regression analysis was that gender significantly predicted self-esteem. Nearly half the sample reported impaired social functioning and a quarter had significant levels of anxiety. Conclusions: Stage of adolescence was not found to have an effect on psychosocial functioning or mood in this population. The small sample size, assigning developmental groups according to age and the mild disease severity of participants limit the conclusions that can be drawn from this study.

No description available.

The possibility that seeing aggression on television and in video games might cause aggression in children is a public health concern. A systematic review found insufficient, contradictory and methodologically flawed evidence regarding this association in children with behavioural and emotional difficulties. It indicated the complexity of the subject, along with numerous gaps in knowledge. There are few studies based in clinical settings. This thesis reports a mixed methods pilot study that explored possible associations between aggression seen on television and in video games and reported aggression in children attending specialist outpatient Child and Adolescent Mental Health Services (CAMHS). Forty-seven children aged 7-11 years with behavioural and emotional difficulties, attending CAMHS, and their carers participated in a survey. Twenty children were purposively selected; they and a parent/carer participated in semi-structured interviews, which were analysed using the Framework Analysis Approach. Quantitative findings indicate that children exhibit various types of aggression, of varying frequency and severity. Qualitative findings reveal that children see aggression in multiple real and virtual settings. Children do not think their own behaviour is influenced by seeing aggression. Carers regard aggression as the result of a combination of inner and environmental factors, amongst which seeing aggression in real life has more impact than television/video games. Verbal aggression is often seen in real and virtual settings, frequently exhibited and strongly associated with poor peer relationships and low prosocial behaviour. There is currently no definitive proof of any association between seeing aggression on television and in video games and exhibited aggression in such children. This thesis makes suggestions for the undertaking of and methodology for future research, tackling the challenges of researching this field and hard to reach population. Carers, professional organisations and policy makers should consider the role of aggression, particularly verbal, that children see in both real and virtual environments.

Existing research indicates that typically developing children pass through predictable stages of fear development throughout their childhood. Evidence suggests that in general, children with disabilities experience more fears than typically developing children. Children with disabilities share similar stages of fear development compared to typically developing children, but at a delayed rate, with a more protracted course. Children on the autism spectrum experience higher levels of anxiety, compared to other children. Limited fear research in children on the autism spectrum suggests that they exhibit a unique fear profile compared to their peers, however, little is known about why this may be. Chapter 1 reviews published literature on fear development for typically developing children, children with physical and intellectual disabilities, and children on the autism spectrum. Chapter 2 presents an empirical study that investigates the relationship between sensory processing and fear profiles in children on the autism spectrum. The results support the notion that sensory experiences may account for a proportion of the unique fear pattern experienced by children on the autism spectrum. The thesis concludes with a reflective account that reviews the process of conducting internet-mediated research on children on the autism spectrum.

Attention Deficit Hyperactivity Disorder (ADHD) is a medical diagnosis, applied mainly but not exclusively to children. Diagnosis of ADHD is a controversial issue as the validity of the condition is questioned, and the main form of intervention offered to children in the UK is Methylphenidate, better known as Ritalin, which is a psycho-stimulant. It is also controversial because it rests on the assumption of a particularly westernised cultural conception of what 'normal' childhood behaviour should be, yet dominant discourses of child development and socialisation have influenced this view of children as less competent, immature and in need of moulding to fit societal demands. The orthodox position on ADHD also appears to compound this assumption, as research which includes the experiential accounts of children who have the diagnosis is extremely rare. Children's own views and perceptions of the diagnosis have not been valued. This thesis is based on in-depth qualitative interviews with seven children aged between 6 and 15 and their parents, plus a small-scale parental survey. In addition, observations of health care professionals' practice, carried out at a Child and Adolescent Mental Health Service, will help to demonstrate that only by giving full consideration to the complexity of medical and lay perspectives can an understanding of ADHD as a concept, a condition, a label, and an experience be achieved. In this study 'medicalisation' debates have been used as a means of reflecting on the concept of AD}ID. It is suggested that within the health professional/parent/child triangle dominant discourses position children as passive and dependenwith their health being mediated through their parents. By drawing attention to the embodied nature of the experience and meaning of ADHD it will be shown that the valuable and insightful contributions which children and young people make to the health care division of labour have largely been neglected to date.

Borderline Personality Disorder (BPD) is a severe and chronic mental health disorder, affecting many areas of functioning including: affect regulation, impulse control, interpersonal relationships and self-image. Causal factors are only partly known due to a scarcity of prospective, longitudinal studies which enable one to delineate the time ordering of antecedents, and allow for tentative causal inferences. This thesis explored the developmental precursors of BPD symptoms at 11 years, using a British cohort sample, with assessments pertaining to the study child from pregnancy to 11 years of age. Three studies were conducted. Firstly, the predictive relationship between exposure to maladaptive parenting and subsequent BPD symptoms was explored within a child population, using a clinically relevant assessment of BPD symptoms. This association has been previously shown in a range of retrospective studies. Secondly, the role of peer victimisation in the development of BPD was considered. This study was designed to extend current aetiological models, which focus on parental rather than peer relationships. It was based on the recognition of a strong interpersonal core in the BPD symptom constellation, and the role of trauma experiences in the development of BPD. Finally, the third study was designed to consider how these two experiential factors (maladaptive parenting and peer victimisation) might magnify a predisposition towards dysregulation, eventually culminating in BPD symptoms. Data was obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC), which studied 6,050 children (43.1% of the total sample population), using questionnaire and interview assessments. Results revealed that, firstly, family adversity during pregnancy and suboptimal parenting, during early to middle childhood was predictive of BPD symptoms at 11 years. Secondly, peer victimisation during early to late childhood was predictive of BPD symptoms at 11 years. There was an especially strong dose response effect for severe, combined or chronic victimisation. Finally, those evincing stable dysregulated trait behaviour from 4 to 8 years were more likely to develop BPD symptoms, and this effect was especially strong for high levels of dysregulation. Consistent with the biosocial developmental model of BPD, the association was fully mediated by psychosocial risk factors (peer victimisation). Those with high levels of dysregulation were more likely to be victimised and, in turn, develop BPD symptoms. Further, the indirect associations were significantly stronger for BPD, compared to psychotic or depression outcomes. The strengths and weaknesses, along with practical and theoretical implications, and future directions are discussed in the final chapter.

Objective: Given the well-established association between epilepsy and sleep disturbance and the evidence suggesting the importance of sleep in memory consolidation, there is reason to investigate the relationship between sleep and rate of forgetting in children with epilepsy. This study aimed to investigate the relationship between sleep and forgetting in children with Genetic Generalised Epilepsy (GGE). Methods: Participants were 19 children with GGE (9-15 years old). Actigraphy, sleep diaries and standardised questionnaires were used to measure sleep over a week long period. Rate of forgetting was measured using neuropsychological tests at the beginning and end of the study week. Spearman’s correlation analysis was used to determine if poorer sleep was associated with poorer initial learning and rate of forgetting in verbal memory recall and recognition. Results: No association was found between sleep efficiency or duration and rate of forgetting. Measures of sleep disturbance were mixed, with sleep onset latency found to be associated with rate of forgetting on the Word Lists test. However, increased wake after sleep onset was associated with decreased rate of forgetting. Conclusions: Whilst there was limited evidence of a relationship between some actigraphic sleep parameters and rate of forgetting for verbal information, the results were mixed and likely biased by the small sample size. There is need for further research with a larger sample to establish the nature of the relationship between sleep and rate of forgetting in children with GGE.

Objectives: The primary objective was to assess if a correlation exists between CVM and statural height growth velocity. The secondary objective was to assess if a correlation exists between CVM and mandibular growth velocity. Design/Setting: A prospective longitudinal study undertaken at Liverpool University. Subjects: Participants were aged between 8-18 years, of either gender and enrolled from the orthodontic waiting list at Liverpool University Dental Hospital. Methods: Standing height was measured every 6 weeks with subjects barefoot and in natural head position. Lateral cephalograms were taken at the start of treatment, on completing functional appliance therapy and prior to debond. Mandibular growth was assessed using the area of the triangle condylion-gnathion-gonion. Intra- and inter-observer reliability of CVM staging, cephalometric and statural height measurements were assessed using Cohen’s weighted kappa, intra-class correlation coefficient, and Bland and Altman plots respectively. ANOVA was used to test for statistically significant differences between the CVM stages. Results: 108 participants were included for analysis. The peak in statural height growth velocity occurred at CVM stage 3 (P=0.001). The peak in mandibular growth occurred at CVM stage 3, although this was not statistically significant. Conclusions: The findings of this study demonstrate that CVM staging is valid for identifying the pubertal peak in statural height. The peak in mandibular growth as assessed by the triangle Co-Go-Gn occurred at CVM Stage 3, but this was not statistically significant. Ethical approval was granted from Liverpool East Research Ethics Committee on 30th October 2013 with reference number 13/NW/0408 and protocol number UoL000751.

Background: Adolescence is a time of significant psychological readjustment. A number of young people experience the transition to adulthood as challenging, however many are able to adapt without significant difficulties and thus demonstrate resilience. Aim: The aim of this study was to investigate the role of hope and resilience in relation to well-being in late adolescence in a sample of young people aged between 16 and 18 years. Method: A cross-sectional questionnaire design was utilised with a sample of 50 participants aged between 16 and 18 years of age and who were recruited from a college. Participants completed three measures relating to well-being, resilience, and hope. Findings: The results support the hypotheses that hope and resilience are related to well-being. High levels of hope are associated with high levels of well-being and hope is a significant predictor of well-being in young people aged between 16 and 18 years. Implications: Young people may benefit from accessing services that enhance their levels of hope and resilience and emphasise their existing strengths and resources in relation to negotiating the transition to adulthood.

This thesis reports a series of laboratory and clinical studies designed to investigate the acute effect of surgical palliation on ventricular function in children with functionally single ventricle anatomy. Ventricular volume and pressure were measured using a combined pressure-conductance catheter. Initial laboratory-based experiments were performed using a physical model of the left ventricle, which allowed examination of the measurement techniques used in the clinical studies but under controlled conditions. These experiments identified a non-linear conductance-absolute volume relationship and demonstrated for the first time that the calibration coefficient, \(\alpha_{SV}\) produced a significant, volume-dependent measurement error. These experiments also demonstrated that conductance volume measurements were adversely influenced by other electrical signals. The ventricular electrogram produced clinically important measurement error that has not previously been described. Two clinical studies were then undertaken to investigate the separate effects of the bidirectional cavo-pulmonary anastomosis (BCPA) and the completion total cavo-pulmonary connection (TCPC). These studies represent the core of the thesis. Both procedures were associated with significant changes in the pressure and volume conditions of the dominant ventricle. In addition, the BCPA was associated with a substantial and immediate improvement in ventricular systolic function but this was accompanied by an increase in diastolic chamber stiffness. By contrast, the TCPC was not associated with a significant change ventricular systolic or diastolic function in spite of the changes in ventricular load. Comparable changes were observed in patients with a dominant ventricle of either left or right ventricular morphology. These studies provide a more detailed understanding about the acute events that accompany surgical palliation in children with functionally single ventricle anatomy. These findings confirm the validity of staged surgical palliation in the management of these children.