Emerging research (Cort and Cline, 2017; Dodd, 2009; Gallagher, 2010) suggests the impact of domestic abuse (DA) on children and young people's lives is a crucial issue for Educational Psychologists (EPs). Whilst there are a number of small scale studies exploring EP practice in this area (Gallagher, 2010; Heath, 2015) researchers are yet to explore EP practice in relation to domestic abuse on a larger scale. This research adopted a mixed method web survey design to explore EP practice at a national level. A pragmatic stance was adopted, and descriptive statistics, thematic analysis and factor analysis were utilised to explore EP practice supporting children, families and schools exposed to DA, factors supporting EP engagement in this area and EPs' views around their unique role in relation to DA. The findings suggest EPs encounter DA within their casework to varying degrees. EPs appear to vary in their consideration of DA within case formulation, and in their exploration of DA with school staff and families. Respondents varied in their approach to exploration of DA and the indicators they utilise to prompt exploration. Factor Analysis identified EPs' confidence in introducing DA to the conversation, whilst also ensuring a co-operative relationship exists with parents, is an important factor for EP practice. EPs reported the use of a range of interventions in response to DA; however interventions specifically focused upon DA were not widely used. EPs identified an interest in further involvement with a range of interventions and 23% of respondents reported involvement in systemic approaches around DA. Further factors perceived to be important by EPs in supporting their work in this area were: supervision and training to support EP knowledge and skills, service level policy, and the establishment of a clear role for EPs around DA. The majority of respondents felt there could be a unique role for the EP around DA, with the EPs' facilitative role and their ability to further the psychological understanding of others identified as key themes.

Background: Insulin pumps have the potential to improve glycaemic control and health in childhood type 1 diabetes (T1D) but they require intensive monitoring and their impact on parental quality of life (QoL) is less well understood. Aims: To explore the views of parents who manage their children’s T1D with insulin pumps, with a particular focus on the impact of this method of insulin delivery on parental QoL. Method: A qualitative, cross-sectional study was conducted. Seven parents with a child aged 12 or younger with T1D, who have used the insulin pump, were recruited using purposive, volunteer sampling. Semi structured interviews were carried out and analysed using interpretative phenomenological analysis (IPA). Results: Four super-ordinate themes describe parents’ experiences adjusting to caring for their child using an insulin pump; ‘life before the pump’, ‘transition to the pump’, ‘life on the pump’, and the ‘perceived impact for their child’. Each super-ordinate theme comprised several sub-themes, and a concept that crossed all themes was ‘fluctuating feelings of control’. Conclusions: Parents were generally positive about using the insulin pump to care for their child with T1D, and most wished to continue with this method of insulin delivery. Parents faced challenges at particular times with the pump, but with support regained control over difficult aspects of pump use. Understanding parents’ experiences will assist diabetes teams to implement care practices centred on the needs of the family.

Background The literature suggests that working and long-term memory are impaired in paediatric brain tumour survivors (Robinson Fraley, Pearson, Kuttesch & Compas, 2013; Robinson et al., 2014). Survivors report difficulties remembering information they learned days before, including for school exams. Sleep and psychological problems can affect memory performance and may exacerbate memory difficulties in this population. Aims Assess learning and long-term memory in paediatric brain tumour survivors relative to healthy controls, and explore associations between memory, sleep and mood. Method A learning paradigm was used to teach verbal and visual material to an 80 percent criterion in ten young brain tumour survivors and ten matched healthy controls (sibling, cousin or best friend) aged between 11 and 24. A between-subjects design compared recall between groups at delays of 30 minutes and one week. Sleep quality (measured by Actigraphy), anxiety and depression were also assessed. Results Verbal learning was significantly impaired in brain tumour survivors relative to controls. There was very tentative evidence of increased visual forgetting in the tumour group, however definitive conclusions could not be drawn from results due to the study lacking power. Some participants had significant impairments in verbal learning or verbal and visual long-term memory, and others did not. Memory was not associated with sleep or psychological variables in the tumour group, although this may be due to the study lacking power. Discussion The variability in memory within the tumour sample emphasises the heterogeneity in the brain tumour population and the need for memory to be monitored in individuals. Education and occupational settings could offer further support to those that require it. Future research should assess memory after delays longer than 30 minutes and further explore how tumour, treatment, sleep and mood variables affect memory.

The main aim of this thesis was to improve our understanding of the development of early inhibitory emotions and emotion regulation from infancy, and the role of these emotions in early risk pathways. More specifically, this thesis investigated (1) the development of fearful temperament, its stability over the first 3 years of life, and its associations with later developing effortful control (EC) and guilt; (2) risk factors in infancy that predict later externalising psychopathology; and (3) the development of EC, and its associations with fear and guilt. Psychophysiological and observational measures were used, when available, to examine these emotional systems as well as their role in predicting later psychopathology. The thesis consists of 3 empirical chapters, investigating a sample of 70 typically developing children in a longitudinal, prospective manner. Behavioural fear was stable over time, but physiological fear peaked in year 2. Fearful infants continued to be fearful toddlers, and fear in infancy predicted fearfulness 2 years later. Fear and guilt were associated, and we showed for the first time that infant fear is a predictor of later developing guilt. EC increased from year 2 to year 3, showed inter-individual stability across time, and girls’ ability for EC surpassed the ability in boys. EC and guilt were not associated; however, EC and fear were associated in year 3, suggesting that early fear does not regulate later EC. This thesis identified two biomarkers in infancy for later psychopathology. A subgroup of toddlers with internalising problems displayed higher heart rate in infancy, whereas skin conductance arousal in infancy predicted aggressive behaviour in toddlers.

Despite current improvement in newborn care, infection is still a common cause of neonatal morbidity and mortality. Innate immunity is the first line of defence against pathogens particularly in newborn infants. Quantitative and functional deficit in non-cellular (complement system) and cellular (neutrophils) arms of innate immune system is believed to contribute to neonatal susceptibility to infection. Neutrophil granule subsets contain a variety of proteases, including elastase, cathepsins, MMP-9 and proteinase 3 along with different granule markers and receptors. This thesis demonstrated that normal term neonatal neutrophils express more proteinase 3 and CD177 on their surface while no differences were found in expression of markers CD35, CD66b and CD63 (representing the secretory, secondary and primary granule subsets, respectively). Cord neutrophils contain more PR3 than adult cells but the proportion of PR3 released by cord and adult neutrophils was similar. In contrast, neonatal neutrophils contained only half of the cathepsin G and elastase functional activity of adult neutrophils. Bronchoalveolar lavage fluid studied from preterm infants ventilated for respiratory distress demonstrated higher proteinase 3 concentrations in lavage samples from infants who went on to develop chronic lung disease than in infants with resolved respiratory distress syndrome. Concentration of proteinase 3 in lavage samples was significantly higher than MMP-9 and elastase levels, suggesting that it may have an important role in disease pathogenesis. Complement is an equally important component of the innate immune system that plays a central role in recruiting and activating neutrophils, as well as being directly bactericidal through the terminal lytic pathway. Analysis of neonatal complement system revealed that Complement function and terminal components levels particularly C9 are deficient (except C7) in healthy term newborn infants compared to normal adults. Bactericidal capacity of a selection of neonatal sera was tested along with adult sera against four serovars of Ureaplasma parvum, a potentially important perinatal pathogen. Results showed impaired bactericidal capacity of neonatal serum compared to adult serum especially against SV1. Ureaplasma SV3 was the most serum sensitive serovar whereas killing of the resistant serovars SV6 and 14 could not be induced by supplementation of the deficient components C6, C8 and C9.

The aim of this study was to explore children's play, looking at developmental domains of play and gender differences in aggressive play. Chapter One reviewed existing literature on types and functions of play. Five developmental domains of play that incorporate types and functions were proposed, namely sensorimotor, cognitive, socio-communicative, imaginative/ creative and emotional. Chapter Two involved an observational study of children's play. An attempt was made to explore the existence and occurrence of the developmental domains that were proposed in Chapter One. Results suggested that the domains exist in this sample of children's play. Children statistically spent the most time in sensorimotor and imaginative/ creative play, compared to the other types of play. No statistical difference was found in gender with respects to time spent playing in the domains. Clinical implications are discussed. Future research is required to create more valid and reliable criteria for the domains and age-related norms. Chapter Three investigated gender differences in the duration of aggressive play. An observational study of children's play was carried out. The duration of time of aggessive play in each child's play was recorded and analysed. Results showed that boys displayed statistically more aggressive play than girls in this sample. Clinical implications are discussed. Chapter Four reviews the previous three chapters, looking at methodological limitations, observations of the research process and personal reflections.

Differential growth was demonstrated between facial features and within some facial features. In particular, the columella, nostrils and philtrum did not grow significantly after surgery, although this would be considered normal in the age group studied. Facial growth in children with UCL and UCLP was independent of the head and body growth. The presence of a cleft of the secondary palate accentuated the amount of soft tissue disruption by the cleft in the lip and nose, but not the pattern of disruption. Primary lip / nose repair had no detrimental effect on the early growth and development of the facial features. Likewise, palate repair had no discernible effect on facial soft tissue growth at age 2 years. Primary lip /nose repair had a beneficial effect on facial morphology in terms of reducing asymmetry and was most successful in the improving philtrum and nasal base symmetry, less successful in improving the nasal rim asymmetry. A possible early beneficial effect of cleft repair remote from the surgery site was noted in the reduction of upper face asymmetry in the first year of life. Residual asymmetry in the facial features did not change by age 2 years, despite increases in size with growth. Facial morphology outcomes for UCL and UCLP children in this study was generally similar at 2 years of age, despite marked differences in pre-operative facial form. However, nasal base asymmetry, upper face asymmetry and residual nostril shape deformity were significantly greater in UCLP children at 2 years of age, than in UCL children. These shape differences were not detectable by measurement of facial dimensions alone.

Background: Changes in clinical management; advances in non-invasive three-dimensional imaging; developments in methods of shape analysis. Aim: To assess three-dimensional dentofacial deformity with a view to early appraisal of primary surgical outcome. Results: Significant differences in upper lip morphology were found between the cleft children and their unaffected peers; nasal asymmetry that became more obvious in function was noted in cleft children; the maxillary dental arches of the children with repaired cleft palate were shallow, short and narrow; and the dental arch, deformity and the facial soft tissue deformity were unrelated. Contributions to the field: It has been shown that deviation from normal could be detected as young as 3 years of age using computerised stereophotogrammetry; preliminary, objective, three-dimensional analysis of facial function has been completed in young children; the accuracy of three-dimensional CT scanning of dentate study models and the time cost of data collection were quantified; and this study has produced a body of three-dimensional data that can test and support analytical advances.

Background: Compared with their term-born peers, school aged children born very preterm (≤32 weeks gestation) are at increased risk of inattention. It remains unclear whether the cognitive and neural mechanisms underlying inattention are the same in both very preterm and term-born children. Aims: The aim of this study was to determine whether the cognitive and neural mechanisms underlying inattention differ between term-born and very preterm children. Chapter 3 explored cognition, while Chapters 4 & 5 explored neural processing in terms of event-related potentials (ERPs) and frequency analysis of functional connectivity respectively, to identify mechanisms underlying inattention. Method: A sample of 65 children born very preterm (≤32 weeks gestation) aged 8-11 years was recruited. A comparison group of 48 term-born peers (≥37 weeks gestation) matched for inattention symptoms using the parent-rated Strengths and Weaknesses of ADHD and Normal behaviour (SWAN) questionnaire was selected for comparison. All children were asked to complete neurocognitive tests to assess basic cognitive processes, executive function and sustained attention. Electroencephalography (EEG) was recorded from a sub-sample of children (very preterm n=43; term-born n=40) while they completed a sustained attention task. The contingent negative variation ERP component and theta and alpha frequency changes following the cue stimulus were derived from the EEG as neural indices of response preparation. Similarly, following the presentation of cued and uncued target stimuli, the P1, P2, and P3 ERP components were derived from the EEG as neural indices of stimulus detection, stimulus categorisation, and evaluation of task-relevance respectively. Results: In both groups, more severe parent-rated inattention on the SWAN was predicted by poorer verbal and visuo-spatial short term memory, visuo-spatial working memory, and greater response time variability, and by smaller amplitude of the P2 ERP to uncued targets at the neural level. In children born very preterm only, slower motor processing speed, and smaller theta increases at the neural level, predicted more severe parent-rated inattention. Similarly, in term-born children only, shorter P2 ERP latencies to all targets predicted more severe parent-rated inattention. Conclusions: In sum, the cognitive and neural mechanisms underlying inattention in term-born and very preterm children were partially overlapping, but some mechanisms were unique to only one group. These results present candidate mechanisms that may be useful for the identification of children at risk for inattention, and as potential targets for intervention.

Hyper-resistance at the joint is one of the most common symptoms in children with cerebral palsy (CP). There are both neural and non-neural factors contributing to the observed joint hyper-resistance. Non-neural alterations to the musculoskeletal system such as a reduced muscle length, increased tendon length and an increase in joint stiffness are commonly treated by physiotherapy interventions such as stretching exercises. However, the effectiveness of these interventions in terms of improvements in function is of a low magnitude and the response of spastic muscles to stretch is poorly understood. Therefore, the main aim of the programme of work presented in this thesis was to increase the effectiveness of stretching interventions at the ankle joint. To achieve this, it is important to understand the behaviour of the medial gastrocnemius muscle and Achilles tendon in response to a stretch applied at the joint. For this first sub-goal, three experimental studies were performed. First, the relationship between joint rotation and muscle and tendon contribution during a single stretch is described. We show that a smaller Achilles tendon moment arm leads to a decrease in muscle lengthening during joint rotation. Additionally, we show that the relative stiffness of the muscle to the tendon is increased in children with CP, which further limits lengthening of the muscle during joint rotation. Secondly, we document the acute effect of stretching on medial gastrocnemius fascicle lengthening properties. It was found that medial gastrocnemius muscle stiffness cannot explain the increased ankle joint range of motion acutely following passive stretching. These studies all indicate that the lengthening stimulus to the muscle is reduced in children with CP. Therefore, to increase the effectiveness of stretching exercises, an intervention was designed with the aim to increase this stretching stimulus seen by the muscle. By performing progressive resistance training, we showed an increase in the stiffness of the tendon, and thus a reduction in the relative stiffness of the muscle to the tendon. Therefore, the amount of stretch seen by the muscle was increased. We have shown that due to this combined intervention a remodelling of muscle is possible, as we showed muscle fascicle length to increase. Even though functional benefits were limited, the proof of principle was demonstrated and future work should explore this model of intervention further.