At the beginning of the 21st Century, the field of child and family mental health presents us with a paradox. Whilst over the last fifty years there have been considerable improvements with regard to the physical health of children there have not been equal improvements in their psychological functioning and mental health. Instead, there appears to be an escalation of a variety of psycho - social problems in children and young people. A critical review of current literature and research reveals that child and family mental health problems are constructed within increasingly narrow theoretical, clinical and research frameworks. These emphasise a medical and pathology based construction of children’s behaviour, rather than one that takes into account the meaning of children’s behaviour within a family and social context. This research project attempts to throw light on this dilemma through conducting individual interviews with twenty - one professionals representing both universal and specialist child and family mental health services. In addition, two focus groups were held consisting of other child and family mental health professionals. The research utilised a qualitative methodology that applied an interpretevist approach to the examination of the data. This included a critical examination of the discursive practices and range of discourses that professionals employ in their everyday practice and the way in which these practices and discourses reflect values and attitudes to meaning, power, and the use of knowledge and in giving legitimacy to particular actions and interventions. Whilst the findings indicate the predominance of a blame-discourse on the part of the professionals who present themselves as the buffers between the parents and the child, a closer examination reveals that for the professionals, the use of the buffer position functions as a defense. The findings indicate a parallel process between the parents and the professionals in which the latter operate largely in the absence of a coherent framework regarding the developmental needs of children, and with an uncritical acceptance of a predominantly medical model approach to children’s behaviour. The self referential and hierarchical nature of each of the professional disciplines and services appeared further to contribute to levels of fragmentation within these services as well as to the absence of the voice of the child. The discourse of complaint and compliance on the part of the professionals in relation to their managers and heads of service further compromised their ability to act as advocates for children. The findings are analysed within the context of a socio-cultural critique that suggests congruence between the bio-behavioural construction of children’s behaviour and the depleted vision of childhood and parenthood in society at large. The findings lead to a number of recommendations that are predicated on the assumption that the construction of child and family mental health cannot be considered as discrete from the construction of child and family wellness. A number of specific recommendations are made concerning the need for an ethical value based and Children’s Rights approach with regard to child and family mental health.

Feminist and management literature (Kanter, 1977; Burton, 1991; Hede 2000) has chronicled the deep stirrings felt by women excluded from choices and marginalised from power in many organisations. This thesis aimed to investigate the experiences of marginality for women who work in organisations and to explore the associations between marginality and career success, and between marginality and quality of work variables such as stress and role conflict. The research used a model that encompasses a version of fit, whereby stress is viewed as a mis-fit between an individual’s personal values and the ‘environmental’ supplies available to fulfil those values (Edwards, 1996; Code & Langan-Fox, 2001). This is a shift away from models that focus on appraisals of demand versus capacity (such as Lazarus & Folkman, 1984). Tenets of marginality theory (Park, 1928) and gender schema theory (Bem, 1981) were key points of reference. These theories support the proposition that individuals who experience greater congruence between their own gender identity and that of the organisational culture will experience less occupational stress and higher quality work outcomes (including career success). Marginality was operationalised as the degree of incongruence between individuals’ self ratings of gender related characteristics and values, and ratings of gender related characteristics and values of the organisational culture. Marginality was conceptualised as both shaped and constructed by the individual–cultural relationship, positioned within a wider social, political and ideological context. The thesis used two studies to explore first the nature of marginality, and then its hypothesised antecedents, effects and their mediators. Three Australian private sector organisations participated in a qualitative study in Study 1 (EducOrg, MetalOrg, and ComputerOrg) and two private sector organisations participated in a quantitative study in Study 2 (ComputerOrg and InsurOrg). Study 1 involved conducting interviews with senior managers across organisations (metal, computing, and education service industries) and Study 2 involved a survey completed by a total 150 participants drawn from both the computing organisation, and from a newly recruited organisation from the insurance sector. Interviews were semi-structured around topics related to gender and career development. The survey in Study 2, the design of which was informed by findings from Study 1, comprised gender and values scales, as well as quality of work indices such as stress and job satisfaction measures. The results in Study 1 appeared to confirm the existence of gendered phenomena in the three organisations studied. Gender polarisation processes appeared to perpetuate exemplars of the ‘good’ manager as masculine, positioning women as deviant within the organisational culture. For women to deviate from the dominant management style involves risk, and many women found themselves with less freedom than expected to move at the ‘contact zone’ between masculine and feminine behavioural modalities. Study 2 provided an opportunity to test the hypothesis that psychological resources and marginality, would significantly mediate stress. As hypothesised, women experienced greater degrees of marginality than men. However, marginality was experienced differently in each of the organisations studied. Findings in both organisations participating in Study 2 suggested the factor that distinguished the organisations on levels of marginality appeared to be perceptions of the existence or non-existence of nurturing values and practices in the organisation. It was hypothesised that perceptions of psychological resources (self-efficacy, locus of control, self esteem) and social support resources (network position, and availability of mentors) would be predictors of marginality and occupational stress. Findings supported this in part. Four of the psychological resource variables significantly mediated the effects of marginality. They were positive and negative affect, self-esteem and mentoring experiences. As expected, psychological and social support variables were also significant predictors of occupational stress factors, though their impact differed according to the particular stress factor. Overall the findings provided some evidence to support the framework of gender marginality developed in this thesis: that marginality, mediated by psychosocial resources, will have adverse effects on perceptions of career success and occupational stress. It was concluded that further research to address the limitations and implications of this thesis, in order to consolidate understandings of the gender differences on career success for women, is worthy of consideration.

Fire fatality statistics show that being asleep in a residential home is a serious risk factor for death in a fire. These statistics also show that this risk is increased according to individual factors such as being very young, or being under the influence of alcohol. Research has shown that sleeping children do not reliably respond to a smoke alarm signal (Bruck, 2001). No previous research has investigated the effect of alcohol on the ability to respond from sleep to a smoke alarm. The current project consists of a series of five studies that investigate the response from sleep of vulnerable populations such as children and young adults under the influence of alcohol to a smoke alarm signal. The purpose of the five studies included: 1. The development and testing of a new signal to be compared to existing manufactured beeping signals in the further studies; 2. Investigating the effect of alcohol on the ability of young adults to respond from deep sleep to three different auditory signals (highpitched Australian Standard Alarm (ASA), a female voice alarm, and a mid-pitched signal in the temporal-three (T-3) pattern) under three alcohol conditions (sober, .05 blood alcohol concentration (BAC) and .08 BAC); 3. Testing several alarms with sleeping children including a message recorded by their mother using the child’s name and stating there was a fire, a female voice alarm, and the T-3. This was then compared to existing data for the ASA from Bruck & Bliss (2000); 4. Investigating the response of sleeping young adults to a male voice alarm and a high-pitched T-3 in two alcohol conditions (sober and .08 BAC); 5. Ivestigating the response of sleeping young adults to naturalistic fire cues including a naturalistic house fire sound, a flickering light, and a combination of the two in two alcohol conditions (sober and .08 BAC). Major findings from the series of studies include that alcohol significantly affected the ability of sleeping young adults to respond to a smoke alarm, even at .05 BAC, and that this effect was worse for males than for females. This effect persisted across all studies were alcohol was used, regardless of signal. The response of sleeping children to the ASA (57%) was significantly poorer than to a voice alarm recorded by their mother (100%), a female voice alarm (94%), and the T-3 (96%). The male voice alarm and high-pitch T-3 were both significantly better than the ASA in waking young adults, but methodological concerns may have affected results for the high-pitched T-3. Finally, light was found to be a poor stimulus in waking people from sleep, and there was no advantage to combining naturalistic stimuli in producing a response. It was concluded that alcohol significantly affects a person’s ability to respond to their smoke alarm signal. Pitch and tonal complexity emerged as potentially important parameters that need to be further explored in relation to smoke alarm signal design.

This thesis was designed to explore the experiences of psychologists in Australia who work as psychotherapists, and who have an interest in Buddhism. The core research question was: What are the professional and personal experiences and perspectives of psychologists in Australia who are informed by Buddhism in the way they conceptualise, approach, and conduct psychotherapy? Two related supporting questions were: How do Buddhist principles inform different aspects of psychotherapy (e.g., therapist self-care, client interventions)? and In what ways do therapists incorporate Buddhist concepts (e.g., compassion) and techniques (e.g., mindfulness) into psychotherapy? In Study 1, the qualitative core of the research, I explored the experiences and impressions of psychologists interested in bringing a Buddhist perspective to psychotherapy. Initial and follow-up interviews were conducted with 14 participants. Buddhist understandings, including suffering, compassion, and mindfulness, were discussed in relation to psychotherapy. Participant psychologists revealed that certain Buddhist ideas and techniques contributed to their perceived efficacy and wellbeing as therapists, as well as to good therapeutic processes and outcomes for clients. Using an interpretative phenomenological analysis (IPA) approach, the two guiding principles of compassion and wisdom emerged from the interviews. Under the guiding principle of compassion, the two major themes that emerged were: the truth of suffering (sub- themes: an acknowledgement of suffering, causes of suffering, and suffering as a path), and compassionate engagement (sub-themes: empathy, openness, and hopefulness). The guiding principle of wisdom also incorporated two major themes: mindful presence (subthemes: a present orientation, the primacy of direct experience, and being with what is), and empowerment through understanding (sub-themes: responsibility, disclosure, and sustaining). The benefits participants perceived for themselves included being sustained by Buddhism, and having increased empathy and mindfulness during therapy. The Buddhist techniques and ideas that participants employed with clients were selected with discernment for their therapeutic benefits along with their compatibility with Western psychology. Participants also used their discretion to select those techniques and ideas that had wide applicability in that they were common to many philosophical and religious systems. Although some participants took an integrationist approach to drawing on Buddhism in psychotherapy, and others took an eclectic approach, all shared the concern of remaining client-centred. Attributing Buddhist sources and labels to concepts and techniques was considered unnecessary in most cases. Study 2 provided descriptive background information and gave support to the qualitative themes that emerged from Study 1. Members of the Buddhism and Psychology Interest Group, the Christianity and Psychology Interest Group, and the College of Counselling Psychologists of the Australian Psychological Society (APS) completed a personal details survey, the Spiritual Orientation Inventory (SOI; Elkins, Hedstrom, Hughes, Leaf, & Saunders, 1988), and the Marlowe-Crowne Social Desirability Scale – Short Form C (W. M. Reynolds, 1982), indicating their spiritual paths and religious affiliations, and the relative importance of different dimensions of spirituality. The main dimension on which the Buddhism and Psychology Interest Group scored higher than the other two groups was the Awareness of the Tragic dimension. The results are interpreted with reference to Buddhist, Christian, and secular understandings. The thesis concludes with a chapter on my personal reflections as researcher in the research process.

Sleep disruption, like that experienced by long-term rotating shift workers, is a physiological stressor which causes a variety of adverse physical, psychological and cognitive symptoms. Some cognitive symptoms are thought to be mediated by the direct effect of stress hormones on the hippocampus. Regardless of its source, stress provokes endocrine responses in the body that affect the hypothalamic-pituitary-adrenal (HPA) axis. Whereas acute activation of the HPA axis adaptively activates the body’s stress response by increasing cortisol production, prolonged or repeated activation is detrimental to health due to dysregulation of the HPA axis. Cortisol affects the hippocampus, which has a high concentration of glucocorticoid receptors and plays a prominent role in the down-regulation of the HPA axis. Overstimulation of glucocortioid receptors can cause hippocampal atrophy and related cognitive deficits. Research has found that air crew with inadequate recovery time between outbound, transmeridian long-haul flights showed performance decrements on cognitive tasks, reduced hippocampal volumes and increased cortisol levels. The current study aimed to investigate whether work-related sleep disruption caused similar effects among rotating shift-workers from outside the flight industry. Twelve long-term female rotating shift-workers (nurses) and 17 day working female control participants (nurses and others) participated in the study. Analyses of the sleep health, cognitive (memory, attention, visual-spatial skills), endocrine (salivary cortisol), magnetic resonance imaging (MRI) and spectroscopy (MRS) data of these participants showed few differences between groups in cognitive performance, volumetric MRI or MRS. Shift workers reported less sleep over a fortnight, higher levels of fatigue and lower levels of vigor compared to controls. Cortisol rhythm changes including earlier morning rise and peak attenuation were apparent in shift workers. The results are interpreted in terms of age differences between the groups and the existence of a 'healthy worker' effect in the shift workers.

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder presenting with a variety of behavioural and cognitive manifestations. Recent conceptual theories of ADHD have implicated a key impairment in executive functioning, namely inhibition, however inconsistencies in the pattern of findings warrant further investigation. As a consequence of increasing awareness of the underlying deficits in ADHD, studies have emerged dedicated to investigating the efficacy of interventions, including psychostimulants and multimodal treatments (medication and behavioural therapy). Whilst the short term efficacy of these treatments is supported, there is a relative absence of convincing empirical evidence to support long term treatment in improving behaviour and cognition. Furthermore, the additive benefit of a combined treatment approach remains contradictory. The aim of the present study was to explore the executive function profile of ADHD and determine the impact of two treatments: medication alone and low intensity, family centred combined therapy treatment on cognition and behaviour. Cognitive test performance and parent ratings relative to published norms were assessed among 27 school age children with ADHD. These children were either assigned medication alone or combined therapy and were followed up over six months to compare treatment efficacy. Changes in performance based executive functioning and parent reported behaviours were evaluated at baseline, three months and six months for the two treatment groups. Results showed that the ADHD children performed poorly relative to test norms across most cognitive and behavioural measures sensitive to executive functions at baseline, however not all children demonstrated significant impairments in inhibition. Both treatment groups evidenced significant improvements with treatment over the six month follow-up period, however this is one of the first studies showing that the combined group was associated with greater and wider ranging improvements than medication alone treatment. Correlational analyses revealed mostly non-significant or low to moderate relationships between objective and subjective executive function measures. These results are discussed in the context of Barkley’s theory of ADHD (1997a) and the value of low intensity, family centred combined treatment for ADHD.

The complaint of insomnia in older adults is associated with the use of hypnotics. This study was aimed at exploring possible differences between self-categorised good sleepers and poor sleepers on a range of variables, and the factors associated with the use of hypnotic medication amongst the elderly. Participants in the current study were aged 60 to 98 years old. A total of 74 (28 males, 46 females) older adult hostel residents participated in the current study. Twenty-two participants were self-reported good sleepers, and 52 participants were self reported poor sleepers, with 21 using benzodiazepine hypnotic medication regularly and 31 not using hypnotics. The measures used included the Pittsburgh Sleep Quality Index (PSQI), Geriatric Depression Scale (GDS), The Beck Anxiety Inventory (BAI), Sleep Beliefs Questionnaire (SBQ), and World Health Organisation Quality of Life-Brief (WHOQoL). The findings demonstrated that self-categorised good sleepers had significantly better sleep quality and habitual sleep efficiency, and significantly shorter sleep latency, regardless of hypnotic use. It was also found that good sleepers and poor sleepers taking benzodiazepines had significantly longer sleep duration than poor sleepers not taking benzodiazepine hypnotics. The prediction that self-classified good sleepers would have lower depressed mood than their self-classified poor sleeping counterparts, whether they were taking benzodiazepine hypnotics or not, was supported. The findings suggested that while self-classified good sleepers had lower anxiety levels than poor sleepers using hypnotic agents, these poor sleepers had significantly lower anxiety levels when compared to their counterparts not using benzodiazepines. Further variables of difference between good and poor sleepers included the psychological and social relationships domains of quality of life. Interestingly, the results indicated that the main role benzodiazepine hypnotic agents have for poor sleepers appears to be longer sleep duration. Benzodiazepine use did not have a significant ameliorative effect on any of the other sleep variables measured in the current sample of hostel dwelling, older adults. The findings indicated that sleep duration and habitual sleep efficiency demonstrated good predictive validity for whether subjective poor sleepers take benzodiazepine hypnotics. It was concluded that an alternative to managing poor sleep needs to be education programs, such as education delivered by nurses or evidence based self-help programs (eg. Morawetz, 2003)

The anterior temporal lobe (ATL) sustains a degree of damage during surgery for temporal lobe epilepsy (TLE), and although classical language models implicate the ATL in language function, and naming difficulties are commonly reported by TLE patients post-surgically, the role of the ATL in language is not well understood. The present study aimed to examine the role of the ATL in language function, and methods for evaluating pre- and post-surgical language function of the ATL in patients with epilepsy using two approaches. The first study employed neuropsychological testing of pre-and post-surgical TLE patients on 3 conventional tests of language function, the Boston Naming Test (BNT), Controlled Oral Word Association Test (COWAT) and Animal Fluency, and one novel test: The Category Specific Names Test (CSNT). The CSNT was selected in an attempt to compensate for the problems of heterogeneous items, and the low ceiling in the BNT. Results of the CSNT had not been previously validated with TLE patients, and had not been routinely used in Australia. The second study looked at ATL activation in healthy controls and TLE patients using two new functional magnetic resonance imaging (fMRI) tasks. For the neuropsychological study, Bayesian analysis showed that the BNT was effective in differentiating left from right TLE in a sample of 42 patients with intractable epilepsy (LR+ = 8.37). The COWAT, Animal Fluency and the CSNT were not effective in differentiating left from right TLE. Very small likelihood ratios indicated only modest changes from pre-test odds. For the fMRI component of the study, although the two new fMRI tasks (Famous Faces naming, and Sentence Reading) resulted in the expected activation of language areas in group averaged data, they did not elicit consistent ATL activation across individuals, and subsequently did not meet the iii criteria recommended for fMRI protocol development recommended by Schwartz, Devinsky, Doyle and Perrine. (1997). Their inclusion in an fMRI protocol was not supported. Findings of the present study have important implications for pre-surgical evaluation of ATL language function in patients with epilepsy. Preliminary evidence was not found to support the use of the CSNT in patients with epilepsy. Results suggest that the BNT alone should be used for detecting naming impairment in patients with left-sided epilepsy. Benefits of using Bayesian analysis to examine the clinical applicability of research results, rather than conventional Null Hypothesis Significance Testing (parameter statistical) techniques are discussed.

Adolescence is considered a time of change and, to some extent, upheaval. Psychological Sense of Community has been utilised as a framework for understanding adolescents’ experiences in their communities. The present study explored the experiences of 10 adolescents from two urban schools in eastern Australia, a specialist school for students with a mild intellectual disability, and a mainstream school. Using Photovoice, an ethnographic research method utilising photographs generated by the research participants as the primary data source, the participants were actively engaged in taking photographs about their day to day lives in their communities. The photographs were supplemented by individual semi-structured interviews and small group discussions. Results confirmed the importance of meaningful relationships with family, neighbours, pets and peers for participants from both groups. Levels of participation in a range of activities were also explored. Concepts of community including place, neighbourhood, virtual communities and communities of interest were elicited from participants. Many aspects of adolescent life were similar for both groups, although family provided more support to participants with an intellectual disability in enabling them to participate actively within the community. Discussions about spirituality were more prominent with participants without a disability, possibly reflecting language and cognitive abilities. All participants expressed concerns about growing up, letting go of childhood and facing responsibilities associated with adulthood. Overall, the present study suggested that the day to day experiences of adolescents from both groups were similar with social interactions underpinning what they considered to be important.

Introduction: Factors have been identified in association with the psychological adjustment of children and adolescents with Type 1 diabetes such as metabolic control (McDonnell et al., 2007), maternal functioning (Schmidt, 2007) and protective parenting (Mullins et al., 2004). Parenting factors may have an impact on young children (Whittemore et al., 2003; Davis et al., 2001); while other factors such as self-efficacy are important to adolescent patients (Littlefield et al., 1992) as responsibility for diabetes management is gradually transferred from parent to child (Palmer et al., 2004). Many studies have examined family and peer support in the context of adolescents’ capacity to cope with their diabetes (La Greca & Bearman, 2002; Lewandowski & Drotar, 2007), but few have demonstrated the link between diabetes-specific factors for adolescent patients and psychological adjustment in their mothers (Berg et al., 2007). The number of studies on very young patients with Type 1 diabetes is also limited (Grey et al. 1995) in spite of the doubling of incidence of diabetes in children under five years of age in Australia (Taplin et al., 2005). Objective: To examine the child, adolescent and parental factors associated with psychological adjustment and health status in children and adolescents with Type 1 diabetes and their mothers over a post-diagnosis period of 12 months.Method: Sixty-two families of young patients from birth to 18 years of age completed standard measures in a longitudinal analysis on psychological and diabetes-specific variables. Data included child/adolescent measures of adjustment, self-report measures of maternal psychological adjustment, parental protectiveness, maternal separation anxiety, adolescent quality of life, self-efficacy and medical records of metabolic control at the first time point following diagnosis, and repeated at the second time point 12 months post-diagnosis. Results: Increased psychological symptoms in mothers were mildly associated with poor child/adolescent adjustment following diagnosis, and then moderately associated 12 months post-diagnosis. Metabolic control was adequate, although levels declined over time, and adolescent metabolic control was predicted by both maternal and adolescent adjustment. In a separate test, maternal and adolescent adjustment and self-efficacy were associated with quality of life for adolescents. Relatively high levels of maternal separation anxiety and protectiveness were shown; however they were not associated with the other variables. Conclusions: This study highlights the role of mothers in the adjustment of children and adolescents with Type 1 diabetes and the potential risk to the adjustment of a significant minority of young patients and their mothers over time. The influence of maternal adjustment to quality of life and diabetes health status of adolescents was emphasised. Support for families in the first year after diagnosis is indicated.