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The purpose of this study is twofold. One is that of developing an instrument for determining a child's concept of how he is thought of by his mother and his father; in other words, a method of measuring parental acceptance as it is perceived by the child, himself. The development of this instrument will be discussed in Chapter IV. The second purpose of this study is that of determining whether or not there is any significant relationship between the child's perception of parental acceptance and the social acceptability of the child, as measured by a sociometric instrument.

De plus en plus d'études mettent en évidence le rôle des déficits de mentalisation dans le développement et le maintien des difficultés psychologiques à l'adolescence. La théorie de la mentalisation propose que les évènements traumatiques, tel que l'abus émotionnel infantile, affectent le développement optimal de la mentalisation et mènent à des difficultés psychologiques. Dans cette optique, la capacité de mentalisation représente un facteur de résilience. Cependant, le manque de mesures de la mentalisation adaptées aux adolescents limite le nombre d'études qui explorent ces hypothèses. Le premier article évalue les associations entre l'abus émotionnel infantile, les traits de personnalité limite et les symptômes de dépression et d'anxiété chez l'adolescent et teste un modèle dans lequel l'incertitude/confusion à propos des états mentaux médie la relation entre l'abus émotionnel infantile, les traits limites et les symptômes de dépression et d'anxiété chez les adolescents en milieu clinique. Les résultats appuient le modèle de mentalisation de la psychopathologie et soutiennent que l'incertitude/confusion des états mentaux est un déficit de mentalisation associé à plusieurs difficultés psychologiques à l'adolescence. Le deuxième article évalue les propriétés psychométriques, y compris la structure factorielle, la validité et la fiabilité du *Reflective Function Questionnaire for Youth* (RFQY-13), en utilisant un système de cotation des items alternatif. Les résultats démontrent que le RFQY-13 possède de bonnes propriétés psychométriques et constitue une mesure fiable et valide de la mentalisation chez les adolescents et les jeunes adultes. Cette thèse met en lumière l'importance de considérer les déficits de mentalisation, notamment l'incertitude/confusion des états mentaux, afin d'optimiser les interventions psychologiques auprès des adolescents. De plus, elle suggère un instrument de mesure de la mentalisation efficace et adapté à la population adolescente francophone.

Globally, overweight and obesity in childhood has already reached pandemic proportions, and this condition is associated with various health problems such as, insulin-resistance, Type 2 diabetes mellitus, and cardiovascular problems, such as hypertension, ischaemic heart disease, and stroke. Overweight and obesity are increasing in most countries, especially developing countries where the rates of obesity have tripled in those that have adapted a Western lifestyle. In low- and middle-income populations, particularly in urban areas, overweight and obesity in children is on the increase. Thus body composition profiles are used to determine the risk category of children such as underweight, normal, overweight, and obese. Overweight and obesity have a negative impact on both the physical and psychological levels of wellbeing during childhood and adolescence. Research on African and South African children living in rural areas on the body composition and prevalence rates will provide an opportunity to understand the role of development in children and adolescents and the importance thereof. The purpose of this study was to determine the status of body composition and the effect of gender, age, and race on body composition. This dissertation comprises four chapters, of which one chapter can be read independently as it is written in the form of a research article. MAIN FINDINGS A literature review was conducted to gain more insight regarding body composition status of children throughout the world, and in Africa and South Africa, and the role that body composition plays in children and adolescents. The importance of these aspects is highlighted and discussed in Chapter Two. Cross-sectional data on a total of 280 learners (109 boys and 171 girls) aged 14 years, who are part of the Physical Activity Longitudinal Study from the Tlokwe municipality area, are participants in the study. Body mass, stature, and skinfolds were used to determine body composition and body mass index of the participants. All data was analysed using SPSS Version 21.0 (SPSS Inc., 2012). The statistical level was set at p-value ≤ 0.05. The results of this study indicate that out of 280 learners 13.1% are overweight, 29.1% normal weight and 57.8% underweight. Boys had a lower overweight value when compared to the girls (9.1% vs 15.7%). In addition, the results show that African girls had a higher prevalence for overweight (15.8% vs 15.4%) than their Caucasian counterparts. As for the impact of gender, age and race-independent effects on body composition or BMI, the results also show no significant (p ≥ 0.05) age-independent effect on body composition measures of percentage body fat, sum of six skinfolds, fat free mass and waist-to-height ratio. In conclusion, overweight and obesity is a growing problem among children and adolescents, especially African girls and Caucasian girls in the Tlokwe municipality. Furthermore, recommendations are made about the implementation of school-screening programmes in semi-urban areas. The role of the government, parents, and teachers, and the importance of health professionals must also be considered. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

Adolescent pregnancy has been a global phenomenon of great concern for a considerable time. Adolescent pregnancy and parenting can lead to negative consequences for both adolescents and their infants in health, psychological, developmental and educational spheres. In South Africa recent media reporting has pointed out that adolescent pregnancy at times culminates in infant abandonment. Adolescence is a difficult transition period and the added stress of pregnancy and parenting creates specific challenges. Adolescent parents’ conflicting roles as adolescents, striving for independence, and as parents, who have to care for their children in a selfless manner, have been shown to complicate their lives significantly. Research has indicated that adolescent pregnancy mostly occurs in resource-poor, black, rural, or semi-rural communities. Support for pregnant and parenting adolescents in such communities seems to be minimal, and research on experiences of adolescent pregnancy and parenting in the South African context is scant. Therefore the aim of this study was to explore late adolescents’ (18-22) experiences of their pregnancy and parenting during early adolescence (12-18). The research context was a resource-poor community, namely Sir Lowry’s Pass Village in the Helderberg basin in the Western Cape. The researcher wanted to shed light on the particular challenges and strengths of participants, to inform practice and make suggestions so as to promote support for such parents. From the findings of this study it became clear that participants found adolescent pregnancy and parenting to be a challenging experience. They made mention of various factors complicating their experience of pregnancy and parenting, such as their socio-economic circumstances; stigma experienced from the community, family, peers, and educational and health-related systems; loss and sacrifices; lack of support; and feelings of powerlessness. They felt overwhelmed by their parenting experiences as a result of lack of parenting skills, and the fact that their parental rights were often not respected. However, pregnancy and parenting were also viewed as positive and inspiring in that adolescent parents viewed their children as a source of comfort. Furthermore, they indicated that parenting was more manageable with support, and that becoming parents rendered them more responsible individuals. These findings concur with prior research on adolescent pregnancy and parenting. This study adds value to the field of adolescent pregnancy and parenting in that prior findings were corroborated, and that an adolescent father’s perspective was included. Research on adolescent fathers in the South African context is limited. This study provides a clearer understanding of pregnant and parenting adolescents’ needs and what they find supportive, which could assist health care professionals, welfare organisations, schools, and significant others in supporting them more adequately. / MA (Psychology), North-West University, Potchefstroom Campus, 2015

Globally, overweight and obesity in childhood has already reached pandemic proportions, and this condition is associated with various health problems such as, insulin-resistance, Type 2 diabetes mellitus, and cardiovascular problems, such as hypertension, ischaemic heart disease, and stroke. Overweight and obesity are increasing in most countries, especially developing countries where the rates of obesity have tripled in those that have adapted a Western lifestyle. In low- and middle-income populations, particularly in urban areas, overweight and obesity in children is on the increase. Thus body composition profiles are used to determine the risk category of children such as underweight, normal, overweight, and obese. Overweight and obesity have a negative impact on both the physical and psychological levels of wellbeing during childhood and adolescence. Research on African and South African children living in rural areas on the body composition and prevalence rates will provide an opportunity to understand the role of development in children and adolescents and the importance thereof. The purpose of this study was to determine the status of body composition and the effect of gender, age, and race on body composition. This dissertation comprises four chapters, of which one chapter can be read independently as it is written in the form of a research article. MAIN FINDINGS A literature review was conducted to gain more insight regarding body composition status of children throughout the world, and in Africa and South Africa, and the role that body composition plays in children and adolescents. The importance of these aspects is highlighted and discussed in Chapter Two. Cross-sectional data on a total of 280 learners (109 boys and 171 girls) aged 14 years, who are part of the Physical Activity Longitudinal Study from the Tlokwe municipality area, are participants in the study. Body mass, stature, and skinfolds were used to determine body composition and body mass index of the participants. All data was analysed using SPSS Version 21.0 (SPSS Inc., 2012). The statistical level was set at p-value ≤ 0.05. The results of this study indicate that out of 280 learners 13.1% are overweight, 29.1% normal weight and 57.8% underweight. Boys had a lower overweight value when compared to the girls (9.1% vs 15.7%). In addition, the results show that African girls had a higher prevalence for overweight (15.8% vs 15.4%) than their Caucasian counterparts. As for the impact of gender, age and race-independent effects on body composition or BMI, the results also show no significant (p ≥ 0.05) age-independent effect on body composition measures of percentage body fat, sum of six skinfolds, fat free mass and waist-to-height ratio. In conclusion, overweight and obesity is a growing problem among children and adolescents, especially African girls and Caucasian girls in the Tlokwe municipality. Furthermore, recommendations are made about the implementation of school-screening programmes in semi-urban areas. The role of the government, parents, and teachers, and the importance of health professionals must also be considered. / MSc (Biokinetics), North-West University, Potchefstroom Campus, 2015

Adolescent pregnancy has been a global phenomenon of great concern for a considerable time. Adolescent pregnancy and parenting can lead to negative consequences for both adolescents and their infants in health, psychological, developmental and educational spheres. In South Africa recent media reporting has pointed out that adolescent pregnancy at times culminates in infant abandonment. Adolescence is a difficult transition period and the added stress of pregnancy and parenting creates specific challenges. Adolescent parents’ conflicting roles as adolescents, striving for independence, and as parents, who have to care for their children in a selfless manner, have been shown to complicate their lives significantly. Research has indicated that adolescent pregnancy mostly occurs in resource-poor, black, rural, or semi-rural communities. Support for pregnant and parenting adolescents in such communities seems to be minimal, and research on experiences of adolescent pregnancy and parenting in the South African context is scant. Therefore the aim of this study was to explore late adolescents’ (18-22) experiences of their pregnancy and parenting during early adolescence (12-18). The research context was a resource-poor community, namely Sir Lowry’s Pass Village in the Helderberg basin in the Western Cape. The researcher wanted to shed light on the particular challenges and strengths of participants, to inform practice and make suggestions so as to promote support for such parents. From the findings of this study it became clear that participants found adolescent pregnancy and parenting to be a challenging experience. They made mention of various factors complicating their experience of pregnancy and parenting, such as their socio-economic circumstances; stigma experienced from the community, family, peers, and educational and health-related systems; loss and sacrifices; lack of support; and feelings of powerlessness. They felt overwhelmed by their parenting experiences as a result of lack of parenting skills, and the fact that their parental rights were often not respected. However, pregnancy and parenting were also viewed as positive and inspiring in that adolescent parents viewed their children as a source of comfort. Furthermore, they indicated that parenting was more manageable with support, and that becoming parents rendered them more responsible individuals. These findings concur with prior research on adolescent pregnancy and parenting. This study adds value to the field of adolescent pregnancy and parenting in that prior findings were corroborated, and that an adolescent father’s perspective was included. Research on adolescent fathers in the South African context is limited. This study provides a clearer understanding of pregnant and parenting adolescents’ needs and what they find supportive, which could assist health care professionals, welfare organisations, schools, and significant others in supporting them more adequately. / MA (Psychology), North-West University, Potchefstroom Campus, 2015

Suicide is a leading cause of death among adolescents and young adults. Numerous risk factors have been identified in the literature, including poor problem-solving skills, poor family functioning, excessive risk-taking behaviors, legal difficulties, and school difficulties. Deficits in problem-solving skills and poor family functioning are typically reported together, indicating a relationship between the two. However, no previous studies have identified this relationship. The purpose of this study was to identify possible relationships between two known risk factors and suicidal ideation, to determine whether problem-solving skills taught in the experimental groups reduce suicidal ideation and improve perceptions of family relationships, and to establish if knowledge of problem-solving skills acts as a mediator between family functioning and suicidal ideation. Archival data of 285 adolescents who participated in up to 10 sessions dedicated to teaching the process of solving problems were analyzed. There was an unusually high attrition rate (64%), and so in some analyses, only data from 85 adolescents was reported. One empirically-validated questionnaire and three additional questionnaires were utilized to assess suicidal ideation, perception of family functioning, risky behaviors, and knowledge of steps in problem-solving. Knowledge of the problem solving process was shown to significantly improve over the course of the group. Although there were not significant improvements in suicidal ideation or family functioning, the change in scores was in the predicted direction. The results also found significant correlations between family functioning and problem solving and family functioning and suicidal ideation; however, no significant relationship was found between problem solving and suicidal ideation. Additionally, there were many significant correlations found between the outcome measures and many of the risk factors for suicide. Lastly, a mediator effect of problem-solving on the relationship between family functioning and suicidal ideation was found at pre-test only.

Le nombre de jeunes avec un surplus de poids est en hausse au Canada (Roberts, Shields, de Groh, Aziz et Gilbert, 2012). Les conséquences négatives de cette condition sont multiples pour le jeune, actuellement et pour son avenir. La recherche visant à comprendre les raisons de cette augmentation cible, entre autres, les environnements alimentaires dont le paysage scolaire. Des restaurants rapides et des dépanneurs sont dénombrés dans l’environnement alimentaire bâti en milieu scolaire (Lalonde et Robitaille, 2014). La présence et la concentration de commerces alimentaires dans le voisinage des écoles favorisent l’achat d’aliments et de boissons par les jeunes (He, Tucker, Gilliland, Irwin, Larsen, et Hess, 2012a; Robitaille, Paquette, Cutumisu, Lalonde, Cazale, Traoré et Camirand, 2015; Seliske, Pickett, Rosu et Janssen, 2013; Virtanen, Kivimäki, Ervasti, Oksanen, Pentti, Kouvonen, Halonen, Kivimäki, Vahtera, 2015). Pourtant, le lien causal entre le paysage alimentaire scolaire et les achats des jeunes n’est pas soutenu par la littérature scientifique actuelle. À Sherbrooke, un changement dans l’environnement alimentaire bâti est survenu en 2012 suite à l’implantation de commerces alimentaires en périphérie d’une école secondaire. Ce projet était une occasion exceptionnelle de valider si la modification naturelle de la densité alimentaire autour d’une école avait un effet sur les comportements d’achat des jeunes dans cet environnement. L’objectif de ce travail de maîtrise était de mesurer le lien entre les comportements d’achat des jeunes du secondaire dans l’environnement alimentaire bâti en milieu scolaire et la densité de certains commerces alimentaires circonscrite autour de leur école. L’hypothèse émise était que les jeunes dont l’école était entourée d’une densité plus élevée de commerces alimentaires étaient plus nombreux à acheter des aliments et des boissons dans ces commerces que les autres adolescents. Pour ce faire, un questionnaire auto-administré a été rempli en classe par des élèves de trois écoles secondaires sherbrookoises. Les données obtenues ont permis de documenter les comportements d’achat de près de 3 000 jeunes en 2013. Ces comportements d’achat ont été comparés à ceux collectés dans le Portrait des jeunes sherbrookois de 4 à 17 ans en matière d’alimentation et d’activité physique et sportive réalisé en 2008 (n = 3 867) (Morin et al., 2009a). Parallèlement, une cartographie des environnements alimentaires autour de chaque école participante à chaque temps a permis de décrire les densités alimentaires scolaires. Au regard de l’environnement alimentaire bâti en milieu scolaire, peu de liens existent entre la prévalence d’acheteurs le midi et la densité de restaurants rapides autour des écoles, selon nos résultats. Seul l’effet défavorable d’une très forte concentration en restaurants rapides (soit plus d’une douzaine) a émergé de nos résultats. De plus, aucune tendance n’a été décelée entre l’évolution du paysage alimentaire autour des écoles entre les deux temps et les changements dans les prévalences d’acheteurs. Ainsi, les efforts fournis pour diminuer la densité alimentaire en périphérie des écoles doivent être remis en question considérant le faible effet mesuré sur les comportements d’achat des jeunes dans notre étude. En ce qui trait aux comportements d’achat des jeunes, nos résultats ont montré que seule une faible proportion de jeunes était des consommateurs dans les environnements alimentaires scolaires. En effet, moins d’un jeune sur dix a acheté un aliment ou une boisson sur l’heure du midi dans un restaurant rapide dans la semaine sondée. Cette pratique ne semblait donc pas caractériser le régime alimentaire global des jeunes et ainsi, son influence réelle sur la hausse des taux d’obésité est incertaine (Macdiarmid, Wills, Masson, Craig, Bromley et McNeill, 2015). De plus, selon nos résultats, la prévalence des acheteurs au restaurant rapide durant une semaine typique a diminué entre les deux temps. D’un autre côté, la qualité nutritive des achats dans ces commerces durant une semaine s’était améliorée entre les deux temps. Cependant, les choix moins nutritifs étaient toujours achetés par plus de jeunes que les aliments et les boissons nutritifs. Les quantités achetées à chaque visite dans un restaurant rapide étant inconnues dans notre étude, il était difficile de statuer sur l’effet réel des achats sur les prévalences d’obésité. En conclusion, il demeure essentiel d’améliorer les habitudes alimentaires des jeunes, entre autres, dans les restaurants rapides lors d’une journée scolaire (Macdiarmid et al., 2015). Par conséquent, l’offre alimentaire dans l’environnement alimentaire bâti en milieu scolaire doit être bonifiée, par exemple en collaborant avec les commerçants alimentaires déjà établis. Il faut également maintenir les efforts déployés pour améliorer l’environnement alimentaire dans l’école et élaborer des stratégies pour que les jeunes mangent à la cafétéria de l’école.

Background: Hospitalizations including the diagnosis of an eating disorder (ED) have increased significantly in the pediatric population over the past few decades. Patients who are male, who areage, who receive an nasogastric (NG) tube, or who require admission to a residential treatment program often remain in the hospital for longer periods of time. Few studies examining LOS exist for children and adolescents with an ED. Longer lengths of stay have previously been associated with factors such as having Medicaid, a reduced body mass index (BMI) upon admission, and a diagnosis of anorexia nervosa (AN). Objective: The purpose of this study is to examine risk factors related to a longer LOS in children and adolescents admitted to a large urban pediatric hospital with AN or bulimia nervosa (BN). Participants/setting: A retrospective cohort study was conducted in 65 patients 9-20 years of age who were admitted to Children’s Healthcare of Atlanta (CHOA) between January 1, 2014 and December 31, 2015. Statistical Analysis: Frequency statistics were used to describe the demographic, anthropometric, and clinical characteristics of the population. A Mann Whitney U test or Kruskal-Walllis test was used to examine differences in LOS by demographic characteristics, mode of nutrition therapy, discharge treatment program location, and admission BMI category. The association between LOS category by demographic and clinical characteristics was determined using a Chi-square statistic. Results: A total of 65 patients (94% female, 89% Caucasian) with a mean age of 14.6 ± 2.4 years were admitted during the study period. The median LOS was 9 days (IQR; 6, 13) and was significantly longer in those who had an NG tube placed vs. oral diet (11 days (IQR; 7, 21) vs. 8 days (IQR; 5, 9.3), respectively; p Conclusion: The characteristics of hospitalized pediatric patients with an ED were consistent with those of other studies. Longer lengths of stay in those who had an NG tube placed may have been due to the patient’s lack of compliance, failure to gain weight, and severity of malnutrition since more time is needed for medical recovery. More treatment centers for children and adolescents with an ED are needed in the state of Georgia to potentially reduce LOS. Future studies should include a greater percentage of males and larger population of children and adolescents.