The purpose of this study was to evaluate the performance of adolescents with traumatic brain injury on a written persuasive discourse task. Nine adolescents with TBI (mean age = 14 years 4 months) and nine age, gender and education matched peers completed a written essay on the topic of whether trained animals in circuses should be allowed to perform for the public. Language measures included productivity (number of words, number of T-units and mean length of T-unit) and complexity (number of clauses, clause density and clause breakdown). Pragmatic measures were drawn from the developmental persuasive discourse literature and included essential elements of argument (claim, number of reasons, number of elaborations, conclusion, irrelevancies, repetition of information and attitude). In comparison to their age-matched peers, the TBI group produced significantly fewer reasons to support their claims, significantly more repetitions of information and failed to take alternative perspectives on the topic. There were no significant differences on any measures of language productivity or complexity, however the TBI group performed consistently below their peers on these measures. The results are discussed alongside current literature in the field of discourse production and persuasion. Implications for clinical practice and future directions for research in this area are also offered.

Research has examined the effects of micronutrients on mood in both healthy and psychiatric populations. EMPowerplus (EMP+) is a formula containing a wide range of vitamins and minerals. It has been examined for the treatment of mood instability, anxiety, Attention Deficit Hyperactivity Disorder (ADHD) and autism. The present study trialled EMP+ with five adolescents, aged 16-21, all with Severe Mood Dysregulation (SMD) as well as co-occuring psychiatric diagnoses i.e. ADHD, anxiety and substance abuse. The sample reflects a group of adolescents with complex psychiatric presentations and therefore difficult to treat. An ABAB (off-on-off-on) research design was employed. An open-label trial (8 weeks) of the micronutrients was followed by a withdrawal phase (8 weeks) and then a reinstatement of the micronutrients for a longer period of time (up to 24 weeks). There were in-depth pre and post assessments and on-going monitoring of the participants for the duration of the study. Clinically significant improvements in symptoms and functioning were demonstrated in three/four participants. Two participants demonstrated on-off control of psychiatric symptoms, with a reversal and replication of treatment effect. Further, one participant demonstrated clinically significant improvements in mood and functioning while on the micronutrients; however, he was lost to follow up following the 7.1 earthquake, and a reversal was not obtained. One participant demonstrated a trend toward improvements in mood while on the micronutrients and subsequent deterioration during the wash-out phase. However, she decided to withdraw from the study at four weeks off to go on psychiatric medication. Further, one participant demonstrated a variable response. This study provides some further evidence that micronutrients may be an effective treatment for psychiatric symptoms, consistent with other reports. Further research, such as randomised clinical trials and studies investigating the mechanisms of action, appears warranted.

Eating disorders are chronic, disabling illnesses associated with significant mortality rates (Crow et al., 2009). Body dissatisfaction has been demonstrated as a prominent risk factor for adolescent eating disorders. However few studies have examined psychological factors that predict body dissatisfaction. The present study examined maladaptive perfectionism and anxiety as possible risk factors for body dissatisfaction in adolescents with eating disorders and controls. Participants completed measures of body dissatisfaction, maladaptive perfectionism, and anxiety. Results demonstrated that maladaptive perfectionism and anxiety were significantly and positively associated with body dissatisfaction. However, these factors did not interact to predict elevated body dissatisfaction in eating disordered adolescents. These findings suggest that current body image treatments for adolescents with eating disorders and from nonclinical populations may be improved by including a focus on maladaptive perfectionism or anxiety. Future research should endeavour to conduct prospective, longitudinal studies that assess whether risk factors for body dissatisfaction are also causal factors. Finally, it is also important that researchers investigate whether body image treatments that target maladaptive perfectionism or anxiety effectively reduce body dissatisfaction in adolescents with and without eating disorders.

Adolescence is a stage that brings about multiple developmental changes for an individual. Parents of adolescent children often find these changes challenging. Parenting programmes have been created however, to help alleviate some of these problems. The review of the literature in this article selects and reviews a few parenting programmes that focus on the adolescent population. The current study then focuses specifically on one in particular; Teen Triple P and its use with 4 families. The participants included were a community sample with identifiable, but non-diagnosable, behavioural problems between the ages of 12-13 years old. Using a triangulation method of results; including a multiple-baseline of behaviour monitoring, parental and youth self-reports, and an observational task, the current study evaluates the effectiveness of Teen Triple P. The results indicate that notable changes were observed and reported in young person and parental behaviour for three of the four families. The other family encountered a crisis prior to the measures being completed at post-intervention which may have influenced their findings. Conclusions regarding this study, limitations, and future focuses for research are also discussed.

Solution-focused therapy is a postmodern strength-based counselling intervention which focuses on the discovery of client strengths, resources and abilities to empower clients to bring about positive change in their lives. My research employed a pragmatic case study (PCS) method to systematically study the self-efficacy experiences of four New Zealand adolescents throughout the solution-focused process. Each client participated in up to five counselling sessions. Following the PCS method my study began with a presentation of my guiding conception which detailed my theoretical approach and the ways in which solution-focused skills and techniques would be applied throughout the study. Case data included analysis of all client counselling sessions and final interviews which were video-recorded, as well as the consideration of a quantitative measurement in the form of the Outcome Rating Scale (ORS). Through analysis of outcome results and using three inductively derived themes to guide cross-case analysis, it was found that the solution-focused counselling process, assisted adolescents in discovering and developing their knowledge and awareness of their personal strengths and resources; encouraged adolescents to feel empowered to act upon these resources, therefore enhancing self-efficacy; and used the quality of the therapeutic relationship to give adolescents a sense of being a co-participator in the counselling process and as a result gave adolescents a ‘boost’ towards taking action, therefore increasing self-efficacy. Process and thematic results, supported by a brief quantitative measure, showed that all four clients made significant progress towards achieving their goals for counselling. Overall the results suggest that the solution-focused process contributed to positive therapeutic outcome and gains in self-efficacy. All four clients demonstrated the confidence to take action to bring about positive change in relation to their counselling goals, supporting enhanced self-efficacy.

Background Suicidal behaviour among young people is one of the major public health problems in low-income countries; it is estimated that every year 70,000 young people take their lives and maybe 40 times as many attempt suicide. Nicaragua has the highest suicide rate among young people of all Latin and Central American countries. This thesis aims at examining: (1) suicidal expressions and their determinants among school adolescents in Nicaragua, (2) cross-cultural aspects on suicidal expressions comparing Nicaragua and Cambodia, (3) pathways to suicide attempts among young men, and (4) primary health care professionals’ perceptions of suicidal behaviour and mental health problems among young people. Method Paper I is a cross-sectional study of 368 school adolescents in Nicaragua using self-report instruments (Youth Self Report and Attitudes Towards Suicide). Paper II compares data from Paper I with corresponding data from a study of 316 adolescents in Cambodia using the same methodology. Paper III is a qualitative study based on interviews with 12 young men who have recently attempted suicide. Paper IV is a qualitative study with 12 primary health care professionals. Results Paper I: Among adolescents, suicide ideation during recent year was reported by 22.6%, suicide plans 10.3%, and suicide attempts 6.5%. Girls were significantly more likely to report suicidal ideation. Multivariate analyses showed that anxious/depressed syndrome (YSR), somatic complaints syndrome (YSR) and exposure to attempted or completed suicide in significant others were significantly associated with their own serious suicidal expressions. Paper II: There was no significant difference in serious suicidal expressions (plans and attempts) between countries, but milder suicidal expressions during past year were more common among Nicaraguan young people. Overall, mental health problems were more commonly reported in Cambodia, where adolescents scored significantly higher on almost all YSR-syndromes as compared to Nicaraguan adolescents, except for withdrawn/depressed syndrome among boys. The pattern of association between mental health problems and suicide plans/attempts differed between countries. In Nicaragua, all eight YSR-syndromes were significantly associated with serious suicidal expressions for both genders compared to only one syndrome among girls and two syndromes among boys in Cambodia. Paper III: A model of the pathways leading to suicide attempts among young men was constructed based on the informants’ experiences. Structural conditions such as poverty or single-headed families, along with normative expectations within a framework of hegemonic masculinity, were all involved to create a sense of failure and an inability to cope. Subsequent increased drinking and drug abuse as well as exposure to attempted and completed suicide among friends and family acted as triggers to their own suicide attempt. Paper IV: Primary health care professionals felt themselves that they lacked knowledge and competence when approached by young people with mental health problems. Misconceptions were common. They felt frustrated which made them either ignore signs of mental health problems or reject help-seeking young people. In practice, a common response from health care professionals was to refer the patient over to someone else, the “hot potato” strategy. Conclusions The prevalence of serious suicidal expressions among young people in Nicaragua is within the range reported from Western high-income countries. Health care professionals need to be aware that somatic complaints as such are related to an increased risk of serious suicidal behaviour among young people, and that those who have been exposed to the attempted or completed suicide of someone close are at increased risk of serious suicidal expressions also when there are no warning signs in terms of mental distress. The cross-cultural comparison lends support to the notion that both cultural specificity and universality characterize serious suicidal expressions, as suggested by several researchers. Whereas prevalence shows less variation between cultures, associated factors might behave differently as shown in the present study, calling for different preventive approaches. The interviews with young men who had attempted suicide tell us that not only difficult socio-economic conditions but also the normative expectations on young men need to be addressed to decrease their risk of suicide. Health care professionals need to be alerted that sometimes serious mental health problems are hidden behind help-seeking for more trivial reasons. There is a necessity of a more integral approach towards mental health problems in PHC, including integral training of staff. The continued involvement of the community, family and other institutions would be essential to develop the care further.

Background: Human Papillomavirus is the most common STI in United States and is most prevalent among the adolescents and young adults. HPV causes cervical, anal, vulvar, vaginal, penile, oropharyngeal cancers and ano-genital warts. Certain populations are found to be at higher risk such as African Americans. 3 doses of HPV vaccine are recommended to adolescents before sexual debut to immunize against HPV. The purpose of this study was to assess the factors associated with the completion of 3 dose HPV vaccination series particularly among the African American adolescents. Methods: National Immunization Survey – Teen 2012 data was used to assess the association of selected factors with the completion of 3 dose HPV vaccination series among the African American adolescents. Univariate and multivariate binary logistic regression was conducted. Results: Factors, gender, age and maternal education are associated with the completion of HPV vaccination series among the African American adolescents. The Black females are 5 times more likely to complete the HPV vaccination than males. The 15 year olds are thrice more likely to complete the HPV vaccination than 13 year olds. Adolescents with maternal education higher than high school are twice more likely to complete the HPV vaccination series. Conclusion: Among the African American adolescents, socio-demographic factors influence the completion of HPV vaccine series. This study provides a direction to public health practices to focus on Black male adolescents and subpopulations with low maternal education to improve HPV vaccination in US.

Individuals with fetal alcohol spectrum disorder (FASD) are more likely to be involved in the criminal justice system than individuals without FASD. Research shows that individuals with FASD are unable to learn from standard methods of punishment, such as incarceration. The objective of this research was to determine how young offenders with an FASD diagnosis differ from young offenders without a diagnosis in order to inform sentencing and treatment options for FASD offenders. Using a pre-existing database of court-referred young offenders, the data of 197 youths were compared. Eighty-six young offenders in this sample were diagnosed with FASD. Information was available on a number of neurocognitive variables, such as cognition, memory, attention, achievement, and language, as well as social data, such as substance use, assistance in school, home stability, and criminal charges. Profile analysis was run on the neurocognitive data for young offenders with and without FASD. The social data were analyzed using a combination of correlation and one-way ANOVAs. Young offenders with FASD differed from young offenders without FASD on severity of impairment on the neurocognitive measures, with individuals with FASD scoring lower that the comparison group. There was no difference in the profile of neurocognitive deficiency between the groups, suggesting that young offenders with FASD have the same profile of impairments as other young offenders but to a more severe degree. There were not found to be any strong or moderate associations between the types of charges accrued and any neurocognitive measure, indicating that deficits likely do not directly lead to offending. Home stability between birth and age seven was particularly important as a protective factor for future crime, and having ever been in foster care was strongly related to number of charges. Current substance use of all kinds was associated with a higher number of charges. Youth with FASD are likely more at risk for criminal behaviour due to lower overall neurocognitive functioning, poor environmental stability, and an interaction of the two. Programs for people with FASD will be required throughout the life span and current correctional programs have yet to be developed for offenders with FASD.

The purpose of this study was to determine the sources of stress, support systems, coping strategies and psychological well-being of adolescents in a rural area, and to use this information to develop a coping and life skills programme. While all families face stressor events and crises, some are more likely than others to experience a series of challenges that threaten their functioning. Rural families often face a greater variety of stressor events on a more continues basis than do families in metropolitan areas (Dyk, 2003). Rural families do not have as many resources and services available lo address their problems as do urban families (Deavers & Hoppe, 2001). Farm schools suffer from a variety of shortages. Many schools suffer from a pressing shortage of space and educational aids and in most cases there is only one teacher for every 50 learners (Van Kleist, 2002). Some of the learners have to walk more than 1Okm to school everyday because of the lack of transport. Most schools lack proper sanitation and electricity. Recreational and cultural activities are curtailed through shortages of equipment and suitable locations. Education in life skills may contribute to the enhancement of life quality, The development of constructive coping strategies protects mental health and enhances bio psycho- social well-being in times of high stress. Previously it was assumed that each individual acquired these skills as part of growing up. Alas, the truth is that many people do not cope with life and never learned these skills. These skills should therefore be taught in a direct and systematic way, rather than being left to be learnt incidentally. The qualitative research design was based on a sample of 56 male and female adolescents between 1 2 and 16 years of age. The adolescents were from four farm schools situated in the Potchefstroom area. Sixteen learners were randomly selected for semi-structured interviews to obtain basic information for the pilot study. Approximately 37 learners took part in the programme. The learners attended Grades 4-7. The deve1opment of the programme was done in five phases. During phase one semi structured interviews were held with some of the learners. During phase two the interviews were evaluated thematically, The data was then organized into conceptual categories and was then analyzed. During phase three the programme was developed according to the themes derived from phase two. In phase four the programme was presented at the schools as a trial test. During phase five the programme underwent some changes according to the findings in phase four. The development of the programme went well, however presenting the programme was a more demanding task. Almost none of the participants could properly speak or understand Afrikaans or English. / Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2007

Many children and adolescents in South Africa are being exposed as witnesses or are direct victims of violence in today's society. The purpose of this study is to explore what violent exposure adolescents have experienced and to develop a programme that includes coping skills, expression of emotion and communication. The research formed part of the FLAGH study. The research was done in the form of action research where the adolescents took part in the whole process of developing the programme. The study was done in four phases. In the first phase a random sample of 36 adolescents from Fikadibeng School in the North West Province were selected. They completed the Coping Responses Inventory-Youth Form, the Survey of exposure to community violence, Things I have seen and heard questionnaire and the Self-expression and control scales. In the second phase the programme was developed using the results of the pre-testing and a literature study on the effects of the exposure of violence on children. During the third phase the developed programme was pilot tested on a randomly selected group of the children and the post-testing took place in order to evaluate and adjust the programme according to the results found. Suggestion for the adjustment of the programme was done during the fourth phase of the study. Adolescents were largely exposed to community violence. They also displayed tendencies to internalize anger and used looking for guidance and cognitive avoidance as part of their coping repertoire. The programme proved to benefit the children in their coping with violence. It is recommended that for the future, larger groups of adolescents should be evaluated and programmes should be presented to a larger community in order to assist adolescent in their use of coping skills. / Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2005.