Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (M.S.P.H.)--University of Michigan, 1939.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.P.H.)--University of Michigan, 1946.

This study explored how having a child with a profound or multiple disabilities affects the home school relationship in a multi-cultural Special School for Primary aged children. Research has highlighted the impact upon the family in terms of coping strategies and how families with good and poor coping strategies differ. The purpose of the study was to consider how a model of systemic thinking called the Family illness systems model (Rolland 1994) might be used to understand the context in which a family might be operating, informing how the school might appropriately foster the home/school relationship. The study took a phenomenological approach using Interpretative Phenomenological Analysis (IPA) to explore the impact of having a disabled child upon the family; how this affects coping strategies of the parent, family functioning, and how this feeds into the expectations and experiences with school. 5 mothers were interviewed using semi-structured interviews. Interview data was analysed using IPA and three superordinate themes emerged: ‘making sense of life changing events’, ‘impact on family dynamics’, ‘impact of a child needing a special school’. These finding were discussed in relation to relevant literature and the initial research questions. Strengths and limitations of the research were acknowledged. Finally the findings of the study were considered in relation to educational psychology practise and for further areas of research.

A typical absence is a non-convulsive epileptic seizure that is a sole symptom of childhood absence epilepsy (CAE). It is characterised by a generalised hyper-synchronous activity (2.5-5 Hz) of neurons in the thalamocortical network that manifests as a spike and slow-wave discharge (SWD) in the electroencephalogram. Although CAE is not a benign form of epilepsy, its physiological basis is not well understood. In an attempt to make progress regarding the mechanism of SWDs, I built a large-scale computational model of the thalamocortical network that replicated key cellular and network electric oscillatory behaviours. Model simulation indicated that there are multiple pathological pathways leading to SWDs. They fell into three categories depending on their network-level effects. Moreover, all SWDs had the same physiological mechanism of generation irrespective of their underlying pathology. They were initiated by an increase in NRT cell bursting prior to the SWD onset. SWDs critically depended on the T-type Ca2+ current (IT) mediated firing in NRT and higher-order thalamocortical relay cells (TCHO), as well as GABAB synaptic receptor-mediated IPSPs in TCHO cells. On the other hand, first-order thalamocortical cells were inhibited during SWDs and did not actively participate in their generation. These cells, however, could promote or disrupt SWD generation if they were hyperpolarised or depolarised, respectively. Importantly, only a minority of active TC cells with a small proportion of them bursting were necessary to ensure the SWD generation. In terms of their relationship to other brain rhythms, simulated SWDs were a product of NRT sleep spindle (6.5-14 Hz) and cortical δ (1-4 Hz) pacemakers and had their oscillation frequency settle between the preferred oscillation frequencies of the two pacemakers with the actual value depending on the cortical bursting intensity. These modelling results are discussed in terms of their implications for understanding CAE and its future research and treatment.

In response to poor levels of fruit and vegetable consumption in children across the UK, numerous interventions have been developed in schools in an attempt to encourage children to meet the recommended five a day. This programme of research examined the potential of a school-based healthy eating intervention, the Food Dudes programme, to increase children’s fruit and vegetable consumption in the long-term, at both school and at home, in 15 schools across the West Midlands. In contrast to previous studies that focused on the internal validity of the intervention, the programme of research utilised a socio-ecological approach to explore the wider contextual factors involved in behaviour change, beyond discussion of efficacy. Evidence from the six outputs indicated that the Programme was: effective in increasing fruit and vegetable consumption in the short-term only; more effective for children who consumed school-provided lunches than those provided from home (output 3); did not result in any decreases in high fat and/or sugar foods (output 4), not able to transfer to the home environment (output 5); and difficult to implement as part of the school day (output 6). Sustaining healthy eating behaviours beyond the intervention was a key challenge. Whilst interventions such as Food Dudes may work at the intrapersonal level of an ecological system, issues of sustainability arise from the intervention’s inability to extend or function beyond individual level behaviour change. The ecological approach on children’s’ eating behaviour offers an alternative theoretical approach to explain the effectiveness of interventions such as Food Dudes, and as a basis for proposing alternative intervention strategies.

Based on Ullman’s (2004) hypothesis that declarative memory impairment will contribute to language impairment, this thesis presents two experiments that test familiarity and recollection in children with Autism Spectrum Disorder (ASD) and Intellectual Disability (ID). Four experimental groups comprised children and adolescents with ASD with language impairment (ALI); ASD without language impairment (ALN), intellectually disabled children without ASD (ID) and typically developing children (TD). Children were tested on two forced choice recognition tests of familiarity and recollection and a shape recognition and cued action-recall test. The relation between familiarity and conceptual semantic knowledge was investigated whilst controlling for visuo-perceptual abilities and fluid intelligence. Findings confirmed an association between familiarity and conceptual semantic knowledge in the ASD population as well as the use of visuo-perceptual skills to enhance familiarity. The broader role of declarative memory in language is addressed in ASD. Implications for future methods of testing in ASD populations are considered, as are implications of declarative memory anomalies in both ASD and ID populations in educational settings.

Childhood undernutrition remains a public health problem in slums in Nairobi, yet little is known about current childcare practices, particularly child eating and maternal feeding behavior and their impact on child growth. Treatment options for malnutrition in this setting involve the use of sweet, high energy ready to use foods (RUF), which have the potential to displace home foods, but few studies have assessed this. This thesis therefore aimed to quantify high-risk caring practices in children aged 6-24 months and how these vary with nutrition status. The effects of RUF on meal frequency and eating and feeding behavior were also assessed. The programme of research was underpinned by the following research questions: • What are the commonest modifiable risk factors for undernutrition found in children and how does this pattern vary with nutrition status? • Do ready to use foods displace complementary foods in moderately undernourished children? • Do ready to use foods affect eating and feeding behaviour? Preliminary studies were carried out to test the feasibility of using observations to assess childcare practices. Caregivers of children aged between 6 and 24 months were recruited in Wagha town, a semi urban area in Lahore, Pakistan and in selected slums in Nairobi, Kenya. A structured observation guide was used to collect information on caregiver child interactions during mid-morning meals in Pakistan and lunch time meals in Kenya. A description of childcare practices in the household, specifically dietary practices, feeding behaviour and hygiene practices were assessed by asking the following questions: Who feeds the child? How is the child fed? What is the child fed and how often? What are the hygiene practices of caregivers? Thirty meal observations, 11 in Pakistan and 19 in Kenya, were carried out in homes, while 11 meals were observed in day-care centres in Nairobi. Eating and feeding behaviours varied between cultures. Compared to caregivers in Kenya, caregivers in Pakistan offered more encouragement during meals. In Kenya, encouragement was mainly in response to food refusal and undernourished children were more likely to show aversive eating behaviour. Caregivers would respond to this behaviour by either restraining the child or simply leaving them alone. In day-care centres, laissez faire feeding was common as children were left to feed themselves with little or no assistance. Poor hygiene practices were also common, especially in Kenya where caregivers did not wash their hands before feeding their children. Meal observations were not representative as only one meal could be observed and they were also not practical because of insecurity in the slums. Based on these findings, a cross sectional study carried out in seven health facilities was designed. Caregivers of children aged 6-24 months were recruited from health facilities in two stages. In the first stage, undernourished children (weight for age or weight for length below - 2 Z scores or length for age below -3 Z scores) were quota sampled either from outpatient therapeutic or supplementary feeding programs based on severity and supplementation status between February and August 2015. Undernourished children were recruited from well-baby clinics during growth monitoring. Between July and August 2016 healthy children (weight for age above-2 Z scores) were also recruited from well-baby clinics at the same health facilities. For both groups, child anthropometric measurements were taken and information on sociodemographic, hygiene breastfeeding frequency, meal frequency, dietary diversity, child eating and caregiver feeding behaviour collected using a structured interview guide. Among children receiving ready to use foods, information on child interest in food, food refusal and caregiver force-feeding was also collected for both family meals and ready to use food meals. We recruited 415 children (54.5% female), over half (58.6%) of whom were undernourished. Caregivers and their children came from disadvantaged backgrounds characterized by low parental education. They also lacked access to basic hygiene and sanitation facilities. There was no association between nutrition status and hygiene as nearly all children came from households that lacked piped water (83.6%) and shared toilets (82.9%). Compared to healthy children, undernourished children were more likely not to be breastfeeding (undernourished 11.5%; healthy 5.2% P=0.002) and to receive plated meals at a low frequency (undernourished 12.2%; healthy 26.2% P=0.002). Diets offered were mainly carbohydrate based and there was no association between dietary diversity and nutrition status. Close to one third of children showed low interest in food 25.8% (107) and high food refusal 22.5% (93). Force-feeding was also relatively common 38.5% (155). Compared to healthy children, undernourished children were more likely to show low interest in food (undernourished 34.2%; healthy 14.0% P < 0.001) and high food refusal (undernourished 30.9%; healthy 10.5% P < 0.001); and their mothers were more likely to be anxious about feeding them (undernourished 20.6%; healthy 6.4% P < 0.001). Within the undernourished group, 49.4% had either low interest in food or high food refusal or both. Force-feeding was common in both groups, with a non-significant trend towards more force-feeding in the undernourished infants (undernourished 41.4%; healthy 34.5% P=0.087). Children were more likely to be force-fed if they had low interest in food (odds ratio[95% CI] 3.72 [1.93 to 7.15] P < 0.001) or high food refusal (4.83[2.38 to 9.78] P < 0.001), after controlling for maternal anxiety and child nutrition status. Children appeared to prefer RUF to home foods which is good for treatment compliance, but it may have a negative impact on intake of home foods. Although a single sachet of RUF appeared not to displace family meals in moderately undernourished children, actual energy intake was not measured in this study and these findings are therefore inconclusive. Children in slum areas in Nairobi are exposed to many risk factors which puts them at risk of infection and undernutrition and provision of ready to use foods as a treatment option does not address the underlying problem. There is therefore a need for poverty alleviation strategies which will lead to improved access to hygiene facilities and better environmental conditions. Measures to improve access and utilization of safe nutritious foods as well as mother-child interactions during meals are also required. A better understanding of child care practices and underlying factors that influence them is also required for the design of effective and sustainable interventions in this setting.