I den här studien intervjuas fem personer som är yrkesverksamma inom verksamheter med konstnärligt skapande som inriktning för personer med neuropsykiatriska funktionsvariationer (NPF) och/eller utvecklingsstörning. Syftet med studien är att belysa konstnärligt skapande som verktyg kopplat till ökade krav på evidensbaserad praktik i gruppverksamheter riktade till personer med NPF och/eller utvecklingsstörning. Forskningsfrågorna avser därför att ge svar på vilka funktioner metoden konstnärligt skapande fyller som verktyg i gruppverksamheter riktade till personer med NPF och/eller utvecklingsstörning, hur dessa funktioner kan förstås samt om de kan/bör leva upp till krav på evidensbaserad praktik. Resultatet bygger på fem semistrukturerade intervjuer som har kodats och analyserats med fenomenologisk tematisk analys. Det teoretiska ramverket består av den salutogena modellen med fokus på ”en känsla av sammanhang” och Jonna Bornemarks perspektiv om ”att mäta det omätbara”.   Metoden konstnärligt skapande används frekvent i verksamheter riktade till målgruppen men samtidigt finns brister när det kommer till kvantitativ forskning för att stödja metodens effekter. Informanterna menade att den subjektiva upplevelsen av metoden är svår att mäta men att de själva upplever att konstnärligt skapande har många fördelar för den specifika målgruppen. Under studiens gång beskrev informanterna aspekter som väl stämde överens med vad som ryms inom den salutogena modellen. De gav uttryck för att det konstnärliga skapandet som metod bidrog till inkludering, kognitiv förstärkning, ökad självkänsla samt att det kunde fungera som ett alternativt kommunikation- och samtalsverktyg. / In this study, five people are interviewed who work professionally in activity groups with creative arts as a focus for people with neurodevelopmental disorders (DSM-5) and / or developmental disorder. The purpose of the study is to investigate the professionals' view of creative arts as a method in the work with the target group, and also their view of creative arts linked to the increased requirement for evidence-based practice. The questions of this research therefore intend to provide answers to what functions creative arts as a tool can have in group activities for people with DSM-5 and / or developmental disorder. We also intend to research how we can understand creative arts as a method and if/how the method should be mesured in relation to an increased requirement for evidence-based practice. The result is based on five semi-structured interviews that have been coded and analyzed with phenomenological thematic analysis. The theoretical framework is based on the salutogenic model and Jonna Bornemarks perspective on "measuring the immeasurable". The method of creative arts is frequently used in group activities for the target group, but at the same time there are deficiencies in the quantitative research bass to support the effects of the method. The respondents argued that the subjective experience of the method is difficult to measure, but that they themselves feel that creative arts has many advantages for the specific target group. During the study, the respondents described aspects that were well in line with what is included in the salutogenic model. The practitioners expressed that creative arts as a method contributed to community, cognitive reinforcement, increased self-esteem and that it could function as an alternative means of expression.

Dans le cadre du programme commun d’études pharmaco-épidémiologiques de la caisse nationale de l'assurance maladie et de l’agence nationale de sécurité du médicament, visant à évaluer l'impact sanitaire en France de l'exposition in utero à l’acide valproïque à partir des bases de données médico-administratives (BDMA) françaises, l’objectif de cette thèse était d’étudier l’utilisation des antiépileptiques pendant la grossesse et les risques de malformations congénitales et de troubles neuro-développementaux associés chez l’enfant. Le premier volet de cette thèse a consisté à formaliser et publier un algorithme d’identification des grossesses spécifiquement adapté aux BDMA françaises. L’application de cet algorithme à la description de l’utilisation des antiépileptiques pendant la grossesse a permis d’estimer à 6,7‰ la prévalence de l’utilisation des antiépileptiques pendant la grossesse et de montrer une baisse de l’utilisation des antiépileptiques de première génération, en particulier de l’acide valproïque, au bénéfice des antiépileptiques de deuxième génération entre 2007 et 2014. Dans le deuxième volet de cette thèse, l’exposition in utero à l’acide valproïque a été retrouvée associée à une augmentation du risque d’un grand nombre des malformations congénitales majeures (MCM) étudiées, avec une relation dose-effet pour les MCM les plus fréquentes, et l’exposition in utero au topiramate à une augmentation du risque de fentes oro-faciales. Des signaux relatifs à la prégabaline, au clonazépam et au phénobarbital ont aussi été identifiés. Dans le troisième volet de cette thèse, l’exposition in utero à l’acide valproïque a été retrouvée associée à une augmentation du risque de chacun des événements neuro-développementaux précoces étudiés versus lamotrigine, avec une relation dose-effet, à l’inverse des autres antiépileptiques. La réalisation d’études pharmaco-épidémiologiques à partir des BDMA françaises a permis aux autorités sanitaires de fournir rapidement des données sur l’utilisation des antiépileptiques pendant la grossesse en France. La réalisation de ces études a aussi permis de participer à l’enrichissement de la littérature observationnelle internationale sur les conséquences de l’exposition in utero aux antiépileptiques pour l’enfant à naitre. / The works of this thesis have been carried out within a programme of pharmacoepidemiological studies initiated by the National Agency of Medicine and Health Product Safety (ANSM) and the National Health Insurance fund (Cnam) in order to evaluate the public health situation in relation to prenatal exposure to valproic acid in France on the basis of the French health care databases. The objective of this thesis was to study antiepileptic drug (AED) use during pregnancy and the risks of congenital malformations and neurodevelopmental disorders associated with prenatal exposure to these drugs. In a first study, we developed an algorithm to identify pregnancy episodes and related outcomes using the French health care claims databases and applied it to study AED use during pregnancy between 2007 and 2014. Over the study period, 6.7 per 1000 pregnancies were exposed to an AED. The use of newer AEDs increased concomitantly with the decreased use of valproic acid and the other older AEDs. In a second study, prenatal exposure to valproic acid was found to be associated with a wide range of malformations among those investigated, with a dose-response relationship for half of them, and prenatal exposure to topiramate with an increased risk of cleft lip with or without cleft palate. Signals concerning pregabalin, clonazepam and phenobarbital have also been identified. In a third study, prenatal exposure to valproic acid was found to be associated with increased risks of all early neurodevelopmental outcomes investigated compared with lamotrigine, with a dose-response relationship. Prenatal exposure to the other AEDs was not associated with an increased risk of any of these neurodevelopmental outcomes versus lamotrigine. Conducting pharmacoepidemiological studies based on the French health care databases enabled the health authorities to rapidly provide data on the use of AED during pregnancy in France. It also brought additional evidence to the international observational literature on the consequences of prenatal exposure to AEDs for the unborn child.

Many people would argue that New Zealand has had a poor reputation for providing support services for the families of people with an Autistic Spectrum Disorder (ASD). The limited support services available for families in this country were highlighted during the trial and the manslaughter conviction of Janine Albury-Thomson. Albury-Thomson was found guilty of the manslaughter of her autistic daughter, Casey (MOH, 1999). The sentencing judge called for an independent inquiry to be held to examine the extent of support services that were available for families affected by the disorder with a view to identifying any gaps that may exist and ascertaining whether or not government policy could be blamed (Norris, 1998). More than twelve years have now elapsed since the Albury-Thomson trial and research was needed to ascertain the experiences of families raising a child with ASD. This research examines the experiences of families who have a child who has an ASD diagnosis. Research participants were families of people with Autism Spectrum Disorder who reside in the Canterbury/West Coast area. The research explored the support needs of families and the informal and formal supports that are available to them in this region. This research was conducted in three parts, with each part having a distinct method of data collection allowing triangulation of research findings. Part one was a survey questionnaire distributed via a range of mediums using a snowball sampling method. The second data set was made up of two case studies that were undertaken with a semi-structured interview approach. The third set of data was elicited via a semi-structured interview process from five local service providers that provide services to those with ASD and their families. A qualitative methodology was adopted to analyse research findings. This methodological approach was selected because it gave participants the opportunity to tell their stories about the diagnostic pathway they travelled and their experiences using available services. This research has social policy relevance as it was designed to examine the participant’s experiences while using services and resources available for the families of people with ASD in the Canterbury/West Coast area. Participants told of various social, emotional, and practical impacts and of the experiences they encountered while using the various services available. While the level of awareness of ASD has increased, the diagnosis process proved to be problematic for some when using the public health system. Consistent with a 2001 study commissioned on behalf of the Autistic Association of New Zealand, participants in this study who sought a diagnosis through the public health system found it to be a protracted process. Participants attributed delays to a lack of resources or staff that had a limited knowledge of ASD and saw these factors as barriers to obtaining a diagnosis within an acceptable time frame. A more timely diagnosis was reportedly received when the private health system was used. With regards to support offered by the agencies involved with ‘day to day’ contact with families it was found that overall, competent, experienced people worked for the existing agencies and they were capable of offering support where needed. However specific issues were identified by participants including a perception that case managers failed to understand their situation because they were unfamiliar with the implications of having a family member with ASD. Significantly, family members and service providers both identified a concern about a lack of suitable accommodation that can be utilised by a person with ASD. Because there is limited research into the support needs of families of a child with ASD this research provides an important insight into the needs of a fairly marginalised, and sometimes socially isolated, group. Implications for ongoing service provision and support of families are discussed in the thesis.

The study proposes an ecosystemic approach as an intervention for attentional difficulties and heightened motor activity, traditionally known as AD/HD. A literature study of AD/HD is presented first as a psycho-educational frame of reference. The focus then shifts to the symtoms of AD/DH to move closer to the possible underlying causes of these symptoms. In doing so, the focus changes from AD/HD as a diagnosis to attentional difficulties and heightened motor activity as presenting symptoms. Attention and motor activity as constructs are investigated in terms of their neuro-anatomical, neuro-chemical and neuro-physiological aspects. Furthermore, neurodevelopment, physiological stress, neurodevelopmental delay, information processing systems, sensory-motor subsystems and integration as constructs are investigated to understand their role in attention and modulation of motor activity. The study of attention and motor activity and their associated neurological factors motivates an alternative, ecosystemic method of intervention. The proposed approach includes an investigation into internal and external biochemical ecosystems such as environmental pollutants, deficiencies of essential nutrients and genetic deficiencies of the immune system. Other aspects such as time, maturation and neurodevelopment are also considered as well as the gentle interplay between these aspects. The therapeutic intervention includes sound therapy, neurodevelopmental movement activities, EEG neurofeedback and nutrition. Experimental research with a sample population of 12 diagnosed grade 4 and 5 AD/HD learners over a 11 week period was conducted. Statistically significant improvements in aspects of attention were noted using 2 standardised instruments and verification through parent interviews in the first and second experimental groups. Statistically significant improvements were noted in aspects of motor activity (a decline in hyperactive behaviour) in the second experimental group with verification from teacher interviews. Additionally, children in the first experimental group improved significantly more than children in the control group with regards to mathematic skills. The second experimental group showed significant improvement with large effect sizes on reading, mathematic skills and spelling. In conclusion, the statistically significant results obtained with the proposed approach motivates implementation, with improvements in attention, motor activity control and academic performance as a prospect. / Psychology of Education / D. Ed.(Psychology of Education)

Purpose: Neurodevelopmental difficulties are correlated with lower mental well-being and more mental health problems. Issues in social relations such as bullying are a prominent risk factor in a social setting of high school, have also been associated with the status of disability. This thesis investigated the relation between mental health problems, mental well-being, and bullying in adolescents with self-reported neurodevelopmental difficulties and compared these with adolescents with Other disabilities. Materials and methods: Data from a Swedish longitudinal survey study (LoRDIA) was used. Mental health problems were measured through emotional and conduct problems scales of SDQ, mental well-being was measured with MHC-SF, and a bullying questionnaire was used. Results: Adolescents with NDD experience more bullying victimization and perpetration than adolescents with Other disabilities such as physical disability and autoimmune diseases. Significant association to bullying perpetration was found in NDD adolescents. Adolescents with Other disabilities indicated high mental well-being compared to NDD. While gender predicts high mental well-being, disability and emotional problems have a negative relation with it. Conclusion: Adolescents with NDD report more bullying victimization and perpetration experiences in comparison to adolescents with Other disabilities. Emotional problems have an inverse relation for predicting high mental well-being for adolescents with NDD and Other disabilities.

The purpose of the study is to acquire knowledge and understanding of successful school development, with a focus on students' cognitive abilities. The survey focuses on the implementation of development work and its effects on the organization and students' development. The theoretical framework is based on special educational perspectives, salutogenic perspective and organizational theory. Two contiguous preschool class‑third grade schools are included in the study and primary data consists of interview responses from school staff. The study also includes questionnaire responses from guardians of children in third grade. However, the response rate from the guardians is insufficient for conclusions. The results show that school development changed the view of students' differences and needs. Furthermore, the schools have shifted their focus to group and organizational level, as well as to more promotional and preventive work. Fewer students are included in the student health team and the number of action plans has decreased. The development of the schools is characterized by a shift towards a more critical perspective and has been conducted through strengthened meaningfulness in the form of defined values, consensus in purpose and vision and collegial cooperation. The conditions that enable successful school development are characterized by a strong sense of coherence, in both leadership and conditions. Increased focus on the environment, as well as enhancement of comprehensibility, manageability and meaningfulness, are also factors that have benefited students' development. Factors that hinder school development can be traced to a compensatory and dilemma perspective, as well as to a lack of sense of coherence. Above all concerning attitudes among school staff and external demands placed on the school activities. Our conclusion is that both school development and students' cognitive abilities can be promoted through the application of a salutogenic perspective.

El trastorno del espectro autista (TEA) se caracteriza por distintas dificultades en la comunicación e interacción social que se puede mejorar con una detección e intervenciones oportunas logrando la mayor potencialidad del niño. Objetivo: Identificar los factores asociados a un diagnóstico tardío del TEA en nuestro país y al conocerse estos, permitan contribuir a un mejor diseño de estrategias para su detección precoz. Materiales y Métodos: Nosotros realizamos un estudio observacional transversal analítico en base al registro de pacientes TEA del INSN, con un poder estadístico suficiente para responder nuestra pregunta de investigación. Se buscó asociación entre diagnóstico tardío y variables sociodemográficas, y características clínicas. Se construyó un modelo de regresión poisson log con variantes robustas para el calculo del RPc y RPa. Resultados: Un total de 171 registros de pacientes fueron analizados. La proporción de diagnóstico tardío fue 50,29%. El sexo masculino tuvo un predominio con 84,0% y el femenino 16,0%. Encontramos que el nivel de severidad del TEA moderado y severo obtuvo un RPa de 0,40 (p< 0,001) y 0,49 ( p 0,104), ser el segundo hijo obtuvo un RPa de 0,49 IC95% 0,31 – 0,77 (p = 0,002). Conclusiones: La edad media de diagnóstico de TEA en el Perú es mayor comparada a otros países, el nivel de severidad es un factor asociado a un diagnóstico tardío, los pacientes con sintomatología más leve se hace el diagnóstico más tardío por lo que se necesita sensibilizar el tamizaje de TEA para que los servicios de salud mejoren la captación temprana. / Autism Spectrum Disorder (ASD) is characterized by different difficulties in communication and social interaction that can be improved with early detection and timely intervention through therapies to achieve the greatest potential of the child. Objective: To identify factors associated with late diagnosis of ASD in our country and, when these are known, to contribute to a better design of strategies for its early detection. Materials and Methods: We conducted an analytical cross-sectional observational study based on the INSN registry of ASD patients, with sufficient statistical power to answer our research question. We looked for association between late diagnosis of ASD and sociodemographic variables and clinical characteristics. We used the Prevalence Ratio (PR) as a measure of association which was then adjusted in a multivariate model (PRa). Results: A total of 171 patient records were analyzed. The proportion of late diagnosis was 50.29%. Male sex predominated with 84.0% and female sex 16.0%. We found that the severity level of moderate and severe ASD obtained a RPa of 0.40 (p < 0.001) and 0.49 (p = 0.104), being the second child obtained a RPa of 0.49 CI95% 0.31 - 0.77 (p = 0.002). Conclusions: The mean age of ASD diagnosis in Peru is higher in comparison to other countries, the level of severity of ASD is a factor associated with late diagnosis, having mild symptomatology the diagnosis of ASD is made later. There is a need to improve screening for ASD with less severe symptoms in health services to increase the early uptake of children and offer greater benefits / Tesis

As every person has the right to participate in leisure, recreational and sports activities, children with disabilities have the same right to freely participate in the activities of their preference without restrictions. Community-based interventions aim to promote this right by modifying the whole environment or enhance the already existing onewith appropriate equipment. However, there is a lack of community-based interventions to promote participation in leisure activities for children and youth with neurodevelopmental disorders and physical disabilities. As a consequence, this systematic literature review aims to identify those community-based interventions and point out their characteristics that are described as effective concerning children’s and youth’s attendance, involvement and activity competence. Furthermore, it is crucial to specify whether those activities are based on children’s preferences. After a scholarly search, both quantitative and qualitative studies were evaluated. Six intervention studies were characterized as appropriate to be included in the review providing important information for those interventions approaches. A narrative analysis of the results was based on the Family Participation Related Construct (fPRC) theoretical framework. Results showed that interventions were based on the children’s and youth’s preferences and intervention referred to the environment rather than to the participants themselves. Furthermore, availability, accessibility, adaptability, acceptability and affordability were all considered in the intervention process while the modification or identification of appropriate environment played a vital role in the interventions’ implementation. However, despite the fact that studies aimed to increase participation, some of the used measurements focused on activity competence rather than participation. All the above were critically discussed, giving the incentive for further research implications in the emerged results. / Καθώς κάθε άτομο έχει το δικαίωμα να συμμετέχει σε δραστηριότητες αναψυχής, ψυχαγωγίας και αθλητισμού, τα παιδιά με αναπηρία έχουν το ίδιο δικαίωμα να συμμετέχουν ελεύθερα στις δραστηριότητες της προτίμησής τους χωρίς περιορισμούς. Οι κοινοτικές παρεμβάσεις στοχεύουν στην προώθηση αυτού του δικαιώματος τροποποιώντας ολόκληρο το περιβάλλον ή ενισχύοντας το ήδη υπάρχον με κατάλληλο εξοπλισμό. Ωστόσο, υπάρχει έλλειψη κοινοτικών παρεμβάσεων για την προώθηση της συμμετοχής σε δραστηριότητες αναψυχής για παιδιά και νέους με νευροαναπτυξιακές διαταραχές και σωματικές αναπηρίες. Κατά συνέπεια, αυτή η συστηματική βιβλιογραφική ανασκόπηση στοχεύει στον εντοπισμό αυτών των παρεμβάσεων που βασίζονται στην κοινότητα και επισημαίνει τα χαρακτηριστικά τους που περιγράφονται ως αποτελεσματικά όσον αφορά την παρουσία, τη συμμετοχή και τη δραστηριότητα των παιδιών και των νέων. Επιπλέον, είναι ζωτικής σημασίας να προσδιοριστεί εάν αυτές οι δραστηριότητες βασίζονται στις προτιμήσεις των παιδιών. Μετά από μια επιστημονική αναζήτηση, αξιολογήθηκαν τόσο ποσοτικές όσο και ποιοτικές μελέτες. Έξι μελέτες παρέμβασης χαρακτηρίστηκαν κατάλληλες για να συμπεριληφθούν στην ανασκόπηση παρέχοντας σημαντικές πληροφορίες για αυτές τις προσεγγίσεις παρεμβάσεων. Μια αφηγηματική ανάλυση των αποτελεσμάτων βασίστηκε στο θεωρητικό πλαίσιο Οικογενειακής Συμμετοχής Σχεδιασμού (fPRC). Τα αποτελέσματα έδειξαν ότι οι παρεμβάσεις βασίστηκαν στις προτιμήσεις των παιδιών και των νέων και η παρέμβαση αναφέρεται στο περιβάλλον και όχι στους ίδιους τους συμμετέχοντες. Επιπλέον, η διαθεσιμότητα, η προσβασιμότητα, η προσαρμοστικότητα, η αποδοχή και η προσιτή τιμή εξετάστηκαν στη διαδικασία παρέμβασης, ενώ η τροποποίηση ή ο προσδιορισμός του κατάλληλου περιβάλλοντος έπαιξε ζωτικό ρόλο στην υλοποίηση των παρεμβάσεων. Ωστόσο, παρά το γεγονός ότι οι μελέτες αποσκοπούσαν στην αύξηση της συμμετοχής, ορισμένες από τις μετρήσεις που χρησιμοποιήθηκαν επικεντρώθηκαν στην ικανότητα δραστηριότητας παρά στη συμμετοχή. Όλα τα παραπάνω συζητήθηκαν κριτικά, δίνοντας το κίνητρο για περαιτέρω ερευνητικές επιπτώσεις στα αποτελέσματα που προέκυψαν.

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Adolescence is a time of change where maturational milestones lead to the prioritization of peerinput, and the social context becomes crucial in its influence of those milestones. Adolescents socialcontext requires adapting to complex social norms through self-regulation, a process which adolescents having neurodevelopmental disorders struggle with, bounding them to a certain incompetencein dealing with the peer group and friendships. In a time where interconnection becomes crucial inconforming the self-concept, it makes sense struggles in this area would influence the experience ofmental health. In this crossectional quantitative study adolescents with NDDs friendship experiencein class and its relation to well-being is analyzed using the data from the prospective longitudinalsurvey LoRDIA project. Variables such as reciprocity and rejection were created from peer nominations and used alongside items on perceived support and the MHC-Mental health continuumscale rating of flourishing. Descriptives, Chi-squares and logistic regression were conducted usingSPSS. Results show an association between well-being and the friendship experience but not between well-being and the presence of an NDD. Adolescents with an NDD experience less reciprocity, more rejection and lower perceived support in higher frequency than their peers. Discussion isguided by the family of Participation Related Constructs (fPRC) and the Two continuum modelperspective of well-being. Methodological limitations and future interventions based on the discussion are exposed.