by Sonya Y.W. Law. / Includes Chinese and English questionnaires. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 80-89). / ABSTRACT --- p.II / ACKNOWLEDGEMENTS --- p.III / TABLE OF CONTENTS --- p.IV / LIST OF TABLES --- p.V / LIST OF APPENDICES --- p.VII / Chapter CHAPTER I - --- INTRODUCTION / The phenomenon of informant discrepancy on child and adolescent psychopathology --- p.8 / Variables affecting the agreement of informants in rating child and adolescent psychopathology --- p.11 / Who is the reliable and valid informant? --- p.25 / Focuses of the present study --- p.30 / Chapter CHAPTER II - --- METHOD / Subjects --- p.33 / Instruments --- p.34 / Procedure --- p.38 / Statistical analyses --- p.38 / Chapter CHAPTER III - --- RESULTS / "Internal Consistency of the CBCL, YSR, TRF syndrome scales and interrelation among syndromes scales" --- p.40 / Informant concordance - on the severity of reported symptoms --- p.46 / "correlation between parent's, teacher's, and child's rating" --- p.53 / "Association between parent-, teacher-, child-rated internalizing and externalizing problems and the external correlates of psychopathology" --- p.61 / Predictive ability of ratings from different informants on the external correlates of psychopathology --- p.64 / Chapter CHAPTER IV - --- DISCUSSION / Informant agreement on the severity of symptoms --- p.68 / "Correlation between ratings of different informants in relation to adolescent's sex, age, clinical status, and type of psychopathology" --- p.72 / Association between ratings from different informants and the external correlates of psychopathology --- p.75 / "Predictive ability of parent's, teacher's and adolescent's rating on the external correlates of psychopathology" --- p.77 / REFERENCES / APPENDICES

A review of the literature regarding behavioral characteristics and underlying factors for behaviorally disordered (BD) students revealed that both elementary school aged and secondary school aged BD students may be able to be described by a similar factor structure. Utilizing ratings obtained on a national sample of BD students with the Behavioral Dimensions Rating Scale (BDRS). Research Edition, the pattern of item ratings for students in grades kindergarten through five (K-5) and grades six through eleven (6-11) was examined to confirm this literature-based theory. Multigroup simultaneous confirmatory factor analysis using maximum likelihood estimation procedures was utilized to compare the covariance structures of students in grades K-5 and grades 6-11. A goodness-of-fit index revealed that the covariance matrices of the two groups were invariant. Since the same factor structure could be used to describe BD students in grades K-5 and grades 6-11, the means for the two groups were compared using Hotelling's T^2 statistic for two independent samples. The analysis resulted in finding a significant difference between the two groups' means. A univariate F test was conducted for the behavioral dimensions to locate the source of the mean difference. A significant difference was found only for Factor I: Aggressive/Acting Out, indicating that teachers perceive these types of behavior to be more problematic for students in grades K-5. No significant differences were found between the two groups' means on Factor II: Socially Withdrawn, Factor III: Irresponsible/Inattentive, or Factor IV: Fearful/Anxious. This investigation has demonstrated that teachers can use the BDRS, Research Edition with confidence when assessing the behaviors of both elementary and secondary school aged students. Areas for further investigation include an examination for invariance across (a) more narrowly defined grade distributions, (b) gender, and (c) socioeconomic status.

Interparental conflict has been shown to be associated with child psychopathology (internalizing and externalizing behaviors). Adolescents are at risk for developing internalizing and externalizing behaviors because they are aware of the implications of the interparental conflict, they can attempt to mediate the conflict, and because of age-related responsibilities, they often experience new and unfamiliar stressors. A comprehensive review of the literature revealed four mediational models with substantial empirical support that explain the relation between interparental conflict and adolescent psychopathology: the cognitive-contextual model, the triangulation model, the spillover model, and the interparental conflict-parental psychopathology model. Typically, the mediators of these models (self-blame/perceived threat; triangulation; negative parenting behaviors; parental psychopathology, respectively) have been examined individually. The aim of this study was threefold: 1) examine the specificity of adolescent psychopathology (dimension versus diagnosis), 2) test each theoretical model, and 3) develop and test an integrative model that included the mediational mechanisms from the individual models. A community sample of 152 families (mother, father, adolescent) was recruited from the contiguous United States. Considering specific psychiatric diagnoses did not improve the fit of models that included the respective adolescent dimensional internalizing or externalizing behaviors. The hypotheses of the cognitive-contextual model (mediator: perceived threat), spillover model (mediators: maternal/paternal parenting), and the interparental conflict-parental psychopathology model (mediators: maternal/paternal internalizing) were supported in this study, but mediation was not supported for the triangulation model. Considering the mediators together, adolescent perceived threat, negative parenting, maternal internalizing and paternal externalizing behaviors were key in predicting adolescent psychopathology. Overall, the findings from the integrative models suggest that externalizing behaviors (interparental conflict, negative parenting, paternal externalizing behavior) lead to both adolescent internalizing and externalizing behaviors; whereas, parental internalizing behaviors leads to internalizing behaviors only. The implications of these findings, especially from the integrative model, have clinical implications and provide guidance for future research.

A significant number of youth experience mental health disorders for which they suffer negative consequences. Although there are evidence-based therapies available to help children and their families, most youth do not receive treatment. Parental problem recognition is likely a primary barrier in this process. This study begins to address why parents may have difficulty recognizing mental health problems by extending existing models and integrating evidence about parental perceptions. Specifically, the study aimed to investigate the relationship between parental attributions and parents’ problem determination, and to examine the influence that parental characteristics have on this judgment process. Participants included 164 parents of youth ages 6-11 years. Purposive sampling was used to recruit mothers and fathers from both lower and higher SES communities. Parents completed self-report measures of parental characteristics, including: parental psychopathology, parenting stress, parental tolerance, and parental self-efficacy. Parents read ten brief child behavior vignettes and completed a version of the Written Analogue Questionnaire to rate the cause of each behavior (assuming it was their own child in the vignette) along four dimensions. Parents also rated the extent to which the behavior was seen as a problem. Results indicated that parents’ causal attributions were highly associated with parents’ problem ratings, and the attributions of stability and controllability were particularly robust predictors of problem determination. Hypotheses regarding parental characteristics as moderators of the relationship between attributions and problem determination were not supported. Findings are discussed in light of clinical and public health implications; results suggest that recognizing the influence of parental beliefs and attributions may help to increase the efficacy of outreach efforts for early intervention and help seeking for parental concerns.

Within the field of developmental psychopathology, research has repeatedly demonstrated that there are multiple complex and dynamic pathways originating in childhood that may lead to the development of internalizing and externalizing problems among adolescents. However, additional research is needed that examines the unique and concurrent contributions among child-, parent-, and family-level risk and resilience factors during childhood that may be associated with internalizing and externalizing problems in adolescence. To address this gap, the current study utilized a person-centered approach to identify profiles of risk and resilience factors among youth in middle childhood (ages 10-12) characterized by the quality and quantity of (a) child-level factors (i.e., temperamental features, executive functioning abilities); (b) parent-level factors (i.e., parental acceptance, control, disciplinary style); and (c) family-level factors (i.e., family cohesion, conflict, organization) among a sample of 775 participants (Aim 1). The study also examined internalizing and externalizing symptom profiles in adolescence (age 16) by identifying subgroups of youth characterized by the quality and quantity of internalizing and externalizing problems within each of the identified childhood risk profiles (Aim 2). Lastly, the study investigated transitions from childhood risk profiles to adolescent symptom profiles (Aim 3). Results demonstrated that a four-class model best fit the data in regard to childhood risk profiles, with classes of youth most saliently characterized by (a) accepting parents, (b) controlling parents, (c) disengaged parents, and (d) chaotic homes. With regard to adolescent internalizing and externalizing symptom profiles, results indicated a three-class model best fit the data and included classes distinguished by the presence of (a) low symptoms, (b) moderate symptoms, and (c) high internalizing and moderate externalizing symptoms. Most youth from the four childhood risk profiles transitioned to the low symptom profile at age 16; however, youth from the chaotic home profile were more likely to transition into one of the two higher-level symptom profiles. Findings enhance our understanding of risk and resilience by identifying distinct childhood risk profiles and corresponding adolescent symptom profiles. These findings will have implications for both prevention and treatment efforts that target specific risk factors within each risk profile. / Psychology

Studies have found a relationship between psychopathology and sleep disturbances, as well as between psychopathology and personality traits. What has not received attention to date, however, is the interplay amongst all three factors: psychopathology, sleep disturbances, and personality characteristics. This study explores the interaction amongst the three areas, as well as examines specific relationships between psychopathology and sleep disturbances and personality and sleep disturbances. Forty clients were recruited from a community mental health center. Participants were receiving outpatient psychological services, were over 18, and did not have a diagnosis of active psychosis or mental retardation. Participants completed 9 questionnaires covering items about demographic information, psychological concerns, sleep, personality style, and social desirability. They received a $10 gift card upon completion of the study. Participants had a mean age of 47.6 (70% female, 77% Caucasian). Results indicated that individuals with more severe psychopathology had poorer sleep quality and greater insomnia severity; however, participants with longer histories of psychopathology did not have more dysfunctional beliefs and attitudes about sleep. Participants with more extraverted personality styles did not sleep less than individuals who were less extraverted, and those who were more neurotic did not exhibit poorer sleep quality or greater insomnia severity. Lastly, when examining the relationship amongst all three factors, it was found that psychopathology may be a better predictor of sleep disturbances than personality is (depending on how sleep was assessed), and personality and sleep disturbances are both significant predictors of psychopathology. The results reinforce the interplay amongst psychopathology, personality, and sleep disturbances. Mental health professionals may want to place greater importance on the role of sleep in the treatment of psychological and personality disorders. Future research could replicate the study with a larger sample, utilize a different personality measure, or follow participants longitudinally from the start of their mental health treatment.

Previous research suggests as more scores are interpreted, there is a coinciding increase in the chance significant scores will be obtained. Interpretation of the MMPI-2 can involve the analysis of as many as 98 or more separate scores, suggesting the measure has a strong proclivity for producing a high frequency of seemingly abnormal scores amongst normal healthy adults. In the current study the incidence of elevated MMPI-2 scores was simulated for the normal population using Monte Carlo methodology. Interscale correlations from the MMPI-2 restandardization sample were obtained to determine the percentage of the population with N or more seemingly abnormal scores. Simulations were conducted for all scales combined, and for the Clinical, Harris-Lingoes, Content, Content-Component, and Supplementary scales separately at varying T-score cutoffs. 36.8% of normal adults are expected exhibit at least one elevated score on the Clinical scales at 65T. The normal incidence of at least one seemingly abnormal score was 38.3% on the Content, and 55.1% on the Supplementary scales. When all scale groups are considered together, approximately 50% of the normal population has three or more significant scores, and at least seven seemingly meaningful scores are found for one out of five normal persons. These results imply that consideration of a large number of MMPI-2 scales should be conducted with caution, and that high T-score cut-points may optimally increase confidence in the absence of corroborative test scores and extra test data.

The subjective experience of paranoia and persecutory delusions is largely overlooked in the extant literature, especially in first episode psychosis (FEP). This study explored the personal experience and understanding of threatening thoughts in FEP, guided by three over-arching research questions addressing: thought content and emotional distress; the role of life events and context; change in experience over time. Semi-structured interviews were conducted with eight participants. Transcripts were analysed using Interpretative Phenomenological Analysis. Five master themes were identified reflecting recurring characteristics of all participants’ experiences: Exposure of vulnerable self; At the limits of endurance; Elusive sense of agency; The urge to explain it all and FEP as a finite experience? 16 sub-themes indicated elements of master themes that varied among individual narratives. Findings indicated the highly interpersonal nature of threatening thoughts and their role as a key organising factor in people’s lives. Emotional distress was often viewed as consequential to multiple types of thought content, overwhelming pressure, powerlessness and expectation of negative judgement. Difficult life contexts often seemed to contribute to thought manifestation. Reduction of novelty was important to positive change. Several participants framed experiences as terrible but completed, rather than as the beginning of chronic difficulties.

The Mental Health Act 1983, amended in 2007, appears based on the assumption that an undisputed entity of “mental disorder” exists, that people who are designated mentally disordered should be treated, and if necessary, detained by doctors. This study aimed to examine how mental disorder was discursively constructed and how different institutional interventions and practices were justified and legitimised in the House of Commons’ debates regarding the Mental Health Act 2007. Verbatim transcripts from House of Commons debates on the Mental Health Act (conducted between 24th April and 15th May 2007) were studied through a discourse analysis. Seven primary discursive constructions were identified: “The Trusted and Medically Objective Expert,” “The Emergency,” “A Fair Process,” “Supporting Subjects,” “The Decision-Making Impaired and Vulnerably Ill Patient,” “The Lawyer’s Field Day,” and “Societal (Dis)Order.” The study concludes that mental disorder was represented in selective and systemic ways that can help justify and legitimise different interventions and practices, for example, enforced medication, making government legislation and psychiatric practices seem necessary. Consideration was given to how psychiatric practices could be problematic for some service users and how legislation could be based on political and public concerns about social disorder.

Psychosis is suggested to be a leading cause of disability, not only as a direct result of the distressing experiences, but due to the social adversity, increased isolation and subsequent negative impact upon quality of life. While psychological therapies for psychosis show promise in assisting people in recovering from psychosis, relatively little is known about the processes involved, specifically the processes worked through to allow clients to understand and adopt strategic, therapeutic approaches to care. This study aimed to explore how people experiencing psychosis made use of understandings and strategies developed during the joint activity of therapy. Semi-structured interviews were conducted with 11 participants (six psychologist-client pairs) towards the end of, or recently after, finishing therapy for psychosis. Transcribed interviews were analysed using grounded theory. The model constructed presents multi-directional, dynamic interactions between three core categories; ‘Enabling Personal Empowerment’, ‘Navigating a Collaborative Journey’ and ‘Building Belief to generate Trust’. This study explored how processes are derived during therapy, both individually and collaboratively, to help clients better understand and implement the most beneficial strategies introduced through therapy. Through exploring these derived processes, a possible model for the conceptualisation of processes which occur during therapy for psychosis, grounded in client and psychologist accounts of therapy, was generated.