Melbourne School of Psychological Sciences - Theses
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ItemAn investigation of family-centred service in the rehabilitation of paediatric acquired brain injury( 2022)Paediatric acquired brain injury (ABI) can have significant impacts on children, adolescents, and their families. Family-centred service is considered best practice in paediatric rehabilitation and emphasises the importance of supporting families and involving them in care planning, implementation, and evaluation. However, there are varied definitions and approaches to delivering family-centred service, family needs are often unrecognised and unmet in rehabilitation, and there is a lack of research evidence informed by the lived experience of families. The aim of this program of research was to develop a better understanding of family-centred service within paediatric ABI rehabilitation. The first part of this project was a scoping review of programs involving the families of children/adolescents with ABI. Information about the programs was synthesised to develop an understanding of how families are involved in ABI rehabilitation programs. The second part of this project explored subjective experiences of family-centred rehabilitation from the perspectives of children and adolescents with ABI, their families, and rehabilitation clinicians. Two qualitative studies were conducted in the context of a state-wide paediatric rehabilitation service. Across the two studies, thirteen rehabilitation clinicians, ten parents/caregivers, five siblings, and four children/adolescents with ABI participated in semi- structured interviews, and data were analysed using constructivist grounded theory methods. The findings yielded three manuscripts, one of which has been published in a peer-reviewed journal, with the remaining two submitted to journals and currently under review. Collaboration between clinicians and families during rehabilitation was identified as central to family-centred service, with participants reflecting on how this collaboration changes over time. The importance of clinicians developing an understanding of families and their unique lives following paediatric ABI was highlighted, as was the value of hearing children’s and adolescents’ voices during rehabilitation. The key role of clinicians was also emphasised, and participants recognised that the implementation of family-centred service requires active input and facilitation from clinicians. The findings contribute novel insights into family-centred service within paediatric ABI rehabilitation, with practice recommendations to support the implementation of this approach in practice. Keywords:
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ItemAn emotion-focused parenting program for parents of children with chronic illness: a pilot study( 2017)Parents play a critical role in socializing children’s emotional experiences which contribute to children’s emotional, social and behavioural functioning. However, when children have chronic illness, more emotionally intense and distressing situations can impact parents and their children. This PhD used a mixed-method approach to examine the feasibility, acceptability and outcome of an emotion-focused parenting program, Tuning in to Kids (TIK), for parents of school-aged children with chronic illness when compared to standard paediatric care at 3-month follow-up. Participants were 52 parent-child dyads (intervention = 27, 51.9%) recruited from the Royal Children’s Hospital, Melbourne. Outcomes were obtained from observation of an emotion discussion task as well as parent-reported and child-reported questionnaires. The individually delivered TIK was well attended with high satisfaction and acceptance for its contents and format. Qualitatively, intervention parents reported increased emotional knowledge, awareness and acceptance of their children’s emotions and their own, as well as learning emotion regulation and coaching skills while understanding and reflecting more on their parenting. When compared to a standard paediatric care control group at follow-up using ANCOVA, results showed that parental emotion socialization skills improved with large effect sizes for intervention parents as their emotion coaching increased while emotion dismissing reduced. Intervention parents also reported increased acceptance of negative emotions, better sense of parenting competence and less difficulties in their emotion regulation. Children of intervention parents also showed an improving trend in their socio-emotional functioning. Overall, findings suggest that TIK is a promising intervention for parents of children with chronic illness.
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ItemAn investigation of parent posttraumatic cognitions and mental health outcomes after trauma exposure in children( 2017)Introduction: Parent posttraumatic cognitions have received little attention in the childhood posttraumatic stress literature, yet potentially play an important role in understanding how parents influence children’s recovery after trauma. The manner in which parents respond to their child’s experience is important in the development and treatment of childhood posttraumatic stress disorder (PTSD), and a range of parenting behaviours and parent psychological problems have been linked to childhood posttraumatic stress (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012; Williamson et al., 2017). To date, limited empirical attention has been given to the nature of cognitions in parents of trauma-exposed children, and the research has been restricted to the use of small item pools, as a multidimensional measure of parent posttraumatic cognitions related to the child’s recovery had yet to be operationalised. The overall aim of this program of research was to develop a measure of parent posttraumatic cognitions for use after a child has experienced a traumatic event, and to examine whether these parent cognitions related to child and parent mental health outcomes. Method: This research had two parts. In Part A, a parent-report questionnaire, the Thinking About Recovery Scale (TARS), was developed to assess specific negative posttraumatic cognitions parents may have after their child is exposed to trauma. The theoretical-rational approach to scale development was used to generate items, which were then subjected to review by experts in the field of childhood trauma. In Part B, the TARS was used in a cross-sectional study, the Thinking About Recovery Project, to examine whether parent posttraumatic cognitions were related to mental health outcomes using a sample of parents and children after children’s experience of accidental injury. Participants were 116 parents and 88 children aged 8-16 years who had been physically injured (e.g., sporting injury, burns, motor vehicle accident) and subsequently admitted to hospital for at least 24 hours. Data collection involved questionnaires to assess parent and child posttraumatic cognitions and mental health outcomes (posttraumatic stress, depression, anxiety, externalising symptoms) between 3 and 6 months post injury. Results: The development and psychometric evaluation of the TARS is reported. The 33-item scale measuring three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated sound internal consistency and convergent validity when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. Posttraumatic cognitions parents had about themselves, the world, and their child’s recovery were significantly associated with both parent and child posttraumatic stress symptoms (PTSS), and a range of other mental health outcomes. A range of parent posttraumatic cognitions were significantly associated with child posttraumatic cognitions. Parent cognitions related to the child mediated the relationship between parents and child PTSS. Discussion and Conclusion: This research was a necessary step in advancing knowledge about parental influences on children’s recovery from traumatic events. Findings provide an empirical basis for ongoing investigation into how parent posttraumatic cognitions may be contributing to the development and maintenance of PTSD symptomatology in parents and children, with particular consideration to cognitions parents have related to their child’s recovery.
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ItemFatigue after child brain injury( 2016)Objective: Traumatic brain injury (TBI) is one of the most frequent causes of childhood disability. Fatigue is commonly reported during the acute and chronic phases of TBI recovery. Fatigue is defined as reduced performance in response to prolonged or unusual exertion and leads to reduced quality of life and school participation in children. Despite the prevalence of fatigue following TBI, there is little examining its nature and course. In particular, patterns of fatigue over time and predictors of longitudinal outcome after child TBI are unclear. The aim of this thesis is to address identified gaps in the existing research within the field of fatigue after child TBI. Throughout, we adopt a model of fatigue that is developmentally sensitive and multidimensional – including physical, sleep/rest, and cognitive elements. First, through systematic review of the literature we identify a psychometrically robust fatigue assessment instrument for use in child TBI. We then use this multidimensional fatigue measure to assess fatigue at three time-points after child TBI: 6 weeks, 6- and 12-months in order to meet the following study aims. First, we aim to compare fatigue in our TBI sample to published control data (at 6-weeks and 12-months post-injury), by TBI severity. Second, we examine fatigue over time (6- to 12-months post-injury) within our sample. Fourth, we explore factors predictive of worse fatigue on the fatigue measure at 6-weeks (child and parent perspectives) and 12-months (parent perspectives) post-injury. Our hypotheses were that fatigue following child TBI (a) would be higher than reported in published healthy children control data, (b) would reduce over time post-injury and (c) would be associated with more severe TBI and other hypothesised risk factors (such as sociodemographic characteristics). Method: Phase 1: A systematic review of fatigue assessment instruments used in children was conducted using key academic databases. Study quality and the psychometric properties of the instruments were assessed. Phase 2: We included participants already recruited to a larger prospective longitudinal study comprising 159 children (0-17 years at injury) with mild, moderate or severe TBI, presenting to one of three participating sites (two Canadian, one Australia). From the larger cohort, a subsample of 47 adolescents (8-18 years at injury) also participated in follow-up- 6-weeks post-injury. As part of the larger study protocol, at the time of child TBI, parents provided pre-injury child data based on retrospective report, including report of pre-injury fatigue and sleep difficulties. Healthy control data published from an American sample of children age 2-19 years was used for group comparisons (Panepinto et al., 2014). Results: Phase 1: Systematic Review identified twenty fatigue instruments, and two demonstrated strong measurement properties. Phase 2: Fatigue was rated by 35 participants (parents and adolescents) 6-weeks post-injury. At 6-weeks post-injury, fatigue in child TBI was significantly worse relative to control data (47 per cent and 29 per cent rated severe fatigue respectively). Between 6- and 12-months post-injury there was no detectable improvement in fatigue. Rather, cognitive fatigue worsened over time. Fatigue 12-months post-injury was again worse relative to control data (parent ratings). Fatigue was predicted by multiple variables, including pre-injury sociodemographic factors (female sex), psychological well-being (general fatigue) and pre-injury fatigue (sleep/rest fatigue). Symptoms after injury in multiple domains (physical/motor, pain, sleep psychological or inattention) additionally predicted fatigue 12 months post-injury. Conclusions: Fatigue is a complex, severe and persistent complaint after child TBI. Interventions are required to help reduce fatigue after child TBI.
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ItemPatterns of relationships in children at risk of developing conduct disorder: parent/child risk factors and treatment implications( 2012)This thesis explores the parent/child correlates and causative factors underlying the development of conduct disorder and associated treatment implications. Recent research has focussed on the role of emotional competence in child problem behaviour. The parent emotion socialisation literature seeks to provide a framework for understanding emotion-based pathways to child conduct disorder. Behaviour problems are of particular relevance during childhood, as difficulties during this period are likely to affect the degree to which young people become well-functioning adults with the capacity to successfully negotiate the challenges of adulthood. It is also a time of opportunity for positive re-direction in life course trajectories through implementation of early intervention parenting programs. This thesis draws on data from a randomised controlled study based in the community. Using a multidimensional model of risk processes that draws on behaviour and emotion theory, the current research aims to contribute to the understanding of child conduct disorder and how it can be averted in young children. The research includes four studies. Study 1 examined the psychometric properties of the new Conduct Problems Risk Screen (CPRS), a seven-item parent- and/or teacher-rated behavioural checklist designed to identify primary-school-age children at risk for conduct disorder. Accurate detection of those at risk can optimise the success of early intervention programs and the results suggest that the CPRS can be used as a valid and reliable screening tool. Studies 2 and 3 investigated the impact of multiple behaviour- and emotion-related parent (Study 2) and child (Study 3) characteristics on child disruptive behaviour among an at-risk sample. Overall findings indicated that inconsistent parental discipline, negative parent emotional expressiveness, and parent emotional wellbeing, in conjunction with problems with child emotional regulation and cognitive flexibility, demonstrated the strongest relations to disruptive behaviour problems. As such, they represent important foci for early intervention parenting programs. Study 4 explored the therapeutic importance of some of these components by examining the relative effectiveness of two early intervention parenting programs designed to reduce child disruptive behaviour. One program draws on behaviour theory and focusses on teaching parents behavioural strategies, and the other program draws on emotion theory and focusses on teaching parents emotion-based techniques. Multilevel modelling was used to assess intervention-related changes over time because children were nested within schools. Analyses followed an intent-to-treat model (which included data from all participants receiving any intervention). The results indicated that, despite different underlying mechanisms and different theoretical orientations, both interventions reduced child problem behaviour and improved facets of emotional competence. Tests of moderation identified groups of parents/children sharing similar characteristics and intervention outcomes. These analyses indicated that distinct strategies to address specific aspects of problem behaviour for certain children/parents may enhance intervention efforts. The four studies in this thesis have important implications for the development of models, theories, and interventions relating to conduct disorder, including the boundaries it shares with other important constructs, such as emotional competence, parent emotion socialisation, and effortful control. It provides a tool to identify at-risk primary-school-age children, identifies multiple parent and child behaviour- and emotion-focussed characteristics that may influence the trajectory of problem behaviour, and compares the outcomes and mechanisms of a behaviour- and emotion-focussed parenting early intervention program. Thus the results can help guide attempts to prevent the development of conduct disorder over this critically important developmental period.