Evidence for measurement of overlap between Autism Spectrum Disorder and Attachment Disorder

The extent of overlapping presentation within Attachment Disorder (AD) and Autism Spectrum Disorder (ASD) gives rise to considerable difficulties for the separation of the disorders. In order to ascertain the impact of the difficulties in differentiating the symptomologies on diagnosis, this study was designed to seek to measure the presenting behaviours of children using psychometric tools with a view to contributing to the understanding of the commonalities, differences and the relationship between ASD and AD. Chapter 2 explored that a percentage of children with ASD meeting the criteria for AD. It was possible to discriminate between the presence or absence of ASD, and of AD, by the presence of all behavioural problems but ASD and AD could not be discriminated from one another either when predicting clinical diagnosis or psychometric classification. There was an indication that when using clinical diagnosis, hyperactivity was more predictive of AD than ASD. The research gave strength to the argument that overlap between ASD and AD exists. Chapter 3 considered overlaps and differences between parent reports of ASD and AD, and examined profiles of children fulfilling criteria for ASD and AD in terms of behaviour problems and attachment styles. There was a large overlap in the reported diagnoses and classifications of ASD and AD. Peer problems predicted a reported ASD diagnosis and conduct problems predicted a reported AD diagnosis. Attachment styles differentiated the diagnosis of those with ASD showing more ambivalent, and those with AD more avoidant and anxious, attachment styles. Chapter 4 compared the similarities and differences in parenting stress and behaviours in parent reports of ASD and AD. Parents of children with AD reported greater levels of parenting stress than parents of children with ASD. Parents of children reaching criteria for both disorders reported the greatest levels of parenting stress. Limit setting was poorest in parents of children with both classifications, followed by parents of children with AD and then ASD. Limit setting mediated the relationship between parenting stress and child behaviour problems for parents of children with ASD, but not for parents of children with AD. Chapter 5 investigated the differences between ASD and AD using Executive Function (EF) tasks in terms of their clinical diagnoses and psychometric traits, on four EF tasks (Wisconsin Card Sorting Task (WCST), Hungry Donkey, Stroop, and Tower of London). Limited difference between the EF performances of individuals with ASD and AD was noted (there was slightly better AD performance on cold EF tasks, and slightly better performance for ASD on hot tasks). Chapter 6 examined whether EF mediated the relationship between either ASD or AD, and behaviour problems, examined in terms of their AD and ASD traits, their levels of behaviour problems, and performance on four EF tasks (WCST, Hungry Donkey, Stroop, and Tower of London). There were positive correlations between levels of ASD and AD, and between both of these traits and behaviour problems. However, there was no relationship between these traits and EF and no relationship between EF and behaviour problems

The role of developmental/relational trauma in therapists' motivation to pursue a psychotherapeutic career: A grounded theory exploration

Background: Psychotherapy research has consistently established a link between developmental/relational trauma and the motivation to pursue a psychotherapeutic career. Understanding why this relationship exists is important given the recognised adverse impact of developmental/relational trauma on sense of self, interpersonal relating, emotional regulation and reflective function, which could have significant clinical implications. Psychodynamic theorising and research exploring this link further suggests that therapists often suffered object-loss, and/or parentification as children, leading to narcissistic injury and a tendency towards compulsive caregiving, which is proposed to motivate towards the therapist role that satisfies a variety of unmet dependency, intimacy and narcissistic needs. However, it has been observed that therapists often deny, or lack conscious awareness of, their relational wounding and how this may incite career motivation, which is clinically problematic. Psychodynamic theorists caution that a lack of insight can increase the risk of burnout and defensive, unethical practice. Conversely, post-traumatic growth (PTG) literature proposes that individuals with trauma histories are motivated towards therapeutic careers to reconstruct meaning, which promotes self-growth. The reflective contexts of psychotherapeutic training and the career may facilitate this process, though these assertions have not been empirically explored. Most research in this field has been quantitative to date, leaving the developmental/relational processes involved in career motivation unexamined and in need of qualitative enquiry to deepen understanding. The aims of the study were twofold: to explore the role of developmental/relational trauma in therapists’ motivation to pursue a psychotherapeutic career and to formulate a grounded theory of this process.Method: This was a qualitative study which adopted a constructionist grounded theory methodology (Charmaz, 2006). A purposive, snowball and theoretical sampling strategy was adopted to recruit 15 therapists and 1 social worker.Findings: The Grounded Theory constructed from the data indicates 6 categories: Sustaining a Wound to the Sense of Self; Defending the Fragile Self; Gratifying Unmet Needs; Moving from Other-ish to Self-ish; Finding Me – Integrating the Self; and Liberating the Self. The first three categories represent a vicious circle formed by the unconscious compulsion to repeat relational wounds, thereby increasing the risk of defensive, unethical practice and burnout. A critical juncture, ‘Confronting the Self’, encouraged via self-reflection in training appears to represent a nexus through which it is essential that therapists must pass to enhance self-awareness. This pivotal process facilitates breaking the vicious circle, thus allowing progression to the later three categories of this process that comprise a pathway towards psychological integration and growth, and may over time, paradoxically, heal the neurosis underlying the motivation to pursue the career.Conclusion: This Grounded Theory describes the developmental/relational processes involved in the pursuit of a psychotherapeutic career. In addition, it identifies a critical juncture involving a confrontation with the disowned self; emphasising the importance of self-reflection to enhance self-awareness in the developmental journey from wounded healer to ‘Healing Healer’. This appears to reduce the risk of defensive, unethical practice and becoming a ‘Wounded Wounder’. As such the findings have significant implications for clinical practice and training

The remains of the taboo: experiences, attitudes, and knowledge about menopause in the workplace

Objectives: This study explored experiences of, attitudes to and knowledge about menopause in the workplace among participants from the UK to assess the extent to which the menopause remains a taboo in this context. Method: An online survey was distributed via TUC (Trades Union Congress, UK) networks and social media and was completed by 5399 respondents. Questions explored three key issues relating to menopause at work: respondents’ own experiences of menopause transition; disclosure at work; and availability of information on menopause at work. Result: The largest group (43.4%) of respondents were perimenopausal and 16.8% were post-menopausal. 12.3% indicated that they might be experiencing menopause but were not sure. Only 45.8% had disclosed their menopause status at work. Fewer than 20% were provided with information about menopause in their workplace but the majority would like such information to be available. Conclusion: The survey findings suggest some progress has been made to raise awareness about menopause in the workplace but that substantial work remains to be done to ensure women transitioning through menopause are supported

An evaluation of workforce (re)design and skill-mix in Airedale NHSFT'S Acute Assessment Unit: Leveraging local advantage through collective and inclusive leadership in urgent care

A review of the health care workforce and skill-mix in urgent and emergency care in a small rural hospital in the Yorkshire Dales. Discusses the context of global nursing and medical workforce shortages. The report reflects on twitter feeds that document inclusive leadership and learning and development in a stressful working environment. We highlight prospects for volunteering and integrated health and social care in enhancing the employer value proposition of anchor institutions

The Models of Authority Project: Extending the DigiPal Framework for Script and Decoration

The DigiPal project for palaeography has featured in previous DH conferences. It includes a generalised framework for the description and analysis of handwriting, initially applied to Old English of the eleventh century but subsequently extended to Latin, Hebrew, and decoration; it incorporates a novel model for describing handwriting; and a recent addition allows the embedding of linked palaeographical images into prose description. The purpose of this poster is to present new developments which form part of two further major grants, one of which is the Models of Authority project. Specifically, the focus here is on the incorporation of textual content into the model for handwriting

Synthesis of zwitterionic compounds for aquatic toxicity testing for QSAR correlation studies.

22 zwitterionic compounds (10 short-chain surfactants; 12 non-surfactants) were synthesised obeying the general formula R-N+(CH3)2(CH2)nSO3', where n = 2 to 4, by reacting the corresponding N, N-dimethylamines with either sodium-2-chloroethane sulfonate (n = 2), 1, 3- propanesulfonate (n = 3) or 1,4-butanesulfonate (n = 4). The R group varied from a C6 to C12 alkyl chain, to a phenylalkyl unit bearing a Cl to C4 chain and finally to a phenylpropyl unit with a C4 to C6 para-substituted alkyl group. Octanol/water partition coefficients of the 22 sulfobetaines were determined by a conventional stir-flask procedure. The amount of solute in both the octanol and water layer was quantified using a reverse-phase HPLC technique. A UV detection mechanism was employed for those sulfobetaines that possessed a suitable chromophore for UV detection and an electrospray ionisation mode of detection was used for the analysis of those sulfobetaines that lacked a chromophore suitable for UV detection. Acute aquatic toxicity to the aquatic invertebrate, Daphnia magna Straus, was reported as log (l/EC50). The EC50 values were determined experimentally using a standard Acute Immobilisation Test recommended by the OECD Guideline 202 and the internal Unilever document, Ecotoxicology SOP 019 11. A log P-based QS AR was then derived which was found to be analogous to the standard polar narcosis equation, suggesting that zwitterionic sulfobetaines act as polar narcotics. Experimental log P determined by the stir-flask procedure and the rules of Rekker and Roberts for the calculation of log P for quaternary ammonium compounds of the cationic type, were then used in the derivation of key fragment values and interaction factors for use in log P calculations of sulfobetaines using the Leo and Hansch approach. Furthermore, log P predictions provided by KowWin, a computerised program developed by the Syracause Research Cooperation, were suitably amended to take into consideration our experimental results. Finally, an investigation into the suitability of the phospholipophilicity parameter, log k'lAM, for defining aquatic toxicity was performed and the efficacy of using this parameter and log P to predict aquatic toxicity was compared. In addition, other chromatographic methods for estimating log P were investigated. These include the indirect reverse-phase HPLC method, the direct reverse-phase HPLC method and Counter Current Chromatography