Associations between parenting and children’s socio-emotional well-being: the role of empathy and social understanding

The socio-emotional well-being of maltreated children is a key priority for practitioners and policy-makers alike; yet not enough is known about the developmental mechanisms that might link children's parenting experiences with their psychosocial adjustment. Previous research suggests that parental abuse and neglect can have adverse effects on children's peer relationships and self-perceptions. Emerging theoretical and empirical work suggests that children's social understanding and empathy could play a key role as mediators of these effects, but we have little knowledge about the differentiated pathways that might be uncovered by adopting a multidimensional conceptualisation of parenting experiences, social understanding and empathy, and peer reputations and self-perceptions. This thesis includes five papers reporting on a programme of empirical research conducted in order to address this gap in knowledge. The first, a meta-analysis and systematic review, revealed a complex and differentiated profile of social understanding among maltreated children. The second paper reports on a thematic analysis of a focus group and detailed semi-structured individual interviews with foster carers. In line with our theoretical model, carers readily identified children's difficulties with social understanding and empathy as relevant explanations for their socio-emotional problems. The third paper presents a new multidimensional self-report measure of empathy in children, demonstrating differentiated connections with socio-emotional functioning. The fourth paper presents comparisons between maltreated children in foster care and their classmates at school (aged 7-11 years), using measures that assess their peer reputations, self-perceptions, social understanding and empathy. Results indicate both direct links from maltreatment status to self-perceptions, as well as indirect links via children's theory of mind skills, their prosocial responses to others' emotional states and their behavioural reputations. The final paper delves deeper into the variations within the non-maltreated sample, uncovering links between specific features of the children's parenting experiences and their behavioural reputations, peer status and self-perceptions, via emotion understanding and empathic responses. Overall, the findings from this programme of research highlight the interplay of parenting experiences and socio-emotional competence in understanding school-aged children's psychosocial functioning. The results carry implications for further research as well as for applied work to support maltreated children and the adults who work with and care for them

Children in care or in need:educational progress at home and in care

By age 16 the attainment of most children in or on the edge of out of home care has fallen well behind the average for their age. This paper uses the English National Pupil Database to examine how much of this falling behind occurs before the age 7, and how any subsequent decline relates to time in care as against time outside it. We compare the previous progress of three groups of 16-year-olds: 5,175 looked after by the state (CLA), 17,392 in need but not in care (CIN), and 22,567 children matched with the CLA or CIN on initial attainment, special educational needs and eligibility for free school meals. We found that the attainment of the CIN and those CLA not yet in care was around one standard deviation below the cohort average at age 7. It then fell relative to their peers while their rate of unauthorised absences and exclusions grew. Removal from home to care appeared to halt or greatly reduce this decline but did not, on average, reverse it. We conclude that educational interventions for CLA should also include CIN, start before 7, target both school and family, and exploit the educational opportunity which care provides

The educational progress of young people in out-of-home care

Young people who grow up in care have worse educational outcomes internationally than those not in care but to what extent does this reflect the care itself or the young people’s experiences before they came into care? A systematic review by O’Higgins, Sebba & Luke, (2015) suggested that it is more likely that care itself is a protective factor in educational outcomes but that children in care are likely to have a range of other factors that put them at risk for poorer outcomes. A major study was then undertaken into what factors seem to contribute to these poorer outcomes by linking two national datasets in England, one that records educational factors for all children and the other which has data about the care careers of young people in care. The analysis focused on the progress at secondary school of young people (aged 11–16 years) who had been in care for over a year at the time of taking their public examinations at age 16 in 2013. Detailed statistical analysis was complemented by interviews with 26 young people and with their foster carers, teachers, social workers and ‘Virtual School headteachers’ who are responsible for supporting their education. The study identified important predictors of outcomes such as instability in care and/or school placement. This paper reports on some of the findings which are influencing policy and practice in England, for example on avoiding young people in care moving school

Exploring the experiences of an autistic male convicted of stalking

Despite an increasing number of studies which examine the interplay between autism and offending mechanisms, there has been a lack of research investigating the interplay between autism and stalking. It was anticipated that findings from this investigation would inform future interventions with individuals with autism who stalk. This secondary data analysis research used a qualitative case study approach to explore the experiences of an individual with a HighFunctioning Autism (HFA) diagnosis, who had been convicted of stalking. Interview data was analysed using Interpretative Phenomenological Analysis to gain a rich understanding of stalking behaviour from the perspective of the individual and to identify the key issues associated with Criminal Justice Service interventions. The following superordinate themes were identified; ‘What she means to me’, ‘Problematic, but unstoppable'’ and ‘Life after prison’. A key impli-cation of the findings was that autistic traits can play a contextual role within stalking behaviour. Future recommendations of a specifically tailored treatment approach recognising and considering autism-related responsivity issues are discussed

The Educational Progress of Looked After Children in England:Linking Care and Educational Data

First major study in England to explore the relationship between educational outcomes, young people’s care histories and individual characteristics. It focused on the reasons for the low educational outcomes of young people in care (looked after) in secondary schools in England

The NAtional randomised controlled Trial of Tonsillectomy IN Adults (NATTINA) : a clinical and cost-effectiveness study: study protocol for a randomised control trial

This project is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 12/146/06).BACKGROUND: The role of tonsillectomy in the management of adult tonsillitis remains uncertain and UK regional variation in tonsillectomy rates persists. Patients, doctors and health policy makers wish to know the costs and benefits of tonsillectomy against conservative management and whether therapy can be better targeted to maximise benefits and minimise risks of surgery, hence maximising cost-effective use of resources. NATTINA incorporates the first attempt to map current NHS referral criteria against other metrics of tonsil disease severity. METHODS/DESIGN: A UK multi-centre, randomised, controlled trial for adults with recurrent tonsillitis to compare the clinical and cost-effectiveness of tonsillectomy versus conservative management. An initial feasibility study comprises qualitative interviews to investigate the practicality of the protocol, including willingness to randomise and be randomised. Approximately 20 otolaryngology staff, 10 GPs and 15 ENT patients will be recruited over 5 months in all 9 proposed main trial participating sites. A 6-month internal pilot will then recruit 72 patients across 6 of the 9 sites. Participants will be adults with recurrent acute tonsillitis referred by a GP to secondary care. Randomisation between tonsillectomy and conservative management will be according to a blocked allocation method in a 1:1 ratio stratified by centre and baseline disease severity. If the pilot is successful, the main trial will recruit a further 528 patients over 18 months in all 9 participating sites. All participants will be followed up for a total of 24 months, throughout which both primary and secondary outcome data will be collected. The primary outcome is the number of sore throat days experienced over the 24-month follow-up. The pilot and main trials include an embedded qualitative process evaluation. DISCUSSION: NATTINA is designed to evaluate the relative effectiveness and efficiency of tonsillectomy versus conservative management in patients with recurrent sore throat who are eligible for surgery. Most adult tonsil disease and surgery has an impact on economically active age groups, with individual and societal costs through loss of earnings and productivity. Avoidance of unnecessary operations and prioritisation of those individuals likely to gain most from tonsillectomy would reduce costs to the NHS and society. TRIAL REGISTRATION: ISRCTN55284102, Date of Registration: 4 August 2014.Publisher PDFPeer reviewe

The NAtional randomised controlled Trial of Tonsillectomy IN Adults (NATTINA): a clinical and cost-effectiveness study: study protocol for a randomised control trial

Background The role of tonsillectomy in the management of adult tonsillitis remains uncertain and UK regional variation in tonsillectomy rates persists. Patients, doctors and health policy makers wish to know the costs and benefits of tonsillectomy against conservative management and whether therapy can be better targeted to maximise benefits and minimise risks of surgery, hence maximising cost-effective use of resources. NATTINA incorporates the first attempt to map current NHS referral criteria against other metrics of tonsil disease severity. Methods/design A UK multi-centre, randomised, controlled trial for adults with recurrent tonsillitis to compare the clinical and cost-effectiveness of tonsillectomy versus conservative management. An initial feasibility study comprises qualitative interviews to investigate the practicality of the protocol, including willingness to randomise and be randomised. Approximately 20 otolaryngology staff, 10 GPs and 15 ENT patients will be recruited over 5 months in all 9 proposed main trial participating sites. A 6-month internal pilot will then recruit 72 patients across 6 of the 9 sites. Participants will be adults with recurrent acute tonsillitis referred by a GP to secondary care. Randomisation between tonsillectomy and conservative management will be according to a blocked allocation method in a 1:1 ratio stratified by centre and baseline disease severity. If the pilot is successful, the main trial will recruit a further 528 patients over 18 months in all 9 participating sites. All participants will be followed up for a total of 24 months, throughout which both primary and secondary outcome data will be collected. The primary outcome is the number of sore throat days experienced over the 24-month follow-up. The pilot and main trials include an embedded qualitative process evaluation. Discussion NATTINA is designed to evaluate the relative effectiveness and efficiency of tonsillectomy versus conservative management in patients with recurrent sore throat who are eligible for surgery. Most adult tonsil disease and surgery has an impact on economically active age groups, with individual and societal costs through loss of earnings and productivity. Avoidance of unnecessary operations and prioritisation of those individuals likely to gain most from tonsillectomy would reduce costs to the NHS and society

YaxAB, a Yersinia enterocolitica Pore-Forming Toxin Regulated by RovA

ABSTRACT The transcriptional regulator RovA positively regulates transcription of the Yersinia enterocolitica virulence gene inv . Invasin, encoded by inv , is important for establishment of Y. enterocolitica infection. However, a rovA mutant is more attenuated for virulence than an inv mutant, implying that RovA regulates additional virulence genes. When the Y. enterocolitica RovA regulon was defined by microarray analysis, YE1984 and YE1985 were among the genes identified as being upregulated by RovA. Since these genes are homologous to Xenorhabdus nematophila cytotoxin genes xaxA and xaxB , we named them yaxA and yaxB , respectively. In this work, we demonstrate the effects of YaxAB on the course of infection in the murine model. While a yaxAB mutant (Δ yaxAB ) is capable of colonizing mice at the same level as the wild type, it slightly delays the course of infection and results in differing pathology in the spleen. Further, we found that yaxAB encode a probable cytotoxin capable of lysing mammalian cells, that both YaxA and YaxB are required for cytotoxic activity, and that the two proteins associate. YaxAB-mediated cell death occurs via osmotic lysis through the formation of distinct membrane pores. In silico tertiary structural analysis identified predicted structural homology between YaxA and proteins in pore-forming toxin complexes from Bacillus cereus (HBL-B) and Escherichia coli (HlyE). Thus, it appears that YaxAB function as virulence factors by inducing cell lysis through the formation of pores in the host cell membrane. This characterization of YaxAB supports the hypothesis that RovA regulates expression of multiple virulence factors in Y. enterocolitica