Psychology (Functional Area: Clinical-Developmental)

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Open Access
Autism Spectrum Disorder In Girls: Sex Differences, Subtypes, And Symptom Structure
(2025-04-10) Rourke, Melissa Laurie-Anne; Perry, Adrienne
The present study investigated how autism spectrum disorder manifests in female children through three separate studies. Two separate datasets were used. The Surrey Place (SP) dataset (N=1725) was composed of children screened to participate in an intensive treatment program. The SFARI dataset (N=2757), is a collection of data representing autistic children who participated in the Simons Simplex Collection (SSC; Fischbach & Lord 2010). Each study boasts a large sample of autistic females (n=301, and n=375, respectively). The datasets differed from one another in many important ways, such as the characteristics of the sample, method of data collection, and the measures used. Study 1 comprised an investigation of sex differences between female and male autistic children across a wide range of developmental and diagnostic characteristics. Groups of male and female children were compared using frequency data, correlations, and Multivariate Analysis of Covariance. Results of this study showed significant differences based on sex. That is, boys tended to have higher FSIQ, Non-Verbal IQ and adaptive abilities than girls. No differences were found in terms of total autism symptom scores. Boys were found to have higher levels of RRBIs and Self Injurious Behaviour. Study 2 used Latent Profile Analysis to explore subtypes within the sample of girls; that is, autistic girls with specific characteristics that cluster together, and likewise within the samples of boys. Results indicated three distinct profiles (or classes) for the SP dataset and these were similar in boys and girls. Class 1 consisted of children who were slightly younger than the sample mean, with adaptive scores close to the sample mean, and autism scores that showed mild to moderate symptoms of autism. Class 2 again consisted of younger children with better adaptive skills, and mild to no autism symptoms. Class 3 consisted of older children, with lower adaptive skills, and more severe autism symptoms. The SFARI sample included more developmental variables and allowed for a more nuanced analysis. As a result, many possible combinations of profiles emerged. Using LPA fit statistics and clinical judgement, a five-profile solution was deemed to best fit the data. Visual comparison across the profiles for girls and boys found that four of the five profiles were largely similar across boys and girls. One of the five profiles showed unique and distinct profiles for girls and boys. Study 3 used confirmatory factor analysis to investigate the symptom structure of autism between females and males, based on factor structures reported in previous research. Overall, the factor structure was found to be largely consistent for males and females. These results suggest that sex differences in the current study were minimal, although some subtle differences were noted. More research is needed to better understand the unique qualities of autistic females. Neuro-affirming diagnostic measures and more representative research samples may allow for the discovery of more sex differences.
Open Access
Cognitive Correlates Of Fatigue In Pediatric-Onset Multiple Sclerosis
(2025-04-10) Fabri, Tracy Lauren; Till, Christine
Fatigue is common in pediatric-onset multiple sclerosis (POMS), yet causal factors and correlates of fatigue are poorly understood in this population. A systematic review of fatigue and cognition was conducted in Chapter 2. The available evidence confirms that fatigue is a common symptom in POMS with rates in samples varying from 9-76% and symptoms typically severe and functionally impairing for POMS patients. The relationship between parent- and self-reported fatigue and cognitive performance is not consistently found in the literature, though higher levels of fatigue tend to associate with performance on measures of sustained visual attention and task switching. In Chapter 3, we investigated associations between cognitive and clinical features of POMS, namely objective fatigability, and subjective fatigue. Fatigability was operationalized as response time variability on a brief version of the Continuous Performance Test (CPT). We found that there is a significantly greater probability of parents and participants endorsing severe fatigue in POMS relative to age- and sex-matched healthy controls (HCs). We also identified that POMS were less accurate and more variable in their performance on the CPT relative to HCs. We did not however observe the expected associations between performance-related fatigability on the CPT and severe levels of parent- and self-reported fatigue. Finally, diffusion tensor imaging was used to explore neural correlates of fatigability. POMS participants demonstrated lower whole brain white matter integrity relative to HCs and while generally in the expected direction, white matter integrity was not significantly associated with fatigability on the CPT. Until there is a cure for MS, it is essential that we continue to understand fatigue and its correlates in this population in order to develop targeted interventions, increase quality of life, and minimize the secondary impacts of fatigue.
Open Access
PECSPERTS: Evaluating Telehealth and Hybrid Caregiver Training Models for Teaching Caregivers How to Implement the Communication System
(2025-04-10) Esteves, Jeffrey Brent; Perry, Adrienne
Roughly 30% of children diagnosed with autism do not develop functional speech. For these children, augmentative and alternative communication systems (AAC) may be used to help develop functional communication systems. One such system is the Picture Exchange Communication System (PECS). Prior research has established professional-delivered PECS as an evidence-based AAC. However, few studies have assessed the efficacy of parent training on caregiver PECS use and there is limited research on the use of telehealth technology when implementing PECS caregiver training. This dissertation reports on two studies designed to expand our understanding of PECS caregiver training using both telehealth and in-person applications of behavioural skills training (BST) and generalized case training (GCT). Study one evaluated the feasibility as well as caregiver outcomes of the PECSperts Caregiver Training package. Six caregivers participated in a two-week telehealth training in which they were taught how to implement the first four phases of PECS (phases 1-3b) using BST and GCT. Caregivers were taught to implement PECS with the use of structured scenarios and demonstrated their skill through roleplay with a trained mediator. Following the conclusion of the 2-week training, all caregivers had met the mastery criteria for all four phases. Caregivers maintained these treatment gains at 1- and 2-month follow-up. Study two evaluated a second iteration of the PECSperts Caregiver Training package and included an evaluation of child outcomes and child characteristics (e.g., cognitive level) and their relations to child PECS outcomes. Nine caregivers participated in a 4-week hybrid (online and in-person) training. Participants were evaluated on their ability to implement the first four phases of PECS (phases 1-3b) with their children and their children were evaluated on their independent PECS use across five timepoints. Overall, there was a significant improvement in both caregiver PECS teaching accuracy and child PECS use accuracy between baseline and the end of intervention. Caregivers and children maintained their treatment gains at both 1- and 3-month follow-up. Baseline child characteristics were not significantly associated with PECS outcomes at the end of the intervention; however, parents reported a significant decline in autism symptom severity over the course of the intervention.
Open Access
An Evaluation of Acceptance and Commitment Therapy Workshops for Parents of Autistic Children
(2025-04-10) Maughan, Andrea Louise; Weiss, Jonathan
Emerging research shows that Acceptance and Commitment Therapy (ACT) may improve mental health for caregivers. This dissertation sought to understand outcomes and experiences for parents of autistic individuals following participating in a 3-day ACT group workshop. Workshops were co-led by other trained parents of autistic people and professional clinicians. In Study 1, parents (N=54) were randomly assigned to either complete a brief group- based ACT intervention or remain on the waitlist. Participants completed surveys immediately prior to randomization, and 3-, 7-, and 17-weeks post-randomization. Mixed effects linear models testing group x time interaction indicated the Treatment group demonstrated greater post- intervention improvements than the Waitlist group in parent depression and family distress. Treatment group parents also reported greater short-term gains in positive affect and personal goal attainment, compared to the Waitlist group. Although there was no significant group x time interaction for other outcomes, stress, defusion, and experiential avoidance showed improvement for the Treatment group, but not the Waitlist group, at post-intervention. All Treatment group improvements were maintained at follow-up. Results suggested that a brief ACT group intervention is efficacious for improving some aspects of mental health for parents of autistic children. In Study 2, 15 parents who had previously attended the ACT workshop participated in individual interviews, focusing on parents’ experiences in a group with a co-facilitation model, and their perspectives about who should facilitate interventions for parents of autistic people. Using a qualitative thematic analysis approach, overall themes identified included the importance of a group environment in which trust is created through establishing credibility of the program and ensuring emotional safety. This environment allowed for parents to be able to fully participate in the workshop by sharing experiences, feeling open minded and hopeful, and focusing on what is important to them. Participants discussed behaviours, knowledge, and skills that they value in facilitators, that both parent leaders and professional clinicians can contribute, as well as emphasizing the unique value that the parent leader brought to the group. Findings lend themselves to developing best practices around creating effective and supportive interventions for parents of autistic people.
Open Access
A Pilot Study Using Machine Learning for Classification of Pain-Related Versus Non-Pain-Related Electroencephalographic Activity in Preterm Infants
(2025-04-10) Hamwi, Lojain; Pillai Riddell, Rebecca
Effective pain assessment and management are crucial to mitigate both immediate and long-term consequences of prolonged NICU stays. Accurately assessing pain in premature infants is challenging due to their inability to verbally communicate their pain, the potential judgement bias by caregivers, the lack of specificity in current pain assessment tools and time constraints in a busy hospital environment. This pilot study explores a machine learning approach to support pain assessment in neonatal care using cortical activity. The current study aims to test machine learning models that autonomously distinguishes non-pain related from pain-related cortical activity. The present dataset includes 72 preterm infants (27 females), born between 24- and 36-weeks gestational age, from two NICUs: Mount Sinai Hospital (Toronto, Canada) and University College London Hospital (London, UK). The primary outcome was to assess the accuracy of various machine learning models (XGBoost, Support Vector Machines, Random Forest, Logistic Regression, Convolutional Neural Networks) in distinguishing EEG features within a one-second pre-lance epoch (non-pain related) from a one-second post-lance epoch (pain-related). Performance metrics varied across post-menstrual age groups, reflecting developmental differences in EEG patterns. Machine learning algorithms can autonomously distinguish the one-second epoch immediately following a heel lance from the one-second epoch immediately preceding the procedure in preterm infants. Moreover, the performance of these algorithms improves with increasing postmenstrual age, demonstrating greater accuracy and reliability in older infants. This study provides a foundation for developing an autonomous and accurate tool for pain assessment in neonatal patients that can improve pain management practices in NICUs.
Open Access
Who Benefits from a Brief Online Couples Intervention? Examining Baseline Moderators of the Effectiveness of the Love Together, Parent Together Program
(2025-04-10) Markwell, Alexandra; Prime, Heather
Brief relationship interventions are needed to support the relationship quality of couples parenting young children who face a heightened risk of relationship deterioration. Accordingly, the Love Together, Parent Together (L2P2) program was created as a brief online writing program for parents. The present study addresses secondary objectives of a two-arm pilot randomized control trial (RCT) of the L2P2 program, examining whether multilevel risk factors across the family system moderate the program’s effectiveness. Participants included 140 couples with children (under six years), randomized to the L2P2 intervention or control condition. They completed baseline, post-intervention, and 1- and 3-month follow-up surveys. The intervention involved three writing sessions teaching couples conflict reappraisal strategies. The current study examined couples’ baseline dyadic adjustment, COVID-19 family stress, children’s effortful control, and composite risk as multilevel risk factors. Piecewise latent growth curve modelling (LGCM), using data from four timepoints, was conducted in MPlus 8.5 to examine rates of weekly change in couples’ relationship quality scores as a function of condition (L2P2 vs. control), baseline risk, and the interaction between the two. Results revealed that none of the moderators predicted weekly change in relationship quality, nor did the interaction between each respective moderator and condition. Findings do not support the differential effectiveness of L2P2 as a function of multilevel household risk. Results contribute to a growing literature that addresses for whom and/ or in what circumstances couples’ prevention programs are most effective.
Open Access
Understanding Problematic Media Use in Children and Youth with ADHD, Early Neurological Risk and a Community Sample: Exploring Parental Cognitions and Perspectives
(2025-04-10) Lyon, Rachael Elizabeth MacLean; Toplak, Maggie
While children at risk of attention difficulties, such as those with ADHD or early neurological risk, are recognized as more susceptible to problematic media use (PMU), less emphasis has been placed on understanding these vulnerable groups. Current theories of PMU draw from a psychopathology framework, aiming to distinguish normal variation from pathological behaviour. Measures like the Problematic Media Use Measure (PMUM) predict children's challenges over and above the amount of screen time. In light of the current literature, parent perspectives, grounded in a theoretical framework of developmental psychopathology, were used to explore the following interrelated research questions: (1) How do attention difficulties interface with PMU and how do these interactions manifest across various developmental stages? (2) How do parents understand PMU when asked to consider their child's perspective? Two studies were conducted. In Study 1, three samples of parents with children aged 6-18 were collected: community (N=386), ADHD (N=66) and early neurological risk (N=65) samples. The purpose of Study 1a was to evaluate PMUM factor structure across ages and compare PMU across samples. Parents also completed an adapted version of the PMUM with questions from their child’s perspective to explore discrepancies between parents’ own perspective and what they thought their child would report (Study 1b). In Study 2, interviews were conducted with a subset of parents in the ADHD sample. The ADHD sample showed higher levels of PMU and experienced more negative outcomes related to screens than the other samples. Parents fell into four groups based on 1) whether a discrepancy in perspective was reported and 2) the level of parent-reported problems (high or low PMU), with most parents reporting no discrepancy. Similar patterns were observed in the early neurological risk sample, while parents in the ADHD sample mainly fell into groups with high PMU, without or without discrepancy. In Study Two, thematic analysis revealed that children with ADHD face unique challenges with screen use and parents may not fully consider their child’s perspective with respect to PMU. Clinical implications and future research directions are discussed with respect to the utility of understanding parent cognitions about their child’s screen use.
Open Access
“It Fostered a Greater Appreciation for my Little Corner of the World": A Feasibility Study of a Therapeutic Photography Intervention for the Well-Being of Autistic Young People.
(2024-11-07) Charalampopoulou, Marina; Weiss, Jonathan
The multifaceted nature of well-being has been overshadowed by an overwhelming focus on negative mental health in the autism literature. This has created a shortage of interventions addressing the promotion of positive emotional (hedonic) and psychological (eudaimonic) states. Therapeutic photography (TP), referring to self-initiated photo-taking activities paired with mindful reflections of the photographs, has the potential to provide an accessible and cost-effective approach to the development of positive mental health interventions for autistic emerging adults. The current study employed a mixed-methods methodology to explore the development, feasibility, and future adaptations of a novel TP intervention aimed at promoting hedonic and eudaimonic well-being among autistic emerging adults. Forty-one autistic young people between the ages of 16 and 25 were recruited. Participant reports indicated that TP is a largely feasible intervention with reference to the domains of demand, implementation, acceptability, practicality, and limited efficacy. Suggestions for future adaptations of the intervention are provided to best address the needs of the community based on study results. Our findings suggest that TP is a promising new direction in the application of positive psychology interventions to promote the well-being of autistic young people.
Open Access
Collateral Benefits Of A Brief, Couple-Focused Intervention On Coparenting: Indirect Effects Through Couple Relationship Quality And Conflict
(2024-11-07) Demy, Jazzmin Stephanie; Prime, Heather
In two-parent households, the interparental relationship is central to the wellbeing of family relationships and individual members. The current study examines whether participation in a brief, online, couple-focused relationship intervention has collateral benefits to coparenting (i.e., how two parents coordinate in their parenting roles), indirectly through improvements in couple relationship quality and conflict frequency, respectively. A community sample of couples with young children (N = 140 couples; 280 participants; 91.4% heterosexual) participated in a longitudinal randomized controlled trial. Both members of the couple (49.3% women) reported on perceived relationship quality and conflict frequency (at baseline and post-intervention; T1, T2), and coparenting (at baseline, 1-month, and 3-month follow-up; T1, T3, T4). Controlling for initial levels (T1), longitudinal path modelling indicated that random assignment to the intervention directly predicted relative increases in relationship quality at T2. In turn, increased relationship quality at post-intervention predicted relative increases in coparenting at T3 and T4, respectively. Consistent with longitudinal mediation, the indirect effect of random assignment to the intervention on later coparenting via relationship quality was also significant. Random assignment to the intervention was not associated with changes in conflict frequency; thus, there was not a significant indirect effect through conflict frequency to coparenting. Similarly, sensitivity analyses testing conflict-related distress as a mediator demonstrated no collateral benefits to coparenting. Finally, a parallel mediation analysis including both mediators indicated that the indirect effect of the intervention to coparenting via relationship quality was significant when controlling for the pathway through conflict frequency. There are positive cascading effects of a couple-focused intervention onto how parents work together to parent their child.
Open Access
Coping, Context And Family Mental Health Within CBT For Autistic Children
(2024-11-07) Black, Karen Rebecca; Weiss, Jonathan
Autistic children experience elevated emotional-behavioural difficulties; links have been identified between these struggles and parent distress. Although parent-involved cognitive behavioural therapy (CBT) helps many autistic children improve overall emotional distress, there is a critical lack of understanding as to the role of children’s coping ability within this process, and the systemic factors that may impact change. To address this gap, this dissertation investigated the impact of family and child moderators of coping skill change within CBT for autistic, school-age children. Data was pooled from three related CBT interventions administered to 186 autistic children ages 8 – 13 years and their families, from 2013 – 2021. In Study 1, Exploratory Item Factor Analysis was conducted with pre-treatment data to investigate the dimensionality of the ERSSQ-P. A multidimensional structure with three factors was identified as the most appropriate fit, comprised of a 10-item subscale within the emotion regulation domain (Coping: a child’s ability to modulate distressing feelings in stressful contexts), and two subscales within the social communication domain (Initiating and Interacting). Validity for the subscales was confirmed based on associations with measures of emotion regulation, depression and social communication. Study 2 used the Coping subscale and multilevel modeling to investigate how pre-treatment child and family factors impact coping skill change for autistic children across three timepoints, and whether these relationships varied according to treatment type (individual vs. small group). Results indicated that on average, all children experienced the same, small level of improvement in coping ability, regardless of treatment type. However, pre-treatment systemic factors (child depression, restricted interests and repetitive behaviours, parent distress, family stress related to child behaviour) were related to lower initial coping ability, suggesting that children experiencing higher levels of difficulties at the beginning of treatment were also likely to finish the program at a relatively lower skill level. Although these relationships do not appear to be a barrier to statistical improvement, meaningful change may require longer than 10 weeks. Greater support for parents may also be warranted. Overall, findings present preliminary, yet practical considerations for clinicians and community agencies that can assist with targeted, strength-based treatment planning.
Open Access
Examining The Interaction Between Parent Gender And Child Sex On Stress And Coping For Parents Of Children With Autism Spectrum Disorder
(2024-11-07) Kuan, Tian Wing-Lam; Perry, Adrienne
Parents of children with autism experience elevated stress, but coping strategies are used to manage stressors. Previous research in these areas uses measures not normed for this population with low representation of fathers, and it is unclear whether child sex and parent gender interact to impact stress and coping. Analyses were conducted to explore this interaction using responses from 501 mother-father dyads, using original and new factor-analytically derived subscales for parenting stress (i.e., PSI-SF) and coping (i.e., F-COPES). With the new subscales, fathers of female children reported lower stress for Child Limits than mothers. Additionally, mothers of male children reported higher stress for General Parental Distress, Behavioural Regulation, Child Limits, and Perceived Disagreeable Behaviour than fathers. This suggests that stress is experienced differently between mothers and fathers of female or male children with ASD. The new subscales may be more sensitive and clinically advantageous to identify specific stressors and strengths.
Open Access
School factors in relation to quality of life for children with severe developmental disabilities and their families
(2024-11-07) Bjornson, Sarah Elizabeth; Perry, Adrienne
Children with severe developmental disabilities (DD) are frequently excluded from research and little is known about their quality of life (QoL). Schools have integral roles in children’s lives. The present study sought to understand how school-related factors impact QoL for children with DD and their families. 171 parents of children with DD completed questionnaires about their children, themselves, their community, and their child’s school. Hierarchical multiple regression analyses were performed to understand the impact of these factors on child and family QoL. 123 parents responded to an open-ended question about their children’s education experiences and responses were analysed qualitatively. School satisfaction predicted QoL for both children and their families, over and above all other variables examined. Thus, there is not one single educational strategy that improves QoL for children with DD. Rather, QoL is positively impacted when strategies implemented are deemed by parents as meeting the needs of their children.
Open Access
Parental Mediation Of Screen Media Use In Children And Youth At-Risk Of Attention Difficulties
(2024-11-07) Wanstall, Elizabeth Arden; Toplak, Maggie
Screen media is an omnipresent and ever-evolving component of children’s lives. Across development, it is essential to understand the strategies that parents use to manage their children’s screen media use (known as parental mediation), as they may serve as important predictors of healthy relationships with screen media. While children at-risk of attention difficulties (e.g., children with ADHD, children with early neurological risk) have been identified as being more vulnerable to screen media related risks, few studies have investigated parental mediation in these populations. Three studies were conducted to characterize parental mediation of screen mediation of children at-risk of attention difficulties by addressing the following research objectives: (1) examine the underlying dimensional structure of parental mediation, (2) characterize and compare parental mediation strategies in a community sample and in children and youth at-risk for attention difficulties, including those with ADHD and those with early neurological risk, (3) assess parent and child factors that relate to parent mediation strategies across community and at-risk samples, (4) determine the parental mediation strategies that predict better screen media outcomes, and (5) develop a more nuanced understanding of parents’ lived experiences of parenting around screen media use in children with attention difficulties via semi-structured interviews. In Study One, the factor structure of parental mediation was assessed, revealing a three factor models representing strategies of restriction, active mediation, and internet safety mediation. In Study Two, parental mediation and associated factors (e.g., parental stress, impact of screen media on the child, child age, child attention problems, etc.) were assessed and compared across three samples, namely a community sample, children with ADHD, and children with early neurological risk. Parents in the community sample generally endorsed using more parental mediation strategies, while parents of children with ADHD endorsed more negative outcomes including parental stress and negative impact of screen media on the child. Parental mediation strategies were found to be differentially associated with various screen media outcomes, including impact on the child, parental stress about child screen use, and daily child screen use. In Study Three, we conducted semi-structured interviews with parents of children with ADHD about their lived experiences of mediating their child’s screen media use and conducted a qualitative analysis to better understand their perspectives. Broadly, parents spoke about their challenges in navigating parental mediation, the strategies that they attempt to use, as well as how they adapt their approaches to their child’s developmental stage and attentional profile. Taken together, these findings suggest that children with attentional difficulties may experience unique challenges with screen media use, which may require unique parental mediation strategies to mitigate the associated risks.
Open Access
Understanding And Supporting The Transition To Adulthood Of Youth Involved In Child Welfare
(2024-11-07) Chan, Samantha; Rawana, Jenine
The transition to adulthood is a developmental stage that has a significant impact on a young person’s growth. Many youth involved in child welfare, particularly those in out-of-home care do not have the option as most youth to reside with their family and receive parental support into their adult years. Research demonstrates that youth transitioning out of care are at risk of poor outcomes as compared to their peers, suggesting that existing programs are insufficient in preparing them for the transition. Recognizing the need to better support youth involved in child welfare, Simcoe Muskoka Family Connexions, an integrated child welfare agency, invited the Teen Relationships research team to collaborate on this dissertation to better understand and support the resilience of youth involved in child welfare during the critical period of transition to adulthood. Study 1 is a qualitative interview study of the experiences of young adults who have navigated the transition from care to adulthood to understand how they conceptualized their perceived readiness for transition to adulthood and identify the factors that promoted and hindered their readiness. Results indicate that while young adults experienced many challenges and reported not feeling fully supported by others and different from their peers, they persevered through the demands of adulthood by drawing on their desire and perceived capacity for autonomy and independence, as well as the support from some of their close relationships. Study 2 is an exploratory, longitudinal, mixed-method evaluation of the Milestone Program, developed by foster parents to support care providers in promoting youth’s relationships and transition to adulthood outcomes while the youth are in out-of-home placement. Findings show that youth and care providers reported positive changes in their youth-care provider relationships, youth’s perceived readiness for transition to adulthood, and care provider’s confidence in supporting youth’s transition after participating in the program for six months. Youth and care providers also identified positive program experiences, as well as challenges in engaging with the program. This study offers preliminary evidence on the values of focusing on relationship development and skills-building as part of promoting the successful transition to adulthood of youth in out-of-home care.
Open Access
Longitudinal Neurocognitive Trajectories In Perinatal Arterial Ischemic Stroke
(2024-10-28) Bondi, Bianca Christina; Pepler, Debra
Perinatal stroke occurs between 20 weeks gestation and 28 days postnatally, with arterial ischemic strokes (AIS) the most common subtype. Research regarding neurocognitive outcomes following perinatal AIS has been primarily cross-sectional with contradictory results given methodological variability (small cohorts, varying age at assessment, differing/non-standardized measures, limited follow-up, mixed populations). No research has characterized neurocognitive trajectories across multiple time points spanning critical developmental periods. Methods: These studies were the first evaluation of neurocognitive trajectories for individuals followed longitudinally at The Hospital for Sick Children across: 1) infancy and early childhood (Study 1; N=40; neonatal AIS), and 2) early and late childhood, adolescence, and early adulthood (Study 2; N=208; perinatal AIS). For Study 1, children underwent developmental assessment(s) at 18- and/or 36-months (Bayley) and neuropsychological assessment(s) from ages 4-13 years (WPPSI/WISC/WASI). For Study 2, individuals underwent neuropsychological assessment(s) from ages 2-25 years (WPPSI/WISC/WASI/WAIS). Predictors included sex, lesion volume, lesion laterality, seizure disorder, neurological diagnoses, medical comorbidities, perinatal AIS type, and early screening. Exploratory multilevel growth curve modelling was used to assess longitudinal neurocognitive trajectories, and to examine main or moderating effects of predictors. Results: Despite age-appropriate functioning statistically extrapolated at stroke occurrence, neurocognitive decline was found across 1) infancy and early childhood and 2) early and late childhood, adolescence, and early adulthood. For neonatal AIS and perinatal AIS, lesion volume moderated neurocognitive change. For neonatal AIS, medical comorbidities (congenital heart disease, genetic conditions) negatively impacted neurocognition at stroke occurrence (main effect) and early screening in infancy positively impacted neurocognition over time. For perinatal AIS, seizure disorder status and perinatal AIS type moderated neurocognitive change. Conclusions: In keeping with the early vulnerability hypothesis, neurocognitive decline was observed across development following perinatal AIS. Lesion volume and seizure disorders had moderating effects on neurocognition whereas medical comorbidities had a main effect; however, differences were apparent for perinatal AIS types. Perinatal AIS type moderated neurocognition such that presumed perinatal AIS involved rapid neurocognitive decline initially followed by improvements relative to neonatal AIS, which demonstrated consistent decline. Understanding neurocognitive trajectories and relevant predictors will inform the early identification of high-risk groups and the implementation of precision-based interventions.
Open Access
Influence of Lifetime Mild Traumatic Brain Injury and Repetitive Head Impact Exposure on the Aging Brain
(2024-10-28) Echlin, Holly; Wojtowicz, Magdalena
This dissertation aims to examine associations between remote mild traumatic brain injury (mTBI), and cortical thickness, subcortical volumes, and cognitive functioning via a systematic literature review and retrospective data analyses. Study 1 consisted of a systematic review of the literature investigating long-term brain impacts, assessed in vivo using neuroimaging methods, of exposure to mTBI and repetitive head impacts (RHIs) during adulthood. Findings from the systematic review showed that remote mTBI/RHI exposure was associated with neurological abnormalities revealed by neuroimaging across several modalities (i.e., diffusion tensor imaging, magnetoencephalography, magnetic resonance spectroscopy, positron emission tomography, spectral domain optical coherence tomography, and several magnetic resonance imaging techniques), though conclusions are limited due to methodological constraints in the studies examined. Given the gaps in the literature identified in Study 1 (i.e., a lack of research on long-term mTBI exposures in veteran samples), Study 2 consisted of analyses to examine associations between mTBI exposure and cortical thickness across the brains of Vietnam War Veterans. Data from this sample of service members was obtained from the Alzheimer’s Disease Neuroimaging Initiative - Department of Defense (ADNI-DOD). Participants included 47 male veterans with mTBI exposures (mean age = 69.43, SD = 5.02) and 82 controls (veterans without mTBIs; mean age = 68.51, SD = 4.69). Associations between mTBI, age, education, cognitive status, PTSD symptoms, and cortical thickness were examined. Three regions, i.e., the left caudal middle frontal and bilateral superior frontal cortices, showed greater cortical thickness for the mTBI group. These findings indicate potential regions for future analyses examining long-term mTBI sequelae. Finally, given the close association between TBI and Alzheimer’s disease pathology, study 3 examined the impact of mTBI on cortical thickness and subcortical volumes in AD-vulnerable regions, as well as memory functioning in this cohort. Narrowing ROIs to those implicated in AD revealed several regions that were associated with mTBI exposures (i.e., left lateral temporal cortex, right posterior cingulate cortex, right amygdala, and right inferior frontal cortex). These studies show that mTBI can have long-term but circumscribed effects on the brain.
Open Access
Autobiographical Memory in Youth with Stroke
(2024-10-28) Sehra, Ramandeep Kaur; Desrocher, Mary E.
Autobiographical memory (AM) consists of both memory for specific past personal events (episodic memory) and personal facts (semantic memory). An increasing amount of research has explored short term memory in youth following pediatric arterial ischemic stroke (AIS), however little work has been done examining long-term memory such as AM in this population. In the current study 28 youth with stroke and 32 age and sex-matched controls were administered the Children’s Autobiographical Memory Interview (cAMI). Youth with stroke showed deficits in the recall of episodic AM, and overall memory recall in comparison to controls. Furthermore, there were significant relationships between area of stroke, lesion lateralization, and time since stroke and specific memory scores. This study unveils, to our knowledge that pediatric stroke is associated with a selective deficit in AM. These results have implications for the adjustment of youth following pediatric stroke, so that earlier diagnosis of memory deficits can occur and early implementation of intervention programs can be put in place to allow these youth to function maximally.
Open Access
Twelve women and their stories: A thematic analysis of the pre and post self-narratives of female survivors of childhood sexual abuse who underwent hospital-based group trauma therapy
(2024-07-22) Rependa, Sara Lynn; Muller, Robert Tom
The importance of treating women with histories of childhood abuse has been well established. The efficacy of the Women Recovering from Abuse Program (WRAP) has also been investigated and established. The aim of the current qualitative study was to understand how women with a history of childhood abuse experienced WRAP, an intensive group treatment program based out of Women’s College Hospital in Toronto, Ontario. Thirteen women were interviewed pre- and post- treatment using the Self Assessment Interview (SAI). A thematic analysis was conducted on both the pre- and post- interviews that identified theme hierarchies for these two sources of data. These findings deepen our understanding about how participants view their trauma histories, relationships, self-concept, hopes for treatment, symptoms, met or unmet expectations, goal attainment, and impressions of the therapy itself. Theoretical and clinical implications are discussed.
Open Access
A Telepsychology-Based Social Competence Intervention for Youth with Learning Disabilities and Mental Health Difficulties During the COVID-19 Pandemic
(2024-07-18) Diplock, Benjamin David; Pepler, Debra J.
Youth with learning disabilities (LDs) have a heightened risk for co-occurring mental health difficulties. The co-occurrence of LDs and mental health difficulties (LDMH) is associated with further risk of adverse impacts on cognitive and academic performance. Therefore, the availability of effective social competence interventions for youth with LDMH is essential to scaffold skill development and prevent cascading difficulties into adulthood. That said, the onset of the COVID-19 pandemic led to the immediate pause of most in-person therapeutic services. In response to worsening of youths’ mental health difficulties and the significant challenges that the pandemic created for mental health service delivery, the Child Development Institute in Ontario, Canada, transitioned their in-person Social Awareness, Competence, Engagement, & Skills (ACES) intervention service to virtual implementation. I conducted two studies with the purpose of gathering qualitative and quantitative data to examine the feasibility, acceptability, and effectiveness of the telepsychology-based adaptations of Social ACES from the clinician, caregiver, and youth perspectives. Methods: Data collection occurred through in-depth semi-structured interviews of nine Social ACES clinicians (Study 1), four caregivers and four youth who partook in the telepsychology-based intervention (Study 2); lived experiences were analysed using the qualitative approach of Interpretative Phenomenological Analysis. For a mixed-methods perspective, I also examined outcomes of the intervention through quantitative parent ratings of their child’s social competence pre- post-treatment, augmented by clinicians’ reports (Study 2). The data was triangulated to provide a deeper perspective of the youths’ progress through the program and challenges experienced. Results: The findings resulted in the emergence of four (Study 1) and two (Study 2) major themes, as well as elucidating four integrated youth case studies, to help clarify clinicians’, caregivers, and youths’ perceptions of the adaptation. Conclusions: These studies provided preliminary evidence for the feasibility, acceptability, and effectiveness of virtual Social ACES. The findings have implications for the future of mental health service delivery, raise further questions about the effectiveness of social competence programming during and after a time of significant disruption, and point to several lines of inquiry for future critical research on virtual interventions for children and youth.
Open Access
The Role of Self-Concept in a Community-Based Study of the Effectiveness of Trauma-Focused Cognitive Behavioural Therapy with Trauma-Exposed Children
(2024-07-18) Konanur, Sheila; Muller, Robert Tom
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) is a widely used treatment model for trauma (Cohen, Mannarino, & Deblinger, 2006). The Healthy Coping Program was a multi-site community-based study which evaluated the effectiveness of TF-CBT with trauma-exposed school-aged children in a diverse Canadian city (Muller & DiPaolo, 2008). Using data from the Healthy Coping Program, the role of children’s self-concept, and its relationship to posttraumatic stress (PTS) symptoms were examined. Self-report data were collected from a total of 111 trauma-exposed children referred for a trauma-focused intervention (assessment and TF-CBT). Children’s self-concept was measured using the short form version of the Tennessee Self-Concept Scale – Second Edition (Fitts & Warren, 1996). Children’s PTS was measured using the Trauma Symptom Checklist for Children (Briere, 1996). Trauma-exposed children’s self-concept was found to have a decreasingly significant negative relationship with PTS symptoms over the course of assessment and TF-CBT. Self-concept was significantly more dysfunctional amongst trauma-exposed children compared to a normative sample of children. Significant improvements in trauma-exposed children’s self-concept were observed after receiving trauma-focused intervention. Trauma-exposed children’s self-concept moved from a clinically dysfunctional range to the clinically functional range over the course of the assessment and continued to improve during TF-CBT. Further, these improvements were maintained at a six-month follow-up. These findings support the effectiveness of TF-CBT in improving trauma-exposed children’s self-concept and underscore the importance of considering how children view themselves after trauma. Clinical implications are discussed.