Ruth Wadman

Changes in emotional health symptoms in adolescents with specific language impairment.

BACKGROUND Adolescents and young adults with specific language impairment (SLI) are at risk of experiencing emotional health symptoms, in particular depression and anxiety disorder. However, there is a dearth of research examining issues of stability versus change in symptomatology across time. AIMS To examine depressive and anxiety symptoms reported by adolescents with and without a history of SLI at 16 years, and a year later. METHODS & PROCEDURES Depressive and anxiety symptoms were examined in 90 adolescents with SLI and in 91 adolescents with typical development (TD) initially at 16 years and again at 17 years. OUTCOMES & RESULTS Participants with SLI experienced significantly more depressive and anxiety symptoms than participants with TD at 16 years, and continued to experience significantly more anxiety symptoms at 17 years. Females, regardless of language status (SLI versus TD), were more vulnerable than males. The group with SLI evidenced a significant drop in depressive symptoms over the year. A similar change in anxiety symptoms was not apparent. Regression analyses revealed that for individuals with SLI peer problems at 16 years predicted concurrent depressive symptoms, but behavioural factors did not contribute significantly to depressive symptoms at 17 years. For individuals with typical development, hyperactivity at 16 years predicted depressive symptoms at both 16 and 17 years. Language ability and non-verbal IQ did not predict depressive symptoms. Adolescents who experienced more bullying at 16 years were more likely to become, or remain, at risk for depression at 17 years. CONCLUSIONS & IMPLICATIONS Anxiety symptoms appear to be a consistent feature of some individuals with SLI in young adulthood whilst depressive symptoms can diminish.

Social stress in young people with specific language impairment

Social interactions can be a source of social stress for adolescents. Little is known about how adolescents with developmental difficulties, such as specific language impairment (SLI), feel when interacting socially. Participants included 28 adolescents with SLI and 28 adolescents with typical language abilities (TL). Self-report measures of social stress, social skills and social acceptance were obtained. Participants with SLI reported experiencing significantly more social stress than did participants with TL. Both groups judged themselves as having adequate social skills and positive social acceptance. Expressive language ability was negatively associated with social stress, but did not predict social stress when social factors were included in the regression model. Perceived social skills and social acceptance scores predicted social stress, in that poorer scores predicted more social stress. Despite perceiving themselves as having adequate social skills and as being socially accepted, social interactions are nonetheless a source of stress for adolescents with SLI.

'Everybody just thinks I'm weird': a qualitative exploration of the psychosocial experiences of adolescents with Tourette syndrome.

BACKGROUND Research suggests Tourette syndrome (TS) can have a negative impact on quality of life. To date, little research has examined the perspectives of young people with this condition in depth. METHODS Six 14- to 16-year-olds with TS took part in semi-structured interviews to explore the perceived impact of this condition on self and on relationships with others. The transcripts were analysed using interpretative phenomenological analysis. RESULTS The young people felt that TS was a constant presence in their lives, but one they have learnt to cope with well. Most had developed supportive friendships but encountered problems when interacting with the wider peer network. Specific concerns around meeting new people and future employment were voiced. CONCLUSIONS The adolescents described specific ways in which TS affects quality of life and social interactions, and the effort it can take to cope effectively with this condition.

Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS)

Background Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. Methods Forty-five young people (aged 13–21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). Results A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. Limitations Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. Conclusions The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions.

An interpretative phenomenological analysis of the experience of self-harm repetition and recovery in young adults.

Six young adults (aged 19–21 years) with repeat self-harm for over 5 years were interviewed about their self-harm, why they continued and what factors might help them to stop. Interpretative phenomenological analysis identified six themes: keeping self-harm private and hidden; self-harm as self-punishment; self-harm provides relief and comfort; habituation and escalation of self-harm; emotional gains and practical costs of cutting, and not believing they will stop completely. Young adults presented self-harm as an ingrained and purposeful behaviour which they could not stop, despite the costs and risks in early adulthood. Support strategies focused on coping skills, not just eradicating self-harm, are required.

Supporting students with Tourette syndrome in secondary school: a survey of staff views

Tourette syndrome is a neurological condition involving involuntary movements and sounds (tics) and is thought to affect as many as 1% of school aged children. Some young people with Tourette syndrome experience educational difficulties and social difficulties. Current clinical guidelines suggest educators can play an important role in maximising learning potential and reducing the negative impact of this condition on students’ social adjustment. Secondary school staff (N = 63) with responsibilities for special educational needs or disabilities completed a survey about support strategies for students with Tourette syndrome. Participants were first asked to suggest potentially helpful strategies and then rated how easily 17 recommended strategies could be implemented in school. The survey participants suggested a range of support strategies that were categorised as (1) promoting knowledge and understanding in school, (2) helping the student to cope with his/her tics, (3) supporting the student’s learning and (4) providing social and emotional support. All the recommended support strategies were rated as being easy to implement (or already in place) by the majority of respondents (e.g., increasing staff awareness and regular communication with home). The strategies that were identified as being least easy to implement were those requiring extra staff input (support from teaching assistants and individual/small group working). Additional challenges to providing support were also identified by the participants (e.g., getting input from outside agencies).

Experience of Self-Harm and Its Treatment in Looked-After Young People: An Interpretative Phenomenological Analysis

We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Qualitative interviews with 24 looked-after young people were completed. Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronized, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation, and increasing support during placement changes.