Eloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych)
<p><strong>Systematic Review of the Literature</p></strong> <p>Which caregiver-led psychological interventions are effective in addressing behaviours of concern in autistic children and young people? A systematic review</p> <p><em>Background:</em&...
| Main Author: | |
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
2024
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| _version_ | 1817930832521723904 |
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| author | Stark, EA |
| author2 | Salkovskis, P |
| author_facet | Salkovskis, P Stark, EA |
| author_sort | Stark, EA |
| collection | OXFORD |
| description | <p><strong>Systematic Review of the Literature</p></strong>
<p>Which caregiver-led psychological interventions are effective in addressing behaviours of concern in autistic children and young people? A systematic review</p>
<p><em>Background:</em> Behaviours of concern in autistic children are relatively common and significantly diminish children’s quality of life. Interventions led by caregivers offer a socially valid means of supporting the young person, yet there is limited consensus regarding implementation.</p>
<p><em>Objectives:</em> Our primary question was to determine which caregiver-led interventions are effective in addressing behaviours of concern in autistic children. Our secondary question was to ascertain whether interventions addressed caregivers’ capacity to respond in highly emotive situations. This systematic review received no funding.</p>
<p><em>Methods:</em> A systematic review was conducted under PRISMA guidelines (CRD42022347485) to identify studies that investigated our two objectives. Studies were included if they were peer-reviewed, in English, and evaluated a means of a caregiver addressing behaviours of concern in autistic young people aged 3 to 18. Studies were excluded if children were under 3-years-old, interventions were aimed at supporting nonautistic children or those with cooccurring intellectual disability only, or where intervention was pharmacological. Six databases were searched in January 2023: PsycINFO, PubMed, CINAHL, ERIC, Scopus, Web of Science, and grey literature, and data was extracted pertaining to participant demographics, intervention, and outcomes. Risk of bias was assessed using a standard quality appraisal tool (Kmet). A narrative synthesis was used to integrate findings.</p>
<p><em>Results:</em> Sixteen studies met inclusion criteria, exploring caregiver-led intervention for 342 children, and were grouped based on intervention focus: 1) mindfulness, 2) cognitive approaches, 3) Predictive Parenting, 4) behavioural interventions. While most studies reported reduced behaviours of concern, there were methodological issues including reporting of thorough demographic information and informed consent, and the selection of appropriate target behaviours of concern.</p>
<p><em>Conclusion:</em> Studies represented high levels of heterogeneity in study design (six RCTs), means of intervention and quality, making it difficult to conclude superiority of one means of caregiver-led intervention over another. Promising findings were found for studies addressing caregiver capacity to respond. Recommendations for future research are provided.</p></br>
<p><strong>Service Improvement Project</p></strong>
<p>“It’s not just a job for me”: An interpretative phenomenological analysis of the experiences of clinicians working with autistic children and young people in supporting positive identity development</p>
<p><em>Purpose:</em> Developing a positive autistic identity is increasingly recognised as crucial for autistic individuals’ wellbeing. This is the first qualitative investigation of the experiences of clinicians in a CAMHS Neurodevelopmental Conditions Service providing support for children’s developing positive autistic identity.</p>
<p><em>Methods:</em> Nine semi-structured interviews with clinicians were held to explore their experiences of impacting upon children and young people’s positive autistic identity development. Interpretative Phenomenological Analysis (IPA) was used to explore and understand the experiences of clinicians.</p>
<p><em>Results:</em> Four superordinate themes were identified: (1) Clinicians’ flexible development of a neuroaffirmative concept of positive autistic identity; (2) Being honest and balanced: acknowledging the challenges for young autistic people; (3) The sociocultural mosaic: Layers of identity construction held within diverse perspectives; and (4) The professional position of self-reflexivity and vulnerability in navigating neurodivergent identities.</p>
<p><em>Conclusion:</em> In line with our theoretical understanding of identity development, the child’s interpersonal network was seen as crucial for their developing sense of self, and in line with research into assimilating an identity as part of a neurominority, a flexible but neuroaffirmative approach was seen as vital. Novel clinical experiences included the need for staff support and reflective spaces to consider their own relationship to neurodiversity.</p></br>
<p><strong>Theory-Driven Research Project</p></strong>
<p>Responsibility beliefs in generalised anxiety disorder and obsessive-compulsive disorder</p>
<p><em>Background and aims:</em> We sought to differentiate OCD from GAD in terms of individuals’ beliefs about responsibility for safety. We hypothesised that beliefs about responsibility for external issues of safety would be more prominent in GAD, whereas beliefs about responsibility related to internal processes such as intrusions, doubts, and impulses would be more prominent in OCD.</p>
<p><em>Methods:</em> A cross-sectional between-groups design was used with three participant groups identified by structured clinical interview: individuals with OCD (n = 22), individuals with GAD (n = 24), and controls (n = 25). Participants completed descriptive and more focused questionnaires on responsibility, and reassurance-seeking as a safetyseeking behaviour.</p>
<p><em>Results:</em> We found no evidence that beliefs about responsibility differentiated between people with OCD and GAD, although both clinical groups scored significantly and similarly higher than controls, indicating that beliefs about responsibility may play a role in both clinical presentations without diagnostic specificity. In a secondary analysis, a measure of reassurance-seeking found that people with OCD reported lower trust in the reassurance they received relative to both people with GAD and controls.</p>
<p><em>Discussion:</em> GAD and OCD were not empirically differentiated regarding beliefs about responsibility relating to internal versus external threat: both clinical groups had similarly inflated beliefs about responsibility relative to controls. Clinical implications include attention to beliefs about responsibility as integral to both formulation and treatment in people with OCD and GAD.</p> |
| first_indexed | 2024-09-25T04:22:48Z |
| format | Thesis |
| id | oxford-uuid:db27f4b5-ba3b-4074-9155-2a3f16dc64b3 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-12-09T03:12:23Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | oxford-uuid:db27f4b5-ba3b-4074-9155-2a3f16dc64b32024-10-09T11:29:53ZEloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych)Thesishttp://purl.org/coar/resource_type/c_db06uuid:db27f4b5-ba3b-4074-9155-2a3f16dc64b3EnglishHyrax Deposit2024Stark, EASalkovskis, PKnight, MAnderson, CStacey, J<p><strong>Systematic Review of the Literature</p></strong> <p>Which caregiver-led psychological interventions are effective in addressing behaviours of concern in autistic children and young people? A systematic review</p> <p><em>Background:</em> Behaviours of concern in autistic children are relatively common and significantly diminish children’s quality of life. Interventions led by caregivers offer a socially valid means of supporting the young person, yet there is limited consensus regarding implementation.</p> <p><em>Objectives:</em> Our primary question was to determine which caregiver-led interventions are effective in addressing behaviours of concern in autistic children. Our secondary question was to ascertain whether interventions addressed caregivers’ capacity to respond in highly emotive situations. This systematic review received no funding.</p> <p><em>Methods:</em> A systematic review was conducted under PRISMA guidelines (CRD42022347485) to identify studies that investigated our two objectives. Studies were included if they were peer-reviewed, in English, and evaluated a means of a caregiver addressing behaviours of concern in autistic young people aged 3 to 18. Studies were excluded if children were under 3-years-old, interventions were aimed at supporting nonautistic children or those with cooccurring intellectual disability only, or where intervention was pharmacological. Six databases were searched in January 2023: PsycINFO, PubMed, CINAHL, ERIC, Scopus, Web of Science, and grey literature, and data was extracted pertaining to participant demographics, intervention, and outcomes. Risk of bias was assessed using a standard quality appraisal tool (Kmet). A narrative synthesis was used to integrate findings.</p> <p><em>Results:</em> Sixteen studies met inclusion criteria, exploring caregiver-led intervention for 342 children, and were grouped based on intervention focus: 1) mindfulness, 2) cognitive approaches, 3) Predictive Parenting, 4) behavioural interventions. While most studies reported reduced behaviours of concern, there were methodological issues including reporting of thorough demographic information and informed consent, and the selection of appropriate target behaviours of concern.</p> <p><em>Conclusion:</em> Studies represented high levels of heterogeneity in study design (six RCTs), means of intervention and quality, making it difficult to conclude superiority of one means of caregiver-led intervention over another. Promising findings were found for studies addressing caregiver capacity to respond. Recommendations for future research are provided.</p></br> <p><strong>Service Improvement Project</p></strong> <p>“It’s not just a job for me”: An interpretative phenomenological analysis of the experiences of clinicians working with autistic children and young people in supporting positive identity development</p> <p><em>Purpose:</em> Developing a positive autistic identity is increasingly recognised as crucial for autistic individuals’ wellbeing. This is the first qualitative investigation of the experiences of clinicians in a CAMHS Neurodevelopmental Conditions Service providing support for children’s developing positive autistic identity.</p> <p><em>Methods:</em> Nine semi-structured interviews with clinicians were held to explore their experiences of impacting upon children and young people’s positive autistic identity development. Interpretative Phenomenological Analysis (IPA) was used to explore and understand the experiences of clinicians.</p> <p><em>Results:</em> Four superordinate themes were identified: (1) Clinicians’ flexible development of a neuroaffirmative concept of positive autistic identity; (2) Being honest and balanced: acknowledging the challenges for young autistic people; (3) The sociocultural mosaic: Layers of identity construction held within diverse perspectives; and (4) The professional position of self-reflexivity and vulnerability in navigating neurodivergent identities.</p> <p><em>Conclusion:</em> In line with our theoretical understanding of identity development, the child’s interpersonal network was seen as crucial for their developing sense of self, and in line with research into assimilating an identity as part of a neurominority, a flexible but neuroaffirmative approach was seen as vital. Novel clinical experiences included the need for staff support and reflective spaces to consider their own relationship to neurodiversity.</p></br> <p><strong>Theory-Driven Research Project</p></strong> <p>Responsibility beliefs in generalised anxiety disorder and obsessive-compulsive disorder</p> <p><em>Background and aims:</em> We sought to differentiate OCD from GAD in terms of individuals’ beliefs about responsibility for safety. We hypothesised that beliefs about responsibility for external issues of safety would be more prominent in GAD, whereas beliefs about responsibility related to internal processes such as intrusions, doubts, and impulses would be more prominent in OCD.</p> <p><em>Methods:</em> A cross-sectional between-groups design was used with three participant groups identified by structured clinical interview: individuals with OCD (n = 22), individuals with GAD (n = 24), and controls (n = 25). Participants completed descriptive and more focused questionnaires on responsibility, and reassurance-seeking as a safetyseeking behaviour.</p> <p><em>Results:</em> We found no evidence that beliefs about responsibility differentiated between people with OCD and GAD, although both clinical groups scored significantly and similarly higher than controls, indicating that beliefs about responsibility may play a role in both clinical presentations without diagnostic specificity. In a secondary analysis, a measure of reassurance-seeking found that people with OCD reported lower trust in the reassurance they received relative to both people with GAD and controls.</p> <p><em>Discussion:</em> GAD and OCD were not empirically differentiated regarding beliefs about responsibility relating to internal versus external threat: both clinical groups had similarly inflated beliefs about responsibility relative to controls. Clinical implications include attention to beliefs about responsibility as integral to both formulation and treatment in people with OCD and GAD.</p> |
| spellingShingle | Stark, EA Eloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title | Eloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_full | Eloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_fullStr | Eloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_full_unstemmed | Eloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_short | Eloise Stark - Thesis submitted in partial fulfilment of the requirements of the degree of Doctor of Clinical Psychology (DClinPsych) |
| title_sort | eloise stark thesis submitted in partial fulfilment of the requirements of the degree of doctor of clinical psychology dclinpsych |
| work_keys_str_mv | AT starkea eloisestarkthesissubmittedinpartialfulfilmentoftherequirementsofthedegreeofdoctorofclinicalpsychologydclinpsych |