SPJI 2012

Student Psychology Journal

VOLUME III

Published by the Student Psychology Journal C/O Department of Psychology, Trinity College, Dublin 2, Republic of Ireland.

All rights reserved.

Copyright Š Contributors to the Student Psychology Journal All views expressed herein are those of the authors and do not necessarily reflect the views of the editors or sponsors.

All correspondence or complaints should be addressed to: The Editor, Student Psychology Journal, C/O Department of Psychology, Trinity College Dublin, Republic of Ireland. or email: journal@tcd.ie Printed by Brunswick Press Ltd. The Student Psychology Journal is also available online at: www.tcd.ie/psychology/SPJ

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SPONSORS

School of Psychology, Trinity College &

The Open University

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Peer Reviewers We would like to extend our immense gratitude to the peer reviewers for their time and invaluable input.

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Dr Patrick Ryan

~ University of Limerick

Dr Stephen Doherty

~ Dublin City University

Professor Richard Carson

~ Trinity College Dublin

Dr Sinead Mc Gilloway

~ NUI Maynooth

Dr Mary Ivers

~ University College Dublin

Dr Annalisa Setti

~ Trinity College Dublin

Dr Fred Cummins

~ University College Dublin

Dr Ian Grey

~ Trinity College Dublin

Dr Yvonne Barnes

~ NUI Maynooth

Dr Matthew Rodger

~ Queens University Belfast

Dr Kathleen McTiernan

~ Trinity College Dublin

Dr Tim Trimble

~ Trinity College Dublin

Patricia Gill

~ Trinity College Dublin

Dr Jonathan Egan

~ NUI Galway

Dr Tim Ritchie

~ University of Limerick

Dr Audrey Sheridan

~ Trinity College Dublin

Student Psychology Journal Honorary Treasurer

Dr Jean Quigley

Editor

Áine Maguire

Assistant Editor

Sarah Jane Winders

General Manager

Dónal Browne

Finance Officer

David Kane

Public Relations Officer

Sadhbh Byrne

Design & Publications Officer

Hugh O’Brien

Launch Manager

Iseult Cremen

Junior Committee Niamh Doyle

Nathalie Freysinger

Mollie-Kate Richardson

Niamh Bergin

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Best Submission Award

Doctor, Doctor what’s Right with me? : The role of optimism in reduced depressive symptomology following a positive psychological intervention ~ Brenda O’Connell

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Table of Contents x

Preface Editor’s Introduction

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Empirical investigations An Investigation into the Relationship between Attitudes towards Mental Health Problems and Vulnerability to Emotional Distress.

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~ Laura Lynham & Dr. Michael Gordon Differences in Subjective Experiences of Flow and Time Distortion between Video Gaming and Reading Exercises

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~ Jason McDonnell Doctor, Doctor what’s Right with me? : The role of optimism in reduced depressive symptomology following a positive psychological intervention

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~ Brenda O’Connell, Dr. Stephen Gallagher, & Dr. Tim Ritchie Growing up on Farms: a Qualitative Exploration into Children’s Perceptions of their Way of Life

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~ Kate O’Gorman Investigating Prevalence and Impact of symptoms of ADHD in a sample of children with Autism

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~ Orla O’ Callaghan & Dr Olive Healy

The Motivation to Have a Virtual Life and the Perception of the Self and Gaming Habit Significance ~ Taylor Lyons, Anne van der Lugt & Gianluca Truscello

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Table of Contents Empirical investigations Positivity from Adversity: the Irish female’s account of Maternal Cancer.

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~ Aileen Russell

Review Articles Amyotropic Lateral Sclerosis: Current Understanding and Considerations

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~ Hollie Byrne A Critical Evaluation of How Adopting A Lifespan Perspective Can Enhance Our Understanding of the Cognitive Change That Occurs With Aging

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~ Orla Meehan Singing in the Rain: A Literature Review of Current Methods for Improving Well-being

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~ Mark Dillon & Megan King Is mental illness a myth? An interdisciplinary lesson for psychology

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~ Darragh McCashin The Impact of institutional Care on children’s development

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~ Cathy Newel

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Preface Welcome to the third volume of the Student Psychology Journal. The SPJ was established to provide an outlet for the outstanding contributions that undergraduate students offer to our understanding of human behaviour. There is no comparable journal for psychology students in Ireland, and we feel that it is necessary that the considerable achievements of students be recognised in print. During the course of their studies, undergraduate students produce original and exceptional work but often their potential contributions to our body of knowledge are left unrealised. We are excited and proud to offer an insight into the minds of Ireland’s psychology undergraduates.

Psychology can play an instrumental role in shaping society, seeking an understanding of behaviour and choices that impact on our lives. In order for Ireland to improve itself, the insights of the new generation of psychology students should not be ignored. This journal offers the opportunity to empower those published with a chance to have their voice heard. Research can and should affect public affairs, and we hope that this year’s contributors will play an integral part in affecting Ireland for the better.

The SPJ endeavoured to expand its reach in 2012. The Journal is now open to submissions from psychology undergraduates from across the island of Ireland. This year’s volume includes work and peer reviews from those studying and working in numerous third level institutions.

The Journal has placed more emphasis on online publication. To this end, previous volumes are now available to read online, and there are on-going efforts to have published papers searchable on recognised psychology databases in future.

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On behalf of this year’s Journal Committee, I would to thank all those who have helped make this third instalment of the SPJ a reality. Special gratitude must go to our Honorary Treasurer, Dr. Jean Quigley, whose insight and dedication acted as a constant support throughout the last year. Sincere thanks to the TCD School of Psychology for their financial and administrative support, and to our Academic Peer Reviewers for generously lending their time and expertise. Our thanks also to Dr. Patrick Ryan for launching the 2012 edition of the Journal.

To everyone who submitted to the Journal, and those who are published in this third edition, thank you for all your contributions and congratulations on your excellent submissions.

I would like to extend our gratitude to our sponsors, the TCD Association and Trust, Open University and TCD School of Psychology for their continued support.

Lastly, I have to thank our fantastic Committee. To the Editors Áine and Sarah Jane, Finance Manager Dave, Design and Publication Officer Hugh, Public Relations Officer Sadhbh and Launch Manager Iseult, you have all worked extremely hard these past six months and this journal is testament to your limitless capabilities. I would also like to recognise the work of this year’s Junior Committee: Niamh, Mollie, Nathalie and Niamh. I wish you all the best of luck with next year’s Journal. Working with you all to create this Journal has been a pleasure.

I hope you enjoy the 2012 Student Psychology Journal, Dónal Browne General Manager, 2012

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Editors’ Introduction Psychology as a science has developed exponentially since its naissance.

Perhaps something similar may be said regarding The Student Psychology Journal. Originally founded in 2010 as a publishing outlet for students of psychology at Trinity College Dublin, the SPJ opened its sleeves to all undergraduate psychology students in Ireland the following year.

This year the SPJ has flourished further and received more submissions than previous years combined.

As the only psychology journal in Ireland dedicated to publishing the works of undergraduate psychology students, the SPJ seeks to encourage students to have confidence in their academic abilities from the very onset of their psychological craft. Further, an ambition is held that by providing a platform for their scholarly work to reach the psychological community, a taste for knowledge, a keen interest in research, and an appreciation for academia will be nourished.

Open to all psychological works from discursive essays to qualitative reports it is felt that the SPJ represents the ability, drive and enthusiasm of all undergraduate psychology students in Ireland. This year’s edition is no exception. Papers presented here were written by students of psychology in all years of their undergraduate degree from several different Irish institutions.

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As with the previous two editions, this year’s publication is divided into two sections; the first contains empirical reports, the second review papers. The articles included cover an array of important topics within the modern world of psychology; methods for well being, developmental and neurodegenerative disorders, and perspectives of mental health and illness to name but a few.

The SPJ 2012 embodies the hard work of numerous authors, the support of countless supervisors and faculty members, the expertise of many reviewers, the resolve of a truly dedicated committee, and the tireless enthusiasm and assistance of Dr. Jean Quigley. To all mentioned we would like to express our sincere gratitude, because without any of whom the SPJ today would not exist.

We hope that the SPJ continues to flourish alongside the expanding realm of psychology, providing a forum for psychology students to publish their first work, allowing them to share it with their peers and other psychology institutions. We trust that its support will only intensify with time and will presently become an outlet for undergraduate endeavours onto which all students, their supervisors, and associated faculties look upon with pride.

Ă ine Maguire Editor Sarah Jane Winders Assistant Editor xiii

Student Psychology Journal, Volume III

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Empirical Investigations

Empirical Investigations

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Student Psychology Journal, Volume III

An Investigation into the Relationship between Attitudes towards Mental Health Problems and Vulnerability to Emotional Distress.

Laura Lynham & Dr. Michael Gordon Trinity College Dublin lynhaml@tcd.ie

Mental Health literacy and the absence of negative attitudes may contribute to ones’ likelihood to seek help in the event of distress. Coping styles, defense styles, and ego resiliency are important psychological characteristics that may diminish the impact of vulnerability factors. The present research posited a potential relationship between attitudes towards mental health problems and susceptibility to emotional distress. Sixty-five Psychology students were recruited from Trinity College, Dublin to participate in this research. Subjects ranged in age from 18-46 years (M= 21.8 years; SD= 5.16). Participants were required to respond to four questionnaires: a modified ‘Attitudes towards depression questionnaire’, the COPE, the Ego Resiliency Scale, and the Defense Styles Questionnaire. A MANCOVA revealed that attitude group (positive and negative) was not significantly related to coping style. Mean scores however indicated a tendency for those with positive attitudes to use an adaptive coping style and to possess a mature defense style. A similar trend was observed for the negative attitude group who had a tendency to use avoidanceoriented coping and to have an immature defense style, although this was not statistically significant.

Coping style was significantly related to defense style, but not to ego resiliency.

Introduction Research has indicated that attitudes towards mental health problems can predict one’s likelihood to seek help in the event of distress (Gulliver, Griffiths & Christensen, 2010). This means that individuals who have negative attitudes towards mental illness may have lower mental health literacy; they may stigmatise and refute help seeking behaviours (ten Have, de Graaf, Ormel, Vigalut, Kovess, & Alonso, 2010). Social isolation and an inability to seek help has been related to higher levels of psychopathology, and an increased risk of suicide (Berman, 2009). One’s vulnerability to emotional distress is related to their resilience, defense styles, and coping strategies (e.g., Letzring, Block, & Funder, 2004; Link, Mirotznik, & Cullen, 1991; and Vaillant & Vaillant, 1990).

Mental Health can be defined as how one thinks and feels about themselves and others, and how one reacts to their interpretations of events in everyday life (Health Service Executive, 2007). It does not only refer to the absence of a mental health problem but to a state of functioning whereby an individual can enjoy life and reach their potential while demonstrating resilience in coping with adverse life events (World Health Organisation, 2007). Mental health is essential 3

Empirical Investigations for general health, acting as a foundation for individual well-being (World Health Organisation, 2010).

Depression, a prevalent mental health problem, ranks fourth in the leading contributors to the global burden of disease (World Health Organisation, 2011). Depression is a debilitating illness that can disrupt an individuals’ “occupational, social and physiological functioning” (American Psychiatric Association, 2000). Aware (2009) reported that over 300,000 people in Ireland experience depression at any one time. Research has shown that depression is a major risk factor for suicide (Berman, 2009). It has also been linked to other life threatening illnesses such as coronary heart disease (Kent & Shapiro, 2009). Consequently, depression poses a significant problem both from an individual and a public health perspective (Monroe & Harkness, 2011).

Despite its’ prevalence, many people suffering from mental health problems do not seek appropriate help (Gulliver, Griffiths & Christensen, 2010). One study suggested that fewer than 25% of those affected have access to effective treatments (WHO, 2011). Many reasons have been proposed to explain why adults do not seek professional help for these problems. These include negative attitudes towards seeking help (Jang, Kim, Hansen & Chiriboga, 2007), concerns about confidentiality (Mojtabai, 2009), embarrassment and stigma, and a difficulty in recognising what the problem is (Gulliver et al., 2010). Some research has shown that people have poor mental health literacy, finding it difficult to recognise the symptoms of depression either in themselves or in others (Gulliver et al., 2010). Jorm et al., (1997), for example, presented participants with a vignette depicting a depressed person. Twenty-eight percent of respondents did not believe the individual was suffering from any mental health problem. A further study found that 23% of respondents believed that an individual suffering from depression was dangerous to the public (Crisp, Gelder, Rix, Meltzer & Rowlands, 2000).

Cognitive-behavioural theories suggest that early influences and the media affect the development of negative attitudes and stigma (Wahl, 1995). This stigma has been noted as a substantial barrier to treatment seeking, treatment adherence, and overall well-being (Kirkwood & Stamm, 2006). In a study that analysed the public’s opinions of many mental health problems, individuals generally found it difficult to communicate with people suffering from depression (Crisp et al., 2000).

Good mental health has been associated with a range of positive psychological characteristics including ego resiliency (Letzring, Block, & Funder, 2004), coping ability (Link, Mirotznik, & Cullen, 1991) and mature defense styles (Vaillant & Vaillant, 1990; as cited in Thygesen et al., 2008 pp. 172).

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Student Psychology Journal, Volume III Ego resiliency can be defined as the ability to adapt one’s level of control in response to situational demands (Letzring et al., 2004). Resilient individuals are more likely to experience positive affect, have higher self-esteem and adjust better in the face of adversity (Block & Kremen, 1996). Protective factors in a young person’s life can greatly reduce the likelihood of several psychological disorders even when the individual is in the presence of risk factors (e.g., Forman & Kalafat, 1998; Resnick, 2000). Correspondingly, when young people report the presence of protective factors in their lives, their probability of attempting suicide is decreased by 70-85% regardless of their number of risk factors (Borowsky, Ireland & Resnick, 2001).

Ego resiliency is directly related to an individual’s capacity to cope with difficult situations (Block & Kremen, 1996) and this influences their ability to deal with mental health problems.

People can employ different types of coping strategies in an effort to overcome problems (Carver, Scheier and Weintraub, 1989), but these individuals also have inherent reactions to stress that are active below the level of consciousness- defense styles (Andrews, Singh & Bond, 1994). Defense styles and ego resiliency combined seem to account for some of the variance in coping style (Liang, Li, Liu, & Quan, 1999 and Tugade, Fredrickson & Barrett, 2004 respectively).

Carver et al., (1989) identified task-oriented, avoidance-oriented, and social/emotional coping as the three primary coping mechanisms for dealing with stressful situations. In stressful situations, people must cope with inconsistencies between their internal resources and their external demands. Carver et al. (1989) proposed that people have stable coping dispositions that they use in a wide range of situations, across time and contexts. Coping ability is essential for psychological well-being as individuals who suffer from mental health difficulties often face stigmatising attitudes (Link, Mirotznik & Cullen, 1991). The extent to which they can cope in the face of such adversity has the capacity to influence their mental health further.

Task-oriented coping refers to specific aspects of problem-solving, such as planning and active coping, which aim to reduce anxiety by finding a solution to the given problem (Gupta & Derevensky, 2001). Avoidance-oriented coping contains items such as mental disengagement, and is generally less helpful than other techniques. Social/emotional coping refers to managing a problem by seeking social support or by altering how one responds emotionally to the problem (Carver et al., 1989).

An individual’s capacity to cope is generally found to account for a significant amount of variance in mental health outcomes (Suldo, Shaunessy & Hardnessy, 2008). Young people who are able to find positive outlets for stress are at lower risk for future psychopathology than those who employ less useful coping strategies (Galaif et al., 2003). Similarly, when a person

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Empirical Investigations suffers from a mental health problem, their coping style may promote improved emotional regulation (Compas, Jaser & Benson, 2009).

Psychoanalytic theory has posited that defense styles are a measure of inherent coping ability, and are associated with variability in mental health outcomes (Vaillent & Vaillent, 1990; as cited in Thygesen et al., 2008). Defense mechanisms can be defined as an individual’s’ style of dealing with conflict or stress that aim to reconcile internal drives and external demands, either consciously or unconsciously (Vaillant, 1992). According to the DSM-IV, they are automatic processes that prevent the acknowledgement of anxiety in awareness (American Psychiatric Association, 1994). Research has shown that defenses are associated with psychopathology (Watson, 2002), psychological adjustment, and well-being (Vaillant & Vaillant, 1990 as cited in Thygesen et al., 2008).

Vaillant (1971) originally developed a hierarchical classification of ego defenses; mature, neurotic, psychotic and immature. Andrews, Singh & Bond (1994), however, refined this list and merged the psychotic and immature styles. A mature defense style has been related to better outcomes in life (Spinhoven & Kooiman, 1997). A neurotic style indicates the use of defenses such as undoing and idealization and has been previously linked to the development of anxietyrelated disorders (Spinhoven & Kooiman, 1997). Finally, an immature defense style implies the use of defense mechanisms such as splitting and denial (Andrews, Singh & Bond, 1993). An immature defense style has been identified as the strongest predictor of psychopathology, with individuals having an increased vulnerability to the development of problems such as depression, anxiety and personality disorders (Watson, 2002).

While much research has studied these factors independently, to the best of the authors knowledge, no study has looked directly at emotional vulnerability (as measured by coping style, defense styles, and ego resilience), and attitudes towards mental illness. This is crucial, as negative attitudes may be a risk factor for the development of a mental health problem. Through education and awareness, it is possible to change people’s attitudes (Warren, Hof, McGriff, & Morris, 2012), thus educational initiatives and early intervention programmes that target schools may play an important role in the prevention of mental illness.

The Present Study This research aimed to examine subjects’ attitudes towards mental illness as it was thought that these may be related to one’s vulnerability to emotional distress.

1. It was hypothesised that there was a relationship between attitudes towards depression and coping style. People with negative attitudes were expected to use less useful forms 6

Student Psychology Journal, Volume III of coping (e.g., avoidance-oriented coping) while people with positive attitudes were predicted to use task-oriented or social/emotional coping.

2. Secondly, attitudes were examined in relation to defense styles with those in the positive attitude group predicted to have a mature defense style. Those in the negative attitude group were expected to have either a neurotic or immature defense style.

3. The third hypothesis predicted a relationship between attitudes towards depression and ego resilience, with positive attitudes assumed to predict a high score on the ego resiliency scale.

4. Furthermore, it was predicted that coping style, ego resiliency, and defense styles would be related. Those scoring high on the ego resiliency scale were expected to possess a mature defense style and to utilize task-oriented coping techniques. Those scoring low on the ego resiliency scale were expected to possess an immature or neurotic defense style, using avoidance-oriented coping.

Method Design A cross-sectional survey was used.

The independent variable ‘attitudes’, had two levels: positive and negative. The dependent variable was ‘coping style’ and it had three levels: task-oriented, avoidance-oriented, and social/emotional coping. In this model, defense styles and ego resilience were covariates.

Defense styles had three levels: mature, neurotic and immature. Ego resiliency had one continuous level.

Participants Participants were 65 Psychology students who were studying in Trinity College Dublin. They were recruited through the use of on campus poster advertisements and college e-mail.

Students did not receive any monetary rewards for their participation. Those eligible were offered research credits in return for their involvement. Of the 65 students, 16 were male and 49 were female. Participants ranged in age from 18-46 years (M= 21.8 years; SD= 5.16).

Measures Modified EAAD Questionnaire: ‘Attitudes and Knowledge Questionnaire’ A modified version of the ‘Attitude and Knowledge Questionnaire’ (EAAD, 2010), a leading 7

Empirical Investigations questionnaire used by the European Alliance Against Depression, was used to evaluate participants' attitudes towards depression. This 30 item questionnaire was adapted by the researcher from the ‘Knowledge and attitudes towards depression’ section of the original questionnaire.

The adapted questionnaire required participants to respond to statements on a four point Likert Scale. Responses to questions relating to opinions & attitudes, causes, and symptoms of depression were ranked from ‘Totally agree’ to ‘Totally disagree’. Responses relating to treatment ranged from ‘Very Effective’ to ‘Damaging’. Some items were reverse scored.. Scores for each attitude ranged from 1-4 with a high score representing a positive attitude. An overall attitude score was obtained by summating the scores for each individual item. A median split was used to determine which attitude group each participant belonged to: positive or negative (please note that this is a relative score –see limitations section). A reliability analysis yielded a Cronbach’s alpha result of 0.57 for this scale.

COPE The sixty-item COPE (Carver, Scheier, & Weintraub, 1989) was used to assess dispositional coping styles. In the present study, Cronbach’s alpha was calculated as 0.85. Test-retest reliability was reported at 0.33, 0.61 and 0.62 for task oriented, avoidance oriented, and socialemotional coping respectively.

Ego Resiliency Scale / ER-89 Participants were required to complete the Ego Resiliency Scale (Block & Kremen, 1996). This is a 14 item scale that aims to assess an individual’s ability to adapt and respond when faced with external stressors. Cronbach’s alpha for this study was reported at 0.77.

Defense Styles Questionnaire Participants were required to complete the Defense Styles Questionnaire (DSQ-40) (Andrews, Singh & Bond, 1993). This is a forty item self-report measure that distinguishes between mature, neurotic and immature defense styles. An overall alpha value of 0.78 was obtained for this measure.

Procedure Prior to data collection, ethical approval was obtained from the School of Psychology Research Ethics Committee, Trinity College Dublin. Participants were recruited via poster advertisements and e-mail. Students received a comprehensive consent form explaining the nature of the study.

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Student Psychology Journal, Volume III After consent was obtained, participants were required to complete the following four questionnaires: a modified version of the ‘Attitude and Knowledge Questionnaire’, COPE Questionnaire, Ego Resiliency Questionnaire and Defense Styles Questionnaire. After completion, participants were given a debriefing sheet which explained in more detail the aims of the study, and gave contact information for support services in case of distress.

Statistical Analysis Statistical analyses were carried out using SPSS 19.0. A multivariate analysis of variance (MANCOVA) was deemed most appropriate for the requirements of the current study. Previous research has suggested that defense styles and ego resiliency influence one’s’ coping style.

Controlling for these covariates would therefore allow the impact of attitudes on coping to be measured.

Following this, three separate ANCOVA’s were conducted to determine which defense mechanisms contributed to the three individual coping styles. The data in this study met the assumptions for both analyses.

Results Preliminary Analysis Prior to statistical analysis, scores for missing data were computed using mean scores for each item. Participants were divided into ‘Positive’ and ‘Negative’ Attitude groups using a median split for results from the ‘Attitudes and Knowledge Questionnaire’ (median = 93). Subjects scoring between 0 and 92 were deemed the ‘negative attitude’ group and those scoring between 93 and 112, the ‘positive attitude’ group.

Descriptive Statistics Participants' attitude scores were generally high with a mean score of 92.3 out of a possible 112.

Participants rated social problems and heredity lower than other potential causes of depression with most participants claiming they partially agreed or partially disagreed with these statements (M=2.97, and 2.96 respectively out of a total of 4). Similarly, subjects partially agreed with the suggestion that depressed people suffer from delusions (M=2.75). People did not generally class depression as a psychological condition (M=1.23), but opted to name it a medical condition (M=3.41). A mean score of 2.70 was also yielded for the item ‘Depressed people should just pull themselves together’.

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Empirical Investigations Table 1 presents the mean scores for participants in the two groups (negative and positive attitudes) on the three dimensions of both coping (Task-Oriented, Avoidance-Oriented, and Social/Emotional Coping), and defense styles (Mature, Neurotic, and Immature), and on ego resiliency. The ‘Negative Attitudes’ group scored higher than the ‘Positive Attitudes’ group on the coping dimension of ‘Avoidance-Oriented Coping’ and the defense style dimension of ‘Neurotic’ and ‘Immature’. The ‘Negative Attitudes’ group scored lower than the ‘Positive Attitudes’ group on the coping dimensions of ‘Task-Oriented Coping’ and ‘Social/Emotional Coping’, on the defense style dimension ‘Mature’ and on the ego resilience dimension.

Table 1: Mean Scores for the Negative and Positive Attitude Groups for each of the Coping, Defense Styles, and Ego Resilience Dimensions

Negative Attitude

Positive Attitude

Group (n=31)

Group (n=34)

DV’s and Covariates

Mean (SD)

Mean (SD)

Task Oriented Coping

50.48 (9.60)

53.32 (8.35)

Avoidance Oriented Coping

41.06 (5.03)

39.97 (5.99)

Social Emotional Coping

42.42 (10.04)

44.82 (10.37)

Neurotic Defense Style

5.15

(1.03)

4.81

(1.09)

Mature Defense Style

5.48

(1.14)

5.77

(1.03)

Immature Defense Style

3.93

(0.87)

3.38

(0.88)

Ego Resilience

41.34 (6.27)

42.15 (5.55)

Group Differences A multivariate analysis of covariance (MANCOVA) indicated that a statistically significant difference existed between the mean scores for the two groups (negative and positive attitudes) on coping style in the neurotic, F(5,59) = 4.53, p<0.05, mature, F(5,59) = 8.17, p<0.05, and immature defense style dimensions, F(5,59) = 2.82, p<0.05. Ego resiliency did not have a statistically significant effect for attitude group on coping, F(5,59) = 1.99, p=0.124. While differences in mean scores between the two groups indicated a link between attitude group and coping style, this result was not statistically significant, F(5,59) = 0.53, p>0.05.

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Student Psychology Journal, Volume III Tests of Between-Subjects Effects An analysis of Between Subjects Effects indicated that the covariate ‘Neurotic Defense Style’ was significantly related to the ‘Social/Emotional’ coping style for both groups, F(5, 59) = 13.77, p<0.05.

A statistically significant result was also yielded for the covariate ‘Mature Defense style’ and the ‘Task-Oriented’ coping style for each group, F(5, 59) = 14.07, p<0.05.

The ‘Immature defense style’ was found to be significantly related to the ‘Avoidance-Oriented’ coping style for the groups, F(5, 59) = 4.24, p< 0.05.

Table 2: A rank order of group differences for the dimensions of Defense Styles and Ego Resiliency on Coping Style between the Negative and Positive Attitudes Groups

Covariates

Mature Defense Style

Neurotic Defense Style

Immature Defense Style

Ego Resilience

Pillai’s Trace

0.301

0.192

0.129

0.095

* Statistically significant at p<0.001 level

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Coping Styles

F

p

Task Oriented

14.074

0.000*

Social Emotional

2.027

0.160

Avoidance Oriented

0.723

0.399

Social Emotional

13.772

0.000*

Task Oriented

2.689

0.106

Avoidance Oriented

0.141

0.709

Avoidance Oriented

4.241

0.000*

Task Oriented

3.209

0.078

Social Emotional

2.605

0.112

Avoidance Oriented

3.291

0.075

Task Oriented

1.737

0.193

Social Emotional

0.167

0.684

Empirical Investigations Moreover, the MANCOVA revealed that the mature defense style accounted for 30.1% of the variability in coping style among the two groups. The neurotic defense style accounted for 19.2% and the immature for 12.9% of this variance. Ego resilience contributed 9.5% of the variance in coping style.

Analysis of Covariance Three individual ANCOVA’s were run to examine which specific defense mechanisms contributed most to their relevant coping style. Defense mechanisms were grouped according to Andrews, Singh, and Bond (1993).

The first ANCOVA yielded statistically significant results for the mature defense mechanisms ‘humour’ and ‘anticipation’ in relation to the task-oriented coping style for both groups, F(5,59) = 11.1, p<0.05 and F(5,59) = 6.71, p<0.05 respectively.

A second ANCOVA yielded a statistically significant result for the neurotic defense mechanism ‘idealization’ and the social/emotional coping style, when both groups were taken into account, F(5,59) = 14.5, p<0.05.

The third ANCOVA yielded no statistically significant results for any immature defense mechanisms and avoidance-oriented coping. Fantasy and somatization were closest to statistical significance, F(13,51) = 2.78, p = 0.10 and F(13,51) = 2.23, p = 0.14. A further MANCOVA however, revealed statistically significant results for the defense mechanisms ‘splitting’ and ‘isolation’ in the social/emotional coping style (but not to the avoidance-oriented coping style as predicted), F(22,42) = 4.65, p<0.05, and F(22,42) = 12.9, p<0.05 respectively.

Discussion This study aimed to examine whether there was a relationship between attitudes towards mental health problems and vulnerability to emotional distress, as measured by coping styles.

Findings of the study suggested that attitudes were not significantly related to coping style.

Mean differences between the positive and negative attitude groups did, however, suggest a potential relationship between the two.

In contrast to previous research (e.g., Crisp et al., 2000) this study found that subjects generally had good knowledge of, and positive attitudes towards depression. Participants were aware that depression may be related to loss, unemployment and poverty, and, they believed, to a lesser extent social problems and heredity. Scores were indicative of participants’ disagreement with the suggestions that depression was a sign of weakness of character and a lack of discipline. Individuals seemed to have good mental health literacy such that they could 12

Student Psychology Journal, Volume III recognise common symptoms of depression: guilt and worthlessness, decreases in attention, and physical complaints. This contrasts with previous research (Gulliver et al., 2010).

Participants, however, did incorrectly believe that depressed people experience delusions. Jorn et al. (1997) suggested that depression is sometimes not recognised as a mental health problem.

Results from this study support this finding further with participants showing disagreement for the statement that ‘depression is a psychological condition’.

In support of the first hypothesis, participants who expressed positive attitudes towards depression scored higher on measures of task-oriented and social/emotional coping, although this was below the level of significance. Task-oriented coping refers to specific aspects of problem-solving which aim to reduce anxiety by solving, re-conceptualising or minimising the effects of a difficult situation (Gupta & Derevensky, 2001). The second hypothesis expected those with positive attitudes to possess a mature defense style. Trends observed throughout the analysis of mean scores for both groups indicated that this was the case. In addition to this, taskoriented coping was significantly related to the mature defense style, as predicted by hypothesis 4. This is interesting as mature defense styles are associated with better life outcomes (Spinhoven & Kooiman, 1997). This corresponds to previous research on coping which indicates that the positive construction of a stressful situation has the capacity to facilitate appropriate coping and problem-solving actions (Kallasmaa & Pulver, 2000). This is to say that both taskoriented coping and a mature defense style are independently indicative of positive outcomes.

Moreover, individuals in this study who possessed positive attitudes relative to other students had higher scores on ego resilience (hypothesis 3), although this difference was not statistically significant.

As mentioned, those in the positive attitude group also scored higher than the negative attitude group on the social/emotional coping dimension, although this was not statistically significant.

There was, however, a significant relationship between the social/emotional coping style and the neurotic defense style. Neuroticism has been linked to the development of anxiety disorders (Spinhoven & Kooiman, 1997). In the current study, idealization in particular was significantly related to the social/emotional coping style. This is logical as idealization is a form of fantasy which often refers to the unrealistic overestimation of a person’s or objects’s value. The alteration of one’s emotional response as seen in the social/emotional coping style may be related to the ability to internally modify the impact of stressful events on the ego.

Providing further support for the first hypothesis, subjects who expressed negative attitudes towards depression scored higher than those with positive attitudes on the avoidance-oriented coping style. This coping style has been linked to experiences of depression, conduct problems,

13

Empirical Investigations and substance abuse (Ayers, 1991). The prediction that subjects in the negative attitude group may be more susceptible to emotional distress did not yield significant results. It did, however, suggest a tendency for these individuals to cope in a maladaptive manner and to possess either an immature or neurotic defense style. Indeed, previous research suggests that immature defense styles are strong predictors of psychopathology (Watson, 2002).

Moreover, this research found a significant relationship between the avoidance-oriented coping style and the immature defense style (hypothesis 4). This was unsurprising as similar items were present in both questionnaires. For example, denial was a measured item for both the avoidance-oriented coping style (Kalassmaa & Pulver, 2000), and the immature defense style (Andrews, Singh, & Bond, 1993). Although results did not find statistically significant results for the impact of attitudes on ego resilience, those in the negative attitude group scored lower on the ego resiliency scale as predicted.

Attitudes towards mental health problems are important as a personâ&#x20AC;&#x2122;s attitudes may influence their likelihood to seek help in the event of distress. For example, this research suggested a tendency for people with negative attitudes to have an immature defense style and to utilize avoidance-oriented coping. The presence, therefore, of stigmatising attitudes may make the decision to seek help even more difficult. Although this study found that attitudes were not significantly related to coping style, defense style, or ego resilience, it is conceivable that this was due to the small sample size. Indeed, mean scores did indicate a tendency for those in each attitude group to employ specific coping styles.

The findings of this research suggest that coping style is significantly related to defense style.

Defense styles accounted for a total of 62.2% of the variance in coping style between groups.

This is very interesting as both measures are attempts to uncover the underlying processes that affect individual coping ability. Both, however, are grounded in different theoretical models; coping styles are measured from a cognitive-behavioural perspective (Lazarus & Folkman, 1985) while defense styles are a psychoanalytic concept (Vaillent, 1992). It is possible that overlaps exist in the conceptualisation of the two constructs. The similarities between the two warrants further exploration as to whether the same underlying construct is essentially being tested. Psychoanalysis has long been interested in the unconscious, while cognitive-behavioural theories posit the influence of thoughts on behaviour. Defense styles may therefore measure the inherent underlying resolution of conflict, while coping may refer to the expression of this in behaviour. If defense styles precede the development of coping style, this may offer an explanation as to why coping styles remain relatively constant through time and contexts

14

Student Psychology Journal, Volume III (Carver et al., 1989). A multi-level approach may be valuable in an attempt to more thoroughly understand these processes.

Limitations The results of the present study should be interpreted with caution, keeping the limitations of the research in mind. Firstly, due to the time constraints a small sample of 65 participants was recruited. Sixteen subjects were male while 49 were female, resulting in a skewed gender balance. In addition to this, all subjects were studying Psychology at the time of participation.

Due to the nature of their study, they may be expected to have increased knowledge of, and positive attitudes towards, depression. While a median split attempted to combat this problem by separating the participants into two groups based on their relative attitudes, this in itself raised its own concerns. In essence, dichotomizing a continuous variable is relatively arbitrary and has the capacity to separate participants into groups based on a one-score difference.

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Berman, A.L. (2009). Depression and suicide. Handbook of depression. New York, NY: Guilford Press.

Block, J. & Kremen, A.M. (1996). IQ and ego resiliency: Conceptual and empirical connection and separateness. Journal of Personality and Social Psychology, 70(2), 349-361.

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Empirical Investigations Bond, M. (2004). Empirical studies of defense style: Relationships with psychopathology and change.

Harvard Review of Psychiatry, 12(5), 263-278.

Bond, M.P. (1995). The development and properties of the defense style questionnaire. In Conte, H.R. & Plutchik (Eds.), Ego defenses: theory and measurement (pp. 202-221) Canada: John Wiley & Sons.

Borowsky, I.W., Ireland, M., & Resnick, M.D. (2001). Adolescent suicide attempts: Risks and protectors.

Pediatrics, 107(3), 485-493.

Carver, C.S., Scheier, M.F. & Weintraub, J.K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267-283.

Compas, B.E., Jaser, S.S., & Benson, M.A. (2009). Coping and emotion regulation: Implications for understanding depression during adolescence. Handbook of depression in adolescents . Nolen Hoeksema, S. & Hilt, L.M. (Eds.). Pp.419-440. New York: Routledge/Taylor & Francis Group.

Crisp, A.H., Gelder, M.G., Rix, S., Meltzer, H.I. & Rowlands, O.J. (2000). Stigmatisation of people with mental illness. British Journal of Psychiatry, 177, 4-7.

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European Alliance against Depression, EAAD (2011). Retrieved October 24 th 2011, from: http://www.eaad.net/ Galaif, E., Sussman, S., Chou, C.P., & Willis, T. (2003). Longitudinal relations among depression, stress, and coping in high risk youth. Journal of Risk and Adolescence, 32,243-258.

Gulliver, A., Griffiths, K.M., Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10, 113.

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Student Psychology Journal, Volume III Jorm, A.F., Korten, A.E., Jacomb, P.A., Christensen, H., Rodgers, B. & Pollitt, P. (1997). “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. The Medical Journal of Austrailia, 166, 182.

Kallasmaa, T., & Pulver, A. (2000). The structure and properties of the Estonian COPE inventory.

Personality and Individual Differences, 29, 881-894.

Kent, L.K. & Shapiro, P.A. (2009). Depression and related psychological factors in heart disease. Harvard Review of Psychiatry, 17(6), 377-388.

Kirkwood, A.D. & Stamm, B.H. (2006). A social marketing approach to challenging stigma. Professional Psychology: Research and practice, 37(5).

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Link, B.G., Mirotznik, J. & Cullen, F.T. (1991). The effectiveness of stigma coping orientations: Can negative consequences of mental illness labelling be avoided? Journal of Health and Social Behaviour, 32, 302-320.

Mandel, D.M. (2003). Psychophysical resilience: A theoretical construct based on threat perception and early programming of restorative and arousal based adaptive mechanisms. Journal of Prenatal and Perinatal Psychology & Health, 17(3), 235-250.

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Empirical Investigations Suldo, S.M., Shaunessy, E. & Hardnessy, R. (2008). Relationships among stress, coping, and mental health in high-achieving high school students. Psychology in the Schools, 45(4).

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Tugade, M.M., Fredrickson, B.L., & Barrett, L.F. (2004). Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of Personality, 72(6), 1161-1190.

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Student Psychology Journal, Volume III

Differences in Subjective Experiences of Flow and Time Distortion between Video Gaming and Reading Exercises Jason McDonnell Dun Laoghaire Institute of Art Design and Technology n00061044@student.iadt.ie

The aim of this study was to examine whether there was a difference in the experience of flow, a state of immersive involvement while engaged in an activity, between two different types of activities; video gaming and reading. An experimental repeated measures design was employed, using 10 participants (7 males, 3 females) in two conditions. Participants were required to play a video game, and were instructed to inform the researcher when they believed 10 minutes to have elapsed. This was then repeated, but participants were required to read a book, again informing the researcher when they believed 10 minutes to have passed, with the expectation being that participants would experience a greater amount of flow in the video game condition than in the reading condition. Flow was measured using participant estimations of 10 minutes having passed and as expected, the actual time elapsed was greater than participant estimations in the video game condition, indicating a greater experience of flow. This is in keeping with existing theory and research which suggests that video games possess a high potential to evoke the flow state.

Introduction Flow can be described as “the state in which people are so involved in an activity that nothing else seems to matter; the experience itself is so enjoyable that people will do it even at great cost, for the sheer sake of doing it” (Csikszentmihalyi, 1990, p. 4). Whether or not an individual experiences flow, and the degree to which flow is experienced, can depend on both the personality of the individual (Teng, 2011) and the activity in question (Csikszentmihalyi, 1997).

Teng (2011) reported that the likelihood of an individual having a flow experience is positively related to character traits such as persistence (perseverance in the face of frustration), selftranscendence (the desire to outperform oneself) and novelty seeking (the tendency to favour new experiences), but negatively related to self-directedness. With regard to the potential of different activities to induce the flow state, Csikszentmihalyi (1997) stated that the potential for flow in terms of leisure activities was highest in hobbies such as playing musical instruments, rock-climbing or going to the movies, and lowest in what he called “passive leisure” activities, such as watching television and reading.

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Empirical Investigations Csikszentmihalyi (1990) identified eight components of flow; a balance between ability level and challenge; concentration on the task in question; clear goals and immediate feedback; a loss of self-consciousness; a sense of control; merging of action and awareness; and finally, a sense of time distortion, usually a sense of the passage of time speeding up. Csikszentmihalyi (1990) further states that the flow experience is intrinsically rewarding. Since the proliferation of highly interactive electronic media such as the internet and video games, much research has taken place examining the extent to which these media evoke the experience of flow (Rau, Peng, & Yang, 2006; Tobin & Grondin, 2009; Wood, Griffiths, & Parke, 2007), alongside research which has examined whether this flow experience plays a role in problematic behaviours such as online games addiction (Chou & Ting, 2003; Wan & Chiou, 2006).

One component of flow which has received attention is time distortion, particularly in the context of video game use. Tobin and Grondin (2009) conducted a study in which adolescents were asked to engage in a video game task and a reading task, and to estimate their time spent on each. Results showed significant underestimation of time spent playing the game when compared to estimates of time spent reading, possibly indicating some degree of flow. Similarly, Rau, Peng, and Yang (2006) found that both novice and expert players of the game â&#x20AC;&#x153;Diablo IIâ&#x20AC;? experienced time distortion, as well as finding it difficult to stop playing the game without external intervention, again possibly indicating a flow experience. Griffiths, and Parke (2007) reported that time distortion can be related to various structural characteristics of games and was experienced by players regardless of age, gender or frequency of play, implying that different types of games may result in different levels of flow experience, depending on how many of the eight components they satisfy.

Despite time distortion being but one component of flow, it could also be considered a consequence of flow that is influenced by the presence of other components, or antecedents of flow such as a sense of control, a balance between ability level and challenge and clear goals (Ghani & Deshpande, 1994; Shin, 2006). Shin (2006) found that there was a positive correlation between the level of flow experienced and flow antecedents such as clear goals, concentration on the task at hand and a balance between ability level and challenge. Furthermore, Shinâ&#x20AC;&#x2122;s study found positive correlations between the level of flow experienced and components such as time distortion, focused attention, engagement and enjoyment, as well as correlations between these components themselves. As such, it is possible to infer the occurrence of a flow state by measuring time distortion experienced and by examining the nature of the task in question to reveal which antecedent components said task may require.

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Student Psychology Journal, Volume III This study attempted to validate previous findings in the area by demonstrating a greater experience of time distortion for participants in the video gaming condition compared to the reading condition. This was achieved by having participants engage in each condition with the requirement that they inform the researcher when they believed 10 minutes to have elapsed since the beginning of the exercise. It was expected that participants would underestimate time spent in the video game condition due to time distortion resulting from a flow experience.

Method Design This experiment employed a repeated measures design, with the time recorded for participant’s estimation of 10 minutes having elapsed serving as the dependent variable, and the video game and reading conditions serving as the independent variable. Means and standard deviations were compared upon completion of the experiment and a dependent t-test was also used in order to determine whether there was any statistically significant difference between the groups.

Participants 10 participants were selected using convenience sampling, consisting of 7 males and 3 females, all of whom were college students. Participant’s ages ranged from 18-24, with a mean age of 21.

Apparatus Apparatus used in this experiment included a puzzle game entitled ‘Cut the Rope’, for use in the video game condition and which is available on the iTunes app store and an iPhone 4 on which to play the game. Other apparatus included a book, in this case a fantasy novel entitled ‘Magician’ by Raymond E. Feist, for use in the reading condition. Finally, a stop watch was required to record participant estimations of 10 minutes having elapsed.

Procedure At the beginning of the experiment, participants were required to give to the experimenter any watches or phones which might be used to determine the amount of time which had passed.

Participants were then brought to a room which lacked a clock or any other means of determining the time. Once settled, participants were presented with a video game of the puzzle genre, entitled ‘Cut the Rope’, in which the player must cut a series of ropes which are attached to a piece of candy, with the aim being to guide the candy into the mouth of a creature which resides at the bottom of the screen. Each level also contains 3 stars which, while optional, the player may collect if they so choose, although this typically increases the difficulty.

21

Empirical Investigations Participants were given 5 minutes to play the first few levels of the game, thus allowing them to familiarise themselves with the game mechanics and objectives by way of a tutorial. The game was then removed temporarily while it was explained to participants that they were to play the game until they believed 10 minutes to have passed, at which point they were to inform the researcher. The difficulty of the game was then increased by the researcher, from the easier ‘cardboard box’ set of levels used by participants to learn the basics of the game, to the more challenging ‘fabric box’ set of levels.

This moderate increase in difficulty helped to ensure the balance between ability and challenge; an important component of flow (Csikszentmihalyi, 1990, 1997). While this could be considered setting participants up to experience a flow state, it was necessary in order to facilitate the experiment as participants already knew how to read and as such it was important that they knew how to play the game, which required learning its mechanics and goals. Participants were then allowed to commence playing, informing the researcher when they believed 10 minutes to have passed. Actual time elapsed was then recorded by the researcher.

Following this, participants were instructed to read the first chapter of a book entitled ‘Magician’. Again, participants were asked to inform the researcher when they believed 10 minutes to have passed. Actual time passed was then recorded by the researcher.

Results Table 1: Summary of conditions, N values, Means and Standard Deviations of actual time elapsed.

Condition

N

Mean Elapsed Time

Standard Deviation

(s) Video Game

10

669.02

45.07112

Reading

10

539.27

46.94713

As Table 1 shows, participants underestimated the duration of time passed in the video game conditon by a considerable amount, on average exceeding the 10 minute goal by almost 70 seconds. Conversely, participants overestimated the amount of time passed in the reading condition by a similar amount, on average reporting 10 minutes to have passed just over 60 seconds before the 10 minute goal.

22

Student Psychology Journal, Volume III The hypothesis for this study was that participants would experience greater flow in the video game condition than in the reading condition, based upon their estimation of 10 minutes having elapsed. The results show that participants experienced greater time distortion in the video game condition, indicating a greater experience of flow. As such, the hypothesis is supported. A dependent t-test was carried out in order to determine whether the results obtained were statistically significant. Results obtained in the t-test, as well as Cohenâ&#x20AC;&#x2122;s d for effectsize, are displayed below. t(9) = 4.872, p < .05, d = 2.820 These results further support the hypothesis on a statistical level by demonstrating a low probability of the results obtained being due to chance.

Discussion The aim of this research was to replicate the findings of previous research into the relationship between flow, time distortion, and video game use, as well as to test the research of Csikszentmihalyi (1997) into the potential for individuals to experience flow across different types of activities; in this case video gaming and reading. With this in mind, it was expected that participants would experience a greater amount of flow, as measured by their losing track of time (underestimating the passage of 10 minutes) in the video gaming condition in comparison to the reading condition.

The results of the experiment support this hypothesis, as participants underestimated time spent in the video game condition. This is symptomatic of time distortion and as such, indicative of a greater flow experience when compared to the reading condition. This result is in line with previous research (Rau, Peng, & Yang, 2006; Tobin & Grondin, 2009; Wood, Griffiths, & Parke, 2007) in the area.

As previously mentioned, Csikszentmihalyi (1990) identified eight components of the flow state.

The present study sought to measure flow by way of the amount of time distortion experienced by participants between conditions, and although this measure can only directly account for one component of flow, Shin (2006) found that that there was a positive correlation between time distortion and other components such as enjoyment (autotelic), engagement (merging of action and awareness), and focused attention (concentration on the task at hand), as well as a correlation between these components and the level of flow experienced. Therefore, by measuring time distortion experienced one can in theory infer the occurrence of these remaining components, and as such the occurrence of flow itself. Furthermore, by examining the task in question, in this case a video gaming task, one can ascertain the presence of some of 23

Empirical Investigations the remaining, antecedent components such as a balance between ability level and challenge, clear goals, immediate feedback, and a sense of control, all of which are present with regard to video games. Shinâ&#x20AC;&#x2122;s study also found a correlation between some of these components and the degree to which flow is experienced, as such the presence of these antecedent components lend further credence to the inference of a flow state in the present study.

With regard to the different activities presented in each condition, it could be said that video games possess a relatively high potential to induce the flow state, owing to their requirement of several antecedent components of the flow state as previously mentioned. Concerning the reading condition by way of comparison, Csikszentmihalyi (1997) reported activities such as reading as having a negative impact or low potential for flow. While this is arguable, the results of this experiment seemed to support this claim, with participants overestimating the amount of time that had passed in the reading condition, possibly indicating boredom and lack of flow.

This could perhaps be explained by the absence or relative ambiguity of certain antecedent components when compared to the video gaming task, but may also have resulted from participants having not been allowed any time to familiarise themselves with the provided text prior to the beginning of the reading condition, as was the case in the video game condition.

Nevertheless, similar results were obtained by Tobin and Grondin (2009), who reported that participants estimated time spent engaged at a video gaming task to be shorter than a reading task. Interestingly, they reported that short durations were overestimated while long durations were underestimated, which would seem to imply that the likelihood of experiencing flow and the resulting time distortion increases along with actual time spent engaged in a given exercise.

Yet another interesting finding of the study was that participants who reported themselves as being inclined toward video games displayed greater underestimation of time played, which implies that an individualâ&#x20AC;&#x2122;s interests play a role in the extent to which they experience flow, regardless of the potential for flow in the activity in question. However, Rau, Peng, and Yang (2006) reported that both novice and expert players of online games experienced time distortion, so a certain degree of flow may be inevitable, owing to the nature of video games in general, as previously mentioned.

Methodological weaknesses included a lack of background information on participants, such as information regarding how often they play games or read, variables which could affect the likelihood to experience flow (Tobin & Grondin, 2009)

or the degree to which flow is

experienced (Rau, Peng, & Yang, 2006). This could have been alleviated through the use of a questionnaire prior to testing or through the use of the Flow State Scale (FSS) after testing had been completed. Similarly, a lack of information regarding character and personality traits of

24

Student Psychology Journal, Volume III participants may have been useful, as Teng (2011) reported that an individualâ&#x20AC;&#x2122;s likelihood of experiencing flow is related to certain traits. Again, this could have been solved using a personality questionnaire. Participant estimation of time elapsed may also have been influenced by participant awareness of the cut-off point, that being 10 minutes. This could have been alleviated by having participants engage in each condition for 15 minutes and then having them estimate time elapsed. It is also worth noting that, as previously mentioned, participants were allowed time to familiarise themselves with the video game provided but not with the text provided, which may have affected their likelihood of experiencing flow in the reading condition. With regard to the use of time distortion experienced as the sole measure of flow in the present study, this was chosen above the Flow State Scale due to the reliance of the FSS on the participantsâ&#x20AC;&#x2122; ability to recall the intensity of their subjective experiences of various flow components. If participants were required to fill out the FSS immediately after each condition, their naivety of what the researcher sought to measure would have been compromised and may have affected results. Conversely, results may have been influenced by an order effect had the participants been required to fill out the FSS only once both conditions had come to their conclusion, possibly skewing results in favour of the most recently completed condition due to reduced ability of participants to recall their experience in the initial condition. This could have been alleviated through use of a between subjects design, in which case the use of the FSS in conjunction with the measure of time distortion experienced may have resulted in a more wellrounded picture of flow experienced. Sample size of n = 10 was also quite small, and thus may not be completely representative. Finally, non-standardised conditions between participants such as time of day may have impacted on results due to fatigue levels, hunger, or other confounding variables. Despite the weaknesses, results were still consistent with existing literature.

As previously mentioned, the findings of this study seem to imply a high potential for flow in terms of video games, resulting from their interactive nature and requirement or evocation of most if not all of the components of flow (Csikszentmihalyi, 1990). Although participantâ&#x20AC;&#x2122;s overestimated time spent in the reading condition, this could be due to participants being aware they had no chance of finishing or even progressing a relevant amount in the text provided, which may have resulted in disinterest, thus not necessarily indicating that flow is experienced to any lesser degree while reading in general. Differences in estimated time between the two conditions may also result from the order in which the conditions were presented; participants progressed from a highly engaging interactive exercise in the video game condition to a less engaging exercise in the reading condition. Thus it is possible that the results may have been different had the conditions taken place in the reverse order. However, it is worth noting that

25

Empirical Investigations Tobin and Grondin (2009) conducted a similar, albeit more complex experiment involving video gaming and reading tasks, which took presentation order effect into account, and concluded that higher time estimations in the reading task should not be caused by a presentation order effect.

In conclusion, this study supports the hypothesis that there would be a greater experience of time distortion and by inference, flow, in the video gaming condition than in the reading condition, suggesting a considerable potential for the experience of a flow state when playing video games. Future research should focus on the aforementioned order effect on the experience of time distortion and flow between different types of activities, as there is very little dedicated research available on this topic specifically. Also worthy of further examination is the capacity of measured time distortion to predict the presence and intensity of the remaining antecedents/components of flow.

References Chin-Sheng, W., & Wen-Bin, C. (2006). Psychological motives and online games addiction: A test of flow theory and humanistic needs theory for Taiwanese adolescents. Cyberpsychology & Behaviour, 9(3), 317-324.

Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New York: Harper and Row. Csikszentmihalyi, M. (1997). Finding Flow: The Psychology of Engagement With Everyday Life. New York: Basic Books Ghani, J. A., & Deshpande, S. P. (1994). Task characteristics and the experience of optimal flow in human- computer interaction. Journal of Psychology: Interdisciplinary and Applied, 128(4), 381-391.

Rau, P., Shu-Yun, P., & Chin-Chow, Y. (2006). Time distortion for expert and novice online game players. Cyberpsychology & Behaviour, 9(4), 396-403.

Shin, N. (2006). Online learner's 'flow' experience: An empirical study. British Journal of Educational Technology, 37(5), 705-720.

Teng, C. (2011). Who are likely to experience flow? Impact of temperament and character on flow.

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Ting-Jui, C. & Chih-Chen, T. (2003). The role of flow experience in cyber-game addiction.

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Student Psychology Journal, Volume III Tobin, S. & Grondin, S. (2009). Video games and the perception of very long durations by

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players: An

Empirical Investigations

Doctor, Doctor whatâ&#x20AC;&#x2122;s Right with me? : The role of optimism in reduced depressive symptomology following a positive psychological intervention Brenda Oâ&#x20AC;&#x2122;Connell, Dr. Stephen Gallagher, & Dr. Tim Ritchie University of Limerick 0870072@studentmail.ul.ie

Building on the pioneering work of positive psychologists Seligman, Steen, Park, and Peterson (2005) the current study examined the role of optimism in reducing depressive symptomology following a two-week positive psychological writing intervention. Participants were required to either reflect on three good things that occurred during the day, or on early memories. Unexpectedly, participants who wrote about early memories experienced a significant reduction in depressive symptomology compared to those writing about events over the day, which was maintained for one month after completing the intervention. Additionally, these changes were explained by increases in levels of optimism following intervention cessation. It is advocated that this self-reinforcing, cost effective writing intervention be further explored before subsequent implementation into practice. Finally, greater attention needs to be paid to the specific underlying mechanisms responsible for the effectiveness of writing exercises, in particular those concerning autobiographical memories.

Introduction The current study re-evaluates a highly innovative and influential study conducted by Seligman, Steen, Park, and Peterson (2005) in the field of positive psychology. Their study examined the long-term efficacy of five positive psychological interventions (PPI) aimed at increasing wellbeing and decreasing depressive symptomology through implementation of a randomized controlled trial. Four hundred and eleven participants were randomly assigned to one of five exercises that were delivered via the Internet and were to be completed daily for one week.

Participants in the three good things over the day exercise wrote three good things that occurred during their day and provided a causal explanation for each good thing accounted. It was this particular intervention which revealed the largest long-lasting increase in well-being and decrease in depressive symptoms for six months following the intervention, compared to a placebo-control exercise; in which participants wrote about their early memories every night for one week. This revelation that such a straightforward, non-intrusive, cost-effective intervention can yield long-term benefit in dysphoric individuals warrants further attention.

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Student Psychology Journal, Volume III Major depressive disorder is widely prevalent in the population, affecting about 151 million people worldwide and a startling one in five people in Ireland (Mathers, Boerma, & Ma Fat, 2008). It is associated with significant symptom acuteness, role impairment, is the most significant risk factor in suicide (Goldstein, Black, Nasrallah, & Winokur, 1991), and its economic costs to society are extensive (Sobocki, Jonsson, Angst, & Rehnberg, 2006). Depression is most commonly treated using medication (serotonin-specific reuptake inhibitors) and psychotherapy (cognitive behavioural therapy). Despite the range of treatments available for depression, an astounding number of people continue to live with this illness untreated.

Firstly, remarkably, it is believed that only 14.8% of individuals potentially diagnosable with Major Depressive Disorder actually receive appropriate therapy from a mental health provider during a one-year period (Young, Klap, Sherbourne, & Wells, 2001). Many individuals with depression are unwilling to seek treatment because of the oppressive stigma associated with mental illness (Sin, Porta, & Lyubomirsky, 2011). Furthermore, the ability to obtain and the choice of therapy or treatment may be limited by financial requisites (Sin et al., 2011). One promising solution to these problems would be to offer treatments that people can administer themselves, in privacy, which are cost effective, and that can be easily integrated into the daily routines of each individual, such as the aforementioned three good things over the day intervention.

Identifying the fine detail by exploring plausible explanations for how a PPI works is essential in the implementation of the three good things over the day intervention into clinical practise and is hitherto understudied. The current study aims to examine how this PPI has the potential to not just repair what is wrong, but also cultivate what is right (Seligman, 2002). It is posited that this PPI will target participantâ&#x20AC;&#x2122;s levels of optimism. Optimism not only leads to positive thoughts; but more importantly, it prompts focus to be placed on positives that actually exist in the daily life of the individual (Rashid, 2008). Although optimism is a trait its estimated heritability is much lower than other personality traits, at approximately 25% (Plomin et al., 1992). Although this appears to suggest relative stability, the recent work of Seligman and colleagues irrefutably reveals that optimism is malleable and can be learned (Gillham, Reivich, Jaycox, & Seligman, 1995) and is susceptible to change through interventions (Magyar-Moe, 2010). Robust research verifying these claims, and challenging the once prevailing assumption that levels of optimism are stable, have only begun to emerge in the past decade and are proving very fruitful.

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Empirical Investigations Therefore, if the three good things over the day intervention indeed alter participants’ levels of optimism, can the fortifying of this strength explain the reduction in levels of depressive symptomology? One of the core beliefs underlying positive psychology is that the building of positive strengths and virtues not only increases subjective wellbeing, but may also actually counter the disorder itself (Duckworth, Steen, & Seligman, 2005). Seligman (2002) characterises optimism as one of these buffering strengths. An abundance of findings support this assertion, for example optimism was found to be a protective factor for psychological and physical health and through the process of “learned optimism” (Seligman, 1990), it has been empirically shown to safeguard against depression. Could it be that writing about three good things each night infuses this positive cognitive strategy and, in doing so, relieves depressive symptomology?

Furthermore, it is interesting that in Seligman et al. (2005) original study, writing about past memories was used as a plausible “placebo control exercise”. Autobiographical memory, our memory for past events, is defined by Brewer (1996) as memory related to the self. It is proposed that this memory should be theoretically limited to memories that are self-relevant, self-defining, or that constitute the self-concept. An abundance of findings suggest that recalling positive events from the past activates positive emotions and positive affect, which are known to improve well-being (Berntsen, 2001; Ritchie et al., 2006; Walker, Skowronski, Gibbons, Vogl, & Ritchie, 2009a). Similarly, Josephson, Singer, and Salovey (1996) demonstrated that by accessing either positive information about the self or recalling past successes, individuals can assuage negative affect. In the Seligman et al. (2005) study, participants in the early memory condition showed significant improvements in well-being and were less depressed at the immediate posttest, after one week of writing. At every testing period thereafter, however, participants in the placebo control condition were no different on these measures than they had been at baseline. It is therefore important to re-evaluate these findings and the efficacy of these writing exercises in the present study.

The current study, firstly, seeks to re-examine the extent to which writing about three good things over the day, and reflecting on their causes, mitigates depressive symptomology compared to writing about early memories. As the original study (Seligman et al., 2005) found that increased writing following the cessation of the intervention was associated with the largest reductions in distress, participants will be instructed to write daily for a period of two weeks as opposed to one week. Finally, in acknowledging the buffering effect of optimism against depression the present study seeks to explain the underlying psychological pathways that serve as an impetus to decreased depressive symptoms, thus it is expected that changes in levels of optimism will explain the group differences in reductions in depressive symptomology.

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Student Psychology Journal, Volume III Method Participants A convenience sample of 165 participants, 64.8% female, was recruited from the University of Limerick. The sample was largely white (94.4%) and single (91%) with ages ranging from 17 to 57 years (M = 23.83, SD = 7.87). Participants were recruited on the Universities Department of Psychology Sonas System, where students participating received course credit. Those who completed all parts of the study were entered into a prize draw for €50. Inclusion criteria included English language proficiency, as all questionnaires utilised in the study were designed for English speakers. Ethical approval for this study was given by the Psychology Research Ethics Committee at the University of Limerick.

Design The present study employs a mixed within and between groups design, with time (pretest, posttest, follow-up) serving as the within-subjects factor and treatment group (intervention × control) as the between-subjects factor. The main independent variables were treatment group (intervention × control) and time: pretest (T1), post-test after two week writing intervention was completed (T2) and follow-up at four weeks (T3).

All participants were randomly allocated (see procedure and results section) according to the CONSORT guidelines (Schulz, Altman, & Moher, 2010). Those in the intervention condition were asked to write about three good things over the day. Every evening for two weeks, these participants were asked to take a moment to reflect on their day and recall three good things they experienced over that day and what initiated them. Those in the control condition were asked to write about early memories. Every evening for two weeks, these participants were asked to take a moment to reflect on their life and recall three memories that they have from their childhood. They were asked what these three memories were and what initiated them.

The dependent variables that were analyzed separately were levels of depressive symptomology and levels of optimism. The latter also served as a covariate, as did the participants frequency of writing over the two week intervention period.

Measures All information was obtained for the following measures within a questionnaire pack distributed at T1, T2, and T3 to all participants.

Depression. Depressive symptomology was assessed using the Center for Epidemiological Studies- Depression Scale (CES-D). This is a self-report adult symptom survey and was employed in Seligman et al.’s (2005) original research. The instrument was designed by Radloff

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Empirical Investigations (1977) and measures the behavioural, cognitive, and affective symptoms of depression over the previous week. It consists of 20 items, for example, “I was bothered by things that don’t usually bother me” and “My sleep was restless”. Four of the scales items measure positive affect and are reverse coded, for example, “I felt that I was just as good as other people”. Participants are asked to rate the frequency of occurrence of each symptom in the past week on a 4-point scale, which ranges from ‘rarely or none of the time (less than one day)’ = 0 to ‘most or all of the time (5–7 days) = 3. This reflects the frequency of depressive symptoms in terms of days per week. Scores range

from

0

to

60,

with

higher

scores

indicating

more

distress.

Radloff’s (1977) study revealed the CES-D to have high internal consistency on a general population sample (α =.85). More recent studies report similar findings with alpha coefficients ranging from .8 to .9 (Maloni, Park, Anthony & Musil, 2004; Nebbitt & Lombe, 2008). The current study reflected this, with a Cronbach’s alpha coefficient of .86.

Optimism. Optimism was assessed using an adapted version of the Life Orientation TestRevised (LOT-R; Scheier, Carver, & Bridges, 1994). The LOT-R is a self-report, ten-item measure.

It consists of 6 scale items and 4 filler items. Three of the six items are reverse scored, for example, “If something can go wrong for me, it will”. The measure assesses to what extent an individual generally expects positive versus negative outcomes. In order to capture predicted changes in participants’ levels of optimism over the three time periods, items were altered to identify such changes if present. “I'm always optimistic about my future”, for example, was altered to “Currently, I am optimistic about my future”, and “Overall, I expect more good things to happen to me than bad” was altered to “Currently, I expect more good things to happen to me than bad”. This was in accordance with recommendations outlined by Burke, Joyner, Czech, and Wilson (2000) on optimal utilization of the LOT-R scale. Participants indicated the extent to which they endorsed each statement using a 5-point scale ranging from “strongly disagree” = 0 to “strongly agree” = 4. Scores range from 0 to 24, with higher scores indicating more optimism.

Scheier et al. (1994) reported a good internal consistency for the LOT-R on a sample of undergraduate students (α = .79). Previous research report Cronbach’s alpha coefficient values in the high .70s to low.80s, also indicating good internal consistency (Burke et al., 2000; Park & Fenster, 2004). The current study reflected this, with a Cronbach’s alpha coefficient of .75.

Procedure This was a randomised placebo-controlled, parallel group study, conducted in the Psychology Department at the University of Limerick. The study consisted of four parts with three main measurement sessions (T1, T2, 2 week writing intervention, and T3).

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Student Psychology Journal, Volume III Part 1. Participants (n =165) were given information sheets and provided written consent before commencing the study. Two hundred identical questionnaire packs were divided equally into two boxes labeled A (intervention) and B (control) by the researchers. Participants were asked to choose a questionnaire pack masking the allocation sequence from the researcher.

However, the nature of the randomization process produced a slightly imbalanced randomisation, with more packs taken from box B. These questionnaires were then completed alone in a quiet room, which took approximately 15 minutes. Participants were then informed by the researcher that they would receive an email at 6pm that day detailing the short writing exercise they were to complete each night over the following two weeks. Participants were blinded to what condition they were in. Appointment cards were then distributed to all participants with the time, location, and date of the post-test, and assured that the times were subject to flexibility within their given date.

Part 2. An email was sent to participants at approximately 6pm every evening for fourteen consecutive days. This email thanked participants for their continued participation and reminded them of the two dates at which they were to complete follow-up questionnaires (T2 and T3). Participants were informed that they would have to complete a short writing exercise which was attached to the email as an excel file, which they filled out and returned to the sender upon completion. Participants completed the same writing exercise (either the intervention or the control) each night. After the two weeks of writing ended, participants received an email stating that they should stop writing and return for their post-test assessment the next day.

Part 3. Participants returned for the post-test, where they completed the questionnaire pack as previously administered in Part 1. Appointment cards were then distributed to all participants.

Part 4. Participants returned for the follow-up, where they completed the questionnaire pack as previously administered in Part 1 and 2. Upon completion, participants were thanked and debriefed.

Results Preliminary Analysis and Manipulation Checks Of the 164 participants who completed baseline questionnaires, 95 (57.9%) completed both the post-test and follow-up assessments. Participants who dropped out of the study (n = 69) did not differ than those who completed all three parts (n = 95) on their baseline depression scores; t(163) = .109, p = .914, or on their baseline optimism scores; t(163) = -1.077, p = .283.

Tests of baseline homogeneity between the two treatment groups were conducted and no 33

Empirical Investigations significant differences were found in sex;

2 (1)

= 0.62, p = .8, age; t(162) = -.113, p = .91, scores

on optimism; t(162) = .841, p = .40 or scores on depression; t(162) = .042, p = .96, between the two groups, indicating successful randomisation.

Baseline scores for participants’ who were analysed (n = 95) on the CES-D in both treatment groups indicated that the average participant was experiencing mild depressive symptoms at the time of measurement (M = 16.65, SD = 7.61); the cut off score for possible depression is 16 or greater (Radloff, 1977). See Table 1 for further details on CES-D baseline characteristics.

Participants scores on the LOT-R (n = 91) scored on average as “neutral” (M = 14.87, SD = 3.16) which matches the normative optimism levels for a college-aged sample (Scheier et al., 1994).

Table 1 CES-D Baseline Characteristics

Mean (SD)

Median Mode

CES-D Score

CES-D Score CES-D Score

≤ 16 (%)

17-26 (%)

≥27 (%)

Intervention 17.61(7.87) 17

17

43.9

43.9

12.2

Control

14

52.7

41.8

5.5

15.93(7.3)

16

Note. Data shown reflects only those participants who completed all three time points and were included in the analysis.

Effect of Intervention on Depressive Symptomology A repeated measures analysis of variance was conducted (two conditions by three time periods) with CES-D as outcome measure. This revealed a significant main effect for time with a large effect size, Wilks’ Lambda = .78, F(2, 92) = 12.76, p < .001,

= .217. This suggests that there

was a significant change in depression scores across the three time periods. Furthermore, a significant Treatment × Time interaction was found with a medium-large effect size, Wilks’ Lambda = .92, F(2, 92) = 3.95, p = .023,

= .079. This interaction effect is illustrated in Figure 2.

To test if this difference between the treatment groups at the four week follow-up was significant, a planned comparison using an independent samples t- test was conducted. This revealed that participants’ scores on depression in the control group (M = 11.18, SE = .98) significantly differed from the intervention group (M = 15.13, SE = 1.08) at T3, t(76.89) = 2.61, p = . 011. The magnitude of the differences in the means (mean difference = 3.95, 95% CI: .95 to 34

Student Psychology Journal, Volume III 6.95) was medium to large, d = .6. Therefore, participants in the early memories exercise experienced a significant decrease in depression scores compared to the three good things over the day exercise, four weeks after completing the two week writing exercise.

Furthermore, as this long term change in depression was unexpectedly observed in the control group, a Bonferroni post-hoc for the significant interaction effect was conducted to further understand the nature of the treatment groups individually and there influence on depression scores at each time period. Pairwise comparisons revealed that for participants in the intervention group, the difference were not significant between T1 and T3, p = 0.082. On the other hand, for participants in the control group, scores on depression significantly decreased between T1 and T3, p = .000.

Therefore, participants who wrote about early childhood memories for a two week period experienced significant decreases in levels of depressive symptomology, which were observed in the long-term, four weeks after completing the writing exercises. There was no comparable long- term change in depression scores for those who wrote about three good things over the day.

Effect of Intervention on Optimism A repeated measures analysis of variance was conducted (two conditions by three time periods) with LOT-R as outcome measure. This revealed a significant main effect for time with a large effect size evident, Wilks’ Lambda = .89, F(2, 88) = 5.35, p = .006,

= .108. This indicates that

there was a significant change in optimism scores across the three time periods. Furthermore, a significant Treatment × Time interaction was found with a medium-large effect size, Wilks’ Lambda = .93, F(2, 88) = 3.33, p = .04,

35

= .07. This interaction effect is illustrated in Figure 3.

Empirical Investigations

Estimated MArginal Means (CES-D)

20

18

16 Intervention: 3 Good Things

14

Control: Early Memories 12

10 Baseline

Posttest

Follow-up 4 weeks

Time Figure 2. Plot of means for depression scores over time. Error bars indicate standard error. Data shown reflects only those participants who completed all three time points and were included in the analysis.

18.000 Estimated MArginal Means (LOT-R)

17.500 17.000 16.500 16.000

Intervention: 3 Good Things

15.500

Control: Early Memories

15.000 14.500 14.000 Baseline

Posttest Follow-up 4 weeks Time

Figure 3. Plot of means for optimism scores over time. Error bars indicate standard error. Data shown reflects only those participants who completed all three time points and were included in the analysis.

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Student Psychology Journal, Volume III To test if this difference between the treatment groups at the four week follow-up was significant, a planned comparison using an independent samples t- test was conducted. This revealed that participants’ scores on optimism in the Control Group (M = 17.07, SE = .552) significantly differed from the Intervention Group (M = 15.4, SE = .605) at Time 3, t(97) = -.2044, p = . 044. The magnitude of the differences in the means (mean difference = -1.67, 95% CI: -3.29 to -0.48) was small to medium, d = .4. Therefore, participants in the early memories exercise experienced a significant increase in optimism scores compared to the three good things over the day exercise four weeks after completing the two week writing exercises.

Furthermore, as this long term change in optimism was unexpectedly observed in the control group, a Bonferroni post-hoc for the significant interaction effect was conducted to further understand the nature of the treatment group individually and there influence on optimism scores at each time period. Pairwise comparisons revealed that for participants in the intervention group, there was no significant differences between T1 and T3 scores, p = 1.00.

However, for participants in the control group, scores on optimism also significantly increased between T1 and T3, p = .000. Therefore, participants who wrote about early childhood memories for a two week period experienced significant increases in levels of optimism, which were more pronounced at the four week follow-up. There was no comparable long- term change in optimism scores for those who wrote about three good things over the day.

Effect of Intervention on Depressive Symptomology, controlling for Optimism It was hypothesised that the effects of treatment group on depression scores across time would be eliminated when controlling for participants changes in levels of optimism. A repeated measure analysis of covariance was conducted with changes in LOT-R scores (between T1 and T2, and between T2 and T3) serving as covariates. This confirmed that controlling for differences in optimism change scores across T1 and T2 did not have an effect on the influence of treatment group on depression scores across time. The Treatment × Time interaction remained significant, with minimal change in F value and a medium-large effect size, Wilks’ Lambda = .923, F(2, 86) = 3.57, p = .032,

= .077. When controlling for differences in optimism

change scores between T2 and T3 the influence of treatment group on depression scores across time became non-significant, Wilks’ Lambda = .962, F(2, 85) = 1.66, p = .195. Therefore, when controlling for the changes in optimism scores between T2 and T3, the intervention no longer accounted for changes in depression scores. This suggests that this long-term change in increased levels of optimism appear to be driving the long-term changes in depression seen in the control group. It appears that variations in increased changes in optimism accounted for changes in depressive symptomology between the groups over time.

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Empirical Investigations Discussion The purpose of this study was to re-evaluate the long-term effect that writing about three good things over the day, and there causal explanations, has on alleviating depressive symptomology and increasing levels of optimism, compared to writing about three memories from the past.

Four weeks following the completion of the two-week writing interventions, there was indeed, a significant change in both participantsâ&#x20AC;&#x2122; levels of depressive symptomology and optimism.

However, unexpectedly these favourable changes were found amongst participants who wrote about three memories from the past as opposed to the hypothesised change, which stemmed from Seligman et al.â&#x20AC;&#x2122;s (2005) original findings. Furthermore, when controlling for increased levels of optimism between T2 and T3, there was no longer a significant interaction between the treatment groups and depression. Therefore, writing about memories from the past directly instigated an increase in levels of optimism, which in turn acted as a buffer against, and assuaged levels of depressive symptoms for up to four weeks after writing.

In order to explain these findings, it was necessary to re-visit the writing assignment that was sent to participants who completed the early memories exercise. Memories from the past submitted by participants predominantly comprised of memories concerning significant milestones, family-orientated events and self-important events. On the other hand, examples of three good events recalled during the day were far more mundane and typical and included, progress with college work, assignments completed, watching a good film, chatting with housemates, and meeting friends/spouses for lunch/drinks. There have been some intriguing findings in the literature on autobiographical memory that may serve to account for these observations.

Events submitted in the early memories exercise were examples of autobiographical memories, many of which were periods of transition, milestones, personally significant events, and firsttime experiences. These specific types of autobiographical memory are high in affective intensity and vividness, have high levels of rehearsal, and are personally important (Moffitt & Singer, 1994). Seemingly, what is important is how this information has been incorporated into the person's life story (McAdams, 1985) via rehearsal and reappraisal. Events submitted in the three good things over the day exercise were explicitly habitual events, typical of every-day life occurrences, which may be classified as low in intensity and hence are not afforded such reappraisal luxuries as the autobiographical memories. A multitude of studies have validated these claims and have shown that high-intensity memories were thought or talked about more often than low intensity memories (Berntsen, 1998; Waters & Leeper, 1936). It is asserted that the intensity of the memory is a better predictor of these properties than is the recency of the

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Student Psychology Journal, Volume III memory (Talarico, LaBar & Rubin, 2004). When positive self-relevant events deemed as valuable moments to one's life story, such as those presented by our participants, were made salient, they provoked more intense positive affect than when recalling events that occurred that day. Findings from several studies, particularly in studies concerning post-traumatic stress disorder, suggest that autobiographical memories produce an emotional response comparable to that experienced at event occurrence (Walker, Skowronski, Gibbons, Vogl, & Ritchie, 2009b).

As aforementioned, research also shows that recalling past accomplishments and retrieving positive information regarding the self can alleviate negative affect (Josephson et al., 1996). The rehearsal over a two week period in the present intervention appears to have aimed at reexperiencing the emotions associated with the recalled event.

The intensity of emotions associated with retrieving these autobiographical memories, and their subsequent influence on optimism and depression, may be explained using the broaden and build theory of emotions (Fredrickson, 2005). It asserts that through experiences of positive emotion, oneâ&#x20AC;&#x2122;s mindset becomes transformed and habitual styles of thinking are broadened, instigating the development of durable personal resources. In this manner, it is posited that accessing positive aspects of the self-schema through thinking about positive events from the past, activates positive emotions (Berntsen, 2001) which creates a broadening of cognition, and through this, pathways that bolster optimism are stimulated. This contributes to the extensive benefits of mobilizing optimism (Gillham, et al., 1995; Magyar-Moe, 2010) and future interventions therefore need to focus on promoting this strength.

Although writing about positive past events led to statistically signiďŹ cant decreases in depression through fostering optimism, these results are viewed as highly preliminary and caution is urged on several grounds. First, there was a very high attrition rate (57.9%) and a final sample size of 95 participants. Although this may be viewed as relatively small, it is noted that this sample size is substantially larger than most psychotherapy outcome studies (see Seligman, Rashid, & Parks, 2006). Second, the participants were University students thus studies with clinical populations and non-student populations are still needed to address the clinical relevance and generalizability of such findings. Nevertheless, the findings are very promising as these participants reported mild depression on average. Thus the present study is certainly an advance in the desired direction. According to Kline (1964) more human suffering has resulted from depression that from any other single disease affecting humankind â&#x20AC;&#x201C; thus an intervention that is self-maintaining, self-reinforcing, cost effective, and so easily distributed

39

Empirical Investigations and integrated into the daily routine of the client is an exciting discovery.

Finally, one must return to a question posed by Seligman et al. (2005) - which interventions really work in establishing long-term benefits and which are at best placebos? This study serendipitously discovered an effective exercise with its own specific ingredient; that increasing levels of optimism, through writing about positive past events decreased levels of depressive symptomology, which was hitherto employed as a control exercise. This highlights the necessity of ongoing randomised controlled trials in testing the efficacy of proposed PPIs before application into practise. The present study indicates that activating positive autobiographical memories may be effective in targeting optimism, a strength known to safeguard against depression. Future research needs to identify both the specific and common components explaining how different PPIs work effectively, so that they can be optimally delivered and customized to meet each client’s specific needs.

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Empirical Investigations

Growing up on Farms: a Qualitative Exploration into Children’s Perceptions of their Way of Life Kate O’Gorman Trinity College Dublin ogormank@tcd.ie

The purpose of this study was to examine the perceptions children from farming backgrounds held with regard to their lifestyles. To achieve this, 8 qualitative interviews and 2 focus groups were conducted with 18 children growing up on farms in rural Ireland today. A thematic analysis of this data revealed four overarching themes. These were concerned with the positive experiences of the farm life for the child, the responsibility and labour intensive aspects of their lifestyles, the contributions of the farm in shaping the child’s identity and finally the parameters of isolation in their community This study provides an insight into the markedly different lives that children from farming backgrounds perceive themselves to lead. It suggests that the farm environment contributes to the internalization of a unique identity and further research is called for with specific reference to gender identity formation, isolation in the community, and the transition to adolescence.

Introduction There is a growing body of research in the social geography domain that currently examines differences between rural and urban environments. However, the importance of issues such as rural children’s peer isolation and its impact upon their psychosocial functioning suggest that research beyond the discipline of social geographers may be warranted. Researchers have identified that “the rural childhood” is not a unitary concept (Matthews, Taylor, Sherwood, Tucker & Limb, 2000) but instead ‘many rurals’ (Pratt, 1996) may exist. Recent work in Ireland

by McGrath and Nic Gabhainn (2001 & 2007), has highlighted marked differences between children who grow up in farm households and those who do not, showing how this particular group of children may encounter an acute form of isolation in their everyday lives. However, there is a dearth of research in the psychological and sociological literature examining the experiences of children from farming households. The present study aims to address this by conducting qualitative interviews with young children growing up on farms in rural Ireland today.

A vast amount of research exists in relation to the impact being raised in a rural or urban environment may have on children (Valentine 1997; Nairn, Panelli, & McCormack, 2003; 44

Student Psychology Journal, Volume III Vanderbeck & Dunkley, 2003). A great deal of attention has focused on the countryside as an ideal environment for children with its inherent tranquillity, proximity to nature and unique social fabric. Reports from Growing up in rural Scotland have even suggested that residing in rural areas may benefit children’s physical health (Jamieson, Bradshaw & Ormston, 2008). This notion has been challenged by Watkins and Jacoby (2007), who attempted to deconstruct the rural ideal and the perceptions that it may benefit health when they examined stigma and social exclusion from rural environments. For people living outside the present gemeinschaft, which refers to kinship and social relations that have existed in a rural place for some time, they argue that this gemeinschaft may in fact lead to exclusion and stress, which may ironically contribute to risk factors for a variety of illnesses.

Matthews et al. (2000) also highlighted how the rural ideal can in fact be challenged by issues of exclusion, isolation and disfranchisement. The “expectation of the Good Life” may not in fact transfer to reality, as children and adolescents have highlighted the negative experiences associated with growing up in poorly serviced areas and having “nothing to do” (Matthews et al., 2001, p. 144). In their ethnographic study of farming families Garkovich, Bokemeier and Foote (1995) have also highlighted how “physical and psychological distances” are part of the rural experience (p. 57).

Internationally children’s lives on rural farms have been given very little research attention with the exception of some North American studies which have reached similar conclusions in their examination of farm children’s lives. Esterman and Hedlund (1995) conducted a longitudinal study with farm adolescents in upstate New York and discovered a pattern of close relationships between the adolescents and their families. Many of the adolescents interviewed felt that their experience of growing up on a farm was generally a positive one, providing opportunities to be close to family, nature and animals. They also addressed the positive aspects of personal responsibility and an appreciation for the difficult working lifestyle. Several of the adolescents felt these values existed directly as a result of being raised on a farm. However some of the adolescents also outlined the limitations that farm youth face in the form of isolation from peers, activities and a lack of free time. This notion of isolation for farm youth has also been addressed by Weigal and Weigal (1987) where they found farm youth reported a reluctance to seek help in coping with stress from those unknown to them, instead they were found to be much more self-reliant on their family unit.

In 2000, Elder and Conger published findings of a longitudinal study that examined the lives of farm youth in rural Iowa. Their study employed both qualitative and quantitative methods and showed how participants endorsed similar beliefs to the adolescents in Esterman and Hedlund 45

Empirical Investigations (1995), with regard to the isolating pattern of farm work and reduced access to activities outside the farm. Greater dependence on the family unit was also observed. However, these farm youth, when followed up almost a decade later, proved to be more socially and academically successfully in later life when compared with their counterparts who did not have any connection to farms.

Cummins (2009) examined the issue in a Canadian setting, conducting interviews with children aged between 7 and 12 years old. Her findings suggested that a farm setting contributes to constructing traditional gender roles for the children. Her study also examined the farm not only as a work place, but also that of an open play space linking, with other international research into the play space utilised by rural children (Valentine, 1997).

In Ireland an examination of the literature in relation to urban-rural childhoods is not very extensive, and studies focusing on farm youth in particular are extremely limited. Recent research from Growing up in Ireland (GUI) (Williams et al., 2009) examines issues in relation to the rural-urban demographic, but does not explain in great detail reasons for differences that exist within this dichotomy. Narrowing the focus to a farming lifestyle, Ni Laoire (2006) has commented on the dramatic changes Irish rural society has undergone in recent years. She suggests that a declining population and changing agricultural system, place certain institutions under threat, in particular the norms and identities of many young farmers. This suggests the importance of examining the issue of identity amongst future generations.

Research by McGrath & Nic Gabhainn (2001 & 2007) has highlighted the importance of place and community to children in the Irish context. In particular they have examined prominent issues such as age, gender and socio-spatial contexts of rural or urban and how these variables may interact with each other and in turn influence a young personâ&#x20AC;&#x2122;s encounters and perceptions of where they live. They have also examined how these may influence friendship patterns amongst the children.

Positive peer relations play an extremely important role in many aspects of a childâ&#x20AC;&#x2122;s life, from healthy psychological adjustment (Kupersmidt & Coie, 1990; Chung-Hall & Chen, 2010) to promoting a high level of academic performance (Bellamore, 2011; Kindermann, 1993).

McGrath & Nic Gabhainn (2001 & 2007) suggest that within the rural context there are marked differences between children who grow up in farm households and those who do not. There was no surprise in their findings that rural children would encounter barriers such as geographical and subsequent peer isolation. Remarkably, marked differences are seen with children from farm households who spend even less time with their friends, less time involved in clubs, and

46

Student Psychology Journal, Volume III less time utilising communication technologies when compared with those from non-farm households; suggesting they encounter a more acute form of isolation in their everyday lives.

Similar to Elder and Conger’s (2009) adolescents, despite lower levels of peer interaction, Irish farm youths are amongst those who attain the highest level of representation at both second and third level education (Clancy, 1995). They are significantly over represented at third level, second only to the children of managers and employers in a socio-economic group distribution (O’Connell, Clancy & McCoy, 2004). This would appear to contradict the peer relations academic performance literature. However, O’Hara (1997) has suggested that Irish farm mothers play a unique role in encouraging and promoting a high level of academic achievement in their children. This could reinforce the importance of the family unit to the farm youth in the Irish context.

Mc Grath & NicGabhainn (2001) also examined the children’s perceptions of place and discovered that farm youths were much more likely to report positive perceptions of their surrounding area and increased feelings of safety and friendliness. However, they are less likely to describe their area as “well-off” when compared with their non-farm rural and urban counterparts.

In a psychological domain one of the most renowned theoretical frameworks for a child’s environment and its influence on their development, comes from the work of Urie Bronfenbrenner (1989). In his bioecological model (Bronfenbrenner and Morris, 2007) children are situated from the outset, inside a microsystem of family, school and neighbourhood. These in turn interact in the mesosystem with bodies of indirect influence from the exosystem, such as family social and community contexts. This theoretical model outlines the relevance of exploring factors in the child’s farming environment which may influence them.

The literature suggests that opportunities for farm youth are shaped and defined by their sociospatial context. This paper intended to examine the lifestyles of farm youth in Ireland today and tease apart the challenges and unique perceptions outlined by previous Irish and international research. It is important to address the idea of isolation and how the farm youth may experience it. As a dearth exists in the Irish literature that details these unique experiences, it is expected the topic will benefit greatly from addressing these issues directly with the children (Docherty & Sandelowski, 1999).

The study endeavoured to conduct semi-structured interviews with pre-adolescent children aged between 11 and 12 years old in an attempt to widen the scope of this research area. It is hoped that qualitative data on the children’s perceptions of their lifestyles will serve to

47

Empirical Investigations compliment previous quantitative research by McGrath & NicGabhainn (2003 & 2007), which they specifically called for in their conclusions. It is hoped this qualitative investigation will produce a more holistic picture of a way of life experienced by the children from farming backgrounds in Ireland today.

Method Participants Eighteen children aged between 11 and 12 years old took part in this study. Eight children, five boys and three girls took part in individual interviews. A further ten children, six boys and four girls, took part in two separate focus groups.

The children were recruited from three rural primary schools within the same parish in the West of Ireland. All children were Irish and spoke English fluently. All the children also reported having at least one sibling.

The children came from a household where one or both parents were engaged in farming as an occupation, either full or part time. All farms types were either beef or dairy.

Analysis All the interviews were then transcribed verbatim by the researcher which facilitated familiarisation. A thematic analysis of the transcripts was conducted according to the guidelines put forward by Braun and Clarke (2006) and Kvale and Brinkmann (2008). Initial coding was conducted by hand on printed versions of the transcripts. All the codes were then tabulated, categorised and streamlined into the themes and sub-themes presented below.

It is important to note that internal coherence was established as similar themes continued to reappear in the transcripts. Particular attention was paid to instances where the researcher may have led the child with the line of questioning. These discourses were excluded from the results.

Finally the themes were reviewed by an academic with experience of working with qualitative data, for internal validity.

Findings From the data four overarching themes emerged with 12 sub themes in total.

The first theme Positive Farm Experience is concerned with the childrenâ&#x20AC;&#x2122;s positive perception of life on a farm, and the unique experiences they are exposed to.

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Student Psychology Journal, Volume III Secondly, Responsibility, Expectations and Hard Work emerged as a theme as the children revealed their understanding of generational farms, a labour intensive lifestyle and the challenges these posed.

Farm as an Identity emerged as some children highlighted how the farm meant “everything” to them and described it as “A good way of living”. The children highlighted aspects of farm life such as gender role differentiation, and negative stereotypes that would contribute to their own sense of identity.

Finally Activity and Isolation in the Community was identified as the children recounted their experiences of geographical isolation, structured activities and how this impacted on their peer relations.

Note: [ ] represents an overlap in speech during a focus group discussion.

For the purposes of this study all the children have been given pseudonyms.

1. Positive Farm Experience 

Open Rural Space vs. Crowded Urban Areas

One of the most striking themes to emerge from the data was the children’s disdain for urban life, contrasted with their own sense of tranquillity and open space in the countryside.

When asked if they could imagine not living on a farm, the children spontaneously assumed this meant leading an urban life. “ I Don’t know,… if I lived in a city I wouldn’t like it…it’s louder on the streets and stuff and like it’s nice and quiet where I live so.” (Lisa, age 12) “The air is more, how would you say, nicer than you’d get in the city, the city’s very closed in, but on the farm it’s open. (Gearoid, age 12) 

Farm as a Play Space

Many of the children also commented on playing on the farm with friends and siblings. The references to play also highlighted the role siblings play in each other’s lives on the farm: “We play cops and robbers in the hay and it’s so much fun like you could be inside hiding behind the cattle.” (Deirdre, age 12)

49

Empirical Investigations Close to Animals and Nature



Some of the children commented on how they felt others would miss out on the being close to nature if they didn’t grow up on a farm: “Ah, seeing all the stuff going on around the place, all the natural stuff like, unlike what you’d see in the city, they’re all just running round the place in cars, but just walking around with the cattle and all” (Gearoid, age 12) Children also recounted their experiences of death on the farm: “We had this old cow … and she had this lovely calf, but she died a few days afterward cause it turned out there was another calf inside her. Then after a few months you could see the skeleton of a calf on the ground. (Donnacha, age 12) As Gearoid describes above they have a rare exposition to “all the natural stuff” incorporating the natural cycle of life and death.

Source of activity



Many of the children highlighted how the farm could act as buffer against boredom and highlighted the gains from having work to do: “ You’d always have dreams like to live in Barcelona with a huge mansion, and everything, but when it comes down to it, like you’d have your swimming pool and everything, but like what if like you’re tired of doing all that stuff? Like on a farm you got loads of stuff new to do.” (Donnacha, age 12) “You’d miss out on being useful.” (Liam, age 12) “My cousins live in the countryside without a farm, and they just sit down playing the Xbox all day. It’s just unhealthy like, they get no fresh air.” (Connor, age 12) 2. Responsibility of expectations and hard work 

Family Farm

Many of the children were aware of the farm being a generational object and spoke of how the land had been passed down from their grandparents. Running of the farm was seen as a duty and a responsibility that a lot of the children accepted: “Well like if you’re the older person and you’re gonna take over the farm and your father dies or somethin’ it’s a responsibility then.” (Liam, age 12) 50

Student Psychology Journal, Volume III Some of the boys were aware that their future paths were beginning to be mapped out: “I’m coming to the age now where dad’d always be giving us these tips and everything, and he’d be bringing us to farm walks.” (Donnacha, age 12) Of the ten boys interviewed only one boy reported disliking farming as a way of life.

"SN: I don’t like farming, I only have to move cows about once a month and that’s it.

CC: Yet he lives on a farm and his Dad’s a farmer!” (Sean & Cormac, age 12) The same boy reported a desire to be rid of the farm in the future: “I’d sell all the cows and the land” (Sean, age 12) Some of the boys found this funny initially but continued to probe Sean about his nonconformist attitude. When the interviewer asked Sean about his work, he admitted that he simply didn’t enjoy farm work but was still expected to help out regularly. 

Labour intensive

Some of the children highlighted the difficult lifestyles their parents lead paying reference to early mornings and long hours: “Like you’d be gettin’ up at the cock crow every morning and then going to bed very late in the evenin’” (Donnacha, age 12) All of the children reported helping out on the farm at different times with a considerable amount having set jobs to do daily and weekly: “My daily job is to bring in a bag of turf in the evening, and in the morning I have to bring in a bucket of milk, then if he needs us to stop cattle during the day, we’d do that after school.” (Gearoid, age 12) Interestingly the children’s perception of the responsibility and labour was one of acceptance and a willingness to help ease the workload. When asked if his help was important to the farm one boy replied: “Yea, cause like one man can’t do it all d’ya know” (Connor, age 12) Some children were not as content with the workload or the restrictions it placed both directly and indirectly on their lives:

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Empirical Investigations “Well my Dad doesn’t go on holidays with us so it’d be nice if he went on a plane holiday with us. Normally the only holidays we’d have altogether as a family would be about three days” (Niamh, age 12) 3. Farm as an identity 

Negative perceptions of farm life

The children were acutely aware of non-farm individuals’ negative perceptions and stereotypes, as they viewed them: “CA: They think that like we’re awful.

DA: They think we’re workaholics CA: Dirt and all that stuff we don’t wear dresses [ DE: ] They think they’re like all posh and they think we’re weird.

DA: We’d be wearing these like ripped jeans and wellington boots with holes and everything.

SA: They think like, you know those cheque shirts with those caps with straw coming out of your mouth all howdy partner.” (Ciara, Deirdre Donnacha & Sarah, age 11, 12, 12, & 12) Some of the children were in agreement that having a farm did not constitute a modern or affluent lifestyle and indeed some suggested it led to their family not being constituted as a “modern family” (Liam, age 12). However, they insisted that their lifestyle was still the most desirable: “Well as a family having a farm it’s not posh. Kind of not having a farm though you don’t get to do anything fun.” (Liam, age 12) 

Gender Roles

In relation to identity and roles the majority of girls reported helping out about the house and having traditional female tasks while their brothers were expected to help on the farm. Only two of the boys interviewed reported doing any chores inside the house: “Everyday I clean the kitchen and on Mondays I like to make cakes or cookies for my Dad and my brothers” (Sarah, age 12) None of the girls interviewed expressed any desire to be farmers when they grew up, instead opting for more traditional roles such as teachers; yet they maintained they would like to live on 52

Student Psychology Journal, Volume III farms in the future. Eight out of ten boys reported wanting to become farmers when they grew up The role the men played on the farm was clearly defined by girls: “We’d need help, like we’d need a man on the farm to help.” (Niamh, age 12) There was also an expectation for boys to enjoy the traditional masculine roles and shock when they refused to adopt these roles: “My neighbour he’s new he’s just moved here… but (he) isn’t used of it (the farm work) he’s into shopping, all girly like, he’d never actually be around the farm.” (Ciara, age 11) Activity and isolation in the community 

Variety of structured activity

Contrary to previous research all but two of these farm children reported a significant amount of after school activity: “Ah, swimming and dancing and I’m going to flute lessons the same day as the dancing, then I do tin whistle that night. Then on Thursday , I’ve piano and banjo on after each other, then for the rest of the week it’s mostly helping out on the farm” (Gearoid, age 12) Despite the amount of activities, the children reported only a small number of incidences where they met their friends outside of school or structured activities. 

Geographical isolation

The children also reported experiences of geographical isolation whereby they had limited access to activities and felt there was a great distance between them and their peers: “I can’t (walk or cycle to friends’ houses) if I was to cycle or walk, I’d be walking five miles” (Ciara, age 11) Despite being aware of the isolation, the children did not report feeling negative consequences and instead were accustomed to the distances they travelled to access various facilities. They did not report being at a specific disadvantage or report any feelings of peer rejection. 

Positive perception of area

Clear efforts were made by the children to present their area in a positive light and downplay the notion of isolation. All of the children interviewed reported feeling safe in their area and listed familiarity with the majority of people in the area as the main contributory factor. A 53

Empirical Investigations considerable amount of the children reported having grandparents who played an active role in their lives, and on their farms, living nearby: “Because everyone is relatives and they would always, like if anything happened like they’d always look after ya, and if anything happened to them, we’d always look after them. D’ya know everyone helps everyone” (Connor, age 12).

Discussion From the findings above it is evident that children growing up on farms perceive themselves as leading distinctly different lives from their non-farm counterparts. Almost all of the children agreed that their experience of growing up on a farm was a positive and unique one. This was displayed with the level of contrast that the children drew between their own lives and those who were not afforded the opportunity, as they saw it, to grow up on farms. The children very often felt that they had a unique insight into “all the natural stuff going on” around them, being close to animals and also having a great deal of their own space. Cummins (2009) reported similar findings of children utilizing the “imaginative geography” they find themselves in. The children’s desire for outdoor activity would appear to contradict the “allure of indoor entertainment” described by Valentine (1997, p.143) and is also surprising in light of recent GUI findings which suggests that Irish children spend a considerable amount of time with indoor entertainment (Williams et al., 2009). Some of the children appear to develop a strong work ethic and sense of responsibility which could feasibly be related to farm children’s academic success later in life.

Overall the children reported a positive attitude toward the notion of a generational farm and the responsibility associated with it. They paid specific reference to spending time with family on the farm and the importance of having family close by, supporting international research and also precisely demonstrating Bronfenbrenner’s bioecological microsystem. The children appear to draw a great deal of comfort from the kinship that the gemeinscheft in their lives can offer. It may be fair to suggest that we are underestimating the significance that a sense of community and social capital could hold for these children in our westernized individualist culture. Some aspects of the child’s environment such as their family and community social relations would normally be placed in the child’s exosystem; however, it may be fair to argue that for farm children these may exercise a more direct influence in their lives. As Garkovich (1995) commented, the farm is not only the family home but also the business, a business which actively interacts with the wider community, drawing this influence directly into the child’s life and impacting on their identity formation.

54

Student Psychology Journal, Volume III This issue was particularly pertinent when the children referred to the formation of gender role stereotypes as defined by specific labour divisions on the farm and home. Eight out of ten boys reported wanting to become farmers when they grow up, demonstrating the esteem in which they hold an agrarian way of life. Conversely, the girls did not wish to become farmers and instead opted for more traditionally female roles such as teaching. The children felt that the boys who did not like or understand farming were “girly” and that men had a specific physical role to fulfil on the farm. Cummins (2009) reported similar findings in her Canadian sample.

Future research could perhaps examine how these gender roles translate to the children’s lives when they move outside the farm environment.

Contrary to findings from NicGabhainn and McGrath (2001), the children interviewed appeared to engage in a great deal of activities in their local area, however the children did not report spending a great deal of time with friends outside of these activities; this was seemingly linked to the geographical isolation they experienced. However, at this preadolescent stage the children do not appear to reflect on the notion of isolation as having specific negative consequences. Interestingly much of the literature dealing with peer isolation is in fact dealing with peer rejection which none of these children make any reference to. They appear to draw solace from the fact that their lifestyle is by no means in a minority in the rural area. This may suggest that “isolation” may only be interpreted in the geographic sense and has no emotional bearing at this pre-adolescent stage.

Similar to findings by Watkins and Jacoby (2007), clear efforts were made by the children to present their area in a positive light and protect their social capital. They may not necessarily be aware or alternatively, be willing to accept the drawbacks their way of life presents. Future research could expand on the child’s transition toward a more negative attitude in adolescence.

Future research could examine if gaining insight to an urban environment during adolescence as the children attend secondary schools will impact positively or negatively on the child’s internalization of their own lifestyle.

Limitations and other future directions It is important to note that the empirical data presented here is not necessarily representative of the population of farm children, nor is it to be taken as the definitive narrative of young people’s experiences of growing up on a farm .The convenient sample is derived from a small parish in the West of Ireland where a large proportion of the farm types and sizes are similar, therefore some of the findings may not be generalizable. Future samples could be taken from various locations throughout the country. Determining the socio-economic status of the child’s family and also gaining parent’s perspectives would greatly benefit future research in this area.

55

Empirical Investigations The limitations however should not detract from highlighting the key findings of this exploration. This study suggests that children from farming backgrounds perceive themselves as leading markedly different lives from their non-farm counterparts. These differences have rarely been previously acknowledged. The specific consequences of this uniquely different way of life, such as internalization of a distinct agrarian identity, overcoming barriers such as isolation, and how these may interact as the child becomes older should be considered for future research.

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Matthews, H., Taylor, M., Sherwood, K., Tucker, T., & Limb, M. (2000). Growing-up in the countryside: children and the rural idyll. Journal of Rural Studies, 16, (2) 141-153.

McGrath, B. & NicGabhainn, S. (2001). Friendship patterns among rural, farm and urban children and adolescents in Ireland, Administration, 55 (3), 205-226.

McGrath, B. & NicGabhainn, S. (2007). Worldviews Apart? Perceptions of Place among Rural, Farm and Urban Young People in Ireland. Youth Studies Ireland, 2 (1), 17-31.

Nairn, K., Panelli, R., & McCormack. (2003). Destabilizing Dualisms: Young People's Experiences of Rural and Urban Environments, Childhood, 10, 9-42.

O’Connell, P., Clancy, D., & McCoy, S. (2006). Who went to college in 2004? A National Survey of Entrants to Higher Education. Dublin; Higher Education Authority, The Stationary house.

O’Hara, P. (1997). Women on Family Farms-Wives, Workers and Mothers. Irish Journal of Sociology,7,124121.

Pratt, A.C. (1996). Discourses of rurality: Loose talk or social struggle? Journal of Rural Studies, 12(1), 6978.

Valentine, G. (1997). A safe place to grow up? Parenting, perceptions of children's safety and the rural idyll. Journal of Rural Studies, 13(2), April 1997, 137-148.

Vanderbeck, G., & Dunkley, C.M.(2003) Young People's Narratives of Rural-Urban Difference. Children's Geographies,1(2), 241-259.

57

Empirical Investigations Watkins, F., & Jacoby, A. (2007). Is the rural idyll bad for your health? Stigma and exclusion in the English countryside. Health & Place, 13(4), 851-864.

Weigal, R.R., & Weigal, D.J. (1987). Identify stressors and coping strategies in two generation farm families. Family Relations, 36, 391-394.

Williams, J., Greene, S., Doyle, E., Harris, E., Layte, R., McCoy, S., McCrory, C., Murray, A., Nixon, E., McDowd, T., O'Moore, M., Quail, A., Smyth, E., Swords, L. & Thornton, M. (2009) Growing Up in Ireland: The Lives of nine-year olds. Dublin: The Stationery Office.

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Student Psychology Journal, Volume III

Investigating Prevalence and Impact of symptoms of ADHD in a sample of children with Autism Orla Oâ&#x20AC;&#x2122; Callaghan & Dr Olive Healy National University of Ireland, Galway O.OCALLAGHAN1@nuigalway.ie Research has observed that autism and Attention Deficit Hyperactivity Disorder (ADHD) may be somewhat intertwined, and that individuals who have displayed symptoms of one, very often have displayed symptoms of the other. This study aimed to identify the occurrence of ADHD symptoms in children with autism, and investigated the impact of such on quality of life (QOL). Participants were 43 children diagnosed with autism, 20.93% (N = 9) female and 79.07% (N = 34) male, with a mean age of 9.90 years (SD = 4.38 years). Parents of the children completed a demographic questionnaire and three rating scales; the Conners-3 ADHD Index, the Gilliam Autism Rating Scale, and the Pediatric Quality of Life Inventory. A number of t-tests and correlation analyses were used in conjunction with multiple regression analyses to examine the data. The majority of the group (76.74%) had an ADHD score of higher than average, with 69.77% of the overall group ranking in the highest possible score category based on their very elevated scores. ADHD was found to be strongly connected with both autism severity and quality of life. In relation to demographic factors, although differences based on age, gender, medication use, and co-morbidity were observed, no strong relationships were found with ADHD.

Introduction The prevalence for Autism and Attention Deficit Hyperactivity Disorder (ADHD) is approximately one in 88 children and 6.69%, respectively (Boyle, et al., 2011; Center for Disease Control and Prevention, 2012). However, these statistics were based on an American population, and their accuracy transferring onto other groupings is unknown. In Ireland, there has been no overall data collection to discover the number of individuals with either of these disorders. Autism has been classified as a neurodevelopmental disorder that is displayed in behavioural impairments in areas of social interaction and communication, and in the occurrence of stereotyped behaviours (American Psychiatric Association, 2000). ADHD has been defined as a neurobehavioural disorder that causes inattention, hyperactivity, and impulsivity (American Psychiatric Association, 2000). In recent years, it has been uncovered that these two neural based disorders may be intertwined and individuals who display symptoms of one often display symptoms of the other. The current study aimed to identify this occurrence, and investigated what the impact of such might be.

59

Empirical Investigations Autism and ADHD similarities and epidemiology.

There are a number of similarities in the two disorders and in the individuals with them. The difficulties that arise for children with autism and children with ADHD can be very similar. Both groups have problems with motor coordination, adaptive functioning, and effortful control (Murray, 2010). Areas of the brain related to the disorders are also thought to be the same (Murray, 2010; Sinzig, Bruning, Morsch, & Lehmkuhl, 2008). Autism and ADHD are both considered to have a strong genetic component and to be inheritable. It is a common occurrence for one sibling to have autism and another to have ADHD, or a combination of the two (Rommelse, Franke, Geurts, Hartman & Buitelaar, 2010). The source of the disorders appears to have much in common; overlapping affected areas of the brain, genetic basis, and hereditability.

The prevalence of symptoms of autism in children with ADHD. A number of studies have investigated the incidence of symptoms of autism in children with ADHD (for example, Grzadzinski et al., 2011; Kochhar et al., 2010). Rommelse, Franke, Geurts, Hartman, and Buitelaar (2010) reviewed a number of studies and concluded that between 20% and 50% of children with ADHD also met the diagnostic requirements for autism. This figure has been recorded to be as high as 75% in other studies (Reiersen, Constantino, Volk, & Todd, 2007), supporting the notion of the two disordersâ&#x20AC;&#x2122; entwinement.

The prevalence of ADHD symptoms in the population of children with autism.

Previous research, including twin, family-based, candidate gene, linkage, and genome wide association studies, has explored the occurrence of ADHD symptoms in children with autism (for example, Hattori, et al., 2006; Lee & Ousley, 2006; Yoshia & Uchiyama, 2004). Overall, the work has found that 30% to 80% of children with autism meet the diagnostic criteria for ADHD (Rommelse, Franke, Geurts, Hartman, & Buitelaar, 2010) with some studies finding rates of up to 95% presence (Grodberg & Kolevzon, 2009). Of the research examined, no study found a lack of the presence of ADHD symptoms in their samples of the autism population.

Importance of investigating ADHD symptoms in the autism population.

The implications of having both autism and symptoms of ADHD are greater than the effect of displaying just one of these symptomatologies. Children who are believed to have autism whilst also exhibiting co-occurring ADHD symptoms generally experience a more difficult daily life; they display a larger amount of symptoms, in a more challenging manner, and also require higher levels of hospitalization (Autism Speaks, 2011; Grodberg & Kolevzon, 2009). If it is 60

Student Psychology Journal, Volume III accepted that a child with autism is also portraying symptoms of ADHD, suitable treatment can be carried out to help the reduction of unfavourable symptoms. This is not only important for the children, but it also critical for other stakeholders. An ambiguous diagnosis may be frustrating and challenging. Acknowledgement of the presence of symptoms of the two disorders can help the individuals to understand and accept the situation more successfully (Gadow, DeVincent, & Pomeroy, 2006).

The Present Study.

Data of this overall genre in Ireland is lacking, with no published studies from Ireland examining the extent of the overlap between ADHD symptoms in those diagnosed with autism. The current study aimed to investigate this concept. Recognition of the overlap between the two disorders may be positive for children with autism who are displaying these symptoms, and also inform assessment and intervention. The focal aim of this study was to examine ADHD symptoms and autism severity in a sample of children diagnosed with autism. A hypothesis that additional demographic factors, such as age, autism severity, and gender could have an impact on the occurrence and amount of ADHD symptoms was examined. The participantsâ&#x20AC;&#x2122; quality of life (QOL) was also of significant interest; it was predicted that the occurrence of ADHD symptoms would forecast health related QOL, and that a higher ADHD score would arise concurrently with a lower health-related QOL. To summarise, this study aimed to investigate the interaction and effect of the occurrence of ADHD symptoms in a person with autism.

Method Participants Data was gathered on 43 children diagnosed with autism, 20.93% (N = 9) female and 79.07% (N = 34) male, with a mean age of 9.90 years (SD = 4.38 years). The mean age of diagnosis was 4.91 years (SD = 1.60 years). Of the participants, 27.91% (N = 12) were using medication, 30.23% (N= 13) had co-morbid diagnoses, and 23.26% (N = 10) had a sibling with an intellectual disability or developmental disorder. The informants were the mother, father, or guardian of the participant. Recruitment of participants is detailed below. There was no reward offered for taking part in this study, but parents were informed that their information would be very valuable in informing research questions in the area.

Procedure Ethical approval was sought and granted by the School of Psychology, NUI Galway. Permission for the use of the PedsQL was sought and obtained from the Mapi Research Trust in France. A 61

Empirical Investigations participant pack was constructed including a letter addressing the parents an information sheet, a consent form, and the four measures, detailed below. An online version of such was also prepared on www.surveymonkey.com. Contact was made with a number of organisations, such as Irish Autism Action, Autism Assistance Dogs Ireland, and parent support groups, which informed parents about the study. Interested parents completed the measures either online (N = 13) or in paper form (N = 30). Following the closure of the project, each participant received a debriefing report, either by post or via email.

Measures Both online and paper forms of a number of measures were incorporated in the study. Measures included a demographic questionnaire along with three rating scales. Informants first completed a participant demographic questionnaire followed by the Conners-3 ADHD Index (AI) Scale, the Gilliam Autism Rating Scale (GARS-2), and the Pediatric Quality of Life Inventory (PedsQL). The participant questionnaire gathered general demographic information for each participant, including age, gender, age at diagnosis, medication use, co-morbid diagnoses, number of siblings, and whether the siblings had an intellectual disability or developmental disorder. The three scales included specific instructions on the method by which to score and interpret the responses.

The Conners 3rd Edition ADHD Index Form (AI; Conners, 2008).

This scale was used to measure the presence of symptoms of ADHD. It was developed for people between the ages of six to 18 years. The measure consisted of 10 items. For each of the participants, a raw score was calculated which was then transformed into a probability score and a standardised t-score using the tables provided. Tests for discriminative validity by Gasllant and Sitarenios (as cited in Conners, 2008) concluded that the index could reliably distinguish the ADHD group from the general population. Across-informant correlations showed that there was a great deal of consistency between different informant’s ratings of the same individual. Finally, relative to validity, convergent and divergent validity was ascertained by tests conducted by Marocco and Rzepa (as cited in Conners 2008). In relation to reliability, Marocco et al. (as cited in Conners, 2008) found the Conners-3 AI to have strong internal consistency, test-retest reliability, and inter-rater reliability. The scale reliability conducted in this study revealed (Cronbach’s α = .97, 95 % CI = 70.87 – 82.85).

The Gilliam Autism Rating Scale 2nd Edition (GARS-2; Gilliam, 2006).

This measure was used to determine each participant’s autism severity score, that is, their Autism Index. The scale had an age range of three to 22 years. The measure was composed of 42 items, divided into three subscales, each of which consisted of 14 items. These categories were 62

Student Psychology Journal, Volume III stereotyped behaviours, communication, and social interaction. A raw score for each subscale for each participant was calculated. This score was then computed into a percentile mark and a standard score. The sums of the subscale standard scores were then transformed into participants’ Autism Index score and percentile. Reliability for the GARS-2 conducted in this study revealed Cronbach’s α = .94, 95% CI = 89.14 – 100.16. In relation to the subscales, stereotyped behaviours (Cronbach’s α = .90, 95% CI = 7.44 – 9.72), communication (Cronbach’s α = .85, 95% CI = 7.44 – 9.52), and social interaction (Cronbach’s α = .90, 95% CI = 10.04 – 12.19) were found to be reliable. Thus, the GARS-2 measure is highly reliable; it has been found to measure consistently over time due to the stability of the measure, and it has internal consistency, indicating all of the individual items are measuring the characteristics of autism (Gillium, 2006). The validity of the GARS-2 is also substantial. It has been well tested (for example, Eaves, Woods-Groves, Williams, & Fall, 2006; Lecavalier, 2005) and found to have discriminative validity and concurrent criterion-related validity (Gillium, 2006). Overall, it is a highly valid and reliable measure of autism and autism severity.

The Pediatric Quality of Life Inventory (PedsQL; Chan, Mangione-Smith, Burwinkle, Rosen, & Varni, 2005; Varni, Burwinkle, Seid, & Rode, 2003; Varni, & Limbers, 2009; Varni, Seid, Knight, Uzark & Szer, 2002; Varni, Seid & Kurtin, 2001; Varni, Seid & Rode, 1999).

The PedsQL was used to measure each participant’s health-related quality of life (QOL). The scale was developed for people between the ages of eight to twelve years. The measure includes 23 items which access the areas of physical, comprising of eight items, and emotional, social, and school functioning, each consisted of five items. The PedsQL provided three overall scores; the physical health summary score, the psychological health summary score, and the total scale score. A number of studies (e.g.Varni, Burwinkle, Seid, & Skarr, 2003; Varni, Seid, & Kurtin, 2001) have tested the PedsQL and found it to be a valid and reliable measure. Reliability for the PedsQL in this study revealed Cronbach’s α = .94, 95% CI = 38.73 – 53.66. The subcategories of physical (Cronbach’s α = .88), emotional (Cronbach’s α = .75), social (Cronbach’s α = .87), and school (Cronbach’s α = .85) in addition to the subscales of physical (Cronbach’s α = .88, 95% CI = 36.57 – 56.16) and psychosocial (Cronbach’s α = .91, 95% CI = 38.28 – 53.04) were also all found to be reliable. The PedsQL has good inter-item reliability and construct validity. Due to the age restrictions of this scale, this information was gathered only on participants between the ages of eight to twelve years old (n = 25). Participants outside of this age range were instructed to skip this section.

63

Empirical Investigations Data Analysis The statistical analyses for this study were conducted using SPSS version 18 (SPSS Inc., 2009).

This was a cross-sectional study with a multiple regression and correlational design. ADHD score was obtained from the Conners-3 AI. Autism severity total score was obtained from the GARS-2, calculated from the subscales and sub-scores for stereotyped behaviours, communication, and social interaction. Health related QOL score was attained from the PedsQL and was further broken down into physical and psychosocial scores. Due to the age restrictions of the PedsQL, only 25 participants completed this measure, and data analysis involving QOL was conducted using this group. Information about the variables of age, sex, age at diagnosis, medication use, number of siblings, whether siblings had a developmental disorder or intellectual disability, and the presence of co-morbid diagnoses were obtained from the participant demographic questionnaire.

A number of independent t-tests were conducted to evaluate if there existed a significant disparity in ADHD score between different groups. These groups were autism severity, age, gender (male versus female), co-morbidity (co-morbid diagnoses versus no co-morbid diagnoses), and medication (medication use versus no medication use). For autism severity, the participants were broken into two groups based on their autism index scores; those who had an autism index score of 85 or above were in the high group, and those who had an autism index score of below 85 were in the low group. In relation to age, the older group consisted of the participants aged 13 years and upwards and participants below 13 years were in the young group. Pearsonâ&#x20AC;&#x2122;s product-moment correlation coefficient analyses were performed in order to test for a relationship between ADHD symptoms and a number of variables - autism index, stereotyped behaviours, communication, social interaction, QOL total score, physical QOL, and psychosocial QOL. Finally, two regression analyses were carried out. The first regression analysis was conducted with the criterion variable as ADHD score and predictor variables of age, sex, age at diagnosis, medication use, the presence of co-morbid diagnoses, number of siblings, and siblings having a developmental disorder (DD) or intellectual disability (ID). A second regression analysis was carried out with the criterion variable of overall health-related QOL and the predictor variables of each of the ADHD symptoms. In general, the numbers required in order to conduct a multiple regression would need to be higher than the number available in the current study. A decision was made to include the multiple regression analyses but use caution in analysing or overly relying on the results.

64

Student Psychology Journal, Volume III Results The means and standard deviations of the variables of participants’ age, age at diagnosis, number of siblings, ADHD score, Autism Index, stereotyped behaviours score, communication score, social interaction score, overall health-related QOL score, physical QOL score, and psychosocial QOL score are presented in Table 1. From the participant questionnaires, it was found that participants had a mean age of 9.90 years (SD = 4.38 years), with a mean age of diagnosis of 4.91 years (SD = 1.60 years), and the mean number of siblings was 1.74 (SD = 1.18).

The Conners-3 AI discovered that participants had a mean ADHD score of 76.86 (SD = 19.45), out of a minimum of 40 and a maximum of 90. In relation to autism severity, the GARS-2 uncovered a mean score of 94.65 (SD = 17.91) out of a minimum of three and a maximum of 60.

Social interaction (M = 11.12, SD = 3.50) was the highest of the participants’ scores of the GARS2 subscales, followed by stereotyped behaviours (M = 8.58, SD = 3.70), and communication (M = 8.48, SD = 3.34). Each of the subscales of the GARS-2 had a minimum score of one and a maximum score of 20. Finally, in relation to health-related QOL, where higher scores indicate better QOL, overall QOL had a mean score of 46.19 (SD = 18.48), physical QOL had a mean of 46.36 (SD = 24.24), and psychosocial QOL had a mean score of 45.66 (SD = 18.28). According to the Conners-3 AI, the majority of the sample group (76.74%) had an ADHD score of higher than average. 69.77% of the overall group were ranked in the highest possible score category based on their very elevated scores (t > 70). Over half (62.49%) the children had a probability of ADHD score of over 90%, with only 20.93% of the group having a probability of ADHD score less than 50%.

Table 1. Means and standard deviations of variables Variable

Mean

Standard deviation

Age

9.90

4.38

Age diagnosed

4.91

1.60

Number of siblings

1.74

1.18

ADHD score

76.86

19.45

Autism index

94.65

17.91

Autism – stereotyped behaviours

8.58

3.70

Autism – communication

8.48

3.34

Autism – social interaction

11.12

3.50

Overall quality of life

46.19

18.48

Physical quality of life

46.36

24.24

Psychosocial quality of life

45.66

18.28

65

Empirical Investigations Group Differences in ADHD Score Autism Levene’s test for equality of variance was significant, F = 7.53, p = .009, therefore equal variances could not be assumed. The results indicated that there was a significant difference in the ADHD scores of the high autism group (n = 28) and the low autism group (n = 15), t(21.22) = 3.48, p = .002, two-tailed, d = 1.17. The descriptive statistics show that the high autism severity group (M = 84.18, SD = 14.28) scored higher than the low autism severity group (M = 63.20, SD = 20.85).

Age Levene’s test was significant, F = 16.28, p = .000. There was a significant difference in the ADHD scores of those aged below 13 years (n = 29), and those aged 13 years and above (n = 14). The older group (M = 84.57, SD = 13.84) scored significantly higher than the younger group (M = 73.14, SD = 20.84), t(36.65) = 2.14, p = .04, two-tailed , d = .65.

Gender Levene’s test was not significant, F = .97, p = .330, ensuring homogeneity of variance. The results showed that there was a significant difference in the ADHD scores of males (n = 34) and females (n = 9), t(41) = 2.51, p = .016, two-tailed, d = .89. Males (M = 80.47, SD = 17.60) scored significantly higher than females (M = 63.22, SD = 21.05).

Co-morbid diagnoses Levene’s test was significant, F = 58.04, p = .000. A significant difference in the ADHD scores of those who had co-morbid diagnoses (n = 13, M = 87.31, SD = 7.74) to those who didn’t have comorbid diagnoses (n = 30, M = 72.33, SD = 21.28), was shown in the results, t(40.33) = 3.37, p = .002, two-tailed, d = .94.

Medication use Levene’s test was significant, F = 16.59, p = .000. There was a significant difference in the ADHD scores of those using medication (n = 12) to those not using medication (n = 31), t(28.55) = 2.11, p = .04, two-tailed, d = .66. Participants using medication (M = 85.25, SD = 14.3) scored higher than the participants who were not using medication (M = 73.61, SD = 20.38).

Variable Relationships with ADHD Score It was observed that a moderate positive correlation existed between ADHD and autism index (r = .58, p≤.001, two-tailed), stereotyped behaviours (r = .60, p≤.001, two-tailed), and social 66

Student Psychology Journal, Volume III interaction (r = .59, p≤.001, two-tailed). A weak positive correlation was discovered between ADHD and communication (r = .32, p≤.05, two-tailed). Strong negative correlations were found between ADHD and overall QOL (r = -.73, p≤.001, two-tailed) and psychosocial QOL (r = -.77, p≤.001, two-tailed). A moderate negative correlation was found between ADHD and physical QOL (r = -.54, p≤.001, two-tailed).

ADHD Score and Demographic Factors In the first multiple regression analysis, which examined if participant demographic variables predicted ADHD score in participants, no strong relationship was observed between the predictor variables (<.9). VIF values (<10) and tolerance values (>.1) for predictor variables were also sufficient. Thus, there was not multicollinearity. The Pearson’s Correlation statistics are displayed in Table 2. Although the model was found to account for 30.7% of the variance in the ADHD scores, this was not significant (R2 = .31, adjustedR2 = .17, F(7,35) = 2.22, p = .06). The overall analysis revealed that none of the demographic variables had a significant impact on the ADHD score.

Table 2: Pearson’s Correlation Matrix of Variables Variable

ADHD

ADHD

Age

Gender

Age D

Med

No. sib

S id/dd

.39**

-.37**

.15

-.27*

.33*

-.15

-.23

.56***

-.33*

.46**

-.06

-.06

.19

-.28*

.15

-.14

.30*

-.29

-.27*

.27*

Age

.39**

Gender

-.37**

-.23***

Age Diagnosed

.15

.56*

-.06

Medication Use

-.27*

-.33**

.19

-.14

No. of Siblings

.33*

.46

-.28*

.30*

-.27*

Sibling ID/DD

-.15

-.06

.15

-.29*

.27*

-.31*

Co-morbid

-.36**

-.33*

.09

-.05

.61***

-.15

-.31* .12

*p<0.05, **p<0.01, ***p<0.001

ADHD Symptoms and Quality of Life The second multiple regression analysis examined if the symptoms of ADHD predicted overall QOL based on the sample who completed the PedsQL (N = 25). The Pearson’s Correlation statistics are displayed in Table 3, the symptoms of ADHD are given the following codes: fidgeting (F) doesn’t listen (L), doesn’t pay attention (P), inattentive (Ia), has trouble organizing (O), gives up (G), squirms (S), restlessness (R), easily distracted (D), and interrupts (Ir). It was found that multicollinearity could not be assured as there was a strong relationship between 67

Empirical Investigations squirms and fidgeting (p = .90), and between restlessness and fidgeting (p = .91), and the VIF value (>10; 15.19) and tolerance values (<.1; .07) for fidgeting were unsatisfactory.

Table 3: Pearson’s Correlation Matrix of Variables Variable

QOL

QOL

F

L

A

Ia

O

G

S

R

D

-.49**

-.61***

-.53**

-.48**

-.54**

-.75***

-.38*

-.51**

-.55**

.73***

.57**

.62***

.57**

.51**

.90***

.91***

.82***

.65***

.66***

.72***

.66***

.59**

.56**

.59**

.78***

.77***

.62***

.48**

.46**

.64***

.67***

.44*

.57**

.55**

.62***

.76***

.50**

.43*

.53**

.37*

.45*

.56**

.85***

.75***

F

-.49***

L

-.61***

.73***

A

-.53**

.57**

.65***

Ia

-.48**

.62***

.66***

.78***

O

-.54**

.57**

.72***

.77***

.67***

G

-.75***

.51**

.66***

.62***

.44*

.76***

S

-.38*

.90***

.59**

.48**

.57**

.50**

.37*

R

-.51**

.91***

.56**

.46**

.55**

.43*

.45*

.85***

D

-.55**

.82***

.59**

.64***

.62***

.53**

.56**

.75***

.76***

It

-.26

.45*

.29

.53**

.39*

.31

.33

.41*

.40*

.76*** .68***

*p<0.05, **p<0.01, ***p<0.001 Table 4: Summary of hierarchical regression model Variable

B

SE B

β

Fidgeting (F)

11.68

11.03

.60

Doesn’t listen (L)

-6.21

5.93

-.31

Doesn’t pay attention (A)

-1.09

6.232

-.05

Inattentive (Ia)

-2.79

5.81

-.14

Has trouble organizing (O)

6.98

9.32

.24

Gives up easily (G)

-13.80

6.05

-.65*

Squirms (S)

.27

6.72

.02

Restlessness (R)

-8.67

7.03

-.50

Easily distracted (D)

-3.97

6.64

-.21

Interrupts (It)

2.35

4.86

.11

*p<0.05

The symptoms of ADHD were found to significantly predict QOL, R2 = .68, adjusted R2 = .47, F(10,15) = 3.22, p =.02. Therefore, the model accounted for almost half (47%) of the variance in the ADHD scores. As can be seen in Table 4, while many of the individual items did not add significantly to the model, gives up easily (G) did (t = 2.28, p ≤ 0.05) significantly add to it. The beta values also indicate this as gives up easily (G) was weighted the most, β = .65, followed by fidgeting (β = .60) and restlessness (β = .50).

68

Student Psychology Journal, Volume III Discussion The main hypotheses of the study were verified by the results from the sample. A large number (76.74%) of the participants displayed symptoms of ADHD. The results indicated that there existed a strong link between autism severity and ADHD symptom score (r = .58). Also as forecasted, ADHD symptom score was linked with health-related QOL, with higher ADHD scores linked to lower QOL (r = -.54). The demographic factors, however, were not found to have a strong influence on the presence or intensity of ADHD symptoms in this sample.

Presence of symptoms of ADHD in the sample was clear. Over three quarters (76.74%) of the group fulfilled the diagnostic criteria and had an elevated probability of having symptoms of ADHD. A low number of participants (20.93%) displayed few or no symptoms of ADHD. Rather, the majority (69.77%) were in the highest possible category, and labelled as having very elevated scores. Similar presence rates have been found in research on the area (Frazier et al., 2001; Lee & Ousley, 2006; Wozniak et al., 1997). This highlights the presence of these symptoms in this population and these findings corroborate with the body of work that has been conducted in this area.

There was a clear connection between ADHD symptoms and autism severity. A positive relationship between ADHD score and autism index score emerged, that is, the ADHD score increased in line with the increase in autism severity. This was also true for each of the subtypes of autism, in particular in stereotyped behaviours and social interaction. A further, albeit weak, connection was noted with communication. Furthermore, the participants in the high autism severity group had significantly higher ADHD scores than those of the participants in the low autism severity group. This highlighted that more severe autism is linked to more symptoms of ADHD being portrayed.

A distinct connection between ADHD score and health-related QOL for those that were analysed (N = 25) was observed. ADHD score had a strong negative relationship with QOL, in that as the ADHD score increased, the QOL decreased. This was true for both the psychosocial QOL and the physical QOL. Additionally, it was observed that the individual ADHD symptoms were predictive of overall QOL, indicating that the presence of many symptoms of ADHD significantly reduced a persons’ QOL, both physically and psychosocially. This supports Autism Speaks’ (2011) conclusions that ADHD symptoms in children with autism significantly worsen the individual’s QOL.

69

Empirical Investigations In relation to demographic factors, differences between groups based on these aspects were noted in the participants; the older children had a higher ADHD score than younger children, males had a higher ADHD score than females, those on medication had a higher ADHD score than those not using medication, and those with a co-morbid diagnosis had a higher ADHD score than those without any co-morbid diagnoses. This indicates that these factors have an effect on the ADHD score, however, no strong statistical relationship was found between the ADHD score and any particular one of the demographic factors. In addition to this, none of the demographic factors were predictive of ADHD symptom presence, thus they did not appear to have an overly influential effect on the presence or magnitude of symptoms. Lee and Ousleyâ&#x20AC;&#x2122;s (2006) investigation into the relationship between age and ADHD symptoms being displayed in children with autism differed from these results; they discovered a negative relationship between age and ADHD symptom score in their study, as the younger members displayed more symptoms than the older participants. The investigation into the effect of demographic factors appears to be ineffectual in relation to this research topic.

This study contained certain limitations that could be improved upon in future versions of this design. The sample size was relatively small; this had a particular influence on the reliability of the data gathered by the multiple regression analyses. Parents of children with autism are generally very busy individuals, and although they may like to engage in a study such as this, it may not always be possible for them to do so. Perhaps an elongated time allowance would have allowed for the recruitment of further participants. Also, the measures were taken all at one particular time and were completed by the parents of the child. Although the reliability tests assure inter-rater reliability it could be interesting to use a method of direct measurement, perhaps with a longitudinal form of the study, in order to examine symptoms across age cohorts and investigate if these symptoms stay stable or change over time. This would allow for real observation and measurement of target behaviours, and further enhance the quality of the resulting designed treatments. In addition to this, the Conner-3 AI includes a measure of attention, a pivotal part of an ADHD diagnosis. However, it is crucial to remember that attentional issues themselves are endemic with Autism. In future, an extensive break down of the ADHD facets without the inclusion of attention is warranted to investigate the presence of other ADHD symptoms in individuals with Autism. This would allow for the ratings of the individuals on other scales of ADHD to be considered in more detail, without the dual-attention component of the two disorders having an influence.

The findings also highlight areas for future research. The occurrence of a connection between the presence of ADHD symptoms in a child with autism and a lower QOL needs to be 70

Student Psychology Journal, Volume III investigated further. It could be a matter of interest to examine why exactly this occurs; perhaps investigating the possibility of factors which may include the lack of appropriate treatment and the symptom interference with daily life. By attending to this aspect ways to impede this lessened QOL may be uncovered. In addition to this, repetition of the current study with an adult population may determine consequences if similar results occur. Finally, perhaps some additional demographic information, such as social class or race, could be gathered in order to identify if any of these items have a significant effect, as this study did not discover any particularly relevant influential demographic factors.

The pivotal aim of this study was to identify if this sample of children displayed symptoms of ADHD. This was done through the use of the Conners-3 AI, which was completed by parents of children diagnosed with autism, and found there to be a very strong presence of ADHD symptoms in the group. Following this, the impact of such an occurrence on health-related QOL, measured by the PedsQL, was examined. It was concluded that the individualsâ&#x20AC;&#x2122; quality of life was substantially reduced as a result of the presence of symptoms of ADHD. Finally, the impact of autism severity (as measured by the GARS) and demographic factors were also taken into consideration. Although the demographic factors were not found to be vitally important, autism severity was highly connected to ADHD score. These findings, in addition to the previous literature on the area, highlight the need for further investigations and improved treatment methods. Recognition, information, and improvement all have the ability to enhance, not only this research arena, but also the lives of all those individuals who are living through it.

Acknowledgements The authors would like to thank the organisations of Schooldays.ie, Autism Assistance Dogs Ireland, and Irish Autism Action were hugely helpful in advertising the study and drafting participants. Additionally, incredible gratitude is expressed to the participants and informants involved in the study for the time and effort they provided, which was of key importance.

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Empirical Investigations Boyle, C. A., Boulet, S., Schieve, L. A., Cohen, R. A., Blumberg, S. J., Yeargin-A;;sopp, M., . . . Kogan, M. D. (2011). Trends in the prevalence of developmental disabilities in US children, 1997-2008). Pediatrics,127(6), 1034-1042.

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Conners, C. K. (2008). Conners (3rd ed.). Toronto: Multi-Health Systems Inc. Eaves, R. C., Woods-Groves, S., Williams, T. O. Jr., & Fall, A. (2006). Reliability and validity of the pervasive evelopmental disorders rating scale and the gilliam autism rating scale. Education & Training in Developmental Disabilities, 41(3), 300-309.

Frazier, J. A., Biederman, J., Bellorder, S. B., Garfield, S. B., Geller, D. A., Coffey, B. J., Faraone, S. V. (2011). Should

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diagnosis of attention-deficit/hyperactivity disorder be considered in children with pervasive evelopmental disorder? Journal of Attention Disorders, 4, 203-211.

Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2006). ADHD symptom subtypes in children with pervasive developmental disorder. Journal of Autism and Developmental Disorders, 36, 271-282.

Gilliam, J. E. (2006). Gilliam autism rating scale – Second Edition. Austin, TX: Pro-Ed. Grodberg, D. M. & Kolevzon, A. (2009). ADHD symptoms in autism spectrum disorder. Primary Psychiatry, 16, 35.

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Kochhar, P., Batty, M. J., Liddle, E. B., Groom, M. J., Scerif, G., Liddle, P. F., & Hollis, C. P. (2010). Autism-spectrum disorder traits in children with attention deficit hyperactivity disorder. Child: Care, Health, and Development, 37, 103-110.

Lecavalier, L. (2005). An evaluation of the Gilliam Autism Rating Scale. Journal of Autism & Developmental Disorders, 35(6), 795-805.

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Varni, J. W., & Limbers, C. A. (2009). The PedsQL 4.0 generic core scales young adult version: Feasibility, reliability and validity in a university student population. Journal of Health Psychology, 14, 611-622.

Varni, J. W., Seid, M., Knight, T. S., Uzark, K., Szer, I. S. (2002). The PedsQL 4.0 generic core scales: Sensitivity, responsiveness, and impact on clinical decision-making. Journal of Behavioral Medicine, 25, 175-193.

Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL™ 4.0: Reliability and validity of the pediatric quality of life

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Yoshida, Y. & Uchiyama, T. (2004). The clinical necessity for accessing attention deficit/hyperactivity disorder (AD/HD) symptoms in children with high-functioning pervasive developmental disorder(PDD).

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Empirical Investigations

The Motivation to Have a Virtual Life and the Perception of the Self and Gaming Habit Significance Taylor Lyons1, Anne van der Lugt2 & Gianluca Truscello3 Queen’s University Belfast1, Utrecht University2 & University of Milan- Bicocca3 tlyons03@qub.ac.uk With 41% of gamers playing online to escape reality and 7% classified as psychologically and behaviourally ‘dependent’ on such games (Hussain & Griffiths, 2009), the effects of online gaming in an increasingly technological era have become ever more apparent. Second Life is an online game in which people can create and experience a whole new life. The current paper questions the motivational influences for having a virtual life and the impacts of having a virtual life on the perception of the self and the importance of gaming behaviours. Method: A qualitative study rooted in the grounded theory approach is undertaken. Triangulation is utilized, with methods consisting of e-interviews (N = 6), chat boxes and forum extracts. Results: The results were twofold. Firstly, friendship and love were the main motivators found. Secondly, two extreme types of gamers emerged from the data; the “Emotionally Involved Gamer” (EIG) who sees their Second Life avatar as an extension of themselves, and the “Emotionally Detached Gamer” (EDG) who makes a distinction between online and offline happenings.

These players operate along a continuum on which all players can be placed. Conclusion: The motivations that lead the gamers to enter the virtual world are different and appear to be linked to the degree of emotional involvement that the players exhibit. Contrary to the experiences of EIGs, it appears that the EDGs’ experiences inside Second Life have no major consequences offline, because they accept the distinction between the virtual and the real world.

In 2003, Second Life was launched as an online 3D virtual world game, developed by Linden Lab. Members can communicate with each other through avatars, which are virtual images created by the players with carefully constructed features. The avatars can engage in a number of ‘lifelike’ activities, including conversations, employment, and even romantic relationships (Kirriemuir, 2010; Linden Research Inc, 2012; Petrakou, 2009).

Przybylski, Rigby, and Ryan (2010) suggest that gaming environments may be understood in terms of real-world psychological needs, such as the need for competence and autonomy. Player motivation may be largely accounted for by the frustrations and affordances that the game lends, as well as the effects of play on wellbeing. The motivators were addressed by advancing the self-determination theory-based motivational model (SDT). The SDT tries to explain an individual’s behaviour in terms of intrinsic or extrinsic motivations. A person is intrinsically motivated when they act for reasons existing within the individual rather than external 74

Student Psychology Journal, Volume III pressures. On the other hand, a person is extrinsically motivated when they act in order to obtain or avoid an outcome (Deci & Ryan, 2000). Using the SDT, Przybylski et al. (2010) found that aggressiveness among players may arise when feelings of competence are undermined in the game. Furthermore, they suggest that individuals are at greater risk of becoming obsessively engaged in games if they are experiencing chronic need deprivation in everyday life, whereas individuals that experience high need satisfaction are more likely to positively engage in games.

Moreover, a positive relationship was found between an obsessive passion for play and low game enjoyment, high game engagement, and negative post-play mood (Przybylski et al., 2010). The study shows that deprivation in real life may intrinsically motivate individuals to increase their engagement in virtual life.

According to Schimmenti & Caretti’s (2010) qualitative meta-analytic study, virtual world addiction may be due to a misuse of psychic retreat. Psychic retreats may be defined as neurological areas that contribute to our imagination and fantasy (Schimmenti & Caretti, 2010, as cited in Steiner, 1993). Total absorption into the virtual world may be used as a defence mechanism to block-out painful or unbearable feelings and to protect the individual from inner conflicts, such as traumatic memories. Support for these claims stem from the work of Toronto (2009), in which he argues that some individuals who feel helpless flee to a virtual world as a means of escaping real-life problems. In this new world, they are able to gain control over their virtual lives and express their ideal self by creating an avatar to suffice for the characteristics the individual feels they lack in reality (Toronto, 2009). Additionally, single case studies have shown that problems in real life – such as relational problems, physical appearance dissatisfaction, and problems coping– can cause excessive gaming (Griffiths, 2008).

Furthermore, the development of social relationships is an important motivator (Jessen, 2009).

Thus, factors may include friendship, attraction, love affairs, and mutual help; as well as factors of immersion, such as fun, fantasy, and imagination. Moreover, manipulation and escapism may also influence player motivation. The expression of status within Second Life is implicit and places greater importance on the avatar’s image, performance, and achievements, resulting in a lower status among novice players (Jessen, 2009).

Therefore, this paper questions the motivations for having a virtual life, and the impacts of having a virtual life on the perception of the self and gaming behaviour significance. In order to address these questions, qualitative methodology is utilised to provide a better representation of the mentality, underlying processes and subjective interpretations related to online sociality, specifically virtual worlds.

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Empirical Investigations Method In order to communicate with the players and recruit participants, the researchers created an avatar on Second Life. Methodological triangulation is utilized, enabling the validity and reliability of the research to increase (Boeije, 2010). Triangulation may be used to provide complimentary data collection methods, with the modalities used here consisting of einterviews, chat-boxes, and forum extracts. The possible benefits and costs of each method will be explained in detail one by one.

E-Interviews The e-interviews were conducted through the private message (PM) function available on Second Life. E-interviews permit access to participants who usually lie beyond geographical reach, and may even be more successful in obtaining certain types of data, such as sensitive information (Bampton & Cowton, 2002). However, they provide a limited source of verbal and non-verbal cues; which are important contributors to an interaction. In addition, there is a delay between question and response during which the respondent can generate and type an answer.

This allows the participant to ponder and edit their response, causing concern for validity and the possibility of social desirability (Bampton & Cowton, 2002). Social desirability bias occurs when a respondent answers in a way that is viewed as socially acceptable, such as underreporting negative behaviour (Breakwell et al., 2006). However, it seemed reasonable to utilize this web-based methodology given the population under study. Six players agreed to participate in the e-interviews, which were semi-structured and open-ended, enabling the participants to talk freely about important areas of their lives. The participants provided informed consent to partake in the research and were permitted full control over the termination of the interview; however, an approximate period of 15 minutes was suggested.

Public Chat Boxes The second data collection method consisted of public chat boxes belonging to each particular â&#x20AC;&#x2DC;worldâ&#x20AC;&#x2122; in Second Life. In addition to the PM option, individuals may post comments publicly through the chat box (Linden Research Inc., 2012). This provides the benefit of group dialogues as well as insight regarding the information these individuals wish others to see. However, as they are public posts, individuals may feel inhibited in their responses. The information gathered from the chat boxes will be used additionally to the obtained e-interviews.

Forum extracts Finally, forum extracts were the third methodology utilized. Archives on websites contain forums in which players can post comments and questions regarding game-play. The forums are separated into topic-related categories. Individuals post threads within each of these topics, in 76

Student Psychology Journal, Volume III which other individuals may respond to the content of the thread. Due to the substantial number of forums and topics, threads were selected from the ‘People Forum’ and from the topics, ‘Lifestyles’ and ‘Relationships’. Archival research holds the advantage of being able to explore large-scale, widely occurring phenomena that may be remote in time; however there are limitations pertaining to this method (Hogg & Vaughan, 2010). These limitations include the possibility of unreliable data due to the lack of control of the researcher, or through missing vital information. In addition, the researcher must make do with what is available and the individuals cannot immediately be questioned about what they have posted (Hogg & Vaughan, 2010). Furthermore, the selection of specific forums and threads may give rise to further limitations and biases; however, auxiliary archival investigation was beyond the scope of this study and future research may benefit from exploring this further.

Ethical Considerations When conducting social research, ethical issues may be confronted. There are common principles undertaken despite the variability in the valid frameworks guiding ethical choices (Miles & Huberman, 1994). During recruitment, individuals are informed immediately about all aspects of the research, their right to withdraw at any time, and of privacy, confidentiality and anonymity. This will ensure that the participants can make an informed decision based on the costs and benefits of partaking in the research (Endacott, 2004). In addition, the rapid disclosure of the researcher’s identity ensures the endurance of trust, eliminates the issue of deception, and may provide a good foundation from which to build relations. This weighing-up of risks and gains is also characteristic of the procedure undertaken by the researchers when assessing ethical concerns. However, McGhee (2001) would argue that the cost-benefit principle carries with it many problems, including the subjective manner of the assessment. He explains that the participant’s themselves may be the only worthy individuals of judging the costs inflicted on them (McGhee, 2001).

Employing the use of forum extracts and chat sessions may pose ethical concerns. This is due to the unavailability of individuals to provide consent. Although this content has been posted publicly, it still may be regarded as a somewhat invasion of privacy.

Analysis-Procedure The analysis commenced simultaneously during data collection. This began with reading through the data and documenting ideas on memos. The data was then uploaded to NVivo 9, a qualitative data analysis computer software package developed by QSR International, and segmenting the data commenced. This consisted of separating the data into relevant and

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Empirical Investigations meaningful categories. By comparing various fragments, themes began to emerge. These themes were labelled and this began the stage of open coding.

The next stage in the analysis, axial coding, consisted of retrieving and comparing fragments assigned to particular codes, defining the categories and exploring the relationships between those categories obtained in the previous stage.

Finally, the stage of selective coding consisted of reassembling the data. This took place through determining core concepts and the relationships between them, with a particular application of theory. Throughout the analysis, all researchers met regularly to discuss newly gathered data and ponder over codes. Codes were only entered when all of the researchers agreed upon them, providing the advantage of inter-rater reliability.

Results Motivation The analysis identified various motivational influences for playing Second Life. In this section; all motivators will be described and illustrated with quotations.

Friendship.

Second Life (SL) players are looking for friendships that are comparable with the friendships people have in the real life (RL), without computing as a medium of communication. Through the use of quotations provided by the online gamers below, the quest for contact and friendship clearly emerges.

“Meeting people in SL is sometimes a lot easier than meeting people in RL. The mask we all wear in world often gives us the confidence to more social.”

“All one really needs is ONE best friend.”

“My ideals for a friend should be someone who you can talk to. Someone that will message you, so that you don’t always have to be the first to message.”

“I felt that what she was looking for on SL, was the thing she was missing with me. I felt insecure. (…) She told me that she had a husband, but she didn’t have any friends.”

Love.

People enter the game to meet possible partners and often engage in different virtual relationships until they find love. Furthermore, Second Life is used to tide over big distances

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Student Psychology Journal, Volume III between partners. Being together online feels like they are together for real. They can do all the activities that they would do if they were together in person, such as cuddling, talking, kissing, etc.

“I met my fiancé on a chat and fell in love. (…) Next year I’m moving to Germany. (…) We use SL to meet. It’s like being together because we voice and stuff at the time. Come online and dance, cuddle, things we can’t do in RL because distance.”

“Have you taken that extra step and moved you relationship from SL into RL? I met Judi in SL and 6 months later, we met in RL. I’m 28 and she is 20. We’ve been together for 2 years and recently moved in together (wedding bells?).”

“I met my love online elsewhere. We both came to SL permanently. (…) SL helped us tremendously, gave us a space to be together, spend time, enjoy each others’ company, etc., until we could do so in person.”

Escapism.

People improve their situation through the creation of their own avatars and worlds. For some players, life is not as positive as their online world. This provides further motivation for remaining in the online world rather than focusing on the offline world. Second Life also offers the opportunity to experiment with behaviour that they might not dare to do offline in everyday life.

“SL is the ability to twist reality into something closer to my liking and it’s the ability to check out other’s twisted realities.”

“I want to create a small group to have the feeling of like the tv show Entourage.”

“What she is doing here is dressing u and putting make up on and getting tattoos. Like she would like to. In the end nobody knows who you are. You are behind a doll.”

Boredom.

Since the creation of a virtual life is non-ending, it continuously occupies the gamer. In the following quotations, participants explain that they have nothing better to do when they go online.

“At the moment I’m here because I wasn’t doing anything. You have got something to do not to enter here.”

“I: How do you feel when you don’t play SL? P: Bored sometimes.”

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Empirical Investigations Handicap.

An unexpected motivating factor is disability. According to the participants, handicapped individuals that cannot leave their home use Second Life to meet people and live “normally”.

“I know people with real physical handicaps that use SL to be normal, people who can’t do things I can in RL. For them it’s nice. They can feel a sense of normal, one you or I might take for granted.”

“On that moment I couldn’t leave the house due to a long term diseases, so I just went to look what it was. (…) I couldn’t leave the house and yet you make friends here and you discover more and more things.”

Language.

Gamers seek people from different countries in order to practice their international skills and socialize with people from other cultures. Some players are merely interested in language, but others practice a language in order to plan for migration or to easily communicate with online love relations.

“Being social is important. Practicing your languages.”

“I like SL, I’m learning German on SL and planning for my move to Germany next year.”

“She liked to socialize with people from other cultures.”

Checking.

Some individuals are attracted to Second Life because of their unresisting curiosity.

They may have had contact with a gamer and want to know what having a virtual life contains.

“My wife was addicted to this game. I was very curious to see what was that amusing for her. I saw that she liked to socialize.”

Another reason is jealousy. Players create love relationships online; however, they may become suspicious about their lovers’ online behaviour. Gamers create a second avatar to anonymously spy on their online lover.

“I: What is an alt?

P: An alt is another avatar. People use them to spy on others.

I: Why do people spy on others?

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Student Psychology Journal, Volume III P: Well let’s say you are dating someone, right? And your man ain’t coming around much.

So you go and see what he is up too. And then he is shagging some blonde.”

Music.

Many worlds contain music (such as bars, discotheques, etc.) where people communicate with each other about what they hear. In some worlds they have live music.

“I: What makes SL so addictive?

P: Uhm, interaction with people, and what you are hearing now… good singers… so communication and live singers.”

In sum, the most common motivations are looking for friendship and love, but other factors come in to play (figure 1).

Figure 1: An organised view of the motivational influences for having a virtual life. (Results: Motivation)

Perception In an attempt to understand whether, and how, the prolonged experience within the virtual world influences the subjects’ perception of themselves and the significance of their gaming habits, the actions and relations of the players, in addition to the attributed meanings of these interactions, are analysed. As discussed previously, the main motivator driving game-play may be the deprivation of particularly important emotional, relational or physical needs. However, the way in which players perceive and approach the virtual world is varied. The findings reveal

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Empirical Investigations that motivational factors exert great influence on how players interpret their Second Life experience.

During the analysis, a dichotomy of players clearly emerged. The first group of users experienced a clear distinction between the perception of the virtual world and offline reality, remaining emotionally detached from the game. On the contrary, the second group did not perceive a fundamental separation between their offline lives and those of their online avatar, with a high degree of emotional involvement present. This dichotomy is not a rigid distinction, but rather a continuum on which all players can be placed.

The first typology of players is defined as the “Emotionally Involved Gamer” (EIG). They enter Second Life to socialize, build strong relationships, and have durable love affairs. They perceive their Second Life avatar as an extension of the self. They do not recognise the difference between online and offline worlds: “SL is not much different from RL I think. The things we can see and share are real where the things we imagine are the fantasy of it all. Take a song for instance. A song is real and a cd that holds the song is real. I can hold the cd in my hand, but not the song. No matter how hard I try, the song won’t play from my hand, but the song is still real when it’s playing.

Where the idea for a song remains fantasy…”

When referring to Second Life as a game, they may react defensively: “It’s not a game per say, it’s a chat program in 3D, where you can explore and interact with others, some take serious offense.”

The EIGs experience Second Life as an open virtual space that creates the possibility to talk and relate with different people from various parts of the world. In their perspective, avatars are a virtual extension of their person and a big part of their identity. Their aim in Second Life is to create friendship communities characterized by sentiments of fraternity, solidarity and mutual help. For this reason, they do not seem to have particular qualms about sharing a great part of their lives online. “ You know… Second Life is Real Life, it’s just we are here with dolls, but the conversations and feelings are real. (…) what is real are the contacts… the persons behind the doll. Your doll does and says nothing without your input. It’s really, you, me, and everyone that is here in fact.”

Indeed, for these players, the concept of feelings is highly relevant. The avatars have real individuals controlling them, guided by real emotions and passions that are reflected within the virtual space. These players exhibit a high level of emotional involvement. Therefore, online 82

Student Psychology Journal, Volume III happenings have a great impact on offline life and basic social norms become highly important in Second Life, further increasing the complexity of interpersonal relations: “She lied, Second Life or real life no one likes being betrayed, we might be toons/avi’s but this is not so different from the real world, one must realize that.”

This participant felt betrayed by a researcher for “the sake of her degree” in another virtual world. After this experience, she and her friends decided to move their virtual world to Second Life. In addition, love relationships and friendships, both online and offline may terminate because of online betrayals between avatars.

The second typology of Second Life players is defined as the “Emotionally Detached Gamer” (EDG). EDGs conversely express an explicit willingness to separate the self from the virtual avatar and identify a distinction between online and offline life. For EDGs, it is just a game where they can find distraction and relaxation. For these gamers, Second Life is perceived as an infinite field of possibilities to express different personalities, act out different roles, and play with new identities.

They do not intend to create strong relationships, because other gamers are perceived as an interactive part of the virtual environment. Second Life offers these EDGs the possibility to experiment with unusual behaviour, activities and a competing character. The players consciously draw the demarcation line between reality and the virtual world. This may be interpreted as a defence mechanism, enabling emotional detachment from the game.

“My avatars are not me, at all, and anyone who thinks they are and can’t maintain the separation between the avatar’s author words and actions and the fictional in-world character that the avatar represents is someone I don’t want to have an in-world relationship with” As shown in the quote, the EDG may have more than one avatar to maximize the opportunities of exploring the myriad of situations, relationships and scenarios permitted by the game.

Conclusion and Discussion In the current study, the researchers aimed to identify the motivations of having a virtual life and the impacts of virtual life on the perception of the self and gaming habit significance.

Through the analysis of data, these questions were answered. Firstly, the main motivators

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Empirical Investigations driving game-play were friendship and love. People meet on Second Life to connect and share ideas, with many individuals expressing previous relationships with others online. The ideas about friendship and love in Second Life are comparable with the ideas about friendship and love in the “real” world. Friendships are a necessary experience for psychological wellbeing (Aikawa, Fujita, & Tanaka, 2007), which may explain why friendship is the leading motivator to join Second Life.

Lesser motivational influences were escapism, disability, language, curiosity, and boredom.

Listening to (live) music is a further motivational drive, and is possible on Second Life, because players are able to connect external devices, such as microphones or instruments, to their computers and broadcast in a particular world. This provides the advantage of a worldwide audience and offers a platform for the identification of talented individuals. Williams, Yee and Caplan (2008) yielded similar results in another online virtual game, in which building social relationships and enjoying the creative experimental aspects of virtual life were the main motivators found.

The second main question considered the gamer’s perceptions of themselves and the significance of their gaming habits. Two extreme poles of players were found: ‘EIGs’ and ‘EDGs’.

EIGs and EDGs experience Second Life differently. Furthermore, the motivations that lead the gamers to enter the virtual world are different and appear to be linked to the degree of emotional involvement that the players exhibit; consequently influencing the complexity of interpersonal relations.

EIGs experience their avatar as an extension of their person. They do not see a distinction between online and offline worlds. They literally assert that, “Second life is Real life!” A large proportion of their motivation for going online is to escape reality and to look for durable friendship and love relations. EIGs experience Second Life more as a social network rather than a game. Unlike some popular social media, Second Life is created to get in contact with unknown users easily. Second Life permits the gamer to create new communities around a particular field of interest. According to Jessen (2009) the feeling of belonging to a virtual community is reinforced by the sense of being together at the same time, sharing the same space.

Conversely, EDGs make a distinction between both worlds. They see Second Life as a game and use it for relaxation. They log in to chat, listen to music, keep occupied, and practice their languages. The main motivators driving the EDG are what Jessen (2009) calls immersion and manipulation factors. These users experiment with forms of socialization and friendships, but the most important dimensions for these players are entertainment, fun, creativity and gaming.

Contrary to the experiences of EIGs, it appears that the EDGs’ experiences inside Second Life 84

Student Psychology Journal, Volume III have no major consequences offline, because they accept the distinction between the virtual and the real world.

In conclusion, Second Life is a social media network in which all gamers experiment with socialization. As with other social networks, Second Life has become a huge part of everyday life and one of the main sources of communication for members (Jessen, 2009). The almost infinite possibilities for action and interaction that this platform provides make it easy for gamers to become absorbed in the game, with a high potential for addiction.

Some limitations found in this research are outlined in the ‘method’ section of this paper. With regards to future research, conducting face-to-face interviews in person may enable the participant’s story to be fully understood and may also reduce social desirability effects.

Furthermore, researching the typology of players would offer more valid, reliable information and may aid the development of a well-grounded theory.

References Abramson, E. E., & Stinson, S. G. (2002). Boredom and eating in obese and non-obese individuals. Addictive Behaviors, 4, 181-185. doi:10.1016/0306-4603(77)90015-6 Aikawa, A., Fujita, M., & Tanaka, K. (2007). The relationship between social skills deficits and depression, loneliness, and social anxiety: Rethinking a vulnerability model of social skills deficits. The Japanese Journal of Social Psychology, 23, 95–103. doi:10.1080/00224545.2011.591451 Boeije, H. (2010). Analysis in qualitative research. London: Sage.

Breakwell, G. M., Hammond, S., Fife-Shaw, C., & Smith, J. A. (2006). Research Methods in Psychology (3 Ed.), p. 247, London: Sage.

Couple let baby starve to death while raising virtual baby online. (2011, May). The Huffington Post.

Retrieved

from

http://www.huffingtonpost.com/2010/03/05/couple-let-baby-starve

to_n_487287.html Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self determination of behaviour. Psychological inquiry, 11, 227-268. doi:10.1037/a0012803 Golub, A. (2010). Being in the World (of Warcraft): Raiding, realism, and knowledge production in a massively

multiplayer

online

game.

Anthropological

Quarterly,

83,

17-45.

doi:10.1353/anq.0.0110 Griffiths, M. D. (2008). Videogame addiction: Further thoughts and observations. International Journal of Mental Health and Addiction, 6, 182-185. doi:10.1007/s11469-007-9128-y

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Empirical Investigations Griffiths, M. D. (2010). The role of context in online gaming excess and addiction: Some case stud evidence. International Journal of Mental Health and Addiction, 8, 119-125. doi:10.1007/s11469 009-9229-x Hussain, Z. & Griffiths M. D. (2009). Excessive use of Massively Multi-Player Online Role-playing Games: A Pilot Study. International Journal of Mental Health and Addiction, 7, 563-571. doi: 0.1007/s11469-009-9202-8 Jessen, S. S. (2009). Actors and their use of avatars as personal mediators: An empirical study of communication and practices in the virtual worlds of EverQuest and Second Life. Journal of Media and

Communication,

47,

29-44.

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http://ojs.statsbiblioteket.dk/index.php/mediekultur/article/view/1403 Larson, R. W. & Richards, M. H. (1991). Daily companionship in late childhood and early adolescence: Changing

developmental

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Child

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62,

284-300.

doi:10.1111/j.1467-8624.1991.tb01531.x Linden Research Inc. (2012, February 13). Second Life. Your world. Your imagination. Country of Origin: America. Retrieved from http://www.secondlife.com Kirriemuir, J. (2010). UK University and College Technical Support for Second Life Developers and Users.

Educational Research, 52, 215-227. doi:10.1080/00131881.2010.482756 Petrakou, A. (2009). Interacting through avatars: Virtual worlds as a context for online education.

Computers and Education, 54, 1020-1027. doi:10.1016/j/comedu.2009.10.007 Phillips, R. (2010, March 4). Gamers' tot 'dies of starvation'. The Sun. Retreived from http://www.thesun.co.uk/sol/homepage/news/2878357/Gamers-tot-dies-ofstarvation.html Przybylski, A. K., Rigby, C. S., & Ryan, R. M. (2010). A motivational model of video game engagement.

Review of General Psychology. 14, 154-166. doi:10.1037/a0019440 Samuels, D. J., & Samuels M. (1974). Low self-concept as a cause of drug abuse. Journal of Drug Education, 4, 421-438. doi:10.2190/VJHU-MRAR-NLG6-1XBH Schimmenti, A., & Caretti, V. (2010). Psychic retreats or psychic pits? Unbearable states of mind and technological addiction. Psychoanalytic Psychology, 27, 115-142. doi:10.1037/a0019414 Toronto, E. (2009). Time out of mind. Dissociation in the virtual world. Psychoanalytic Psychology, 26, 117-133. doi:10.1037/a0015485

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Student Psychology Journal, Volume III Weinstein, A. M. (2010). Computer and video game addiction â&#x20AC;&#x201C; A comparison between game users and non-game users. The American Journal of Drug and Alcohol Abuse, 36,

268-276.

doi:10.3109/00952990.2010.491879 Williams, D., Yee, N., Caplan, S. E. (2008). Who plays, how much, and why? Debunking the Stereotypical gamer profile. Journal of Computer-Mediated Communication, 13, 993-1018. doi:10.1111/j.1083-6101.2008.00428.x

87

Empirical Investigations

Positivity from Adversity: the Irish femaleâ&#x20AC;&#x2122;s account of Maternal Cancer.

Aileen Russell Trinity College Dublin arussel@tcd.ie

This study sought to explore posttraumatic growth (PTG), positive change resulting from dealing with trauma, and the role that various support resources can play in the amelioration of PTG development particularly within mother-daughter relationships. The study was qualitative in nature - semi-structured interviews were conducted with 7 young Irish females who have had or currently have a mother with cancer, using an interview schedule based on previous literature. Analyses focused on three main subject areas - subjective well-being, health behaviours and support. All the data collected was naturalistic and was analysed using Interpretative Phenomenological Analysis. Results indicated a growth in four out of the five PTG domains, while participants reported a severe paucity in knowledge of external support and a defined need for more knowledge about cancer, both as a disease and an incremental development. The present findings indicate a need for more accessible information; implicit in this is the need to discuss cancer openly, while external support resources are documented to be inadequate. This research advocated the implementation of further support and talking, that can help adolescents and young adults accentuate PTG while attenuate the adverse effects of having a parent with cancer.

Introduction In recent years, there has been an accumulation of literature on the impact of cancer on families (Lewis & Darby, 2003; Visser, Huizinga, van der Graaf, Hoekstra, Hoekstra-Weebers 2005).

Although there is a wealth of literature centred on cancer among adults with young children (Bugge, Helseth & Darbyshire, 2009), there is a dearth of literature on childrenâ&#x20AC;&#x2122;s adjustment to parental cancer (Faulkner & Davey, 2002).

Existing literature on the influence of parental cancer on children is contradictory with both positive and negative impacts being reported. Psychological distress is among the most prevalent negative symptoms of interaction with cancer (Armsden & Lewis, 1994; Birenbaum, 2000; Nelson, 1994; Visser et al., 2004; Flahault & Sultan, 2010). This distress is manifested by perceived heightened risk, depression, anxiety, behavioural problems and lower self-esteem (Harris & Zakowski, 2003). Van Oostrom Meijers-Heijboer, Duiven-voorden, Brocker-Vriends, 88

Student Psychology Journal, Volume III Van Asperen, & Sijmons (2006) postulate that these effects may perpetuate into adulthood.

Walsh, Manuel and Avis (2005) found that several familial shifts may contribute to these maladaptive effects. Heightened emotional distress is anchored within the necessity of providing more sibling care, parental support and performing significantly more household chores (Wagner & Compas, 1990). Girls report greater distress than boys when a parent has cancer, this is rooted in the parent’s, particularly the mother’s, tendency to share their psychological concerns, treatment procedures and survivorship issues with older daughters; as sharing emotional experiences is common in female bonds (Silverstein, Bengtson & Lawton, 1997).

Stanton, Sears & Danoff-Burg (2003) report that over half of individuals who experience a psychologically seismic life event report positive outcomes as a result, including changes in selfperceptions, social relationships and life-perspectives. Research by Tedeschi and Calhoun (2004, 1996) is perhaps the most remarkable in terms of positive growth following a traumatic event. They purport that “Posttraumatic growth refers to positive psychological change experienced as a result of highly challenging life circumstances” (p1). Posttraumatic growth implicates growth in five areas:

greater appreciation for life, strengthened personal

relationships, increased personal strength, awareness of new possibilities, and spiritual development. Kilmer (2006) described this growth as positive changes that go beyond effective coping and adjustment. Although not previously identified by Tedeschi and Calhoun, subsequent research has identified a sixth domain of PTG, that of increased conscientiousness of health behaviours (Stanton et al., 2006; Wong, Cavanaugh, Macleamy, Sojouner-Nelson, & Koopman, 2009). This domain includes ameliorated cancer monitoring and more positive health behaviours. In Wong and colleague’s (2009) qualitative study of nineteen females and 8 males, it was established that these positive developments may be enduring. They call for more qualitative research on the ways to identify factors that improve the experience of PTG in adolescents, an area this study seeks to investigate.

Tedeschi and Calhoun (2004) argue that “varieties of factors in different domains interact with, influence and are influenced by posttraumatic growth” (p.12). Adolescent’s reactions to trauma vary across age and developmental stages dependant on their cognitive and emotional maturity (Oofsky, 2004). Other research highlights the inherent importance of the ability to understand the trauma, the attributions children assign to their circumstances, their repertoire of effective coping skills and their capacity to attend to and report their internal experiences (Cryder, Kilmer, Tedeschi, & Calhoun, 2006). Previous research has garnered information and focused on individual elements that contribute towards later development of PTG; the child’s age at diagnosis, gender, sex of parent, time elapsed since diagnosis, family structure, the diagnosed 89

Empirical Investigations parent’s physical and mental health, marital satisfaction and family communication (Compas, Worsham, Epping-Jordan, Grant, Mireault, & Howell, 1994; Visser et al., 2004; Welch, Wadsworth & Compas, 1996). First-degree female relatives of women who are diagnosed with cancer, such as daughters, have exhibited a significant amount of cancer-related distress and more general emotional distress (Mosher & Danoff-Burg, 2005; Zakowski et al., 2004). It is hypothesized, therefore, that PTG development is mediated by various supporting scaffolds.

Tedeschi and Calhoun (2004) propose the importance of support in a variety of forms.

Neimeyer (2001) accentuated the importance of ‘narration’ as a process as it helps individuals confront questions of meaning and how it can be reconstructed, in a more positive light.

Disclosure, particularly to those who have been in a similar situation has determined the extent of the aspiration to incorporate new perspective or augment current schemas (Tedeschi & Calhoun, 2004). Fredrikson (2001) demonstrated that close, safe relationships often trigger positive emotions that facilitate cognitive processing by broadening the survivors’ thoughtaction armoury. It has been established that discussing stressors with helpful and understanding people aid adjustment, encourage adaption to adverse trauma-related cognition, feelings and information (Lepore et al., 1996).

Focusing more specifically on the mother-daughter relationship, Stiffler et al., (2008), in a qualitative study with eight adolescent females whose mothers had been diagnosed with and treated for breast cancer, noted that communication patterns between mothers and younger adolescent daughters change dramatically. Furthermore, in Stiffler’s study, it was highlighted that parents often have scarce information on how their daughters are thinking, feeling or coping when their mother has breast cancer. While in a study by Krisjanson, Chalmers, and Woodgate (2004) adolescents reported that most of their information needs had not been met.

There is an increasing need for information and support to help daughters cope with the major stressor that is inherent in maternal cancer (Chalmers et al., 2003), however decisions about how, when and how much to tell is a continual challenge (Stiffler et al., 2008).

The present study echoed Stiffler and colleague’s (2008) study, in that it utilized face-to-face interviews with females where they discussed how their mother’s cancer affected their lives.

Irish female adolescents and young adults documented their experience with cancer. This investigation included participants whose mothers had been diagnosed with various types of cancer, as opposed to just breast cancer as in previous studies. Participants included those whose parents were alive at the time of the study, along with parents who had died from cancer.

Interpretative Phenomological Analysis was chosen as a method of analysis as it provides a means of eliciting insightful interpretation and phenomenological description. By appending 90

Student Psychology Journal, Volume III useful knowledge to the recently accumulating information regarding stimulation and the developmental pathway of PTG, future implications for more constructive support systems and networks could be provided, which would prove propitious for adolescents and young adults who have parents with cancer. Areas this study seeks to address are: (1) The development of PTG within mother-daughter relationships, (2) Identify any psychosocial elements that influence this development, (3) The relationship, if any, of social support and PTG, (4) Other salient themes that may prove beneficial for understanding how the motherdaughter relationship is transformed due to cancer.

Method Participants The sample consisted of 7 females ranging from 18-35 years of age (mean age=23). Parents diagnosed with cancer included mothers who had recovered from cancer (n=4) and mothers who had died from cancer (n=3).

Procedure After ethical approval was granted from the appropriate institutional review board, participants were recruited using message boards, email lists, recruitment posters and the snowballing effect. To be eligible, participants had to be over 18 years of age, had a mother diagnosed with terminal or non-terminal cancer when the participant was under the age of eighteen, speaking, willing and able to provide consent. When a potential participant responded to the studyâ&#x20AC;&#x2122;s advertisement, a more detailed information e-mail was sent. If the participant met the eligibility criteria set out by the study and agreed to participate, a time and date for interview was arranged. If no response was received after the receipt of the informational e-mail, a follow-up e-mail was sent to the participant. Participants who did not respond to follow-up e-mail were considered no longer interested in the study.

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Empirical Investigations Table 1: Demographic profile of participants Sex Age

Sex of

Age of daughter

Parent

at diagnosis

Outcome

Age of

Pseudyonym

daughter at death/ remission

F

18

Mother

12/18

Undergoing

14/currently

treatment

undergoing

Aoife

treatment F

20

Mother

18

Remission

19

Brianna

F

21

Mother

2

Remission

4

Carla

F

20

Mother

Newborn

Remission

2

Deirdre

F

35

Mother

16

Terminal

27

Eva

F

33

Mother

6

Terminal

7

Freya

F

19

Mother

7

Terminal

9

Gráinne

Before interview, participant’s were fully informed of the interview topics and told of their right to withdraw at any time. Participants were given a consent form detailing the procedure involved and asked to sign it if they were fully satisfied. The interview schedule was based on previous literature (Wong et al., 20009; Stiffler et al., 2008) and included three main subject areas were subjective well-being, health behaviours and support. Questions were open ended to elicit original answers from the participants and present an opportunity for open discussion.

During the interview, participants completed a questionnaire assessing their demographic characteristics and sequentially were asked open-ended questions in a semi-structured interview about how their parent’s cancer impacted on their lives. Participants were facilitated with the opportunity to correct researcher’s assumptions by discussing any confusion that may have occurred through the interview.

Care was taken to ensure that the interview was set in a private and convenient location for the participant, in order to minimise any potential extraneous effect of location on the interview data. The majority of interviews were conducted in participant’s homes, two were conducted over the phone, and one took place in a private room in a college building. All interviews were held on an individual basis and were recorded using a Sony ICDPX312 Dictaphone. While there was minimal deviation between consecutive interviews, interviews varied in time length due to interviewees becoming uncomfortable or upset. Participants were given pseudonyms, and any identifiers within the texts were removed to ensure anonymity.

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Student Psychology Journal, Volume III Data Analysis All the data collected was naturalistic and was analysed using Interpretative Phenomenological Analysis. IPA was considered the best means of analysis as it implements an idiographic approach and is suitable for a close examination of idiosyncratic meaning-making processes.

Using homogenous sampling, a deeper understanding of an experience can be garnered using IPA. Transcriptions were then read and analysed by the primary author with constant referral to the recording to ensure reliability and, using a content analysis method, a systematic overview of the transcriptions was gained (Miles & Huberman, 1994). The transcriptions were read through independently and then open codes were assigned to the text. The most prevalent codes were grouped together into clusters to form overarching themes (Braun & Clarke, 2006).

Themes were authenticated by re-reading the texts and counting the number of times each participant mentioned each theme. Only themes that were mentioned by five or more out of the seven participants were thought to be the most salient and were retained and used for analysis.

To ensure inter-rater reliability a second person coded the data. Both coders found a high level of agreement throughout the categories.

Results Seven participants with the age range of 18 to 35 years, the mean age being 23.7, were interviewed. The females had an average of 2.7 years experience with cancer. The data was analysed using IPA; three super-ordinate, posttraumatic growth, support and lack of knowledge, and eleven sub-themes emerged from the analysis. These will be detailed below with illustrative quotes.

Greater Appreciation for Life Six participants reported a growth of appreciation for life, disclosing that they felt luckier and happier since their experience with cancer.

“I feel so lucky like, that you don’t have cancer, you can see what goes wrong and you feel more appreciative of your life,” (Aoife), Strengthened Personal Relationships Six out of the seven participants reported a strengthening of relationships within the familial circle. A change in maturity and roles seem to lead to these stronger relationships with; Their close family “We gel together more for the person who does have it [cancer]” and also spoke of her family becoming “stronger as a unit”. (Brianna)

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Empirical Investigations Their siblings “I got close to my brother more so than my sisters, because he’s older than me and I used to be the annoying wee sister... We all got closer definitely” (Brianna), Contrary to the majority, Freya commented she had to “grow up very fast; I never really had teenage years. I never got going to the youth club disco… I sort of lost my childhood” and that as a result of responsibilities and pressures involved “my relationship with Daddy broke down … we didn’t speak for a couple of years… I know if Mammy was alive that probably wouldn’t have happened.”

Increased Personal Strength All participants reported that they felt “stronger” after their experience with cancer. Four participants reported that this behaviour emulated their mother’s attitude to cancer; “Mam, she’s like a role model that you could say ‘Oh look she can do it, we can do it too’” (Deirdre), “I felt like no matter what happens you just kind of deal with it or it’s almost like you’re surprised at how strong you are... You kind of realise that while it’s the worst thing that could possibly happen... I’m still such a happy person and no matter what happens it kind of makes me realise, well, how adaptable people are” (Gráinne).

Awareness of new possibilities All participants reported a change in life goals, with Freya remarking she’d become “more determined”.

“I just meet everything head on, I’m not afraid, because life is there to be lived and be enjoyed, because it’s wonderful.” (Eva).

Spirituality Spirituality was not explicitly mentioned as an area of growth. However, two participants mentioned the role spirituality played during their mother’s treatment; “Mammy took to her prayers and found ease within herself, by turning to prayer.” (Eva).

Health behaviours All participants reported that their experience influenced their health behaviours, with younger participants engaging in healthier behaviours like running and avoidance of carcinogenic food, while older participants reported going for mammograms and engaging in more discourse with medical personnel.

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Student Psychology Journal, Volume III “I threw myself into football, that’s what I did, I was more active, and I was going out running and cycling” (Brianna), And mammograms, “Put my mind at rest” (Eva).

In contrast, “I was stressed out and I think that’s what made me start smoking, and I know that’s a bad thing, like I know I shouldn’t be smoking”.(Brianna) Support Family and Friends Five out of seven participants acknowledged having enough support within their circle of family and friends. These five admitted that they had no knowledge of any other support resources for people in their situation; “No, it’s not something you hear very much about at all now; All the help lines are geared towards adults more so”.(Carla), “We always had what we needed here at home. We had a good network of family and friends that were always here for us”. (Deirdre) Aoife highlighted the advantageous aspects of familial support “Because your family knows you best, more than a support group”.

External Support The remaining participants engaged with external support agents.

“It probably did [help]… Just talking about it. Up until that I would never have spoken about it with anybody”. (Freya) Talking All participants highlighted the importance of talking about cancer, and all reported the benefits of talking, particularly Gráinne, who indicated several instances where she would have liked to know more.

“Yeah, for me, it is just kind of talking about it and feeling the love and closeness of family, or feeling as if you still belong somewhere” (Gráinne) She also remarked “It’s not something that I talk about with friends and even close friends at that.

I’m always conscious of making people uncomfortable because it’s kind of hard to know what to say”

95

Empirical Investigations “It should be talked about. It wasn’t talked about back then. I mean I didn’t know my mother was going to die.” (Freya), “it’s only in recent years that I’ve realised that the reason I couldn’t sleep is because obviously I was upset about Mum and stuff whereas at the time, I just didn’t know, I just hadn’t a clue what was going on. It was just something terrifying; it would have been nice if someone had told me that it’s normal, you’re going through grief, but they didn’t”(Gráinne) Lack of Knowledge All participants verbalized the dearth of information about (a) cancer as a disease (informational knowledge) and (b) the incremental progression of cancer (discursive information).

Informational Knowledge “If [people] were more educated about it, it would definitely help” (Aoife) “[Children] can see what Mammy and Daddy are going through…maybe they don’t understand it.

And they don’t want to ask Mammy or Daddy in case they get upset” (Carla) Discursive Knowledge “It’s just important that they have support and someone to talk to and that they’re not left in the dark or anything. Because if you’re not told you’re going to worry more, and at least you know why your Mam or Dad aren’t around.” (Deirdre), “No just to be told, kept up to date, and to understand what death is, if that is what’s going to happen and to be more involved.” (Freya) Participants also suggested panoply ideas, including education about cancer to be taught in schools, more contact hours between the medical staff and the patients family, memory boxes, while Gráinne highlighted the lack of support in secondary school viz. counsellors and psychologists.

“More about cancer could be taught in schools” (Aoife), “If there was someone [at the hospital] to explain to the family exactly what’s going on” (Brianna), “Even little pamphlets or little booklets for the kids” (Carla), While both Eva and Gráinne called for more interaction with counsellors and professional help.

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Student Psychology Journal, Volume III Discussion From an analysis of the results, what became apparent was an interactional triadic model that supported a positive experience of maternal cancer; constituting the components of personal and environmental factors, support and PTG. This model will be explained and discussed in more detail in the following piece.

Posttraumatic Growth Posttraumatic growth that could be categorized into four of the five domains of Tedeschi & Calhounâ&#x20AC;&#x2122;s conceptualization was reported from females who had lost mothers and those who had mothers still alive - suggesting that the potential loss of a parent may be a catalyst of PTG. Similarly, the participants also mentioned an additional category of improved health behaviours that has been recently established (Wong et al., 2009). Contrary to the commonly believed characteristic that young adults engage in risky health behaviours and possess a sense of indestructibility (Werch et al., 2011), six out of seven participants in this study reported implementing more stringent health behaviours. This echoes Stanton, Bower and Lowâ&#x20AC;&#x2122;s (2006) finding that recognising benefit in the aftermath of stress and trauma is common among people experiencing a variety of negative events.

Spirituality was not mentioned as an area of growth in the present study which is noteworthy as Ireland is well-documented as a religious country (McCleary et al., 2011). These findings prove contrary to alternative research focused particularly on women with breast cancer in which spiritual change was found to be more prominent (Cordova et al., 2001). While growth was not mentioned, reliance on religiosity by the mother was mentioned in two accounts. Prospective studies could address alternative samples and the relevancy of spiritual reliance to PTG growth in children of cancer patients.

Tedeschi and Calhoun (2004) theorise that it is not the trauma itself that is responsible for PTG, but rather what happens in the aftermath of the trauma. The development of PTG seems to be rooted within personal and environmental variables that are vectors for the sustenance of this phenomenological growth.

Factors affecting PTG Personal factors It has been emphasized that myriad characteristics of the child at the time of diagnoses all have an impact on the development of PTG (Visser et al., 2004; Hoke, 2001). Participants varied on a multiplicity of factors, yet, in the present study, all reported PTG. At the time of the study, a 97

Empirical Investigations participant was coping with their mother’s undergoing treatment, after a re-occurrence of cancer following a period of remission. Even in this conflicting time, growth was still reported.

However, the extent to which PTG develops is unknown, so prospective quantitative studies, perhaps implicating the Posttraumatic Growth Inventory which could assess which variable affects the most positive influence on the development of PTG. Social factors Five out of the seven participants reported that life remained normal. Participants felt a need to maintain normality to stymie the cancer from intruding on their lives. A need to reduce the impact of cancer on the family’s life promotes a homeostatic level of normality. The maintenance of a normal life counteracts turbulent upheaval and negativity that can undermine the development of PTG. (Walsh, Manuel and Avis, 2005; Wagner & Compas, 1990).

An element not previously identified in the literature was the elevation of the mother to a position of role model for the daughters, echoing Weiss’ (2004) concept of modelling PTG behaviour. Brown and Gilligan (1992) published findings that identified early adolescence as a pivotal point in the relationship between mother and daughter, with the developmental goal being a balance between independence from and connection to their mothers. A cancer diagnosis may attribute additional salience to the pivotal positioning of the mother.

Ishraelashvili, Gilad-Osovitzki and Asherov (2006) found a correlation between the coping strategy employed by the mother and that subsequently employed by the daughter. The majority of mothers in this study adopted a problem-based coping strategy which was subsequently emulated by daughters. Participants acknowledged reflexive communication patterns that adapted to the presence of cancer, mother’s want to protect daughters from distress and in doing so, may have neglected their information needs, leading daughter’s to becoming more distressed, reflecting previous findings (Stiffler et al., 2008).

The maintenance of normality and the accessibility to a positive role model seems to act as a springboard for the cognitive ruminations inherent within the process of PTG. How support mediates its development will now be examined.

Support From this study, it became apparent that talking is the fulcrum around which support revolves reflecting Neimeyer’s (2001) concept of narration formation. Reflecting Stiffler’s research, the inability to talk openly is a cogent atrophy of the oncologic relationship. Surprisingly, the five participants who did not partake in external support, such as helplines or support groups, reported that they had very little or no knowledge of the resources that were available.

98

Student Psychology Journal, Volume III Internal Support Five out of seven participants reported that they received sufficient support from their immediate circle of family and friends. The dyadic relationship between support and talking, highlighted in every account, has a reinforcing, reciprocal nature. Disclosure facilitates more intimate relationship while this in turn provides more opportunity for disclosure (Fredickson, 2001). This type of support provides a symbiotic bind that determines the degree of willingness trauma survivors have to incorporate new perspectives (Tedeschi & Calhoun, 2004). Thus, talking about the event helps reconstruct the architecture scaffolding trauma as a mental representation, revealing emotions that may be surprising.

External support The remaining participants’ partook in social support, one in the form of counselling and another in the form of a group who had lost parents. Both found that talking and discovering that they were not unique in their position resulted in intimacy that may be comforting (Tedeschi & Calhoun, 2004), providing a “sense of belonging”. Both spoke of the detrimental effect that not talking had on them, stemming from a gap incongruity between what they thought was best for them and what their parent’s thought. They purported that disclosing their affective state was integral for initiating a more positive perspective on their experience.

Although the implicit mechanism underpinning the relationship between social support and PTG remains somewhat ambiguous, literature has shown that specific elements of social support such as openly discussing your experience with others may be influential in promoting PTG (Lechner et al., 2006).

Lack of knowledge Participants highlighted the lack of two forms of knowledge; informational knowledge and discursive knowledge.

Informational knowledge Participants believed that this paucity of knowledge heightened anxiety. Melton and Northouse (2001; in Stiffler et al., 2008) established that a family with fewer accessible resources perceives the mother’s diagnoses more threatening. All participants declared that there was a definite need for information throughout every stage of their mother’s cancer. Three participants accentuated a need for professional help, while others advised family counselling, paediatric leaflets and booklets about the various aspects of cancer, and education on cancer to be made available. Perhaps, for future cases, extra resources could be provided to alleviate the burden of the unknown, easing fear and promoting a more positive process when coping with cancer.

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Empirical Investigations Discursive knowledge Adolescents need and want to know about the treatments and the implications of the disease (Stiffler et al., 2008). From the accumulation of the previous literature and the present study, there is an apparent need for appropriate communication methods between cancer patient, healthcare provider and child. Research has established that there is no generic approach to communications with adolescents or children (Hay et al., 2010; Kristjanson et al., 2004; Faulkner & Davey, 2002). The conclusion can be drawn that idiosyncratic and developmentally appropriate information about cancer can only be beneficial towards the development of PTG. This study simultaneously compounds and expands upon these previous findings in that it demonstrates that PTG can be found in daughters whose mothers have experienced various types of cancer, not just daughters of mothers who have breast cancer. What became startlingly apparent was the need for both informational knowledge and discursive knowledge on the topic of cancer. The process of PTG can only be ameliorated with the provision of more knowledge about cancer, be it disseminated through education, hospital personnel or paraphernalia. This knowledge seems to have a dualistic effect, diminishing fear of the unknown while permeating the boundaries of social awkwardness that shroud the topic of cancer within society, both elements which seem to have a beneficial impact on PTG. Limitations and directions for future research These findings should be interpreted with caution as the sample of self-identified participants demarcates the generalisations that can be drawn. It should be noted that the growth experiences unveiled in this study could be a consequence of having an all female sample, as sex is an element intrinsically linked to the development of PTG (Linley & Joseph, 2004).

Furthermore, retrospective interviews proved to be problematic as participants may formulate new representations of themselves, their parent and their experience. This is particularly applicable to those whose parents are deceased (Normand, Silverman & Nickman, 1996). In addition to future studies mentioned above, studies with larger, more diverse participants are essential as a means to ameliorate the literature. In order to simultaneously disambiguate and elevate the role of social support in the development of PTG, future research could adopt some of the practice care implications suggested by participants in this study to investigate if there is amelioration of PTG.

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Student Psychology Journal, Volume III References Armsden, G.C., Lewis, F.M. (1994) Behavioural adjustment and self-esteem of school-age children of women with breast cancer. Oncology Nursing Forum, 21, 39-45 doi:10.1037/0882-7974.9.1.34.

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Student Psychology Journal, Volume III

Amyotropic Lateral Sclerosis: Current Understanding and Considerations Hollie Byrne University College Dublin byrnehollie@gmail.com

Amyotropic Lateral Sclerosis (ALS) is a neurodegenerative disorder characterised by impairment of muscle movement. Previously, cognitive functioning was considered to be largely intact among those with ALS. This review discusses the cognitive impairments proposed by the current research, including frontotemporal dementia, semantic and verbal fluency, emotion recognition, pseudobulbar effects, and the memory deficits which may be associated with the neurodegeneration characteristic of ALS. The methodology research which attempts to highlight these cognitive deficits, is critically discussed. The social and behavioural impacts of this progressive disorder are examined for example, the adjustment to needing a high level of care. Future avenues for research into neurocognitive assessment tools which fully cater to the capabilities of ALS patients are discussed.

Introduction Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder causing degeneration of the upper and lower motor neurons, located in the cranial nerves and spinal cord (Bruijn, Miller & Cleveland, 2004). The disorder was once considered to leave cognitive functioning largely intact, however variation among cognitive ability in sufferers has been highlighted (Meier, Charleston & Tippett, 2010). Impairment extends out from the motor cortex to other areas, as evidenced in studies which demonstrate frontal and temporal lobe dysfunction (Witgert et al., 2010). Thus ALS leads to debilitating effects upon an individualâ&#x20AC;&#x2122;s motor and cognitive ability, significantly diminishing quality of life (Abrahams, 2011).

Neuropathology The disorder is characterised by progressive atrophy of the muscles, leading to dysarythria and dysphagia, muscle fasciculations and spasticity (Johnson, Hoskins & McCluskey, 2011). The disease has three sites of onset: cervical onset, with projection in the upper or lower limbs, bulbar onset which projects to the muscles associated with speech and nasal functioning, and respiratory onset (Mitchell & Borasio, 2007). It was originally assumed that muscles in the bladder, stomach and eyes were not affected, but more recent research has suggested a progressive weakening of eye muscles as the associated neurodegeneration occurs (Palmowski et al., 1995). The majority of individuals with ALS, suffer death due to the degeneration nerves

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Review Articles which project to the respiratory muscles, for example the diaphragm and oesophageal muscles (Bourke et al., 2006). Degeneration of the nerves which project to bulbar muscles can lead to laughter or crying for no discernible reason, and ALS sufferers will have great difficulty terminating this behaviour (Merrilees, Klapper, Murphy, Lomen-Hoerth & Miller, 2010).

The cause of the disorder in familial cases is attributable to a mutation of the SOD1 gene, which produces an enzyme called superoxide dismutase (Rothstein, 2009). Superoxide dimutase is responsible for the collection of toxic free radicals (Rothstein, 2009). The mutation leads to malfunctions in protein folding and impairment in transmission of neural messages along axons (Rothstein, 2009). This mutation of the SOD1 gene also causes oxidative damage to neurons (Rothstein 2009), although Anderson (2004) states that it is unclear if oxidative stress is a cause or consequence, in relation to damage to motor neurons. In sporadic cases of ALS, there is no familial link to explain the onset of the disorder (Vance et al., 2009). In the sporadic category, difficulties in the editing of ribonucleic acid (RNA), is an attributed cause of the disease, leading to the increased manufacturing of glutamate, an excitatory neurotransmitter, which causes exitotoxicity (Vance et al., 2009). ALS sufferers typically experience malfunctions in the late stages of RNA metabolism, which contribute to RNA processing difficulties (Vance, 2009). These processing difficulties contribute to abnormal functioning of glutamate receptors, and high levels of glutamate is toxic to neurons (Vance, 2009).

Epidemiology In terms of epidemiology, the disorder is known to effect between 1.5 and 2.0 individuals in every 100,000, per annum (Banks & Ruff, 2011). The ratio of males to females who are affected with the disorder is approximately 1.3:1 (Hoppitt et al., 2011). The disorder is more likely to have its onset within individuals after the after the age of 40 (Vance et al., 2009), and can occur under the age of 25 in the form of juvenile ALS (Rabin et al., 1999), but the life expectancy for individuals with this juvenile form is significantly increased. Familial ALS occurs at a rate of approximately 5.1%, with lower rates appearing in southern European areas (Byrne et al., 2010). Rabin et al. (1999) states however, that the estimated rate of familial lateral sclerosis is approximately 10 percent, with 90 percent sporadic onset. Within an Irish context, it appears that there is consistency between worldwide epidemiology and Irish levels of occurrence (Oâ&#x20AC;&#x2122;Toole et al., 2008). The issue of how susceptible one is to the disorder, when centring on the familial occurrence of the disorder, is illustrated in areas such as Sardinia, where there is an extremely high occurrence of the disorder due to shared genes among local families (Chio et al., 2011). This high occurrence can also be evidenced in areas such as that of Guam and the Kii peninsula in Japan (Byrne et al., 2010). It is hypothesised that individuals with high rates of athleticism are at an increased risk of having the disorder(Turner et al., 2011). Once such 108

Student Psychology Journal, Volume III incidence of this occurred within Italy where a sample of soccer players had an increased likelihood of suffering from ALS (Turner et al., 2011). Repetitive head trauma and the use of drugs for illegal and therapeutic purposes during sporting careers have been proposed as explanations for the link between ALS and sportspeople, but a consensus on the reasons for why ALS may occur within sporting populations has not been reached (Chio et al., 2009). It is also proposed that individuals with increased exposure to high levels of toxicity within environments are at an increased risk of having the disorder, e.g. military soldiers (Banks & Ruff, 2010).

Neurocognitive Effects Fronto-Temporal Dementia There are a number of neurocognitive effects associated with ALS. Lillo, Garcia, Hornberger, Bak & Hodges (2010) discuss the prevalence of frontotemporal dementia (FTD) which is associated with ALS. In comparing patients with behavioural variant FTD (bvFTD), and those who have FTD and ALS, it was discovered that the ALS group had higher rates of psychotic delusions, less inhibition and increased attentional deficits (Lillo et al., 2010).

Verbal & Sematic Fluency Word finding problems were present from the first consultation (Lillo et al., 2010). The entire ALS group (n=18) presented with loss of insight into their condition, and reduced speech output compared to the bvFTD group (Lillo et al., 2010). Methodological concerns however, are present as the author states that it may be unnecessary to compare both groups in terms of word finding, as bvFTD sufferers typically do not present with this problem (Lillo et al., 2010).

However all patients had diagnoses conducted using DSM-IV criteria, and received treatment in homogenous facilities (Lillo et al. 2010).

Lepow et al. (2011) demonstrated a decline in verbal fluency associated with ALS. They examined semantic fluency, which was investigated by assessing word categories, and phonemic fluency, which is assessed by naming words beginning with the same letter (Lepow et al., 2010).

This study compared performance on two tests of verbal fluency by Troyer,

Moscovitch & Wincour (1977) and Abwender, Swan, Bowerman & Connolly (2001), in order to discern if they pick up all sensitivities which would go unnoticed with only one measure. The 49 ALS patients in their study were stratified according to those with intact cognitive ability, mild cognitive impairment and those with FTD. A significant effect was observed in terms of impairment on both phonemic and semantic fluency, and as a group, the ALS group demonstrated more temporal lobe involvement (Lepow et al., 2011). However, within the 109

Review Articles group, temporal lobe involvement decreased from the ALS intact to the ALS/FTD group (Lepow et al., 2011). It is proposed that fluency deficits may be attributed to the degeneration of the neural systems which moderate the central executive component of the working memory or the selective attentional system (Abrahams, Leigh, Harvey, Vythelingum, Grise & Goldstein, 2000) Given that bulbar and respiratory muscles can be affected due to the neurodegeneration associated with ALS, one might consider whether this allowed individuals to vocalise properly during testing (Lepow et al., 2011). It might also be worth considering that Abrahams et al.

(2007) demonstrates that those with bulbar onset may already have pre-existing cognitive impairments.

Memory Deficits It is proposed that patients with ALS have significant working memory deficits (Abrahams et al., 2000). Working memory involves the processing of verbal and visual spatial information (Hammer, Vielhaber, Rodriguez-Fornells & Mohammadi & Munte, 2011). In an investigation of the working memory ability of ALS patients, Hammer et al., (2011) discovered a significant deficit among the patients, in the processing of spatial instruction. The authors noted poorer performance than healthy controls, on the recall of words (Hammer et al., 2011).

In investigating the functioning of the orbitomedial prefrontal cortex in ALS patients, Meier, Charleston & Tippett (2010) demonstrated a significant deficit among ALS patients in terms of discerning a social faux-pas. Using vignettes, the ALS patients failed to identify situations in which socially undesirable behaviour had occurred (Meier et al., 2010). However, there was no difference between control and ALS groups for the control faux-pas stories (Meier et al., 2010).

Emotion Recognition & Pseudobulbar Effects Zimmerman, Eslinger, Simmons & Barrett (2007) demonstrate that ALS patients have difficulty in identifying facial expressions, and certain emotions during prosody tasks. This study investigated bulbar onset patients in particular who often exhibit the pseudobulbar effect (Zimmerman et al., 2007). The pseudobulbar effect is exhibited when neurodegeneration of the neural networks which regulate the expression of emotions lead to uncontrollable episodes of laughing of crying (Zimmerman et al., 2007). Patients demonstrated difficulty identifying disgusted, sad and surprised emotions with visual stimuli, and surprise on the prosody test (Zimmerman et al., 2007). The authors added to the methodological strength of the study by controlling for depression and fatigue effects, however it is difficult to interpret the results in light of this, as half of the proportion of ALS patients who performed worse than controls fell in the depressed category, thus this may have affected the result (Zimmerman et al., 2007).

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Student Psychology Journal, Volume III Social and Behavioural Effects The social and behavioural effects with ALS, as with any motor neuron disease, operate across many levels. With regards to the effects of symptoms such as the pseudobulbar effect, ALS sufferers often experience embarrassment and discomfort from the effects of their uncontrollable laughter, and this effect can often occur even when none of the other cognitive deficits discussed above, are present (Merrilees et al., 2010). The associated FTD and the effects on executive functions, levels of apathy, insight, emotional change and irritability, can affect the social relationships surrounding the individual with ALS (Merrilees et al., 2010). Mirowsky & Ross (1992) state that apathy can often increase with a change in oneâ&#x20AC;&#x2122;s locus of control, thus having to depend increasingly on a carer may influence apathy. Apathy can have a significant effect on the relationships which the individual maintains, as caretakers find it difficult to engage the individual in a motivatory activity or access the patients interest (Merrilees et al., 2010). This can cause significant difficulties and distress for caregivers, as apathy is often difficult to distinguish from other states, such as depression (Woolley & Jonathan, 2008). With regards changes in executive functioning, planning and organisational skills are affected, leading to the patient needing assistance with managing finances, general household chores and paperwork (Merrilees et al., 2010). Kurt, Nijboer, Matuz & Kubler (2007) state that because of the severity of the disease there is a high rate of depression among individuals. Groenestijen et al. (2011) have proposed depressive symptoms involved in chronic conditions, responded well to cognitive behavioural interventions and thus, may be applicable to ALS sufferers.

Orbitofrontal dysfunction may cause difficulty for the individual in discerning a social faux-pas (Meier et al., 2010), which could lead to the loss of social friendships due to a lack of knowledge about the behavioural effects of the condition. Irritability can often occur, as a result of the fatigue associated with the disorder, thus family members may limit visitors or activities when the patient usually experiences these symptoms (Merrilees et al., 2010).

Prognosis The prognosis of amyotrophic lateral sclerosis is variable depending on the type of disorder.

The life expectancy for those with the juvenile onset is longer than the adult onset condition (Rabin et al., 1999). In adult onset, the prognosis for survival is considerably shorter, with estimates of three to five years post diagnosis, but this can be variable among individuals (Chio et al., 2009). The location of onset can have an effect, with those who have respiratory onset having a more negative prognosis (Chio et al., 2009). Furthermore the patient will most likely have to avail of mobility aids, and will require the assistance of a carer or family member (Peters & Floeter, 2009). Due to the degeneration of respiratory functions, individuals often 111

Review Articles have invasive or non-invasive, respiratory apparatus (Bourke et al., 2006). Peters and Floeter (2009) report that in order to mediate for social effects the caregiver and patient increasingly use the internet, for example by the use of online support groups. The neuropathology of amyotrophic lateral sclerosis is such that currently, there is no known therapy which leads to a curative effect (Johnston et al., 2011). Medication such as riluzole may increase life expectancy by 23% if administered early at six months post-diagnosis and by 15% if it is administered by one year post diagnosis (Chio et al., 2009).

Conclusions and Future Research It is clear that the neurocognitive deficits and social and behavioural effects make ALS a complex disorder to contend with. Miller et al., (2010) propose that multidisciplinary teams are therefore necessary when dealing with ALS. Future research may centre on strategies for helping individuals cope with difficulties in executive functioning and social effects. Finally it is evident that tests which adapt to the needs of the ALS individual, are being developed in order to overcome methodological flaws, for example non-physical tests of executive functioning which might more accurately represent the executive functioning of individuals with motor difficulties (Stuckovnick, Zidar Podnar & Repous, 2010).

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Abrahams, S., Leigh, P.N, Harvey, A., Vythelingum, G.N., Grise, D., Goldstein, L.H. (2000). Verbal fluency and executive dysfunctioin in amyotrophic lateral sclerosis. Neuropsycholoogica, 38(6), 734-747.

Abrahams, S., Leigh, P., Harvey, A., Vythelingum, G., Goldstein, L. (2000). Verbal fluency and executive dysfunction in amyotrophic lateral sclerosis. Neuropsychologia, 38, 734-747.

Abwender, D.A., Swan, J.G., Bowerman, J.T., & Connolly, S.W. (2001). Maunal for the composite method for scoring qualitative aspects of verbal fluency performance v. 2.1. New York: Brockport University.

Anderson, J. (2004). Oxidative stress in neurodegeneration: cause or consequence. Nature Reviews Neuroscience, 5, 18-25, Banks, P., & Ruff, R. (2011). Management of patients with amyotrophic lateral sclerosis. Federal Practitioner, 32-35.

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Student Psychology Journal, Volume III Bourke, S.C., Tomlinson, M., Williams, T.L., Bullock, R.E., Shaw, P.J., Gibson, G.J. (2006). Effects of noninvasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. The Lancet, 5, 140-147.

Bruijn, L., Miller, T.M & Cleveland, D. (2004). Unravelling the mechanisms involved in motor neuron degeneration in ALS. Annual Review of Neuroscience, 27, 723-749.

Byrne, S., Walsh, C., Lynch, C., Bede, P., Elamin, M., Kenna, K., McLaughlin, R., Hardiman, O. (2010). Rate of familial amyotrophic lateral sclerosis: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry, 82, 623-627.

Chio, A., Borghero, G., Pugliatti, M., Ticca, A., Calvo, A.,... Restagno, G. (2011). Large proportion of amyotrophic lateral sclerosis cases in Sardinia due to a single founder mutation of the TARDBP gene. Archives of Neurology, 68(5), 594-598.

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Hammer, A., Vielhaber, S., Rodriguez-Fornells , A., Mohammadi, B. & Munte, T. (2010). A neurophysiological analysis of working memory in amyotrophic lateral sclerosis. Brain Research, 1421, 90-99.

Hoppitt, T., Pall, H., Calvert, M., Gill, P., Yao, G., Ramsay, J.,...Slackley, C. (2011). A systematic review of the incidence and prevalence of long-term neurological conditions in the UK. Neuroepidemiology, 36(1), 19-28.

Johnston, W.S, Hoskins, K., McCluskey, L. (2011). Amyotrophic lateral sclerosis: Ethical considerations.

Neurology, 76(7), 1-7.

Kurt, A., Nijboer, F., Tamara, M., &Kubler, A. (2007). Depression and anxiety in individuals with amyotrophic lateral sclerosis: epidemiology and management. CNS Drugs, 21(4), 279-291.

Lepow, L., Van Sweringen, J., Strutt, A, Jaiwad, A., MacAdam, C., ... York, M. (2010). Frontal and temporal lobe involvement on verbal fluency measures in amyotrophic lateral sclerosis. Journal of Clinical and Experimental Neuropsychology, 32(9), 913-922 Lillo, P., Garcia, B., Hornberger, M., Bak, T., &

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Review Articles Merrilees, J., Klapper, J., Murphy, J., Lomen-Hoerth, C. & Miller, B. (2010). Cognitive and behavioural challenges in caring for frontotempral dementia and amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis, 11(3), 298-302.

Miller, R., Jackson, C., Kasarskis, J., Forshew, D., Johnston, S., Kalra, J., ... Woolley, S. (2009). Practice parameter update: the care of the patient with amyotrophic lateral sclerosis: Multidisciplinary care, symptom management, and cognitive/behavioural impairment (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology, 73, 1227-1233.

Mirowsky,J. & Ross,C. (1992). Age and depression. Journal of Health and Social Behaviour, 33(3), 187-205.

Mitchell, J., & Barasio, G. (2007). Amyotrophic lateral sclerosis. The Lancet, 369(9578, 16-22.

McKee, A., Cantu, R., Norwinski, C., Hedley-Whyte, E., Gavett, B.,... Stern, R. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy following repetitive head injury. Journal of Neuropathology and Experimental Neurology,68(7), 709-735.

Oâ&#x20AC;&#x2122;Toole, O., Traynor, B., Brennan, P., Sheehan, C., Frost, E., Corr, B., Hardiman, O. (2007). Epidemiology and clinical features of amyotrophic lateral sclerosis in Ireland between 1995 and 2004. Journal of Neurology, Neurosurgery & Psychiatry, 79, 30-32.

Peters, T., & Floeter, M. (2009). Usage of support services in primary lateral sclerosis. Amyotrophic Lateral Sclerosis, 10(3), 185-187.

Palmowski, A., Jost, W.H., Prudlio, J., Osterhage, J., Kasman, B., Schimrigk, K., Ruprecht, K.W. (1995). Eye movement in amyotrophic lateral sclerosis: A longitudinal study. German Journal of Ophthalmology, 4, 355-362.

Rabin, B., Griffin, J., Crain, B., Scavina, M., Chance, P. & Cornblath, D. (1999). Autosomal dominant juvenile amyotrophic lateral sclerosis. Brain, 122, 1539-1550.

Rothstein, J.D (2009). Current hypotheses for the underlying biology of amyotrophic lateral sclerosis.

Annals of Neurology, 65(1), 3-9.

Stuckovnick, v., Zidar, J., Podnar, S., & Repovs, G. (2010). Amyotrophic lateral sclerosis patients show executive impairments on standard neuropsychological measures and an ecologically valid motor-free test of executive functions. Journal of Clinical and Experimental Neuropsychology, 32(10), 1095-1109.

Troyer, A.K., Moscovitch, M., & Wincour, G. (1997). Clustering and switching as two components of verbal fluency: evidence from younger and older healthy adults. Neuropsychologia, 11, 138-146.

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Student Psychology Journal, Volume III Turner, M.R., Wicks, P., Brownstein, C., Massagli, M., Toronjo M., Talbot, Chalabi, A. (2011). Concordance between site of onset and limb dominance in amyotrophic lateral sclerosis. Journal of Neurology, Neurosurgery & Psychiatry, 82, 853-854.

Vance, C., Rogelj, B., Hortobagyi, T., de Vos, K.J., Nishimura, A., Sreedharan, J., ...Shaw, C. (2009). Mutations in FUS, an RNA processing protein, cause familial amyotrophic lateral sclerosis type 6. Science, 323(5918), 1208-1211.

Witgert, M., Salamone, A.R., Strutt, A.M., Jawaid, A., Massman, P.J., Bradshaw, M.,...Schultz, E. (2010).

Frontal-lobe mediated behavioural dysfunction in amyotrophic lateral sclerosis. European Journal of Neurology, 17, 103-110.

Woolley, S., & Jonathan, K. (2008). Cognitive and behavioural impairment in amyotrophic lateral sclerosis.

Physical Medicine and Rehabilitation Clinics of North America, 19(3), 607-617.

Zimmerman, E., Eslinger, P., Simmons, Z. & Barrett, A. (2007). Emotional perception defecits in amyotrophic lateral sclerosis. Cognitive Behavioural Neurology, 20(20), 79-82.

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Review Articles

A Critical Evaluation of How Adopting A Lifespan Perspective Can Enhance Our Understanding of the Cognitive Change That Occurs With Aging Orla Meehan University College Dublin orla.m.meehan@gmail.com

The lifespan perspective emphasises the entwined nature of an individual’s development within their cultural, interpersonal and biological contexts (Lang, Wagner & Neyer, 2009) and has become an increasingly active area of inquiry in recent years (Heckhausen & Schulz, 1995). The present review using the five assumptions of the lifespan perspective, offers a critical evaluation of the extent to which this perspective could offer a more integrated understanding of the cognitive change that occurs with ageing.

Introduction According to Salthouse (2004), the occurrence of cognitive ageing has been noticed nearly as long as the occurrence of physical ageing, but is still not fully understood. Craik and Bialystok (2006) believe the notion that cognitive ageing is simply ‘development in reverse’ is too simple.

There is large variation in differences between individuals in both level of change and change in mental ability throughout the life course (Gow et al., 2011). Lifespan psychology involves the study of an individual’s development from conception through to old age (Baltes et al 1980, Dixon & Lerner 1988, Neugarten 1996, Thomae 1979; as cited in Baltes, Staudinger, & Lindenberger, 1990). Lifespan development has become a progressively active area of inquiry in recent years and has shown the potential of generating important theories regarding the emergence and development of human behaviour throughout life (Heckhausen & Schulz, 1995).

Both plasticity and permanent change of an individual’s experience of both gains and losses across the life course characterise the lifespan perspective of human development (Baltes, 1987; as cited in Greve & Bjorkland, 2009). This perspective emphasises the entwined nature of an individual’s development within their cultural, interpersonal and biological contexts (Lang, Wagner & Neyer, 2009). Therefore the lifespan perspective could enable a more integrated understanding of the cognitive change that accompanies ageing.

116

Student Psychology Journal, Volume III The Five Assumptions of the Lifespan Perspective According to Newman and Newman (2009) there are five assumptions of the lifespan perspective: the first is that growth occurs at every period of life and new capacities emerge, the second is that individualsâ&#x20AC;&#x2122; lives show continuity along with change, the third is the need to understand the whole person as we function in an integrated manner, the fourth is that behaviour must be interpreted in the context of the applicable settings and finally that individuals actively contribute to their development. The present review will critically evaluate the applicability of this perspective, using these five assumptions as a means of determining the ways in which it could offer further understanding of cognitive change, in particular cognitive ageing.

The Applicability of Each of the Five Assumptions to Cognitive Change To begin with, the first assumption holds that growth occurs at each period in life and with each new period comes new roles/abilities and in doing so the lifespan perspective infers plasticity (Newman & Newman, 2009). Cognitive skills increase sharply from infancy to young adulthood and then are either upheld or deplete in old age, depending on the ability (Craik & Bialystok, 2006). For example, fluid abilities that depend on fast encoding and transformation of novel information generally demonstrate deterioration as a result of genetically driven biological changes related to age, whereas, crystallized abilities that are contingent on knowledge and acquisition of culture can remain constant or increase into late adulthood (Stine-Morrow, 2007). Despite this, a longitudinal study carried out by Gow et al. (2010) found that early cognitive ability is the greatest single predictor of cognitive ability in later life, suggesting that early cognitive ability may be the most important indicator for later cognitive change. A key methodological issue is the timeframe of the lifespan and so difficulties arise in identifying the source and extent of plasticity and its changes associated with age (Baltes, Staudinger, & Lindenberger, 1999). Therefore, further study using the lifespan perspective in regard to growth throughout the life course is needed.

Following on from this, individuals show both continuity and change in cognitive abilities throughout their lives (Newman & Newman, 2009). Take language for example- during childhood vocabulary and grammar develop with only small losses related to age after the age of 70 (Wingfield & Stine-Morrow, 2000; as cited in Craik & Bialystok, 2006), therefore demonstrating continuity. However, ageing results in difficulties with access to stored information (Craik & Bialystok, 2006). A difficulty in recalling names and words that are specific labels is the most frequent memory complaint of older adults (Cohen & Burke, 1993; as cited in Craik & Bialystok, 2006). Despite this, the information is not gone from memory, as it is possible 117

Review Articles to retrieve either spontaneously or with superior cues (Craik & Bialystok, 2006). Thus, although knowledge discrepancies are linked to development and ageing, the limitation in children is caused by incomplete acquisition, whereas, the limitation in older adults is related to problems of access (Craik & Bialystok, 2006) therefore demonstrating change. For this reason, language nicely illustrates how both change and continuity in cognition takes place throughout the lifespan.

On the other hand, the need to understand the whole person as we function in an integrated manner (Newman & Newman, 2009) of the lifespan perspective is not as clear for cognitive change at this time. Although it is evident that a large variety of variables are associated with cognitive change it appears that further study is needed to determine this. For example a critical review of the literature regarding cognitive-enrichment studies involving older human and nonhuman participants carried out by Hertzgog et al (2008) suggests that a variety of activities such as exercise or physical activity and both intellectual and social engagement, have shown potential in either reducing cognitive decline, postponing the onset of neurodegenerative diseases related to age, or improving elements of cognition in older adults. On the other hand, Hertzgog et al. (2008) remark that more information is needed to determine the degree to which â&#x20AC;&#x153;personality traits, positive attitudes, and positive beliefs foster healthy lifestyles that facilitate cognitive enrichmentâ&#x20AC;? (p. 44, Hertzgog et al., 2008). An obvious difficulty is the evident methodological issues associated with this assumption. As Hertzgog et al. (2008) assert, actual cognition in normal everyday settings is very dependent on knowledge and experience, both of which are unique to each person and therefore difficult to measure. Therefore although it is apparent that cognitive change is not independent of the whole individual, the study of the interaction between cognitive change and the whole person requires further research.

The fourth assumption of the lifespan perspective is also applicable to cognitive change as the context of the relevant settings (Newman & Newman, 2009) appears to be relevant to cognitive abilities. According to Baltes and Baltes (1990; as cited in Hertzgog et al., 2008) individuals are selected into certain contexts and from there, their own unique developmental cognitive histories develop. To begin with, cultural psychologists have consistently found differing patterns of thinking and perception in different cultures, for example, much research has found that Westerners tend to be more analytic and East Asians tend to be more holistic (Varnum, Grossman, Kitayama & Nisbett, 2010). Following on from this, a study carried out by Finkel, Reynolds, McArdle, and Pedersen (2005) found aspects of cognition such as processing speed, as well as developmental changes in processing speed to result from both genetic and environmental influences in their study using both identical and non-identical twins. This data has demonstrated that the enrichment of one twinâ&#x20AC;&#x2122;s environment over the other can result in a 118

Student Psychology Journal, Volume III deviation of their cognitive paths of development (King & Suzman, 2008). Therefore, this demonstrates that the environment can contribute to cognitive change. With this in mind, evidence suggests that it is early exposure to both education and enriched environments, as opposed to late exposure, that may have the greatest effects on both cognitive and non-cognitive skills in old age (King & Suzman, 2008) which highlights how societal interactions such as more educational opportunities at an early age can contribute to cognitive development.

Furthermore, results from the Seattle Longitudinal study have highlighted the occurrence of considerable generational differences between the cohorts in psychometric abilities (Schaie, 1983, 1996; Willis, 1989; as cited in Schaie, Willis, & Caskie, 2004). For example, a linear positive cohort change in inductive reasoning has been observed, whereas, number skills which reached a maximum in the 1924 birth cohort have experienced a negative decline since then (Schaie, Willis, & Caskie, 2004). Kail and Cavanaugh (2012) suggest that these cohort differences likely reflect differences in educational experiences with the younger cohortsâ&#x20AC;&#x2122; education having a greater emphasis on rote learning and the older cohorts having a greater emphasis on figuring it out themselves. Therefore these examples nicely illustrate how cultural, societal and environmental context impact on an individualâ&#x20AC;&#x2122;s cognitive change.

The final assumption of the lifespan perspective is that individuals contribute actively to their development (Newman & Newman, 2009). According to Antsey (2008) the interaction between an individual and their environment moulds the way in which the environment influences their cognitive development. An individual is not passive to the effects of risk factors on both cognitive and brain development, but they actively interact through their behaviour with the environment (Anstey 2008). The literature suggests that physical activity and aerobic exercise enhances older adultsâ&#x20AC;&#x2122; cognitive abilities (Hertzgog et al. 2009) which demonstrates an interaction that can occur at an individual level (e.g. making the personal decision to increase physical activity) (Antsey, 2008). According to Hertzgog et al. (2008) social isolation, neuroticism, and adverse reactions to stress are all risk factors for the decline of cognitive skills and the emergence of dementia in old age. All of these risk factors are subject to individual differences and involve certain behaviours suggesting that an individual plays an active part in the execution of such behaviours. Following on from this, an individual can make the decision to pursue or take part in cognitively difficult situations or refrain from such activities both of which can be related to either cultural stereotypes of deterioration in cognitive functions or as a result of fewer opportunities to take part in intellectually challenging situations (Stine-Morrow, 2007). Therefore it is possible that declines in cognitive performance result from task relevant processes not being utilised along with the possibility that not utilising these processes could

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Review Articles result in more pronounced age related biological declines in cognitive functions (Stine-Morrow, 2007).

Advantages of Adopting a Lifespan Perspective Having explored the applicability of the five lifespan perspective assumptions to cognitive change it appears to have a variety of advantages. It acknowledges that there are both advances and losses in cognition across adulthood but also that, with increasing age, advances become less common and losses are more common (Hertzgog et al., 2008). Two important characteristics of this perspective are that: levels of performance are flexible and open to enrichment all the way through the life span, but that the upper levels of performance are restricted by the boundaries associated with biological ageing (Hertzgog et al., 2008). The lifespan perspective also suggests that individuals at all ages operate within ranges of cognitive functioning that commonly do not equal their peak performance potential (Hertzgog et al., 2008). Movement within this range of possible performance can be thought of as a type of behavioural plasticity that is always being reshaped as a result of the person’s environmental context, biology, health, and relevant behaviours to cognition (Denney, 1984; as cited in Hertzgog et al., 2008).

Limitations of Adopting a Lifespan Perspective On the other hand despite apparent advantages of this approach to cognitive change there are few integrated accounts of changes in cognitive abilities across the lifespan (Craik & Bialystok, 2006). Gow et al. (2011) believe that the greatest challenge to determining if cognitive ability in early life impacts on the trajectory of cognitive ability later in life is the shortage of research with the proper data. According to Heckhausen and Schulz (1995), psychologists have made little attempt to develop lifespan theories of development, which they suggest is due to the fact that these efforts would demand the integration of information from a variety of areas including the behavioural, social, and biological sciences along with the problems of analysis. Birren and Bengtson (1988; as cited in Heckhausen & Schulz, 1995) believed that the field of life-course development and ageing was at that time “best characterised as data rich but theory poor”(p.284)” which appears to be quiet true today

as a result of the aforementioned

methodological issues associated with such a perspective.

Conclusion Despite these limitations, Craik and Bialystok (2006) suggest that an incorporation of the processes of cognitive change in development and ageing is necessary for a complete account of the structure of cognition and the identification of the factors that influence cognitive 120

Student Psychology Journal, Volume III performance. Salthouse (2004) asserts that given the limited understanding of cognitive change it is probably healthy for a field to pursue differing approaches to explanation. Furthermore, there is a vast literature that highlights the association between alleged risk factors and cognitive decline in later life (Antsey, 2008). According to Antsey (2008), there is a need to integrate this literature within a framework that takes into account the interaction between behavioral and ecological influences with cognitive development. This framework would enable the development of a variety of personal and environmental interventions that could help optimise cognitive development within the population, and reduce the risk of cognitive deficiencies in later adulthood (Antsey, 2008). Therefore the lifespan perspective offers the potential for an integrated account of cognitive change along with potential for producing more effective interventions for cognitive performance. Moreover, future studies of cognitive change that occur with ageing could benefit from adopting this perspective through use of longitudinal studies that follow individuals from birth to old age. Craik and Bialystok (2006) believe that the facts of cognitive change are now known in sufficient detail for a wider perspective to be applied. Therefore the lifespan perspective on cognitive change provides a fruitful avenue for furthering our understanding of cognitive change through ageing.

References Antsey, K.J. (2008). Alcohol exposure and cognitive development: An example of why we need a contextualized, dynamic life course approach to cognitive ageing—A mini-review. Gerontology, 54(5), 283-291.

Baltes, P. B., Staudinger, U. M., & Lindenberger, U. (1999). Lifespan psychology: Theory and application to intellectual functioning. Annual Review of Psychology, 50, 471– 507.

Craik, F.I.M. & Bialystok, E. (2006). Cognition through the lifespan: Mechanisms of change. Trends in Cognitive Sciences, 10(3), 131-138.

Finkel, D., Reynolds, C.A., McArdle, J.J., & Pedersen, N.L. (2005). The longitudinal relationship between processing speed and cognitive ability: Genetic and environmental influences. Behavioral Genetics, 35, 535–549.

Gow, A.J., Johnston, W., Pattie, A., Brett, C.E, Starr, J.M., Roberts, B. and Deary, I.J. (2011). Stability and change in intelligence from age 11 to ages 70, 79, and 87: The Lothian Birth Cohorts of 1921 and 1936. Psychology and Aging, 26(1), 232-240.

Greve, W. and Bjorklund, D.F. (2009). The Nestor effect: Extending evolutionary developmental psychology to a lifespan perspective. Developmental Review, 29(3), 163–179.

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Review Articles Heckhausen, J. & Schulz, R. (1995). A life-span theory of control. Psychological Review, 102(2), 284-304.

Hertzog, C., Kramer, A.F., Wilson, R.S., & Lindenburger, U. (2008). Enrichment effects on adult cognitive development: Can the functional capacity of older adults be preserved and enhanced?

Psychological Science in the Public Interest, 9, 1–65.

Kail, R.V. and Cavanaugh, J.C. (2012). Human Development: A Life-Span View (6thEd.).Belmont : Wadsworth, Cengage Learning.

King, J.W. and Suzman, R. (2008). Prospects for improving cognition throughout the life course.

Psychological Science in the Public Interest, 9(1), i-iii.

Lang, F. R, Wagner, J. and Neyer, F. J.(2009). Interpersonal functioning across the lifespan: Two principles of relationship regulation. Advances in Life Course Research, 14(1-2), 40–51.

Newman, B.M. and Newman, P.R. (2009). Development through a Psychosocial Approach. Belmont: Wadsworth.

Salthouse, T.A. (2004). What and when of cognitive aging. Current Directions in Psychological Science.

13(4), 140-144.

Schaie, K.W, Willis, S.L. & Caskie, G.I.L. (2004). The Seattle longitudinal study: Relationship between personality and cognition. Aging, Neuropsychology, and Cognition, 11 (2-3), 304-324.

Stine-Morrow, E.A.L (2007). The Dumbledore hypothesis of cognitive aging. Current Directions in Psychological Science, 16(6), 295-299.

Varnum, M.E.W, Grossman, I., Kitayama, S. and Nisbett, R.E. (2010). The origin of cultural differences in cognition: Evidence for the social orientation hypothesis. Current Directions in Psychological Science, 19(1), 9–13.

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Student Psychology Journal, Volume III

Singing in the Rain: A Literature Review of Current Methods for Improving Well-being Mark Dillon & Meggan King Dublin City University kramnollid@gmail.com; meggan.king25@mail.dcu.ie

Well-being is defined as a state in which the individual is aware of their own potential, has the coping ability to deal with ordinary life stressors, is able to work effectively and can contribute to society in a meaningful way (WHO, 2011). However, much research indicates that there is no clear consensus regarding the definition and scientific measurement of the concept of well-being (Smith, Fleeson, Geiselmann, Settersten, & Kunzmann, 2001). Despite this difficulty, well-being will be discussed according to the WHO definition due to its centrality in this review. Throughout this literature review, various methods are explored which overcome barriers to well-being. Research evidence indicates that mindfulness and Rational Emotive Behaviour Therapy (REBT) are efficacious methods for treating stress, depression and anxiety in both nonclinical and clinical populations. Acceptance and Commitment Therapy (ACT) and Mindfulness Based Cognitive Therapy (MBCT) are also discussed as they incorporate multiple psychological perspectives and have demonstrated success in positively affecting well-being by initiating changes to an individual’s consciousness, thus reducing anxiety, depression and psychosis.

Meanwhile, systematic desensitisation has been shown to increase well-being by resolving psychosomatic and psychological issues. Thus, the current review explores the reason behind the efficacy of various contemporary methods available to enhance well-being, while recognising the diverse perspectives of what constitutes and impacts well-being.

Of the methodologies mentioned, it is evident that the

individual’s awareness of their behaviour can be utilised to guide and maintain more favourable behaviours, thus having positive implications for well-being. This theme will begin to unfold throughout, as various contemporary methods are examined.

Introduction Well-being is not merely the absence of pathology; it is both objective and subjective in nature (McAllister, 2005). It is a complex concept concerning an individual attaining a heightened level of functioning and experiencing (Ryan & Deci, 2001). The study of well-being can be explained in terms of two perspectives: the hedonic approach and the eudaimonic approach. The hedonic approach views well-being as the achievement of pleasure and the aversion of pain while the eudaimonic approach views well-being in terms of, “meaning and self-realization and defines well-being in terms of the degree to which a person is fully functioning” (Ryan & Deci, 2001, p.

141). Two recognised and imperative elements of well-being include positive emotion and life satisfaction (Quoidbach, Berry, Hansenne & Mikolajcza, 2010). One method of measuring well123

Review Articles being is through a subjective means of self-reporting one’s life satisfaction and level of happiness (McGillivray & Clarke, 2006). Emotions are understood to be important factors which influence behaviour. Individuals have the ability to alter their emotional experience due to controlling their own cognitive appraisals (Gross, 1998; Quoidbach et al., 2010) and their physical sensations which result from emotion (Porges, 2007). According to Rothermund, Voss and Wentura (2008), individuals also have a high degree of control over the processing of their emotions. This management of emotion is known as emotion regulation. Emotion regulation has shown to have a significant impact on mental health outcomes (Gross & Muñoz, 1995), relationship satisfaction (Murray, 2005), physical health (Sapolsky, 2007), and work performance (Diefendorff, Hall, Lord, & Strean, 2000). Although these variables constitute a support framework for the potential of well-being, it remains to be seen whether emotion regulation directly effects well-being as defined. Therefore, it could be argued that being aware of one’s emotions as well as the ability to regulate one’s emotions positively impact well-being.

Happiness, sometimes misconceived as well-being, is however a more specific reference to the perceived distance between an individual’s current position and their desires (Bruni & Porta, 2007). Furthermore, confusion exists whether or not ill-being (which includes anxious, depressed and angry states) and well-being are independent of one another, that is; can someone be in a state of ill-being but also in a state of well-being (Ryff et al., 2006). Threats to well-being include depression (Seligman, 2006), life stressors (Grossman, Niemann, Schmidt & Walach, 2004), irrational thoughts (Vernon, 1990), anxiety (Maredpour, Najafi, & Rafat-Mah, 2012), family separation (Yoosefi, 2011), anger problems (Fuller, Digiuseppe, O'Leary, Fountain, & Lang, 2010), phobias (Russell, & Jarvis, 2003) and physical complaints (Van Rood, & de Roos, 2009). The escalation of depression is one such example, as severe depression has increased tenfold over the past fifty years, directly affecting 121 million people (Parker et al., 2001; Seligman, 2006). In the present day, methods for dealing with these threats are a necessity. The current review addresses the reasons for the efficacy of contemporary methods for improving well-being. Such contemporary methods include, the use of Mindfulness based therapy, Rational Emotive Behavioural Therapy, Logotherapy, Acceptance and Commitment Therapy and Systematic Desensitisation.

Mindfulness Mindfulness involves achieving a greater understanding of the present by concentrating on thoughts, feelings, one’s bodily sensations and the world around us (Bishop et al., 2004). Bishop et al. identified two key parts of mindfulness: mastery of one’s attentional focus and the ability to live in the present moment. A prolific amount of research has been done on the role that 124

Student Psychology Journal, Volume III mindfulness has on improving subjective well-being (Brown & Kasser, 2005; Brown & Ryan, 2003; Hollis-Walker & Colosimo, 2011). It has recently gained huge scientific backing in the domain of psychology, as well as gaining rich popularity in recent years (Baer, 2003).

Mindfulness enhancing training can be used to improve an individual’s level of mindfulness.

One such method used to train mindfulness is Mindfulness-Based Stress Reduction (MBSR) (Grossman et al., 2004). It involves a group programme, lasting 8 to 10 weeks, instructing individuals on the use of mindfulness in different areas (such as meditation, yoga, stress inducing situations, and interactions with others), with the aim that through practice, mindfulness as a whole will improve. Grossman et al. conducted a meta-analysis and found that M.B.S.R. provided a relatively stable effect of around .49 as an intervention for problems such as depression, stress and anxiety. One other form of mindfulness training is Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002) which similarly involves a heightening awareness of one’s cognitions and how to redirect their antecedent manifestations.

It consists of a similar framework to that of MBSR (Grossman et al., 2004), but incorporates more cognitive elements, focusing on the use of mindfulness with feelings and thoughts. A meta-analysis conducted by Hofmann, Sawyer, Witt and Oh (2010) on mindfulness behavioural therapy (MBT), found that MBT had a large effect size for improving depression and anxiety.

The meta-analysis also established that MBT can be used to improve the well-being of individuals affected by anxiety and depression, regardless of their degree of symptom severity.

However, a more substantial intervention effect was found for people with higher levels of depression and anxiety. Furthermore, the use of mindfulness based interventions has also been found to empower individuals. Its importance is highlighted by the fact that it has no serious side-effects and can also be used to maintain a heightened level of well-being and improved quality of life. In review of various mindfulness based therapies, it is apparent that one’s awareness of one’s own behaviour improves well-being as it guides one’s actions in a way uniquely relevant to the individual.

Rational Emotive Behaviour Therapy Another contemporary method for improving well-being is REBT (Vernon, 1990). REBT is a form of Cognitive Behavioural Therapy which focuses on resolving emotional and behavioural issues within the individual in a rational manner (Ellis, 1994). The primary aim of REBT is to enable the individual to lead a happier, more fulfilling life. This is achieved by instilling in them, a sense of autonomy through developing their self-awareness, self-regulation and self-control (Ellis, 2001). It can be argued that all three of these components influence an individual’s behaviour and with development encourages them to reflect on their behaviour, thus improving awareness of the self furthermore. A similar concept is the self-actualising approach of Carl 125

Review Articles Rogerâ&#x20AC;&#x2122;s Person-Centred Therapy (PCT; Corsini & Wedding, 2000). REBT and PCT are similar in that they both focus predominantly on the notion of resolving irrational, self-defeating beliefs which individuals often hold of themselves (Sherin & Caiger, 2004). However, the effectiveness of REBT has proven to be much higher than that of PCT for more social issues such as selfdifferentiation (Yoosefi, 2011). Self-differentiation is indicative of well-being as it is the ability of an individual to maintain a positive attitude and to remain autonomous, while cooperating and supporting others, facilitating optimum growth and development in a group that is experiencing trauma (Yoosefi, 2011). However, REBT and PCT differ in certain ways. For example, REBT therapists have a more directive role as they help to identify irrational beliefs which are negatively affecting the client, while the PCT therapist has a more facilitative role (Corsini & Wedding, 2000). Benefits of REBT include its efficacy in non-clinical as well as clinical populations. A study by Sherin and Caiger (2004) demonstrated that the benefits of practicing REBT endure over time, as desirable thoughts become more integrated within an individualâ&#x20AC;&#x2122;s automatic thought processes. A recent study examined the effectiveness of various treatments for anger issues in a clinical population (Fuller et al., 2010). Despite the employment of various empirically grounded treatments (skills training, relaxation, and cognitive restructuring), motivational enhancement and REBT skills had more positive effects on the participantâ&#x20AC;&#x2122;s well-being. Additionally, it was found that cognitive restructuring which was based on REBT, was most beneficial as it could be learned promptly, used by the individual in various situations and was independent of the therapist. Thus, REBT proved to be an economical and effective means of empowering the individual to achieve a reduction in anger.

Furthermore, the accumulative effect of the therapies had a statistically significant effect on anger and symptoms of depression, with 10 out of 12 participants significantly improving or recovering fully post treatment based on the Trait Anger Scale (TAS) (Fuller et al., 2010).

Systematic Desensitisation One therapy which contrasts with REBT is systematic desensitisation (Russell and Jarvis, 2003).

Despite REBT and systematic desensitisation having different approaches, both have demonstrated effectiveness in enhancing well-being. Systematic desensitisation involves the habituation of individuals to certain situations, objects or experiences which cause distress for them. Systematic desensitisation has proven highly effective for the resolution of phobias, reducing negative affect and increasing well-being. The use of systematic desensitisation has demonstrated to be effective for both psychological and physiological symptoms (Shapiro, 2001; Van Rood & de Roos, 2009). A meta-analysis by Van Etten & Taylor (1998) found that Eye Movement Desensitisation and Reprocessing (EMDR) was a more successful treatment for individuals with Post Traumatic Stress Disorder (PTSD) than both Selective Serotonin Reuptake 126

Student Psychology Journal, Volume III Inhibitor (SSRI) drugs and exposure therapy. One systematic desensitisation method is (EMDR) which involves the visual focusing of attention to a target image while having a negative cognition, emotion or sensation (Shapiro, 2001). The client has to visually follow a static object, after which the client reports on what thoughts, memories, feelings or sensations they experienced. The client then focuses on these recovered thoughts and has to undergo a new set of eye movements by following the target image in a different fashion. The main issue challenging individuals with PTSD is that they find it difficult to process the disturbing memories of the traumatic event. EMDR enables these individuals to process these memories, with the aim of developing more adequate coping strategies. EMDR has been demonstrated to reduce psychosomatic symptoms such as phantom limb pains which are medically unexplained (Van Rood & de Roos, 2009). Further evidence for the efficacy of systematic desensitisation was found by Maredpour et al. (2012). Their study examined the impact of systematic desensitisation and study skills on test anxiety. A significant difference was recorded between the reduction of test anxiety in the control and experimental groups (systematic desensitisation, study skills, and a combination both methods). Despite systematic desensitisation proving to be a more effective method than study skills, a combination of the two methods was most beneficial at decreasing test anxiety. A meta-analysis conducted by Luebbert, Dahme and Hasenbring (2001) examined the effect of relaxation on cancer patients while systematically desensitising them to various treatments (e.g. chemotherapy, radiotherapy, bone-marrow transplantation).The average effect sizes for emotional adjustment to their illness ranged from 0.08 to 0.54, thus proving it as a valuable and effective treatment. In review, the use of systematic desensitisation methods can enhance well-being independently or complement the use of other therapies.

Acceptance and Commitment Therapy Over the last couple of years new behavioural therapies have been developed, incorporating aspects from multiple psychological perspectives (Hayes, 2004). Acceptance and Commitment Therapy (ACT; Hayes & Wilson, 1994) and the previously mentioned MBCT (Segal, Williams & Teasdale 2002) are two examples of such therapies. These therapies have become known as the third wave of behavioural therapies (Hayes, 2004). Putting aside the point that MBCT is seen as cognitive therapy and ACT is considered to be a behavioural therapy, both share commonalities, with both focusing on a change of consciousness rather than changing problematic thoughts (Segal, Teasdale & Williams, 2004, p.54.) ACT for example, does not view anxiety as the main cause of anxiety disorders, or depressive thoughts as the constituent part of depression (Hayes, 2004). Instead ACT views the superficial interpretation of such experiences and subsequent attempts to overcome them (e.g. psychotherapy) as the main cause of such psychological 127

Review Articles problems. ACT therapists view such experiences as a form of growth, helping rather than damaging clients. The aim of ACT is to encourage the client to feel their feelings and think their thoughts, rather than repress them, learning to accept them rather than actively trying to change them, as this is seen as counterproductive (Forman, Herbert, Moitra, Yeomans & Geller, 2009). ACT, “promotes the concept of committed action as movement toward one’s goals in the context of experiential acceptance” (Forman et al., 2009, p. 776). ACT, therefore, is in distinct contrast to other behavioural therapies, such as cognitive behavioural therapy, which highlights the need to change problematic thoughts. Similarly, another therapy known as Logotherapy has a comparable ideology to ACT in that it encourages the acceptance of difficult issues (Frankl, 2004). Logotherapy recognises the need for meaning in life as an important factor of well-being.

Life is filled with challenges, be it dealing with the death of a loved one, family separation, or even passing an important exam. The traumas of these events often manifest themselves in debilitating ways, thus leading to suffering. Despite the perceived notion that suffering can only hinder one’s well-being, Frankl (2004) argued that suffering ceases to be debilitating once the person has found meaning in their suffering. Logotherapy deals with existential issues and is based on transcending the individual. Hence, in Logotherapy the individual’s focus is extended beyond a particularly troubling situation or experience (Cates, 2011). One example includes the separation anxiety experienced by children. In a recent study, the fundamental principles of Logotherapy were employed which aimed to increase the well-being of children by diffusing their own and their parents’ anxiety. Results demonstrated that Logotherapy is effective for reducing anxiety of both parent and child and thus enhancing well-being. In a similar fashion, ACT has been applied to a variety of different disorders including psychosis (Bach & Hayes, 2002), anxiety and depression (Forman et al., 2009). Bach and Hayes (2002) applied the principles of ACT to a group of eighty participants, all of whom displayed various symptoms of psychosis. In line with ACT (Hayes and Wilson, 1994), they taught participants that experiences were unavoidable and to focus on goals that were important to them. Their randomised controlled trial found that participants who received the ACT intervention were subject to a reduction in hospitalisation of fifty per cent, over the course of four months. Forman et al.

(2009) in their study established that ACT was effective and comparable to cognitive therapy in terms of reducing depression and anxiety and increasing satisfaction with life and quality of life.

ACT is also seen as the most comprehensive and empirical of the new age therapies (PerezAlvarez, 2012).

Conclusion On reviewing the literature, it is apparent that the use of therapies which involve the individual’s awareness of their own behaviour and help to guide their actions in support of their 128

Student Psychology Journal, Volume III personal values are most effective for improving well-being. Thus, future research could examine the efficacy of self-directing and empowering treatments for enhancing well-being as the sum of previous research lends to this evidence. It could also be investigated whether illbeing and well-being should be treated as independent concepts, as contemporary research has started to investigate the differences between the two. In summary, the contemporary methods evaluated (ie. MBT, ACT, Logotherapy and Systematic Desensitisation) for enhancing well-being provide very promising empirical evidence for demonstrating high efficacy in combating a wide variety of issues which challenge well-being.

References Bach, P., & Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalisation of psychotic patients: A randomised controlled trial. Journal of Consulting and Clinical Psychology, 70(5), 1129-1139.

Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Camody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G., (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-241.

Brown, K.W., & Kasser, T. (2005). Are psychological and ecological well-being compatible? The role of values, mindfulness, and lifestyle. Social Indicators Research, 74(2), 349-368.

Brown, K. W., & Ryan, R. M.(2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848.

Bruni, L., & Porta, P. L. (2007). Introduction. In Luigino Bruni and Pier Luigi Porta, eds. Handbook on the Economics of Happiness. Cheltenham, UK: Edward Elgar.

Cates, M. (2011). Logotherapy with children: Separation anxiety, simple phobia, social phobia. International Forum for Logotherapy, 34(1), 24-27.

Diefendorff, J.M., Hall, R.J., Lord, R.G., & Strean, M.L. (2000). Action state orientation: Construct validity of a revised measure and its relationship to work related variables.

Journal of Applied Psychology, 85, 250-263 Ellis, A. (1994). Reason and Emotion in Psychotherapy: Comprehensive Method of Treating Human Disturbances: Revised and Updated. New York, NY: Citadel Press.

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Review Articles Ellis, A. (2001). Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy. New York, NY: Prometheus Books.

Forman, E. M., Herbert, J. D., Yeomans, P. D., & Geller, P. A. (2009). A randomised controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavioural Modification, 31, 772-799.

Frankl, V. E. (2004). Manâ&#x20AC;&#x2122;s Search for Meaning. United Kingdom, UK: Rider.

Fuller, J.R., Digiuseppe, R., O'Leary, S., Fountain, T., & Lang, C. (2010). An open trial of a comprehensive anger treatment program on an outpatient sample. Behavioural and Cognitive Psychotherapy, 38, 485-490.

Gross, J.J. (1998). Antecedent and response focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74, 224-237 Gross, J.J., & MuĂąoz, R.F. (1995). Emotion regulation and mental health. Clinical Psychology: Science and Practice, 2, 151-164.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35-43.

Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioural and cognitive therapies. Behaviour Therapy, 35, 639-665.

Hayes, S. C, & Wilson, K.G. (1994). Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. The Behaviour Analyst, 17(2), 289-303.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.

Hollis-Walker, L., & Colosimo, K. (2011). Mindfulness, self-compassion, and happiness in non-mediators: A theoretical and empirical examination. Personality and Individual Differences, 50(2), 222-227.

Luebbert, K. Dahme, B., & Hasenberg, M. (2001). The effectiveness of relaxation training in reducing treatment related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a metaanalytical review. Psychonchology, 10(6), 490-502.

Maredpour, A., Najafi, M., & Rafat-Mah, M. (2012). Article abstract: The comparison of the effectiveness of systematic desensitisation, study skills and combination method in decreasing test anxiety. Journal of Clinical Psychology, 4(1), 55-64.

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Is mental illness a myth? An interdisciplinary lesson for psychology Darragh McCashin Trinity College Dublin mccashd@tcd.ie

Introduction This paper investigates the critical controversy within psychology which questions whether mental illness actually exists; it adopts an interdisciplinary perspective in order to strengthen the examination of such a broad and challenging question. There exists a group of critics who believe that there is no such thing as a mental illness – chief among them is psychiatrist Thomas Szasz (1961). This essay also incorporates a societal perspective in what is a debate touching upon various disciplines, to function as an additional tool for uncovering the crux of the debate, as well as attempting to answer the key question. Asserting that mental illness is a myth is potentially reductionist, but there are serious lessons to be learned, to demonstrate the lack of credibility among psychology and psychiatry when dealing with mental illness. This essay summarises these lessons and the arguments made by Szasz and others before encapsulating the debate using a case example of schizophrenia in 1970s rural Ireland. Rather than using the word ‘myth’, psychology needs to be more aware of the inescapable socio-cultural and sociopolitical roots of the practice of labelling mental illness, as well as the wider motivations for psychology to be a science. What this all means and how it all combines in the contemporary moment of psychological science and mental health research in society will be discussed as a means of forming a conclusion.

An overview of the debate ‘The laws of psychology cannot be formulated independently of the laws of sociology’ -Szasz (1961, p. 7) Popper (1957, p. 177) once stated that ‘science must begin with myths, and with the criticism of myths’. In his book The Myth of Mental Illness (1961), Szasz states outright that mental illness is a myth (for example, when does a mental state transition to an illness, and who decides?), with controversial reactions among professionals (as summarised in Kelly et al, 2010). Although his work refers to the discipline of psychiatry, he is operationally referring to any of the 133

Review Articles practitioners of psychoanalysis and psychosocially-orientated psychiatry, and any discipline which coordinates itself under the umbrella of the notion of mental illness or disorder. Of course, psychology is interrelated to psychiatry as both fields share the space of studying the human mind and behaviour (but in different ways). Szasz (1961, p. 4) identifies the lack of commitment to psychology as a legitimate science which is revealed by some scientists’ expectations that all scientific observations will, in the end, be phrased in a mathematic-physical idiom. Szasz (1961) observes social manipulation when reading the sciences of mind and behaviour as being manifested to imitate medicine (e.g. psychopathology). He illustrates this using Soviet Russia as an example; the ambiguous label of mental illness is used to straddle and evade the conflict of interests between the patient and their social environment (including socio-political and interpersonal difficulties). The Soviet therapist is bound to discover a malingering mental illness, because he bases his prescription on the premise that he is an agent of society.

As Stanovich (2007) discussed, psychology has the pressure of trying to adhere to the scientific method when attempting to answer what are hugely challenging questions about the human condition, which can contravene many philosophical, phenomenological and epistemological viewpoints. These viewpoints are all largely misrepresented by the media or by folk psychology, according to Stanovich. Indeed, Broadbent (1961) suggests that psychology must be prepared to live with an incomplete knowledge of behaviour, but with confidence in the power of objective methods to provide that knowledge someday. A closer look at the views of Szasz (1961) will illustrate that much of psychology and psychiatry is not prepared to live with an incomplete knowledge of behaviour.

The incorporation of sociologist and philosopher Foucault (1967) at this juncture is useful. His ‘history of the present’ explains why the two disciplines are not prepared to live with incomplete knowledge – power and control (a theme that also emerges in the case example below). Foucault (1967) charts the evolution of madness within the societal context from the 18th century, revealing the pseudo-medical categorisation from which clinical psychiatry has sprung (of which Szasz targets). The actual sciences of mind and behaviour are in effect quasiacademic compartmentalisations of certain states of experience into formally reduced types of ‘illnesses’ that are then logically disposable in the field of curing (Cooper in Foucault, p. ix). This approach may be seen to be opposed to healing in the sense of making a person whole.

Furthermore, Foucault queries the world that thought to measure madness through psychology, stating that psychology must justify itself before madness – which it has not. Rather, mental illness has received legal approval within criminal statutes that codify certain types of actions as

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Student Psychology Journal, Volume III potentially the results of mental illnesses: this is part of the consequences of the myth of mental illness which contributes to Szasz’s theories of personal conduct.

Indeed, a relevant experiment by Rosenhan in 1973 is worth reflecting upon. Rosenhan (1973), working under the logic that, mental disorders cannot be defined because it is not possible to define normality, sent eight people who psychology and psychiatry would deem ‘sane’ into mental institutions. In doing so, the rationale was that if this sanity was detected by the scientists in the institutions, there would be prima facie evidence that a sane person can be differentiated from the ‘insane’ context where he is found. The results showed that none of the pseudo-patients were detected. Instead, some were detained for up to several months and had to declare insanity and take drugs to ensure their release. Aside from the controversy which this experiment created among professionals (e.g. Spitzer, 1975), Rosenhan was keen to not merely focus on the results, but to ask what these results meant for psychology and society: how can anyone know therefore what normality or insanity is?

The consequences The overview above has identified the key constituents of the argument vis-á-vis the conceptual framework of mental illness. The notable results of Rosenhan’s experiment, coupled with the theoretical proclamations of Szasz (1961) and Foucault (1967) offer a sceptical interdisciplinary framing worthy of exploration. However, it is also worthwhile to briefly focus on a specific case example of a society in order to ascertain what the effects are of using mental illness definitions on individuals.

Scheper-Hughes (2001) developed a psychological anthropology paradigm for her fieldwork (for example, adopting the Thematic Apperception Test, see Scheper-Huges, 2001, p.64-65). Her interest lay in rural Western Ireland in the 1970s where, in comparison to European and international averages, rates of schizophrenia were notably high. For example, the country topped the table for psychiatric hospitalisation in both 1955 and 1965, according to the World Health Organisation’s (WHO) Statistics Report in Scheper-Hughes (2001, p.137-141), with the intermittent years also exhibiting this salient trend. The international average for psychiatric hospitalisations was 2.31 per thousand of the population in 1965 (p.137). In 1971, the Irish Psychiatric Hospital Census showed that out of a total of 16,661 diagnoses of psychiatric disorder, 8,353 of them were schizophrenia. Scheper-Hughes sought to locate the causes of such high rates through observational methods. This ethnography unveiled, in her view, that the highly paradoxical behaviours of Irish villagers who, rooted to the values of Catholicism, Irish mythology and tradition, created a society where madness was a social script. Irish socialisation processes linked to such values left certain individuals isolated (such as bachelor farmers whose 135

Review Articles family intended on him to keep the good name of the family, thereby defining his future in what was a dying area), according to the author.

However, a lack of sexualisation development, and child-rearing that was not conducive to expressiveness or nurturing meant that, although some individuals could bypass some of these developments (and perhaps leave to pursue future successes), others would become stuck.

Consequently, these individuals became lost in a haze of alcoholism and anomie within damaging socialisation patterns (such as ‘doublespeak’, (Scheper-Hughes, 2001, p. 158-160), eventually leading to institutionalisation for many, due to the resultant diagnosis of a mental illness (typically schizophrenia). This study illustrates what Szasz (1961) would term as the ‘problems of living’ of a society. It serves to illustrate the unavoidable interconnectedness of cultural values with the breakdown of individuals which may lead to incarceration as a form of social control, definition, and indeed power - from a rural-fundamentalist standpoint. There is an aspect of controversy associated with ethical conduct of the ethnographer of this study however; her immersion in daily life of a rural village was solely to pursue academic research unbeknownst to the trusting villagers who accommodated her slow transition to acceptance in the society.

Interestingly, from the perspective of Rosenhan’s (1973) earlier work, Scheper-Hughes (2001) identified many non-incarcerated villagers, who were supposedly ‘sane’, to be actually more ‘mad’ than those who were labelled and institutionalised. Further studies of this nature reiterate such themes – namely the work of Saris (1996; 1999) who outlined the narrative between an institution and a locality. Saris (1996) commented not on an exceptional Irish connection to insanity, but rather offered a glimpse of the certain cultural connections between the transformations of a person’s senses of place, place-names, and narrative memory - the mental institution is implicated in the local moral world.

Closer to the present ‘Etiology – Many theories have been introduced in an attempt to explain this disorder. Currently, most professionals believe it is a result of a physiological condition.

Treatment – Medication is the most important part of treatment [...]’

- Adapted summary of the Diagnostic and Statistical Manual of Mental Disorders’ brief on schizophrenia (DSM-IV).

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Student Psychology Journal, Volume III In the area of criminality (an area of increasing focus for some psychologists), Garland (2001) from a Foucauldian inspiration - investigated the developments in the punitiveness of the U.S and Britain to show how a paradoxical schizophrenic crime control complex now exists in Western society – a culture of control. One critique of the use of a psycho-pharmaceutical treatment approach is that it merely treats the symptoms of the client’s issues and not the cause, or ‘the problems of living’ from which they suffer from. Paradoxically, they may become numbed or even incapacitated by such treatments, and therefore potentially be seen to be progressing – such as the case of criminals alleged to have mental illness. For example, it was found that increased prescription of psychotropic drugs resulted in less crime (National Bureau of Economic Research, 2009). Such reporting masks the underlying cultural struggles which contribute to what psychology terms ‘mental illness’, despite the knowledge of cultural affects now circulating which merely confirms the socio-political, power and control issues embedded here, yet socio-cultural variables are dubiously considered or left out of datasets.

The role of the concepts of power, control, politics and sociology in this topic might not appear surprising. Indeed, psychology possesses sub-fields dealing some of the issues that arise from such concepts overlapping (media psychology for example (Giles, 2003)). Another example is that of MacLachlan (2006) who writes critically towards culture’s relationship to health, advocating a right for people to have their own health psychology. These critics, on top of previous works presented here serve to show that they have yet to affect the level of mental health policy-making, psychiatry and psychological diagnosing.

Conclusion Psychology repeatedly calls for adherence to objective scientific thinking (Elmes, Kantowitz, and Roedgier, 2012) With the above debates in mind, it seems wise to reserve healthy scepticism towards the roots of the motivation for psychological enquiries to be wholly scientific and nothing else, because this undermines the value of studies such as Scheper-Hughes (2001), or indeed the value of other social sciences such as sociology. This is seen in their lack of involvement come diagnosis and policy-making outside of academia.

If psychology adopted the various perspectives presented in this essay, or like Scheper-Hughes did in her fieldwork, it would be difficult to see how psychology would continue to label and operate under mental illness definitions as it currently does, as per the Diagnostic and Statistical Manual of Mental Disorders. It is the view of this essay that psychology must incorporate all these insightful perspectives through interdisciplinary work, despite the large-scale task this entails, if it is to develop workable frameworks to deal with whatever societal circumstances affect the mental states of whole persons. Returning to Broadbent’s message (in Stanovich, 137

Review Articles 2007), if psychology were to do this, then it can rest in the knowledge that it will someday learn of new knowledge through objective methods, but in the meantime, it must be prepared to live with incomplete knowledge. To live with incomplete knowledge would be less damaging

References Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Retrieved December 15th, 2010, from http://allpsych.com/disorders/psychotic/schizophrenia.html.

Elmes, D. G., Kantowitz, B. H., and Roedgier, H. L. (2012). Research Methods in Psychology. Wadsworth: Belmont.

Foucault, M. (1967). Madness and Civilisation. New York: Mentor.

Garland, D. (2001). The Culture of Control: Crime and social order in contemporary society. Oxford: Oxford University Press.

Giles, D. (2003). Media Psychology. New Jersey: Lawrence Erlbaum Associates Publishers.

Goffman, E. (1961). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Doubleday.

Kelly, B. D., Bracken, P., Cavendish, H., Crumlish, N., MacSuibhne, S., Szasz, T., and Thornton, T. (2010). â&#x20AC;&#x2DC;The Myth of Mental Illness: 50 years after publication: What does it mean today?â&#x20AC;&#x2122;. Irish Journal of Psychological Medicine, 17(1), 35-43.

MacLachlan, M. (2006). Culture and Health: A critical perspective towards global heath. 2nd Edition. West Sussex: John Wiley & Sons.

National Bureau for Economic Research (2009). A Cure for Crime? Psycho-Pharmaceuticals and Crime Trends (Working paper no. 15354). Massachusetts: National Bureau for Economic Research, Inc. Popper, K. (1957). Realism and the aim of science. Routeledge: London.

Rosenhan, D, L. (1973). On being sane in insane places. Science, 179, 250-258.

Saris, A. J. (1996). Mad kings, proper houses and an asylum in rural Ireland. American Anthropologist, 98, (3), 539-554.

Saris, A. J. (1999). Producing Persons and Developing Institutions in Rural Ireland. American Ethnologist, 26, 690-710.

Scheper-Hughes, N. (2001). Saints, Scholars, and Schizophrenics: Mental illness in rural Ireland. California: University of California Press.

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Student Psychology Journal, Volume III Spitzer, R. L. (1975). ‘On pseudoscience in science, logic in remission, and psychiatric diagnosis: a critique of Rosenhan’s ‘On being sane in insane places’’. Journal of Abnormal Psychology, 84(5), 442-452.

Stanovich, E. (2007). How to think straight about psychology. London: Pearson.

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Review Articles

The Impact of Institutional Care on Childrenâ&#x20AC;&#x2122;s Development Cathy Newell Trinity College Dublin newellcc@tcd.ie

For over half a century, clinicians and researchers have been concerned with the deleterious effects of institutional rearing on children's development, and there is now a sizeable literature documenting the numerous physical, emotional, behavioural and cognitive impairments which characterize the youth raised in these settings (Bowlby, 1951; Goldfarb, 1944; Rutter et al., 1998). Despite a consensus that institutional care poses substantial risks for child development, sharply divergent opinions exist regarding the immutability of the early delays documented among post-institutionalized children. While some studies reveal an unrelenting persistence of malfunction throughout development (Goldfarb, 1944; Province & Lipton, 1962), others highlight the remarkable resilience of post-institutionalized youth, and the potential for marked improvements in various domains following a radical change in environmental conditions (Kreppner et al., 2007; Rutter et al., 1998;). This paper will critically analyse the evidence for the impact of institutional care on child development. It will, in turn, discuss the negative impact of early institutionalization on various developmental outcomes, examine the issue of resilience and recovery following institutional care, briefly consider the potential mechanisms by which institutionalization might result in negative outcomes, and provide a critical evaluation of the available evidence, along with some recommendations for future research.

Introduction Over the past few decades, the welfare of children in institutional care has been the subject of extensive research within the developmental and clinical literature (Bowlby, 1951; Goldfarb, 1944; Lee et al., 2011; Province & Lipton, 1962; Rutter et al., 1998; Skuse, 1984; Tizard & Rees, 1974). Browne (2009) has defined an institution or residential care home as a group living arrangement in which ten or more children, without parents, are cared for by a much smaller number of paid adults. In many parts of the world institutions remain the standard form of care for orphans and abandoned children (Zeanah, Smyke, & Settles, 2006), with as many as 8 million currently residing in these settings (Bos, Fox, Zeanah, & Nelson, 2009). The caregiving environment of institutions tends to be qualitatively and quantitatively deficient to that of youngsters raised in families (Zeanah et al., 2006), and the â&#x20AC;&#x153;damaging consequencesâ&#x20AC;? associated with institutional care have been widely documented (Johnson, Brown, & Hamilton-Giachritsis, 140

Student Psychology Journal, Volume III 2006, p. 35). Despite a consensus that institutional care is a risk factor for compromised development, there exists contrasting opinion on the pervasiveness and persistence of malfunction associated with this type of upbringing (Kreppner et al. 2007). On the one hand, an unabated persistence of problems throughout development has been documented by some studies on post-institutionalized youth (Goldfarb, 1944; Province & Lipton, 1962). On the other hand, evidence suggests that children can show marked improvements in various domains once they are removed from institutional settings (e.g. Kreppner et al., 2007; Rutter et al., 1998). This paper will critically analyse the evidence for the impact of institutional care on childrenâ&#x20AC;&#x2122;s development. It shall begin by describing the numerous physical, emotional, behavioural and cognitive impairments, which characterize institutionalized youth. It will subsequently examine the issue of resilience and recovery following a radical improvement in environmental conditions, and shall briefly consider the mechanisms by which institutionalization might result in negative developmental outcomes. Finally, it will provide a critical evaluation of the available evidence, along with some recommendations for future research.

The Impact of Institutional Care on Child Development There is a long history of research on the developmental outcomes of children institutionalized as infants (Gunnar, Bruce, & Grotevant, 2000). While the findings of early studies (e.g. Goldfarb, 1945; Provence & Lipton, 1962; Spitz; 1946) will be interspersed throughout this review, because these studies were mostly descriptive and poorly controlled, the focus shall be on more recent research which has been carried out over the past two decades, and which is considered to be methodologically superior (Zeanah, et al., 2003). Most of the contemporary research which shall be discussed in this paper has used samples of children adopted internationally, primarily from Romanian orphanages following exposure to severe global institutional deprivation during the first few months or years of life. These studies include the English and Romanian Adoptees study (ERA): (Beckett et al., 2006; Kreppner et al., 2007; Rutter et al., 1998), and the Canadian Study (Ames, 1997; MacLean, 2003). Other studies, which shall be included, have investigated the effects of a foster care intervention on institutionalized Romanian children (the Bucharest Early Intervention Project (BEIP): e.g. Zeanah et al., 2003).

The evidence these studies have provided regarding the effects of institutional care shall now be discussed.

While malnutrition may contribute somewhat to the many negative sequelae associated with institutional care, most researchers have been concerned with the effects of stimulus and maternal deprivation in these settings (Skeels, 1940; Spitz, 1945; cited in Gunnar et al., 2000).

Institutional life tends to be excessively regimented, lacking adequate stimulation, and because 141

Review Articles of high caregiver to child-ratios and staffing limitations, children reared in them lack individualised care and psychological investment. Upon leaving these institutions, children’s height, weight and head circumference are frequently severely compromised (Smyke et al., 2005; cited in Zeanah et al., 2006) and they endure a wide range of medical problems such as respiratory and intestinal infections, and skin conditions (Rutter et al., 1998). Intellectual impairments abound, with the IQs of institution-reared children ranging from 10 to 40 points lower than those brought up in family care (Goldfarb, 1945, Smyke et al., 2005; Spitz, 1945; Tizard & Rees, 1974; Vorria et al., 2003; cited in Zeanah et al., 2006). Given that language develops within an environment rich in stimulation and contingency (Stromswold, 1995; cited in Zeanah et al., 2006), it is not surprising that language delay is a primary deficit among institutionalized and post-institutionalized youth (Goldfarb, 1945; Provence & Lipton, 1962).

Behavioural problems such as stereotyped or “quasi-autistic” behaviours (e.g. body-rocking and head shaking) are often documented, and may have served the function of self-stimulation or self-soothing in unresponsive environments (Rutter et al., 1999; Thelen, 1979; cited in Johnson et al., 2006). Sleeping difficulties and eating problems are frequently present (Fisher et al., 2007; Greene et al., 2008), as are internalizing disorders and other abnormalities in the domain of emotional development (Fisher et al., 1997).

As predicted by attachment theory, profound disturbances in attachment are the "rule rather than the exception” among infants raised within the socially deprived contexts of orphanages (Zeanah, Smyke, Koga, & Carlson, 2005, p. 1023). Post-institutionalized Romanian children are less likely to be securely attached to their adoptive parents. Displaying high levels of reactive attachment disorder, of which there are two forms: an ‘emotionally withdrawn’ or ‘inhibited type’ in which no discriminated attachments have been formed whatsoever, and an ‘indiscriminately social’ or ‘uninhibited type’ which characterizes children who do not display expectable reticence around unfamiliar adults (Chisholm, 1998; O’Connor et al., 1999; cited in Zeanah et al., 2005; Zeanah & Smyke, 2008). Often referred to as 'indiscriminate friendliness', this latter type is particularly common and may represent an adaptive response to institutionalization (Chisholm, 1998; cited in Zeanah et al., 2002). Attachment difficulties among post-institutionalized youth are not surprising given that the opportunities available to develop selective attachments within institutional settings are extremely limited. Caregivers usually perform shift-work and are responsible for the care of large numbers of children (Johnson, 2000; cited in Smyke et al., 2002), limiting the emotional investment they can offer to each child (Smyke et al., 2002). A main tenet of attachment theory (Bowlby, 1969; cited in Bowlby, 1977) is that caregiver-infant interactions in infancy provide a child with the social experiences that “initiate a trajectory influencing later relationships” (Gonzalez, Atkinson, & Fleming, 2009, p.

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Student Psychology Journal, Volume III 225). As shall be seen later, the absence of early secure attachments does indeed seem to impact on relationships later in life.

Resilience and the Potential for Recovery Following Institutional Care A long-standing debate exists regarding the immutability of the early delays documented among institutionalized and post-institutionalized children (Gunnar et al., 2000). During the last century, super-environmentalists such as J.B. Watson and Freud convinced many that early experiences could “make or mar the life path” (as cited in Clarke & Clarke, 1998, p. 433).

Psychoanalytic theory and attachment theory made deterministic forecasts about the irreparable consequences of early maternal deprivation, especially if it continued beyond the first two years of life (Bowlby, 1951; Goldfarb, 1945; cited in Gunnar, 2000, p.678). Many early studies on post institutionalized children supported this view (e.g. Goldfarb, 1945; Provence & Lipton, 1962), and more recently, a growing literature suggests that severe early deprivation may have enduring effects through the damage it causes to neural structures and its influence on the “biological programming of the brain during a sensitive period” (Bateson & Martin, 1999; Greenough & Black, 1992; Gunnar et al., 2001; Hubel & Wiesel, 2005; cited in Kreppner et al., 2007). However, several studies provide evidence of a continuing responsivity to experiences throughout development in children who have experienced early adversity, and the potential for marked improvements in several domains (Clarke & Clarke, 1976; Duyme, Arsenault, & Dumaret, 2004; cited in Kreppner et al., 2007). For example, during their extensive research on over 200 youths who had experienced early severe adversity, Clarke and Clarke (1998) claim they discovered the "surprising rule" that “the worse the background, the better the prognosis following minimal intervention"(p. 433).

Natural experiments such as the ERA study (e.g. Rutter et al., 1998) have had considerable methodological advantages in terms of examining the persistence (or otherwise) of early institutional deprivation on long term cognitive, behavioural, social, and emotional outcomes (O’Connor, 2003). In this research, institutional deprivation was limited to the first few months or years of life, and was followed by a major discontinuity in the characteristics of the caregiving environment (Kreppner et al., 2007).

However, these studies and others have

demonstrated that there is no clear-cut resolution to the debate. In some instances, they have highlighted the remarkable recovery many post-institutionalized children make, often functioning within the average or even superior range very soon after adoption (Ames, 1997; Greene et al., 2007; Rutter et al., 1998). By the age of four, prodigious catch-ups have been documented in the weight, height, and cognitive function of Romanian adoptees particularly those adopted before the age of six months (Rutter et al., 1998; cited in Johnson et al., 2006).

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Review Articles Rapid improvements are also seen in eating problems and stereotyped behaviour once the child is removed from care (Johnson et al., 2006). When post-institutionalized Romanian children were examined across numerous domains (cognitive impairment, quasi-autistic patterns, inattention/overactivity, disinhibited attachment, conduct, emotional and peer problems) at the ages of six (Rutter, Kreppner, & O’Connor, 2001), and eleven (Kreppner et al., 2007), it was concluded that a significant proportion of youth exposed to profoundly depriving institutional conditions function normally in later childhood (Kreppner et al., 2007). By age six, 73% of those adopted within the first six months of life showed no impairments in any of these domains, and at the age of eleven, 79% of these children continued to no signs of disturbance (Kreppner et al., 2007).

Despite this evidence of remarkable resiliency, it appears that there may be a certain timeperiod during which exposure to institutional deprivation will have a particularly enduring, negative influence on development.

A continuity of impairment appears evident in

institutionalized children who are adopted after six months of age. Kreppner et al. (2007) found that nearly half of such children remained multiply impaired at age six, and of these, the majority (74%) continued to exhibit impairments across several domains at eleven. While 34% of this group did appear to have made a full recovery by the age of six, only 59% of these children continued to have no impairments at age eleven. Even after 7 ½ years in a stimulating, caring environment, children adopted after 6 months of age perform on average 15 points below children adopted from within the U.K. and those adopted from the same institutions before 6 months on measures of cognitive functioning, implying that some type of “intraorganismic change” has occurred which is relatively resistant to the restorative effects of the improved environment (Beckett et al., 2006, p.705). The mechanisms by which institutional deprivation might have long-term effects shall be discussed in a later section. Studies generally point to a stepwise increase in impairments between groups adopted from institutions before six months and those adopted beyond this age. While institutional care lasting at least six months appears to have a particularly negative impact on cognition, attention/hyperactivity, quasi-autistic behaviour, attachment, conduct, emotion regulation, and peer relationships, beyond this, the duration of deprivation experienced has little additional negative effects (Beckett et al., 2006; Kreppner et al., 2007). These findings support the notion of a sensitive period in development.

Among those who experience persistent difficulties, psychosocial problems are particularly common and may even increase over time (Ames, 1997, Rutter et al., 1998; Tizard & Rees, 1975; cited in Gunnar et al., 2000). While some children go on to form secure attachments, those adopted after the age of 6-8 months continue showing greater signs of atypical insecure 144

Student Psychology Journal, Volume III attachments upon follow-up (Chisholm, 1998; O’Connor, 2000). 'Indiscriminate friendliness' appears to be especially chronic (Chisholm, 1998). Peer problems and a lack of intimate friendships are often evident among post-institutionalized adolescents (Hodges & Tizard, 1989), and enduring difficulties with emotion regulation may be accountable for this (Gross & Ileana, 1996; cited in Gunnar et al., 2000). Secure attachments and good family relationships are not impossible however (Chisholm, 1998; Marvin & O’Connor, 1999; cited in Zeanah et al., 2002), suggesting that the absence of a secure attachment in the first few years of life does not result in a complete inability to form close personal relationships in later years (Zeanah et al., 2002).

While there is a powerful main effect of institutional deprivation on child development, it should now be clear that there remains significant variation in developmental outcomes among youth who have experienced comparable levels of deprivation (Lee et al., 2011). Several risk and protective factors may be responsible for this variation in outcomes, including, age of adoption, duration of deprivation, degree of privation, genetic differences (Moffit, Caspi, & Rutter, 2006; cited in Kreppner et al., 2007), physical illnesses or abnormalities, preinstitutional experiences, the presence of vocalisations upon family placement (Kreppner et al., 2007), the overall quality of caregiving within the institution (Smyke et al., 2007), and being a staff worker’s “favourite” (Kreppner et al., 2007). The experiences children encounter after they leave institutions are also likely to influence the resilience they demonstrate (Rutter, 2000; cited in Lee et al., 2011).

The Possible Mechanisms by which Institutional Care may Impact Development Several researchers have considered the mechanisms by which institutional deprivation might influence child outcomes. Research has shown that interaction with a living and responsive environment in early life is necessary in order for normal brain development to occur (Balbernie, 2001, p. 239; cited in Johnson et al., 2006). A convincing argument has been proposed for brain development being “embedded in the attachment relationship between the infant and the primary caregiver” (Schore, 2001, p.10; cited in Johnson et al., 2006). Thus, the inadequate caregiving and attachment patterns experienced in institutions may exert a suppressive effect on brain development.

In terms of the biological changes which mediate the long-term negative effects associated with early institutionalization, Beckett et al. (2006) claim that three possibilities exist. Firstly, animal studies have shown that exposure to extreme stressors in early life can damage brain structures, particularly the hippocampus (Bremner, 1999; McEwen, 1999; cited in Beckett et al., 2006), and it has been claimed that the deprivation experienced in institutions similarly leads to brain dysfunction (Chugani et al., 2001). However, there remain uncertainties about this 145

Review Articles assumption (Rutter, 2006). Another possibility is that institutional life may lead to a deprivation of input required by the developing brain at times of 'experience-expectant maturation', or sensitive phases during which particular experiences are necessary in order for the appropriate somatic structures to be laid down (Glaser, 2000; cited in Johnson et al., 2006). A useful model for the concept of experience-expectant developmental programming is the role that visual input plays in the development of the visual cortex (Hubel & Wiesel, 2004). The third possibility involves experience-adaptive developmental programming, whereby a particular form of brain development may be shaped by the specifics of institutional experiences during a sensitive period such that it is adaptive to the institutional environment, but later proves to be nonadaptive in the improved environment of the adoptive family (Rutter, 2006). Rutter (2006) suggests that the disinhibited attachment patterns found in post-institutionalized children may be due to biological programming of the experience-adaptive variety. Although much evidence suggests that psychosocial deprivation has “a pervasive effect across biological and psychological systems” (Sonuga-Barke et al., 2010, p. 161), research also illustrates the remarkable plasticity of the brain (Gunnar et al., 2000). The processes that enable later experiences to modify the effects of early adversity are not yet clear however (Gunnar et al., 2000).

Analysis of Research Evidence and Directions for Future Research Having discussed the impact of institutional care on child development, the evidence used within this paper must be critically evaluated. Unfortunately, the methodological problems found in research on post-institutionalized children are “many and complex” (MacLean, 2003, p.

878). Firstly, the generalisability of the research findings discussed above may be limited. Most of the studies (The BEIP; The Canadian Study; The ERA study) have focussed on poor quality institutions where children have experienced global deprivation (in terms of their health, nutrition, stimulation and relationship needs), when in reality institutions are “diverse in their characteristics and achievements” (Berridge & Brodie, 1998; Sinclair & Gibbs, 1998; cited in Hicks, Gibbs, Weatherly, & Byford, 2009, p.829). Results may not pertain to children coming from less deprived contexts therefore. The representativeness of the families used in these studies has also been questioned (MacLean, 2003). Adoptive parents are usually middle class and well educated and may not be representative of the general population (O’Connor, 2003).

Within the ERA studies the parents of Romanian adoptees differed from the control parents (they were generally older, did not have fertility as their main motive for adoption, and did not satisfy U.K. conventions relating to infant adoptions) (O’Connor, 2003), so differences between adoptive families could have been responsible for differences in child outcomes.

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Student Psychology Journal, Volume III Some other concerns have been expressed in relation to the control groups and the measures used in these studies (e.g. Gunnar et al., 2000; MacLean, 2003; Tarullo, Bruce, & Gunnar, 2007).

For example, in research carried out by the ERA project (Rutter et al., 1998), and the Canadian Study (Ames et al., 1997) it proves difficult to disentangle the effects of institutional rearing from international adoption given that the control groups were composed domestically adopted children. Ideally, these studies should include comparison groups that have been internationally adopted from foster care so that both groups would share the experience of international adoption, and would differ only in their social experiences prior to adoption (Tarullo et al., 2007). It has been claimed that the measures of attachment utilized in these studies are inappropriate given that they are standardized on family-reared populations, and because they are designed to measure the quality of, rather than the presence or absence of attachment, and therefore implicitly assume that an attachment relationship exists (MacLean, 2003).

Furthermore, gross measures of cognitive functioning were utilized in most studies which have documented a substantial recovery of function in post-institutionalized children, when more specific tests might have uncovered domains that are less resilient (Gunnar et al., 2000).

With respect to the child outcomes associated with institutional care, “understanding the causal processes is fraught with difficulties” (Greene et al., 2007, p. 11). The poor quality of records at many institutions means little can be known about children’s experiences prior to adoption, such as the status of their biological parents’ health, their experiences in utero, their delivery and health status at birth, and their early medical history (Beckett et al., 2006; Greene et al., 2007). Further, levels of privation are not uniform between or even within institutions (Gunnar et al., 2000; Smyke et al, 2002), yet studies lack sufficient information to determine the level of privation children have experienced in them. Only by quantifying each of these risks can it be possible to isolate the effects of institutional care specifically. Even then, 'institutionalization’ as a variable is a “complex mix of social, perceptual, physical, intellectual, and emotional deprivation” (MacLean, 2003, p.854), making it extremely difficult to specify which type of deprivation has led to a particular outcome.

While many studies cited above claim to address questions regarding sensitive periods in development, in reality, they are very limited in the answers they can provide (MacLean, 2003).

In order to establish that a certain age period is critical for development, it is not enough to show that a shorter duration of deprivation does not produce the effects. It must also be demonstrated that the same length of institutional deprivation would not have the same impact at a period in later life (MacLean, 2003). This was not possible for the experiments discussed in this paper.

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Review Articles Most research has so far only investigated the impact of institutionalization on outcomes in childhood and adolescence. Lee et al. (2011) urges researchers to “look beyond the early childhood years” to fully understand the impact of institutionalization (p.16). Mild or latent problems often do not reveal themselves until adolescence or early adulthood (Greene et al., 2007; Gunnar et al., 2000; Sonuga-Barke et al., 2010), becoming salient as new challenges are faced in later life (Greene et al., 2007). One study found that the normalization of weight and height seen in middle childhood (among children adopted from Romania after 6 months) was merely a transient phenomenon, for it was followed by a period of deceleration in growth in adolescence (Sonuga-Barke et al., 2010). Premature conclusions about the extent of resiliency following care should be avoided for this reason. There is a clear need for longitudinal studies which explore the consequences of early institutional experiences for adult adjustment. Due to the considerable resources that would be required to undertake such studies however, they may not be feasible, particularly in the current economic climate.

Very little research looks at the effects of institutionalization that lasts throughout childhood, or the consequences of such experiences in adulthood. In recent years, adult submissions to government inquiries on institutional care have illustrated the impact institutional experiences can have on identity formation, the ability to form relationships and parent effectively in adulthood, and the ability to live independently following care (e.g. The Senate Community Affairs References Committee (SCARC), 2003). While these subjective reports may not constitute empirical evidence, they are useful for overcoming another criticism of the literature, which has been that the voices of the children themselves have been “conspicuously absent” (Morantz & Heymann, 2010, p.11).

Furthermore, experiences of physical or sexual abuse

within institutions can have detrimental consequences for development above and beyond those of stimulus and psychosocial deprivation, yet very few empirical studies are available on the effects of institutional abuse (Carr et al., 2010). In Ireland, the Report of the Commission to Inquire into Child Abuse (CICA; 2009; also referred to as the 'Ryan Report') has confirmed the occurrence of such abuse within religiously-affiliated residential institutions over the past few decades. Psychological research commissioned by the CICA found a high prevalence (over 80%) of psychological disorders such as anxiety, mood, and substance-related disorders among adult survivors of institutional abuse, along with elevated rates of trauma symptoms and insecure adult attachment styles (Carr et al., 2010). There is an urgent need for studies that investigate the short- and long-term consequences of institutional abuse for development, due to the distinct lack of systematic research in this area.

Very often, the positive aspects of institutional settings have been overlooked in research.

Institutions offer shelter to extremely vulnerable children who may have been victims of abuse 148

Student Psychology Journal, Volume III or abandonment (Beard, 2005; Jacques, 1999; Varnis, 2001; cited in Morantz & Heymann, 2010), and may be better for some children than living with their biological families (Hodges & Tizard, 1989). Goldsmith (1999) implies orphanages may be superior to foster care settings, for they are places where children can reside for longer than a few months at a time, affording them a better sense of ‘belonging’. However, given that even 'good' institutions have been associated with negative outcomes (e.g. Hodges & Tizard, 1989) there must be something about institutional culture that is fundamentally harmful to developing children (Johnson et al., 2006).

Johnson et al. (2006) claim however, that it may be better to carefully investigate which aspects of institutions are harmful and how the harm can be limited, “rather than simply write off institutional care completely” (Johnson et al., 2006, p. 56).

Conclusion In conclusion, research consistently demonstrates the negative effects early institutional care can have across all domains of development. According to MacLean (2003), “there is not an area in which orphanage children are left unscathed” (p. 879). Although early institutional care is certainly a risk factor for compromised development however, it by no means dooms a child to physical ailment or psychopathology (MacLean, 2003, p. 2003). This paper has demonstrated the remarkable resilience seen in post-institutionalized children, particularly those adopted very early in infancy. There are no clear outcomes associated with early institutional experiences. Instead, studies reveal a “complex mix of both continuities and discontinuities” in terms of physical and psychological development (Rutter, 1987a; cited in Rutter, 1989, p.25).

There are many pathways that can be taken by children post-institutionalisation. The timing and the nature of the institutional experiences they encounter will influence their impact (Rutter, 1989), and children’s own personal characteristics, as well as the experiences they face before and after their time in care will also mediate outcomes.

This paper has identified several factors which complicate research in this area, and which limit the conclusions that can be drawn from the evidence discussed. It has also highlighted the urgent need for a greater number of well controlled, longitudinal research studies which extend beyond the childhood years, and which investigate not only the effects of stimulus and psychosocial deprivation, but also the impact of institutional abuse on developmental outcomes.

While the evidence would imply that adoption (Rutter et al., 1998) or foster-care (Zeanah et al., 2003) is superior to institutional care, McKenzie (1999) claims that “the nations growing problems with family stability, child abuse and neglect, welfare reform, and foster care ensure that a modern form of private orphanage care will return” (p. 291). If this is truly the case, it is crucial that ongoing research informs policy and practice as to the factors that protect against 149

Review Articles (and increase risk of) developmental problems for children in this type of care. After all, â&#x20AC;&#x153;it is easier to build strong children than to repair broken menâ&#x20AC;? (Frederick Douglass, 1818-1895).

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