What are the barriers and enablers to trauma-informed emergency departments? A scoping review protocol.

INTRODUCTION: There is a high prevalence of psychological trauma among the population. Such people are more likely to have poorer health outcomes and these factors may contribute to increased use of the emergency department. There has been some attempt to implement a trauma-informed approach across public services, especially in health and social care. However, it is unclear how this concept applies to the challenging and high-demand emergency department context. The review aims to locate, examine and describe the literature on trauma-informed care in the unique and challenging healthcare delivery context that is the emergency department. The review aims to identify the barriers and enablers that may facilitate trauma-informed care in the emergency department context. METHODS AND ANALYSIS: This scoping review will use the Joanna Briggs Institute methodology for scoping reviews. Systematic searches of relevant databases (CINAHL, MEDLINE, PsycINFO, EMBASE, Knowledge Network and Web of Science) will be conducted. Empirical studies of any methodological approach, published in English between January 2001 and September 2023 will be included. The 'grey' literature will also be accessed. Two reviewers will independently screen all studies. Data will be extracted, collated and charted to summarise all the relevant methods, outcomes and key findings in the articles. ETHICS AND DISSEMINATION: Formal ethical approval is not required. The findings of this study will be disseminated through peer-reviewed publications, conference presentations and condensed summaries for key stakeholders in the field. The data generated will be used to inform a programme of work related to trauma-informed care.

The Rating of Emotional Abuse in Childhood (REACH) Questionnaire: A new self-report measure assessing history of childhood emotional abuse.

BACKGROUND: A history of childhood emotional abuse (CEA) is prevalent among adults with affective disorders; therefore, a comprehensive measure of it is vital. The Rating of Emotional Abuse in Childhood Questionnaire (REACH) was developed to assess history of CEA in relation to parental behaviours of threat, ignoring, humiliation/denigration, scapegoating, antipathy, and overcontrol/conditionality in a single measure. This paper investigated the psychometric properties of REACH in a community sample and proposes values for classifying individuals as high-risk for CEA. METHOD: A convenience sample of N = 483 adults (Female, 78.3%) was recruited to complete questionnaires that included the REACH alongside measures of mental health, insecure attachment, emotion regulation, and childhood abuse. A subset of participants (n = 198) completed the REACH 7 days later. RESULTS: Factor analysis indicated a 2-factor model provided a good fit. Factors were named 'threatening' and 'devaluing'. A total scale score of CEA was also recommended. The threatening, devaluing, and total scales demonstrated strong psychometric properties with high internal consistency, test-retest reliability, and convergent validity, while cutoff values for identifying a high-risk CEA group demonstrated good discriminant utility. CONCLUSIONS: The results support REACH as a valid measure and suggest a history of CEA should be measured in relation to threatening and devaluing CEA as they represent unique dimensions of CEA even though they often co-occur.

Perceptions of social support and relationships while living with a brain tumour: a qualitative study.

OBJECTIVE: Having a brain tumour can disrupt social roles and networks. Despite growing evidence on the significance of social support in adjustment to chronic illness, research rarely focuses on the role of relationships when coping with a brain tumour. The current study sought to explore individuals' experiences of social support, and the dynamics within their social relationships, following a diagnosis of a brain tumour. METHODS: Interpretative Phenomenological Analysis (IPA) was used as a methodological framework. Participants were 12 individuals (83% female) aged 29-54 years diagnosed with primary brain tumour (83% low grade), on average 3.5 years post-diagnosis. In-depth semi-structured interviews were conducted, transcribed verbatim, and analysed using IPA. RESULTS: Five themes were identified: Coping together in the family; Being concerned about others; Giving and receiving support; Needing to share the experience; and Negotiating independence. The results highlighted that the illness affected a whole network of closest relationships, and that coping was not an individual task. CONCLUSION: Coping with the condition was deeply socially embedded. There was a cost associated with seeking support and participants did not always ask for it, in order not to burden the caregivers. Talking to others with similar diagnoses provided a sense of validation and belonging.

The Prevalence of Attention Deficit/Hyperactivity Disorder Symptoms in Children and Adolescents With Autism Spectrum Disorder Without Intellectual Disability: A Systematic Review.

OBJECTIVE: ADHD commonly co-occurs with ASD without ID in young people. It has been difficult to obtain accurate prevalence estimates of ADHD in this population, as a dual-diagnosis was not permitted until DSM-V. We systematically reviewed the literature on the prevalence of ADHD symptoms in young people with ASD without ID. METHOD: 9,050 articles were identified through six databases. Articles were reviewed against inclusion and exclusion criteria and 23 studies were included. RESULTS: ADHD symptom prevalence varied from 2.6% to 95.5%. We discuss these findings according to the ADHD assessment measure, informant, diagnostic criteria, risk of bias rating and recruitment pool. CONCLUSION: ADHD symptoms are common in young people with ASD without ID, but there is substantial variance in study reporting. Future studies should recruit participants from community sources, provide information on key sociodemographic sample characteristics and assess ADHD with standardized diagnostic criteria, using both parent/carer and teacher report.

'Make Them Wonder How You Are Still Smiling': The Lived Experience of Coping With a Brain Tumour.

A brain tumour can be a life-threatening illness and cause unique symptoms compared to other types of cancer, such as cognitive or language deficits, or changes in personality. It is an exceptionally distressing diagnosis which can affect quality of life, even for those with a low-grade tumour or many years after the diagnosis. This study sought to gain an in-depth understanding of the lived experience of adjustment to living with a brain tumour. Twelve individuals (83% female) with a primary brain tumour (83% low-grade) took part in the study. Participants were aged 29-54 years, on average 43 months following the diagnosis, and were recruited through the charitable support organisations in the United Kingdom. In-depth semi-structured interviews were conducted, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). Six inter-related themes were identified: making sense of the diagnosis, seeking empowerment, feeling appreciative, taking charge of coping, learning to accept, and negotiating a new normality. Notions of empowerment, gratitude, and acceptance throughout the illness journey were prominent in the participants' narratives. Receiving sufficient information and initiating treatment were important in negotiation of control. The results highlighted what facilitates and hinders adaptive coping. Aspects which facilitated positive coping were as follows: trust in clinician, feeling in control, feeling grateful, or accepting. Participants on a 'watch and wait' approach, while feeling appreciative, perceived the lack of treatment as difficult and frustrating. Implications for patient-clinician communication are discussed, particularly for patients on a 'watch and wait' who might need additional support in adjusting.

The Impact of COVID-19 Restrictions on Psychological Distress in Family Caregivers of Children with Neurodevelopmental Disability in the UK.

Caregivers of a child with a neurodevelopmental disability are more vulnerable to mental health difficulties. These difficulties are influenced by the child's challenging behaviours, and the caregiver's coping strategies; factors impacted by the COVID-19 pandemic. An online mixed methods survey was conducted on caregivers of children with neurodevelopmental disabilities (n = 43) and children who are typically developing (n = 67). The results showed that presence of challenging behaviours related to neurodevelopmental disability, and caregiver coping strategies predicted caregiver psychological distress during lockdown. Themes that emerged included 'confusing messages and guidance', 'loss of freedom' and 'unsupported and forgotten'. The results demonstrate the pressing need for the implementation of appropriate support to protect the mental health of caregivers across the UK.

The relationship between attachment insecurity and experiences on the paranoia continuum: A meta-analysis.

OBJECTIVES: Attachment has long been theorized to play a key role in the development of paranoia. Associations between both constructs have been reported over the last decade, but have ranged widely in magnitude to date. The present study is the first publication to synthesize existing literature and provide a meta-analytic estimate of the attachment-paranoia relationship. METHODS: A systematic search of studies available up to January 2019 was conducted using Embase, MEDLINE, CINAHL, PsycINFO, OpenGrey, and ProQuest Dissertations & Theses Global. This yielded 26 studies which met inclusion criteria (N = 10,539; mean age range 16-47; 45% male). Data were analysed using random effects models with restricted maximum likelihood variance estimator. Age and sex were examined as moderators in meta-regressions. RESULTS: Paranoia was significantly associated with attachment anxiety (r = .38; 95% CI: 0.32, 0.44; p < .0001; I2  = 88%; k = 26) and attachment avoidance (r = .24; 95% CI: 0.18, 0.29; p < .0001; I2  = 79%; k = 26). The strength of these associations did not differ between clinical and non-clinical participant samples. Neither age nor sex moderated identified relationships. CONCLUSIONS: There is a moderate association between both constructs of interest. These findings suggest that attachment insecurity may be an active agent in the aetiology and/or maintenance of experiences on the paranoia continuum. Implications for psychological treatment, for example, consideration of attachment status in formulations, are briefly discussed. PRACTITIONER POINTS: Paranoia is associated with both attachment anxiety and attachment avoidance. These associations are of similar strength for people with and without psychosis. Attachment may contribute to the development and/or maintenance of paranoia. It may be beneficial to target attachment in psychological therapies for psychosis.

The relationship between adult attachment and coping with brain tumour: the mediating role of social support.

OBJECTIVE: A primary brain tumour diagnosis is known to elicit higher distress than other forms of cancer and is related to high depressive symptomatology. Using a cross-sectional design, the present study explored how individuals cope with this diagnosis using an attachment theory framework. Attachment anxiety and attachment avoidance were hypothesised to be positively related to helplessness/hopelessness, anxious preoccupation, and cognitive avoidance; and negatively related to fighting spirit and fatalism coping. We proposed perceived social support to play a mediating role in those associations. METHODS: Four hundred and eighty participants diagnosed with primary brain tumours completed the Mini-Mental Adjustment to Cancer Scale (Mini-MAC), the Experiences in Close Relationships Questionnaire-Revised (ECR-R), and the modified Medical Outcomes Study-Social Support Scale (mMOS-SSS) online. RESULTS: Lower perceived social support mediated the positive associations between both higher attachment anxiety and avoidance and higher helpless/hopeless coping. Attachment anxiety was also positively associated with anxious preoccupation. This relationship was not mediated by perceived social support. Cognitive avoidance was unrelated to both attachment dimensions and social support. CONCLUSIONS: The findings highlight that the differences in coping repertoire are associated with social relatedness factors, specifically attachment security and its relationship to perceived social support. Implications of the findings are discussed.

Towards population screening for Cerebral Visual Impairment: Validity of the Five Questions and the CVI Questionnaire.

INTRODUCTION: Cerebral Visual Impairment (CVI) is the most common cause of visual impairment in children in the developed world and appears to be more prevalent in children with additional support needs (ASN). There is an urgent need for routine screening for CVI, particularly in children with ASN, however, current screening questionnaires for CVI have limited validation. The aim of this study was to evaluate two screening tools: the Five Questions and the CVI Questionnaire. Additionally, the distribution of CVI across neurodevelopmental disorders is unknown. This too was investigated. METHODS: An online survey was completed by 535 parents. The survey was advertised via social media, CVI websites and parent email systems of four schools. The survey comprised of the Five Questions, the CVI Questionnaire and additional questions regarding the child's diagnoses. Whether or not a child had a diagnosis of CVI and/or additional neurodevelopmental disorders was based on parental report. RESULTS: Based on parent reports, both the screening tools accurately screened for CVI diagnoses in children. The Five Questions and the CVI Questionnaire have construct validity (as determined through factor analysis), high internal consistency (as determined by Cronbach's alpha) and convergent validity (as determined by correlation analysis of the raw scores of each questionnaire). This study also highlights that among children with neurodevelopmental disorders, a large proportion have parent-reported CVI (23%-39%) and potential CVI (6.59-22.53%; as identified by the questionnaires). CONCLUSION: The current study demonstrates that the Five Questions and CVI Questionnaire have good convergent validity, internal consistency and a reliable factor structure and may therefore be suitable as screening tools. The study also highlights that reported or potential CVI is evident in a large proportion of children with neurodevelopmental disorders.

Attachment as a partial mediator of the relationship between emotional abuse and schizotypy.

Developmental theories highlight the salience of attachment theory in explaining vulnerability towards psychosis. At the same time there is increasing recognition that psychosis is associated with childhood trauma variables. This study explored the interaction between attachment and several trauma variables in relation to schizotypy levels in a non-clinical sample. 283 non-clinical participants completed online measures of schizotypy, attachment, childhood abuse and neglect. When five types of abuse/neglect were entered into a linear regression analysis emotional abuse was the sole independent predictor of schizotypy. Age, attachment anxiety and avoidance were independent predictors after the effects of emotional abuse were controlled for. The overall model was significant, explaining 34% of the variation in schizotypy. Moderation analysis indicated that the effect of emotional abuse was not conditional upon attachment. Parallel mediation analysis indicated small but significant indirect effects of emotional abuse on schizotypy through attachment avoidance (13%) and attachment anxiety (8%). We conclude that emotional abuse contributes to vulnerability towards psychosis both directly and indirectly through attachment insecurity.

Visuospatial bootstrapping: implicit binding of verbal working memory to visuospatial representations in children and adults.

When participants carry out visually presented digit serial recall, their performance is better if they are given the opportunity to encode extra visuospatial information at encoding-a phenomenon that has been termed visuospatial bootstrapping. This bootstrapping is the result of integration of information from different modality-specific short-term memory systems and visuospatial knowledge in long term memory, and it can be understood in the context of recent models of working memory that address multimodal binding (e.g., models incorporating an episodic buffer). Here we report a cross-sectional developmental study that demonstrated visuospatial bootstrapping in adults (n=18) and 9-year-old children (n=15) but not in 6-year-old children (n=18). This is the first developmental study addressing visuospatial bootstrapping, and results demonstrate that the developmental trajectory of bootstrapping is different from that of basic verbal and visuospatial working memory. This pattern suggests that bootstrapping (and hence integrative functions such as those associated with the episodic buffer) emerge independent of the development of basic working memory slave systems during childhood.

Harry, Paul and the Filipino maid: racial and sexual abuse in local contexts.

Estacio argues for critical health psychology to take action to address three issues raised (unintentionally) in the 'Harry and Paul' sketch broadcast on British television. It is suggested that, although attempting humour, the sketch offensively reflected and reproduced patterns of social injustice that are far from funny. We argue here that micro-level analysis of the interactional elements of the sketch provides an understanding of how in everyday contexts Filipino workers are constructed in socially unjust terms and of how abuse can be justified. Such an understanding can allow critical health psychology to make a distinctive contribution to these topics.