Shama El-Salahi - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)
Keywords: social identity
children and adolescents
autism
traumatic childbirth
postnatal PTSD
perinatal
psychosocial wellbeing
new mothers
hospital admissions
eating disorders
mainstream education

Critical Review of the Literature
Background: Increasing numbers of Children and Young People on the Autism Spectrum (CYP-AS) are attending mainstream education in the United Kingdom, yet little is known about how their school experience affects their psychosocial wellbeing.
Objectives: To examine the qualitative literature examining the experiences of CYP-AS in British mainstream schools.
Data sources: PsycINFO, Web of Science, Educational Resources Information Center (ERIC), the British Education Index, CINAHL, Applied Social Sciences Index and Abstracts (ASSIA), Scopus, ProQuest Dissertations & Theses Global, and EducatiOn-Line.
Study eligibility criteria: Qualitative studies exploring the experiences of CYP-AS aged 0-18 years in mainstream British schools, published in peer-reviewed journals.
Participants: CYP-AS, their parents, and educational staff.
Study appraisal and synthesis method: A combination of narrative synthesis and critical review described and synthesised studies’ findings and assessed risk of bias.
Results: 22 papers reporting on 19 studies met the inclusion criteria. Six main themes arose: awareness and understanding of ASD, identity and belonging, interactions with peers, interactions with educational staff, school environment, and school culture.
Limitations: Several papers insufficiently reported on study design, methodology, data collection and analysis, presenting threats to the validity of findings. Potential bias on behalf of the authors in interpreting the data and developing themes may impact on the objectivity of this review.
Conclusions and implications of key findings: Integration of CYP-AS in mainstream education alone is insufficient for the development of positive psychosocial outcomes. Social connectedness and belonging may be critical factors that improve mainstream school experiences for this population.
Systematic review registration number: CRD42020158737
Service Improvement Project Abstract:
Objective: Relatively little is known about the impact of brief paediatric admissions on treatment trajectory for children and young people (CYP) admitted for medical complications of their eating disorder, i.e. whether young people are more or less likely to go on to an inpatient psychiatric admission afterwards. This service improvement project aimed to identify factors that influenced treatment trajectory and ways of improving families’ experiences during paediatric admissions. Method: Retrospective NHS data was analysed to explore differences between paediatric admissions that are followed by (1) community-based care and (2) inpatient psychiatric care within three months of discharge. Twelve parents provided feedback in interviews that were thematically analysed to understand useful components of paediatric admissions and how they could be improved. Results: CYP who went on to receive inpatient psychiatric care were unwell for longer before the paediatric admission, stayed on the paediatric ward for longer, had more crisis team input, were more likely to have had previous paediatric and psychiatric admissions, and had higher parent-reported anxiety and depression. The groups did not significantly differ in the severity of eating disorder symptoms, clinical impairment, physical risk, child-reported anxiety or depression, or presence of self-harm or suicide risk. Four key themes were identified from interviews: impact of the admission on mental health, communication, role of different systems, and knowledge and expertise. Discussion: Identifiable factors linked with illness severity appear to explain why some CYP return to community-based care, and some require more intensive psychiatric input following brief paediatric admissions. These factors may be useful indicators in predicting who may require subsequent inpatient care, allowing clinicians to target more intensive support earlier in treatment and to facilitate smoother transitions between services where required. Recommendations for improving families’ experiences in paediatric hospitals include improving paediatric staff’s understanding of eating disorders, enhancing communication channels, and providing psychological support for parents as well as the young person.
Main Research Project Abstract:
Objective: To investigate whether traumatic childbirth affected new mothers’ social identity and their psychological wellbeing, and whether strength of identity as a new mother protected psychological wellbeing following traumatic childbirth.
Method: 123 new mothers completed digital questionnaires about their birth experience, social identity, mental health and psychological wellbeing.
Results: Compared to women who did not have a traumatic birth (N=39), women who had a traumatic birth (N=84) had significantly lower psychological wellbeing but did not differ in the strength of their new mother identity, which was generally high across both groups. Strength of identity did not moderate the relationship between traumatic childbirth and psychological wellbeing. All analyses controlled for emotional and practical support, perceptions of healthcare staff, and mode of birth. Having a caesarean section independently reduced strength of the new mother identity. Common reasons for childbirth being traumatic included physical health complications that interrupted mother-and-baby bonding, unanticipated separation from birth partners, and negative interactions with healthcare staff.
Conclusions: Having a traumatic birth does not appear to have a clear effect on the strength of new mother identity and may be mediated by factors such as mode of birth. Further research is needed to understand the relationship between these constructs. Investigating the relationship between caesarean sections and strength of the new mother identity may identify effective ways of protecting new mothers’ mental health.