Alexandra Harper - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Critical Review of the Literature Abstract
Background: Parents of children and young people with Obsessive Compulsive Disorder (OCD) often “accommodate” (adapt their behaviour), attempting to help alleviate their child’s distress. However, the varying types and function of accommodation that can be exhibited are poorly understood. Aims: This systematic review aimed to evaluate the types of parental accommodation. It also aimed to evaluate how these types of accommodation relate to the cognitive behavioural understanding of OCD, and the implications for treatment. Method: The databases searched in this systematic review were Scopus, Web of Science, CINAHL, PsycINFO, Ovid SP, ProQuest Dissertations & Theses Global, ProQuest ASSIA Applied Social Sciences Index and Abstracts, and Proquest Sociology Collection. Publication dates ranged from January 2008 to May 2021. Studies were included if they were peer reviewed, quantitative articles or review papers, used cognitive-behavioural theory, used a sample of children and young people with OCD, and accommodation was explored descriptively or categorically. Results: The search returned 1124 papers; 68 papers were selected for detailed screening. One additional paper was included from citation and hand searches. A final 11 papers were identified for the review. All papers demonstrated the presence of five theoretically derived categories of accommodation behaviours. However, some categories identified in papers overlapped as accommodation is mainly measured and operationalised by topography rather than function. Conclusions: The findings suggest accommodation is frequently observed in young people with OCD. Further research should examine how distinct these categories are in terms of function as present measures of accommodation overlook the function of and motivation for such behaviour.
Service Improvement Project Abstract
Background: Across the UK, autistic young people receive very little post-diagnostic support despite the importance highlighted in policies and best practice guidelines. This study reported on a service improvement project exploring the needs of young people post-diagnosis and delivering a service user informed post-diagnostic support package. Method: A sample of twenty-two (n = 22) young people aged 13-18, and their parents, who were diagnosed within the last year were recruited using purposive sampling within a CAMHS service in Oxfordshire, UK. The research was in two phases. Phase one gathered feedback from young people and parents on what support they had and what support they would like post-diagnosis. Phase two was a tailor-made post-diagnostic support package in line with their feedback. Results: The results of phase one indicated a need for young people to meet and hear from others diagnosed with autism , as well as speak to a clinician. The results from phase two found young people enjoyed a live space to meet other autistic young people and found the chance to speak to a clinician and have their views heard valuable. Conclusions: Further improvement and provision of post- diagnostic support for young people is needed. Post-diagnostic support is recommended to be routinely offered to young people in services.
Theoretically Driven (Main) Research Paper Abstract
Background: Current research suggests that foster carers experience higher carer stress than biological parents and face more behaviours that challenge from the children they care for. Reflective functioning (the ability to view one’s own mental state separately to the child’s; viewing them as a separate, independent entity) may facilitate foster carers to persevere when highly stressed and faced with behaviours that challenge. Wellbeing factors may also play such a role. Aims: This study aimed to explore whether foster carers who are highly stressed also report their foster child to have higher levels of behaviours that challenge. It also aimed to explore whether higher stress impacted upon a carer’s ability to use reflective functioning and their wellbeing. Finally, it explored whether wellbeing moderated the impact of behaviours that challenge. Method: Seventy- eight (n = 78) foster carers took part by completing online questionnaires. The highest and lowest scoring forty-six (n = 46) foster carers on a measure of carer stress were compared. The total sample was used to explore whether wellbeing was a moderator in a regression model. Results: The results showed that carers with high parental stress reported higher levels of behaviours that challenge and had lower levels of wellbeing. Reflective functioning abilities did not differ between the high and low stress groups. Wellbeing did not moderate the impact behaviours that challenge had on carer stress. Conclusions: Further research is required to explore variability in reflective functioning abilities in foster carers, and factors that help moderate the impact of factors that increase carer stress.

Advisor: Anderson, C
Stacey, J
Salkovskis, P