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Background: Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are two common childhood-onset neurodevelopmental disorders, and about 30–80% of children with ASD meet the diagnostic criteria for ADHD, whereas about 20–50% of children with ADHD meet the diagnostic criteria for ASD. For a full understanding of the functional levels of children with these disorders, neuropsychological and emotion recognition (ER) examinations are important. Studying ASD across countries allows identifying possible different phenotypes of ASD. Evidence of similar neurocognitive profiles and ER ability across countries might strengthen the notion of innate ASD features. Aims: We aimed to compare neuropsychological and ER abilities in Egyptian children with ASD (with and without ADHD), with ADHD, and typically developing children; to assess the effect of comorbid ADHD on neuropsychological and ER abilities in Egyptian children with ASD; and to compare Egyptian and Finnish children with ASD on their neuropsychological and ER abilities. Methods: Using Developmental Neuropsychological Assessment (NEPSY) and the Frankfurt Test and Training of Facial Affect Recognition (FEFA), we evaluated 34 Egyptian children with ASD (17/34 pure ASD; 17/34 comorbid ASD+ADHD), 37 ADHD, and 34 typical development (TD). We also evaluated Finnish children with ASD (Finnish ASD n = 54 with NEPSY; n = 32 with FEFA). Diagnoses were determined with the ICD-10. The Autism Diagnostic Interview and Autism Diagnostic Observation Schedule were used to obtain diagnostic confirmation. Results and Conclusions: Our results suggest that in Egypt, both children with ASD and with comorbid ASD+ADHD have lower neuropsychological and ER abilities in general than children with ADHD. Children with ASD and comorbid ASD+ADHD did not differ significantly on NEPSY and FEFA. However, compared to TD children, ADHD symptoms in children with ASD may worsen planning ability, hand motor coordination, a, Tiivistelmä Tausta: Autismikirjon häiriö (ASD) ja aktiivisuuden ja tarkkaavuuden häiriö (ADHD) ovat kaksi yleistä lapsuusiässä alkavaa neurobiologista kehityshäiriötä. Noin 30–80% lapsista, joilla on ASD, täyttää ADHD:n diagnostiset kriteerit, kun taas noin 20–50% lapsista, joilla on ADHD, täyttää ASD:n diagnostiset kriteerit. Jotta voidaan saavuttaa kattava käsitys lasten toimintakyvystä näissä häiriöissä, on tärkeää saada tutkittua tietoa heidän neuropsykologisesta suoriutumisestaan ja kyvystään tunnistaa tunteita. ASD:n tutkiminen eri maissa antaa mahdollisuuden tunnistaa häiriön mahdolliset erilaiset fenotyypit. Viitteet samanlaisista neurokognitiivisista profiileista ja tunteiden tunnistamiskyvystä eri maissa voisivat vahvistaa kulttuurista riippumattomien ASD-piirteiden käsitettä. Tavoitteet: Tutkimuksen tavoitteena oli arvioida egyptiläislasten, joilla on ASD, ASD+ADHD, ADHD tai tyypillinen kehitys (TD) neuropsykologista suoriutumista ja kykyä tunnistaa tunteita; tutkia samanaikaisen ADHD:n vaikutusta egyptiläisten ASD-lasten neuropsykologiseen suoriutumiseen ja tunteiden tunnistamiskykyyn; ja verrata egyptiläis- ja suomalaislasten, joilla on ASD, neuropsykologista suoriutumista ja tunteiden tunnistamiskykyä. Menetelmät: Arvioimme egyptiläislapsia, joilla oli ASD (n = 34; ASD n=17; ASD+ADHD n=17), ADHD (n = 37) ja tyypillinen kehitys (TD) (n = 34) sekä suomalaislapsia, joilla oli ASD, neuropsykologisella tutkimuksella (NEPSY) ja tunteiden tunnistamistestillä (the Frankfurt Test and Training of Facial Affect Recognition; FEFA) (suomalaiset ASD-lapset: NEPSY n = 54; FEFA n = 32). Diagnoosit määritettiin ICD-10:llä ja diagnostiikan apuna käytettiin autismin diagnostista haastattelua ja autismin diagnostista havainnointimenetelmää. Tulokset ja johtopäätökset: Tuloksemme viittaavat siihen, että Egyptissä sekä lapsilla, joilla on ASD, että lapsilla, joilla on samanaikainen ASD ja ADHD, on heikommat neuropsykologiset taidot ja kyky tunnistaa tunteita kuin lapsilla

Adolescence is a vulnerable age for emerging mental health problems. As schools are everyday environments for children and adolescents, mental health promotion interventions may be especially effective when delivered within them. The aim of this study was to generate knowledge on mental health promotion interventions in comprehensive schools in northern Finland. First, a mental health promotion model for comprehensive schools was developed by psychiatric nurses in collaboration with school professionals in workshops in Oulu, Finland. A review of the literature, which revealed that mental health promotion in schools includes indicated, selective and universal interventions, was used as a basis for the study, together with written reports from the workshops. Secondly, school professionals from comprehensive schools with or without interventions developed in the mental health promotion model in Oulu were included in the study, and their perceptions of student well-being and mental health promotion in school were queried. The study samples consisted of school professionals from 9 intervention schools and from 49 non-intervention schools. School professionals considered that student well-being has declined and that students show a general disregard for their own well-being. Mental health promotion was regarded as a ‘core business’ of schools. Thirdly, a universal psychoeducation intervention, including lectures and group work on mental health issues, was delivered to 14-years old students in eighth grade. Students from two comprehensive schools were included, 85 pupils in 8th grade forming an intervention group and 77 a non-intervention group. The psychoeducation intervention delivered in classroom settings increased boys’ recognition of conduct disorders and altered girls’ attitudes to regard mental health disorders more as real medical conditions than as personal traits. Students reported feeling more comfortable seeking help from family members and friends th, Tiivistelmä Erilaiset mielenterveyteen liittyvät ongelmat ovat lapsilla ja nuorilla yleisiä ja suuri osa aikuisiän mielenterveyden häiriöistä alkaa lapsuudessa tai nuoruudessa. Koulut ovat lapsille ja nuorille yhteinen ja luonnollinen ympäristö edistää lasten ja nuorten mielenterveyttä, jonka vuoksi mielenterveyden edistämisen interventiot kouluympäristöissä voivat olla erityisen vaikuttavia. Tämän tutkimuksen tavoitteena oli tuottaa tietoa mielenterveyden edistämisestä peruskouluissa. Mielenterveyden edistämisen malli peruskouluihin kehitettiin Oulussa työpajoissa yhdessä psykiatristen sairaanhoitajien sekä eri yhteistyötahojen, koulun toimijoiden sekä vanhempien ja oppilaiden kanssa. Tutkimuksen pohjana toimi kirjallisuuskatsaus, jonka mukaan mielenterveyttä edistetään kouluissa yksilö-, ryhmä- ja yleistasolla sekä työpajojen raportit. Tutkimuksessa tarkasteltiin koulujen henkilökunnan kokemuksia oppilaiden hyvinvoinnista sekä mielenterveyden edistämisen toiminnasta kouluympäristössä. Tutkimukseen osallistui henkilökuntaa 9 koulusta, joissa toteutettiin työpajoissa kehitettyjä interventioita sekä 49 koulusta, joissa ei toteutettu työpajoissa kehitettyjä interventioita. Koulun henkilökunta koki, että oppilaiden hyvinvointi on heikentynyt ja oppilaat osoittavat välinpitämättömyyttä omaa hyvinvointia kohtaan. Koulujen henkilökunnan mielestä mielenterveyden edistäminen on osa koulun perustoimintaa. Yleistason psykoedukatiivinen interventio, johon kuului opetusta sekä ryhmätöitä mielenterveyden teemoista toteutettiin 8-luokan noin 14-vuotiaille oppilaille. Tutkimukseen osallistui oppilaita kahdesta peruskoulusta, 85 oppilasta interventiokoulusta sekä 77 ei-interventiokoulusta. Luokkaympäristössä toteutettu interventio lisäsi poikien osalta käytöshäiriöiden tunnistamista ja tyttöjen asenne muuttui mieltämään mielenterveyden häiriöitä enemmän lääketieteellisenä häiriönä eikä henkilökohtaisena ominaisuutena. Oppilaat raportoivat hakevansa mieluummin apua perheen jäseniltä

Since prior research has mostly focused on children, less is known about how autistic adults and adults with sub-clinical autistic traits interpret pragmatically complex social situations and the kind of narrative discourse they produce. 32 autistic young adults, 18 young adults with sub-clinical autistic traits and 34 non-autistic young adults participated this study. They were shown videos of social interactions which required complex pragmatic processing and were asked to freely narrate what they thought was occurring in each video. Their narratives were coded for aspects of social-pragmatic and narrative discourse. The results indicate that the autistic and sub-clinical groups differed from the comparison group in what they inferred as relevant video content. The narratives of the autistic group also differed from the comparison group in meaning, focus and emphasis on details. In addition, the comparison group produced more holistic narratives whereas the autistic and sub-clinical groups produced more atomistic narratives. Correlational findings indicated that perceptual reasoning has stronger associations with pragmatic inferencing in the autistic and sub-clinical groups than in the comparison group. This study suggests that autistic adults and adults with sub-clinical autistic traits differ from non-autistic adults in what they perceive to be relevant in their social world.

Background: Despite increasing knowledge of social communication skills of autistic peole, the interrelatedness of different skills such as non-linguistic comprehension, social inference and empathizing skills is not much known about. A better understanding of the complex interplay between different domains of social communication helps us to develop assessment protocols for individuals with social communication difficulties. Aims: To compare the performances of autistic young adults, young adults with autistic traits identified in childhood and control young adults in social communication tasks measuring non-linguistic comprehension, social inference and empathizing skills. In addition, to examine associations between the different social communication measures. Methods & Procedures: Autistic young adults (n = 34), young adults with autistic traits (n = 19) and control young adults (n = 36) completed the extra- and paralinguistic scales of the Assessment Battery for Communication (ABaCo), the Faux Pas Recognition Test, Social–Pragmatic Questions (SoPra) and the Empathy Quotient (EQ). Outcomes & Results: Group differences were found in the performance in the ABaCo, SoPra and EQ scores. Compared with the control young adults, autistic young adults scored lower. The performance of the young adults in the autistic traits group fell in between the other two groups. There were no group differences in the Faux Pas Recognition Test. The variability within the groups was large in all measurements. In the control group, there was a significant correlation between EQ and SoPra scores and between the Faux Pas and SoPra scores. In the autistic group, a significant correlation was found between Faux Pas and SoPra scores. Also, other patterns were observed but these were not statistically significant. Conclusions & Implications: The young adults with autistic traits fell in between the control and autistic young adults, highlighting the presence of the contin

Chronic conditions are common in childhood. We investigated the associations of childhood chronic conditions reported by parents with subsequent self-reported internalizing and externalizing problems in adolescence. A sample of 6290 children (3142 boys and 3148 girls) with data on chronic condition reported by parents both at 7 and at 16 years of age was obtained from the Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort (n = 9432) from an unselected, regionally defined population. Internalizing and externalizing problems were measured at 8 years of age with Rutter Children’s Behavioral Questionnaire by teachers and at 16 years of age with Youth Self-Report by adolescents. When studying the effects of history of chronic conditions on these problems at 16 years of age, childhood internalizing and externalizing problems and social relations were adjusted. A history of chronic condition predicted subsequent somatic complaints among all adolescents. Early-onset chronic conditions were related to subsequent externalizing (OR 1.35; 1.02–1.79) and attention problems (OR 1.33; 1.01–1.75) and later onset of chronic conditions with internalizing (OR 1.49; 1.22–1.82) and thought problems (OR 1.50; 1.18–1.92). The effect was specific for sex and the type of chronic condition. Conclusion: Childhood chronic conditions predicted internalizing and externalizing problems in adolescence. To prevent poor mental health trajectories, children with chronic conditions during their growth to adolescence need early support and long-term monitoring.

The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated local services’ use experiences of autistic adults, carers and professionals with interventions for autistic adults. The majority of the 697 participants experienced recommended considerations prior to deciding on intervention and during the intervention plan and implementation. Psychosocial interventions were the most commonly experienced interventions, while pharmacological interventions NOT recommended for core autistic symptoms were reported by fairly large proportions of participants. Family interventions were experienced slightly more commonly by carers than adults or professionals. Less than the 26% of autistic adult responders who had experienced challenging behaviors reported receiving an intervention to change them. These results provide insights for improving gaps in service provision of interventions among autistic adults.

Weaknesses in context-sensitive socio-pragmatic understanding are common in autism spectrum disorder causing challenges in social relationships. This research studied the neural-basis of socio-pragmatic understanding in young autistic adults and non-autistic controls by examining their brain functioning in task-free (resting-state) and task conditions. The brain-level data were acquired using functional magnetic resonance imaging (fMRI). When the communication between the brain network pairs was measured in task-free conditions utilising a fast fMRI sequence and a dynamic lag analysis approach, responses in the autistic persons showed temporally and directionally altered patterns of mutual communication in network pairs associated with social information processing, suggesting atypical deactivation mechanisms related to the posterior default mode network. In addition, deviant interplay between brain networks in autistic persons was found in network pairs including sensory networks. While neural-level associations were examined using video clips containing non-verbal pragmatic communication events as stimuli, inter-subject correlation analysis revealed more homogenous brain activation patterns in the control group, and less synchrony of brain activity in the autistic group, suggesting weaker modulation of brain states in response to the stimulus. Reduced synchrony of brain activity in the autistic group was concentrated predominantly in the region of the salience network. On the behavioural level, no significant difference between the groups was found in answering accuracy concerning the pragmatic content of the video clips, although there was more variability in accuracy in the autistic group. Long mean reaction and answering times were associated with more severe autistic traits implying altered processing mechanisms in autism. Neural-level responses to socio-pragmatically challenging communication were studied using video clips of complex social scenes as, Tiivistelmä Kontekstisidonnaisen sosiopragmaattisen ymmärtämisen pulmat ovat yleisiä autismikirjon henkilöillä, ja ne aiheuttavat haasteita sosiaalisiin suhteisiin. Tässä väitöstyössä tutkittiin sosiopragmaattisen ymmärtämisen neuraalista perustaa autismikirjon häiriö -diagnoosin saaneilla nuorilla aikuisilla sekä verrokeilla tarkastelemalla heidän aivotapahtumiaan lepotilassa sekä heidän katsoessaan videoleikkeitä. Aineistona tutkimuksessa käytettiin toiminnallisen aivokuvantamisen (fMRI) keinoin kerättyä dataa. Kun lepotilahermoverkkojen välinen kommunikaatio mitattiin hyödyntäen nopeaa fMRI-sekvenssiä ja dynaamista viiveanalyysiä, havaittiin, että autismikirjon henkilöillä informaation välittyminen ja ajallinen kytkeytyminen sosiaalisen tiedon käsittelyyn osallistuvien hermoverkkojen välillä oli verrokkeihin nähden poikkeavaa. Hermoverkkojen välinen poikkeava kommunikaatio ilmeni erityisesti epätyypillisenä posteriorisen peruslepotilaverkoston deaktivaatiokuviona. Lisäksi autismikirjon henkilöillä havaittiin poikkeavaa aistihermoverkkoihin liittyvää hermoverkkojen välistä vuorovaikutusta. Kun neuraalisen tason ilmiöitä tarkasteltiin käyttämällä herätteenä ei-verbaalisia pragmaattisia kommunikaatiotilanteita sisältäviä videoleikkeitä, intersubjektiivinen korrelaatioanalyysi paljasti, että verrokkiryhmässä aivojen aktivaatiokuviot olivat enemmän toistensa kaltaisia, kun taas autismikirjon ryhmässä aivotoiminnan keskinäinen synkronoituminen oli vähäisempää. Autismikirjon henkilöillä synkronoituminen oli vähäisempää etenkin olennaisen tunnistavan hermoverkon alueella. Vaikka käyttäytymistasolla ryhmät vastasivat samankaltaisesti videoleikkeiden pragmaattista sisältöä koskeviin kysymyksiin, reaktioajan ja vastauksen keskipituuden korreloiminen autististen piirteiden vaikeusasteen kanssa viittasivat prosessointimekanismin erilaisuuteen autismikirjon henkilöillä. Tarkastelemalla videoleikkeillä esitettyjen sosiaalisesti ja pragmaattisesti monimutkaisten kommunikointitil

One of the most important factors in a child’s growth environment is the emotional atmosphere of the family. Childhood experiences and perceptions of interaction with parents can be reflected in the offspring’s later life course. This study explored, i) the connections between parental images and the quality of the offspring’s current intimate relationships; ii) differences between females and males in relation to their parental images and the quality of their relationships; and iii) whether the mother’s self-reported assessment of her strictness and the adult offspring’s recollections of the disciplinary methods of their parents are associated in the adult offspring’s recalled parental images and current emotional distress, anxiety and depression as assessed by the Hopkins Symptom Check List (HSCL-25); and whether their parental images are associated with their emotional distress. The data is a part of the Oulu University Hospital “Mother-Child Follow-up Study 1971–1972”. The mothers responded to a 1st follow-up questionnaire (the assessment of her strictness) when the children were 7 years old (N = 354). The offspring responded to a 2nd follow-up questionnaire concerning experienced discipline methods, their parental images and current intimate relationship quality and HSCL-25-scores in the year 2000 (N = 337). A supportive mother image was associated with the daughters’ and sons’ — and a supportive paternal image only with the daughters’ — balanced relationships. A dominant father image was associated with both the daughters’ and sons’ submissive/repressive relationships. A supportive image of the opposite sex parent was associated with the offspring’s loving relationships and protected them from quarrelsome relationships. A supportive image of the father also protected the female offspring from a submissive/repressive relationship. A recollection of dialogic discipline of both parents was positively associated with the corresponding parent’s supportive, Tiivistelmä Kasvuympäristön tärkeimpiä tekijöitä on lapsuudenperheen tunneilmapiiri. Lapsuudenkokemukset ja käsitykset vuorovaikutuksesta vanhempien kanssa voivat heijastua jälkeläisten myöhempiin ihmissuhteisiin ja hyvinvointiin aikuisiässä. Tämän tutkimuksen tarkoituksena oli selvittää i) nuorten aikuisten vanhempimielikuvien ja nykyisen parisuhteen laadun välistä yhteyttä, ii) naisten ja miesten välisiä eroja liittyen vanhempimielikuviin ja parisuhteen laatuun, iii) liittyvätkö äidin ilmoittama arvio hänen omasta ankaruudestaan ja aikuisten jälkeläisten muistamat vanhempiensa käyttämät kasvatusmenetelmät jälkeläisten vanhempimielikuviin ja tämän hetkiseen emotionaaliseen stressiin, ahdistukseen ja masennukseen Hopkinsin menetelmällä (HSCL-25) mitattuna, sekä liittyvätkö jälkeläisten vanhempimielikuvat heidän HSCL-25-oireisiinsa. Aineisto on osa Oulun yliopistollisen sairaalan ”Äiti-lapsi-seurantatutkimusta 1971–1972”. Äidit vastasivat ensimmäiseen seurantakyselyyn ja arvoivat omaa ankaruuttaan kasvattajina lapsen ollessa seitsemänvuotias (N = 354). Jälkeläiset vastasivat vuonna 2000 (N = 337) toiseen seurantakyselyyn, joka koski heidän kokemaansa kasvatusta ja muistiin palautettuja vanhempimielikuviaan sekä tämänhetkistä parisuhteensa laatua ja HSCL-25–menetelmällä mitattuja oireitaan. Kannustava äitimielikuva liittyi sekä tyttären että pojan tasapainoiseen parisuhteeseen, mutta kannustava mielikuva isästä heijastui vain tyttären tasapainoiseen suhteeseen, ja se myös suojasi tyttäriä alistavalta/alistuvalta suhteelta. Dominoiva isämielikuva liittyi sekä tyttären että pojan alistavaan/ alistuvaan suhteeseen. Kannustava mielikuva vastakkaista sukupuolta olevasta vanhemmasta liittyi sekä naisilla että miehillä rakastavaan parisuhteeseen ja suojeli riitaisalta suhteelta. Muistikuva äidin ja isän dialogisesta kurista liittyi kannustavaan ja sosiaaliseen mielikuvaan vastaavasta vanhemmasta. Rajoittava ja ruumiillisesti rankaiseva kuri liittyi dominoivaan vanhempimielik

Harsh parenting can predispose a child to emotional distress, whereas a supportive childhood environment furthers later subjective well-being. We investigated whether the mother’s self-reported assessment of her strictness and the adult offspring’s recollections of the disciplinary methods of their parents are reflected in the adult offspring’s recalled parental images and current emotional distress, anxiety and depression as assessed by the Hopkins Symptom Check List (HSCL-25). Further, we investigated whether the offspring’s parental images were also associated with the HSCL-25 scores. Data was collected from northern Finland. The mothers responded to a questionnaire when their child was seven years old (N = 354) and the adult offspring responded at age 28–29 (N = 337). The mother’s assessment of her own strictness was associated both with the adult offspring’s dominating images of their parents and their current emotional distress, anxiety and depression. The offspring’s recollections of restriction and corporal punishment were associated with dominating parental images, and these images further with current emotional distress, anxiety and depression of the offspring. Correspondingly, the offspring’s recollections of parental dialogic discipline were associated with supportive and sociable parental images, and recalled paternal dialogic discipline was associated with lower current emotional distress, particularly in the female offspring. In conclusion, harsh parenting was associated with dominating parental images, which in turn were associated with emotional distress in adulthood. Dialogic discipline and the father’s role in parenting were emphasized in the offspring’s well-being, but more research is needed to assess the importance of paternity for the offspring’s subjective well-being.

Research providing an evidence-base for autistic adult services is sparse. The Autism Spectrum Disorders in the European Union (ASDEU) network implemented an on-line survey to determine gaps in autistic adult diagnostic evaluation and post-diagnostic support services. More than 55% in all groups experienced most of the recommended features for diagnostic evaluation for autistic adults. In contrast, < 2% of adults or carers, and < 21% of professionals experienced each of the recommended features for post-diagnostic support. In contrast to 61% of professionals, only about 30% of autistic adults and carers had knowledge of good local services models for autism diagnosis in adulthood. There are major differences between good practice guidelines for diagnostic and post-diagnostic care for autistic adults, and what is actually experienced by services users and professionals.

The death of one’s own child is among the heaviest and most difficult events a person can have to face. Losing a child can be considered an extreme existential event, a limit situation, defined by Karl Jaspers. A limit situation refers to an existential crisis triggered by a traumatic experience. This interdisciplinary doctoral thesis examines representations of grief related to the loss of a child in Finnish autobiographical literature. Nineteen works published from 1996 to 2019 have been selected as research material. The subject of this research is the phenomenology of grief and its manifestations in the research data. The analysis is built on Lauri Rauhala’s theory of the three basic forms of human existence: corporeality, consciousness and situationality. Grieving manifests itself at all these levels: as affects set at the interface of body and mind, as verbalized thoughts and emotions, and in relationships with the surrounding reality. The theoretical frame of reference for this research consists of trauma theory, psychoanalytic affect theory, theory linked to literary therapy, and philosophy that considers existential issues. As the research material shows, the traumatic experience takes shape along with the psychological processing from a non-verbal core experience into words and stories, narratives of grief. The narratives are interpretations of the pure raw experience, which in itself is difficult to describe in words. With words the authors aim to approach an originally non-linguistic experience with the goal of creating a verbal interpretation of it. The research data consist of such linguistic descriptions of the experience of grief. The process of producing written material can be considered as therapeutic writing, and the final product of that process, literature about grief, as therapeutic literary material providing the opportunity of peer support and growth in understanding to the reader as well. The therapeutic writing process in the rese, Tiivistelmä Oman lapsen kuolema kuuluu raskaimpiin ja vaikeimpiin tapahtumiin, joita ihminen voi elämässään joutua kohtaamaan. Lapsen menettäminen voidaan nähdä eksistenssin rajatilanteena, Karl Jaspersin määrittelemänä rajatilannesituaationa, joka viittaa traumaattisen kokemuksen laukaisemaan äärimmäiseen eksistentiaaliseen kriisiin. Poikkitieteellisessä väitöstutkimuksessa tarkastellaan lapsen kuolemaan liittyviä surun kuvauksia kotimaisessa omaelämäkerrallisessa kirjallisuudessa. Kohdeteoksiksi on valikoitunut 19 kotimaista julkaistua teosta ajalta 1996–2019. Tutkimuksen kohteena on surun fenomenologia ja sen ulottuvuudet tutkimusaineistossa. Analyysi rakentuu Lauri Rauhalan teoriaan ihmisen olemassaolon kolmesta muodosta: kehollisesta, tajunnallisesta ja situationaalisesta. Sureminen toteutuu näillä kaikilla tasoilla: kehon ja mielen rajapinnalle sijoittuvina affekteina, kielellistyneinä ajatuksina ja emootioina sekä suhteina ympäröivään maailmaan. Tutkimuksen teoreettinen viitekehys muodostuu traumateoriasta, psykoanalyyttisesta affektiteoriasta, kirjallisuusterapiaan kytkeytyvästä teoriasta sekä eksistentiaalisia kysymyksiä käsittelevästä filosofiasta. Traumaattinen kokemus muotoutuu kohdeteoksissa psykologisen prosessoinnin myötä kielen ulkopuolisesta ydinkokemuksesta sanoiksi ja tarinoiksi, kertomuksiksi surusta. Kertomukset ovat tulkintoja puhtaasta raakakokemuksesta, jota itsessään on vaikeaa sanoin kuvata. Kirjoittajat lähestyvät sanoilla alun perin ei-kielellistä kokemusta, josta pyritään luomaan verbaalinen tulkinta. Tutkimusaineisto koostuu tällaisista surun kokemuksen kielellisistä kuvauksista. Aineiston tuottamisen prosessi voidaan nähdä terapeuttisena kirjoittamisena ja tuon prosessin lopputuote, surusta kertova kirjallisuus, terapeuttisena kirjallisena aineistona, joka tarjoaa vertaistuen ja ymmärryksen kasvun mahdollisuuden myös lukijalle. Terapeuttinen kirjoittaminen kohdeteoksissa näyttäytyy minää rakentavana ja evolutiivisena prosessina, joka o

The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults—especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups, <20% of responders knew an organization or clinician which has developed a way to monitor health, and prevent poor health, that works well for adults on the autism spectrum. The results point to means for better management of co-occurring conditions associated with autism in adulthood in order to reduce hospital admissions and potential areas of improvement in health and social services for autistic adults. Specifically, efforts should be focused on (1) professionals’ education on risks for co-occurring conditions in autistic adults; (2) promoting preventive health behaviors; (3) making services user-friendly for autistic adults and their families; and (4) encouraging knowledge of good local services.

Abstrakti Tarkastelemme referointikeinoja, joita aikuiset autismikirjon henkilöt ja verrokit käyttävät puhuessaan toisen henkilön ajatuksista. Aineisto on kerätty tutkimustilanteessa, jossa tutkittavia pyydetään kertomaan, mitä videolla nähty henkilö voisi ajatella. Tässä tutkimuksessa referointikeinot on luokiteltu kuvaileviksi ja esittäviksi sen mukaan, pysyykö vuoron näkökulma eli deonttinen origo meneillään olevassa puhetilanteessa vai siirtyykö se referoitavaan puhetilanteeseen. Tutkimus osoittaa, että autismikirjon henkilöiden ja verrokkien referointikeinot ovat pääosin samankaltaisia, joskin verrokkiryhmän edustajien vastauksissa on hieman enemmän kuvailua ja autismikirjon henkilöillä esitystä. Kaksi tutkittavaa autismikirjon henkilöä käyttää myös ns. paljaita esityksiä, jotka eivät sisällä lainkaan sellaisia deonttisia markkereita, jotka sitoisivat sanotun meneillä olevaan puhetilanteeseen. Tällainen referointi on suomenkielisessä puheessa melko harvinaista, ja katsomme sen mahdollisesti kuvastavan yksittäisten autismikirjon henkilöiden erilaista tapaa hahmottaa tai käsitellä puhetilanteen osallistumiskehikkoa., This paper examines participants’ responses to questions regarding the thoughts of another person. The data is drawn from semi-structured interviews with 56 young adults, 26 of whom have been diagnosed with autism spectrum disorder. The interviews are in Finnish. The focus of this study is on linguistic means used by the participants in a task in which they are asked to watch a video clip and then tell what one of the characters is thinking. A common type of response to the latter question is an assertion, such as noo (.) se oli selvästi kiinnostunu siitä (2.0) kurssista ja (.) siitä mitä siellä tehdään ja ’well, she was clearly interested in the course and what it’s all about and’, which names the thought (e.g., kiinnostunu ‘interested’). The responses also include demonstrations, such as kuulostaapa tosi hauskalta kurssilta haluanpa itsekin mukaan sinne ‘That sounds like a fun course. I think I’d like to join.’ The study shows that individuals on the autism spectrum and control group members use similar linguistic means in their reported speech utterances. Most demonstrations in the data are combined with an assertion or other markers that show a deictic shift between the reported speech situation and the situation here-and-now. Two individuals on the autism spectrum, however, use a rare type of ‘bare demonstration’ which is not linguistically tied to the situation here-and-now. We pose a hypothesis that this may reflect some difficulty of individuals on the autism spectrum in processing the complex participation framework in a reported thought situation. In this part, ‘bare demonstrations’ resemble repetitive speech of children on the autism spectrum, which also reflects difficulty in intersubjective processing and interactional deictics. However, bare demonstrations are not reproductions of something the speaker has heard but, instead, a creation of the speaker’s own imagination.

Background: Chronic illness, such as juvenile idiopathic arthritis (JIA), appears to have an impact on the mental health of children and adolescents. The aim of this study was to explore the incidence of mental and behavioural disorders according to age at JIA onset and gender in JIA patients compared to a control population. Methods: Information on all incident patients with JIA in 2000–2014 was collected from the nationwide register, maintained by the Social Insurance Institution of Finland. The National Population Registry identified three controls (similar regarding age, sex and residence) for each case. They were followed up together until 31st Dec. 2016. ICD-10 codes of their psychiatric diagnoses (F10-F98) were obtained from the Care Register of the National Institute for Health and Welfare. The data were analysed using generalized linear models. Results: The cumulative incidence of psychiatric morbidity was higher among the JIA patients than the controls, hazard ratio 1.70 (95% Cl 1.57 to 1.74), p < 0.001. Phobic, anxiety, obsessive-compulsive, stress-related and somatoform disorders (F40–48) and mood (affective) disorders (F30–39) were the most common psychiatric diagnoses in both the JIA patients (10.4 and 8.2%) and the control group (5.4 and 5.1%), respectively. Female patients were more prone to mental and behavioural disorders than males were, and the risk seemed to be higher in patients who developed JIA in early childhood or adolescence. Conclusions: Patients with JIA are diagnosed with mental and behavioural disorders more often than controls, and the age at onset of JIA could have implications for future mental health.

This video-based study examines the pragmatic non-verbal comprehension skills and corresponding neural-level findings in young Finnish autistic adults, and controls. Items from the Assessment Battery of Communication (ABaCo) were chosen to evaluate the comprehension of non-verbal communication. Inter-subject correlation (ISC) analysis of the functional magnetic resonance imaging data was used to reveal the synchrony of brain activation across participants during the viewing of pragmatically complex scenes of ABaCo videos. The results showed a significant difference between the ISC maps of the autistic and control groups in tasks involving the comprehension of non-verbal communication, thereby revealing several brain regions where correlation of brain activity was greater within the control group. The results suggest a possible weaker modulation of brain states in response to the pragmatic non-verbal communicative situations in autistic participants. Although there was no difference between the groups in behavioural responses to ABaCo items, there was more variability in the accuracy of the responses in the autistic group. Furthermore, mean answering and reaction times correlated with the severity of autistic traits. The results indicate that even if young autistic adults may have learned to use compensatory resources in their communicative-pragmatic comprehension, pragmatic processing in naturalistic situations still requires additional effort.

Abstrakti Aiemmissa tutkimuksissa on saatu ristiriitaisia tuloksia autismikirjon naisten ja miesten tavasta orientoitua sosiaalisiin tilanteisiin, tulkita niitä ja kertoa niistä. Tässä tutkimuksessa tarkastelimme, kuinka autismikirjon naiset (n = 7) ja miehet (n = 24) ja verrokkiryhmän naiset (n = 11) ja miehet (n = 24) kuvaavat sosiopragmaattisesti monimutkaisissa videoleikkeissä esiintyvien henkilöiden tunteita. Tarkastelimme tutkittavien vapaata kerrontaa keskittyen siihen, kuinka paljon tutkittavat tuottivat suoria ja epäsuoria tunnekuvauksia sekä missä määrin he taustoittivat tunnekuvauksiaan. Tutkimuksessa havaittiin verrokkiryhmän naisten ja autismikirjon naisten tuottavan enemmän epäsuoria tunnekuvauksia kuin autismikirjon miesten. Lisäksi autismikirjon miesten, mutta ei naisten, havaittiin taustoittavan tunnekuvauksiaan vähemmän kuin verrokkiryhmän naisten ja verrokkiryhmän miesten. Verrokkiryhmän naiset ja verrokkiryhmän miehet eivät eronneet toisistaan suorien tai epäsuorien tunnekuvausten määrässä tai tunnekuvausten taustoittamisessa. Tulokset kannustavat kiinnittämään huomiota sukupuolierojen tarkasteluun, jotta autismikirjon naisia ja autismikirjon miehiä voidaan sekä tunnistaa paremmin että tukea kohdennetummin.

This study examined social-pragmatic inferencing, visual social attention and physiological reactivity to complex social scenes. Participants were autistic young adults (n = 14) and a control group of young adults (n = 14) without intellectual disability. Results indicate between-group differences in social-pragmatic inferencing, moment-level social attention and heart rate variability (HRV) reactivity. A key finding suggests associations between increased moment-level social attention to facial emotion expressions, better social-pragmatic inferencing and greater HRV suppression in autistic young adults. Supporting previous research, better social-pragmatic inferencing was found associated with less autistic traits.

The northern provinces of Finland are mostly not densely populated, with long distances to healthcare services. This creates a challenge for how to reach all children and adolescents with mental health services. In order to assess the effectiveness of school-based mental health promotion interventions, it is essential to understand the views of school professionals on student well-being and mental health promotion activity in schools. This study was carried out in urban area comprehensive schools where psychiatric nurses delivered additional mental health promotion interventions. The data were collected using a questionnaire, and a mixed-methods approach was utilised in the analysis. School professionals perceived that students are more unwell than before; they exhibit a general disregard for their well-being and more mental health problems. The respondents regarded the promotion of students’ mental health as a basic function of schools. Teachers need adequate support with this work.