Very Low Birth Weight Infants as Young Adults : Focus on aspects of cognition, behavior and sleep

Major advances in the treatment of preterm infants have occurred during the last three decades. Survival rates have increased, and the first generations of preterm infants born at very low birth weight (VLBW; less than 1500 g) who profited from modern neonatal intensive care are now in young adulthood. The literature shows that VLBW children achieve on average lower scores on cognitive tests, even after exclusion of individuals with obvious neurosensory deficits. Evidence also exists for an increased risk in VLBW children for various neuropsychiatric disorders such as attention-deficit hyperactivity disorder (ADHD) and related behavioral symptoms. Up till now, studies extending into adulthood are sparse, and it remains to be seen whether these problems persist into adulthood. The aim of this thesis was to study ADHD-related symptoms and cognitive and executive functioning in young adults born at VLBW. In addition, we aimed to study sleep disturbances, known to adversely affect both cognition and attention. We hypothesized that preterm birth at VLBW interferes with early brain development in a way that alters the neuropsychological phenotype; this may manifest itself as ADHD symptoms and impaired cognitive abilities in young adulthood. In this cohort study from a geographically defined region, we studied 166 VLBW adults and 172 term-born controls born from 1978 through 1985. At ages 18 to 27 years, the study participants took part in a clinic study during which their physical and psychological health was assessed in detail. Three years later, 213 of these individuals participated in a follow-up. The current study is part of a larger research project (The Helsinki Study of Very Low Birth Weight Adults), and the measurements of interest for this particular study include the following: 1) The Adult Problem Questionnaire (APQ), a self-rating scale of ADHD-related symptoms in adults; 2) A computerized cognitive test battery designed for population studies (CogState®) which measures core cognitive abilities such as reaction time, working memory, and visual learning; 3) Sleep assessment by actigraphy, the Basic Nordic Sleep Questionnaire, and the Morningness-Eveningness Questionnaire. Actigraphs are wrist-worn accelerometers that separate sleep from wakefulness by registering body movements. Contrary to expectations, VLBW adults as a group reported no more ADHD-related behavioral symptoms than did controls. Further subdivision of the VLBW group into SGA (small for gestational age) and AGA (appropriate for gestational age) subgroups, however, revealed more symptoms on ADHD subscales pertaining to executive dysfunction and emotional instability among those born SGA. Thus, it seems that intrauterine growth retardation (for which SGA served as a proxy) is a more essential predictor for self-perceived ADHD symptoms in adulthood than is VLBW birth as such. In line with observations from other cohorts, the VLBW adults reported less risk-taking behavior in terms of substance use (alcohol, smoking, and recreational drugs), a finding reassuring for the VLBW individuals and their families. On the cognitive test, VLBW adults free from neurosensory deficits had longer reaction times than did term-born peers on all tasks included in the test battery, and lower accuracy on the learning task, with no discernible effect of SGA status over and above the effect of VLBW. Altogether, on a group level, even high-functioning VLBW adults show subtle deficits in psychomotor processing speed, visual working memory, and learning abilities. The sleep studies provided no evidence for differences in sleep quality or duration between the two groups. The VLBW adults were, however, at more than two-fold higher risk for sleep-disordered breathing (in terms of chronic snoring). Given the link between sleep-disordered breathing and health sequelae, these results suggest that VLBW individuals may benefit from an increased awareness among clinicians of this potential problem area. An unexpected finding from the sleep studies was the suggestion of an advanced sleep phase: The VLBW adults went to bed earlier according to the actigraphy registrations and also reported earlier wake-up times on the questionnaire. In further study of this issue in conjunction with the follow-up three years later, the VLBW group reported higher levels of morningness propensity, further corroborating the preliminary findings of an advanced sleep phase. Although the clinical implications are not entirely clear, the issue may be worth further study, since circadian rhythms are closely related to health and well-being. In sum, we believe that increased understanding of long-term outcomes after VLBW, and identification of areas and subgroups that are particularly vulnerable, will allow earlier recognition of potential problems and ultimately lead to improved prevention strategies.

Turning the Kaleidoscope - (E)FL Educational Experience and Inquiry as Auto/biography

This book is a study on learning, teaching/counselling, and research on the two. My quest has been to find a pedagogically-motivated way of researching learning and teaching interaction, and in particular counselling, in an autonomous language-learning environment. I have tried to develop a method that would make room for lived experience, meaning-making and narrating, because in my view these all characterise learning encounters between language learners and counsellors, and learners and their peers. Lived experience as a source of meaning, telling and co-telling becomes especially significant when we try to listen to the diverse personal and academic voices of the past as expressed in autobiographical narratives. I have aimed at researching various ALMS dialogues (Autonomous Learning Modules, University of Helsinki Language Centre English course and programme), and autobiographical narratives within them, in a way that shows respect for the participants, and that is relevant, reflective and, most importantly, self-reflexive. My interest has been in autobiographical telling in (E)FL [(English as a) foreign language], both in students first-person written texts on their language- learning histories and in the sharing of stories between learners and a counsellor. I have turned to narrative inquiry in my quest and have written the thesis as an experiential narrative. In particular, I have studied learners and counsellors in one and the same story, as characters in one narrative, in an attempt to avoid the impression that I am telling yet another separate, anecdotal story, retrospectively. Through narrative, I have shed light on the subjective dimensions of language learning and experience, and have come closer to understanding the emotional aspects of learning encounters. I have questioned and rejected a distanced and objective approach to describing learning and teaching/counselling. I have argued for a holistic and experiential approach to (E)FL encounters in which there is a need to see emotion and cognition as intertwined, and thus to appreciate learners and counsellors emotionally-charged experiences as integral to their identities. I have also argued for a way of describing such encounters as they are situated in history, time, autobiography, and the learning context. I have turned my gaze on various constellations of lived experience: the data was collected on various occasions and in various settings during one course and consists of videotaped group sessions, individual counselling sessions between students and their group counsellor, biographic narrative interviews with myself, open-ended personally-inspired reflection texts written by the students about their language-learning histories, and student logs and diaries. I do not consider data collection an unproblematic occasion, or innocent practice, and I defend the integrity of the research process. Research writing cannot be separated from narrative field work and analysing and interpreting the data. The foci in my work have turned to be the following: 1) describing ALMS encounters and specifying their narrative aspects; 2) reconceptualising learner and teacher autonomy in ALMS and in (E)FL; 2) developing (E)FL methodologically through a teacher-researcher s identity work; 4) research writing as a dialogical narrative process, and the thesis as an experiential narrative. Identity and writing as inquiry, and the deeply narrative and autobiographical nature of the (E)FL teaching/counselling/researching have come to the fore in this research. Research writing as a relational activity and its implications for situated ways of knowing and knowledge turned out to be important foci. I have also focussed on the context-bound and local teacher knowledge and ways of knowing about being a teacher, and I have argued for personal ways of knowing about, and learning and studying foreign languages. I discuss research as auto/biography: as a practising counsellor I use my own life and (E)FL experience to understand and interpret the stories of the research participants even though I was not involved in their course work. The supposedly static binaries of learner/teacher, and also learner autonomy/teacher autonomy, are thus brought into the discussion. I have highlighted the infinite variability and ever-changing nature of learning and teaching English, but the book is also of relevance to foreign language education in general.

Exploring the experiences and conceptions of good teaching in higher education : Development of a questionnaire for assessing students' approaches to learning and experiences of the teaching-learning environment

The aim of this dissertation was to adapt a questionnaire for assessing students’ approaches to learning and their experiences of the teaching-learning environment. The aim was to explore the validity of the modified Experiences of Teaching and Learning Questionnaire (ETLQ) by examining how the instruments measure the underlying dimensions of student experiences and their learning. The focus was on the relation between students’ experiences of their teaching-learning environment and their approaches to learning. Moreover, the relation between students’ experiences and students’ and teachers’ conceptions of good teaching was examined. In Study I the focus was on the use of the ETLQ in two different contexts: Finnish and British. The study aimed to explore the similarities and differences between the factor structures that emerged from both data sets. The results showed that the factor structures concerning students’ experiences of their teaching-learning environment and their approaches to learning were highly similar in the two contexts. Study I also examined how students’ experiences of the teaching-learning environment are related to their approaches to learning in the two contexts. The results showed that students’ positive experiences of their teaching-learning environment were positively related to their deep approach to learning and negatively to the surface approach to learning in both the Finnish and British data sets. This result was replicated in Study II, which examined the relation between approaches to learning and experiences of the teaching-learning environment on a group level. Furthermore, Study II aimed to explore students’ approaches to learning and their experiences of the teaching-learning environment in different disciplines. The results showed that the deep approach to learning was more common in the soft sciences than in the hard sciences. In Study III, students’ conceptions of good teaching were explored by using qualitative methods, more precisely, by open-ended questions. The aim was to examine students’ conceptions, disciplinary differences and their relation to students’ approaches to learning. The focus was on three disciplines, which differed in terms of students’ experiences of their teaching-learning environment. The results showed that students’ conceptions of good teaching were in line with the theory of good teaching and there were disciplinary differences in their conceptions. Study IV examined university teachers’ conceptions of good teaching, which corresponded to the learning-focused approach to teaching. Furthermore, another aim in this doctoral dissertation was to compare the students’ and teachers’ conceptions of good teaching, the results of which showed that these conceptions appear to have similarities. The four studies indicated that the ETLQ appears to be a sufficiently robust measurement instrument in different contexts. Moreover, its strength is its ability to be at the same time a valid research instrument and a practical tool for enhancing the quality of students’ learning. In addition, the four studies emphasise that in order to enhance teaching and learning in higher education, various perspectives have to be taken into account. This study sheds light on the interaction between students’ approaches to learning, their conceptions of good teaching, their experiences of the teaching-learning environment, and finally, the disciplinary culture.

Beatific Enjoyment in Scholastic Philosophy and Theology: 1240-1335

This dissertation examines the concept of beatific enjoyment (fruitio beatifica) in scholastic theology and philosophy in the thirteenth and early fourteenth century. The aim of the study is to explain what is enjoyment and to show why scholastic thinkers were interested in discussing it. The dissertation consists of five chapters. The first chapter deals with Aurelius Augustine's distinction between enjoyment and use and the place of enjoyment in the framework of Augustine's view of the passions and the human will. The first chapter also focuses upon the importance of Peter Lombard's Sentences for the transmission of Augustine's treatment of enjoyment in scholastic thought as well as upon Lombard's understanding of enjoyment. The second chapter treats thirteenth-century conceptions of the object and psychology of enjoyment. Material for this chapter is provided by the writings - mostly Sentences commentaries - of Alexander of Hales, Albert the Great, Bonaventure, Thomas Aquinas, Peter of Tarentaise, Robert Kilwardby, William de la Mare, Giles of Rome, and Richard of Middleton. The third chapter inspects early fourteenth-century views of the object and psychology of enjoyment. The fourth chapter focuses upon discussions of the enjoyment of the Holy Trinity. The fifth chapter discusses the contingency of beatific enjoyment. The main writers studied in the third, fourth and fifth chapters are John Duns Scotus, Peter Aureoli, Durandus of Saint Pourçain, William of Ockham, Walter Chatton, Robert Holcot, and Adam Wodeham. Historians of medieval intellectual history have emphasized the significance of the concept of beatific enjoyment for understanding the character and aims of scholastic theology and philosophy. The concept of beatific enjoyment was developed by Augustine on the basis of the insight that only God can satisfy our heart's desire. The possibility of satisfying this desire requires a right ordering of the human mind and a detachment of the will from the relative goals of earthly existence. Augustine placed this insight at the very foundation of the notion of Christian learning and education in his treatise On Christian Doctrine. Following Augustine, the twelfth-century scholastic theologian Peter Lombard made the concept of enjoyment the first topic in his plan of systematic theology. The official inclusion of Lombard's Sentences in the curriculum of theological studies in the early universities stimulated vigorous discussions of enjoyment. Enjoyment was understood as a volition and was analyzed in relation to cognition and other psychic features such as rest and pleasure. This study shows that early fourteenth-century authors deepened the analysis of enjoyment by concentrating upon the relationship between enjoyment and mental pleasure, the relationship between cognition and volition, and the relationship between the will and the beatific object (i.e., the Holy Trinity). The study also demonstrates the way in which the idea of enjoyment was affected by changes in the method of theological analysis - the application of Aristotelian logic in a Trinitarian context and the shift from virtue ethics to normative ethics.

University Students' Approaches to Learning, Self-Regulation, and Cognitive and Attributional Strategies : Connections with Well-Being and Academic Success

This dissertation empirically explores the relations among three theoretical perspectives: university students approaches to learning, self-regulated learning, as well as cognitive and attributional strategies. The relations were quantitatively studied from both variable- and person-centered perspectives. In addition, the meaning that students gave to their disciplinary choices was examined. The general research questions of the study were: 1) What kinds of relationships exist among approaches to learning, regulation of learning, and cognitive and attributional strategies? What kinds of cognitive-motivational profiles can be identified among university students, and how are such profiles related to study success and well-being? 3) How do university students explain their disciplinary choices? Four empirical studies addressed these questions. Studies I, II, and III were quantitative, applying self-report questionnaires, and Study IV was qualitative in nature. Study I explored relations among cognitive strategies, approaches to learning, regulation of learning, and study success by using correlations and a K-means cluster analysis. The participants were 366 students from various faculties at different phases of their studies. The results showed that all the measured constructs were logically related to each other in both variable- and person-centered approaches. Study II further examined what kinds of cognitive-motivational profiles could be identified among first-year university students (n=436) in arts, law, and agriculture and forestry. Differences in terms of study success, exhaustion, and stress among students with differing profiles were also looked at. By using a latent class cluster analysis (LCCA), three groups of students were identified: non-academic (34%), self-directed (35%), and helpless students (31%). Helpless students reported the highest levels of stress and exhaustion. Self-directed students received the highest grades. In Study III, cognitive-motivational profiles were identified among novice teacher students (n=213) using LCCA. Well-being, epistemological beliefs, and study success were looked at in relation to the profiles. Three groups of students were found: non-regulating (50%), self-directed (35%), and non-reflective (22%). Self-directed students again received the best grades. Non-regulating students reported the highest levels of stress and exhaustion, the lowest level of interest, and showed the strongest preference for certain and practical knowledge. Study IV, which was qualitative in nature, explored how first-year students (n = 536 ) in three fields of studies, arts, law, and veterinary medicine explained their disciplinary choices. Content analyses showed that interest appeared to be a common concept in students description of their choices across the three faculties. However, the objects of interest of the freshmen appeared rather unspecified. Veterinary medicine and law students most often referred to future work or a profession, whereas only one-fifth of the arts students did so. The dissertation showed that combining different theoretical perspectives and methodologies enabled us to build a rich picture of university students cognitive and motivational predispositions towards studying and learning. Further, cognitive-emotional aspects played a significant role in studying, not only in relation to study success, but also in terms of well-being. Keywords: approaches to learning, self-regulation, cognitive and attributional strategies, university students