Origins of common fears in South African children

The present study examined the origins of common childhood fears within a South African context. Six-hundred-and-fifty-five 10- to 14-year-old children were given a brief fear list that helped them to identify their most intense fear and then completed a brief questionnaire for assessing the origins of fears that was based on Rachman's [Rachman, S. (1977). The conditioning theory of fear acquisition: A critical examination. Behaviour Research and Therapy, 15, 375-387; Rachman, S. (1991). Neoconditioning and the classical theory of fear acquisition. Clinical Psychology Review, 17, 47-67] three-pathways theory. More precisely, children were asked to report whether they had experienced conditioning, modeling, and negative information experiences in relation to their most feared stimulus or situation, and also had to indicate to what extent such experiences had actually played a role in the onset and/or intensification of their fears. Results showed that children most frequently reported indirect learning experiences (i.e., modeling and negative information) in relation to their fears, whereas conditioning was clearly less often mentioned. The majority of the children had no precise idea of how their fear had actually begun, but a substantial proportion of them reported various learning experiences in relation to the onset and intensification of fears. Significant cultural differences were not only observed in the prevalence of common fears, but also in the pathways reported for the origins of fears. The results are briefly discussed in terms of the living conditions of South African children from various cultural backgrounds.     

DSM-IV-defined anxiety disorder symptoms in South African children

OBJECTIVE: To examine -defined anxiety disorder symptoms in a large sample of normal South African schoolchildren. METHOD: Children completed two self-report questionnaires: the Spence Children's Anxiety Scale (SCAS) and the 41-item version of the Screen for Child Anxiety Related Emotional Disorders (SCARED). RESULTS: Psychometric properties of the SCAS and the SCARED were moderate (convergent validity) to sufficient (reliability). Factor analyses yielded evidence for the presence of a number of hypothesized anxiety categories (i.e., social phobia, panic disorder, fears, and generalized anxiety disorder). Furthermore, anxiety levels of South African children were higher than those of Western (i.e., Dutch) children. Differences were found with regard to the content of prevalent anxiety symptoms among South African and Western children. CONCLUSION: Although psychometric properties of the SCAS and the SCARED in South African children somewhat deviated from those obtained in Western countries, both scales seem to be useful for assessing childhood anxiety symptoms in this country.     

Moment-to-moment dynamics of ADHD behaviour in South African children

Background  

The behaviour of children with Attention-Deficit/Hyperactivity Disorder is characterized by low predictability of responding. Low behavioural predictability is one way of operationalizing intra-individual ADHD-related variability. ADHD-related variability may be caused by inefficient behavioural selection mechanisms linked to reinforcement and extinction, as suggested by the recently published dynamic developmental theory (DDT) of ADHD. DDT argues that ADHD is a basic neurobehavioural disorder, caused by dysfunctioning dopamine systems. For establishing ADHD as a neurobehavioural disorder, findings from studies conducted in Western countries should be replicated in other cultural populations. The present study replicated the study conducted in Norway, with children from the Limpopo province in the Republic of South Africa.     

Hydatid disease of the spine in South African children

We present three patients with neurologic complications of the spine from hydatid disease. The first was a 6-year-old girl with lower limb paralysis evolving over 2 weeks. Neuroimaging revealed a cystic mass compressing the spinal cord at the level of T8 and extending from the vertebral body. She underwent surgical decompression. Histopathologic examination confirmed hydatid disease. At 6-month follow-up, functional improvement had occurred with full ambulation. She continues on long-term albendazole therapy. Two other patients are described, one with primary spinal disease and the other with cerebral disease and secondary seeding to the spine. Spinal hydatid disease is a rarity, even more so in children. Although secondary disease, primarily affecting bone, carries a poorer long-term outlook, the first patient made a dramatic recovery and has raised therapeutic dilemmas as to the total duration of continuing albendazole therapy. The literature documents some 37 reports, mostly in adults. Considering the frequency of hydatid disease in South Africa, the incidence in our population could be under-recorded. Unless the clinician includes spinal hydatid disease, in endemic areas, as part of the differential list for paralysis and considers performing neuroimaging, this potentially treatable diagnosis will be missed.     

Applicability of the temperament construct to black South African children

Evidence is cited for the relevance of temperament to the scholastic achievement of black South African children, who are severely disadvantaged. While highlighting cultural differences in the meaning of certain behavior assessed by the Teacher Temperament Questionnaire, the results generally provide support for the universality of the temperament construct.     

Factors associated with readmission in South African adolescents discharged from two inpatient psychosocial rehabilitation units

Objective: This study aimed to describe the socio-demographic and clinical factors associated with readmission in an adolescent population discharged from two inpatient psychosocial rehabilitation (PSR) units in Cape Town, South Africa.

Method: Data were obtained from 97 consecutive patients discharged from two adolescent psychiatric PSR units over a period of one year. Patients were followed up for readmission to hospitals offering specialised psychiatric care in the Western Cape Province over a period of 18 months.

Results: 35 patients (36%) were readmitted during the study period. Multivariable analysis showed that previous admission increased readmission rate (Incidence Rate Ratio (IRR): 8.01, p < 0.001). Adolescents who were still schooling (IRR: 0.29, p < 0.001) or had a higher level of education (IRR: 0.45, p = 0.001) were less likely to be readmitted. No association was seen with type of diagnosis and readmission, although 51 adolescents (53%) were diagnosed on the schizophrenia spectrum of disorders.

Conclusion: Study findings highlight the need for increased collaboration between the Departments of Health and Education. Furthermore, the study illustrates the need for specific post-discharge community follow-up for adolescents. Prospective research in this particular population group is needed to contribute to the literature on factors associated with readmission in South African adolescent patients.     

Chondrodystrophic myotonia (Schwartz-Jampel syndrome) in South African children

Three children with the clinical features of the Schwartz-Jampel syndrome are presented, two with classical features and the third with physical and radiological features resembling those found in the Schwartz-Jampel syndrome but myotonia could not be elicited either clinically or electrophysiologically. Various arguments are put forward for the absence of myotonic phenomena in the latter child.     

Social competence of children and adolescents with epilepsy.

BACKGROUND: This study compared children and adolescents with epilepsy with their healthy peers on measures of social competence. METHODS: Children and adolescents with epilepsy (70 subjects aged 11-18 years; 47.1% girls) and their healthy peers in control group (95 subjects aged 11-18 years; 50.9% girls) were compared on measures of social competence from the Child Competence Checklist (part of Child Behavior Check List). The questionnaires were completed by the parents. All participants were of normal intelligence. RESULTS: The difference of means of total T scores for subscales of sociabilitiy and activities in the epilepsy group and in the control group were statistically significant (p<0.05). The results showed that 5.7% of children and adolescents with epilepsy were in the clinical range compared to 2.1% of subjects in control group. The girls with epilepsy demonstrated greater problems with social competence (45.8+/-8.27) than boys with epilepsy (48.1+/-8.27) and this difference was statistically significant (p<0.05). Multiple analysis of variance of T scores for social competence subscales related to neurobiological variables in the group of participants with epilepsy demonstrated a statistically significant association of reduced sociability with multiple generalized seizure types (F=4,405; d.f.=2; p<0.05). CONCLUSIONS: The study clearly shows that epilepsy is a limiting factor for social competence of children and adolescents.     

Correlates of social competence in retarded children.

The relationship of role-taking and referential-communication skills with social competence was assessed in 32 retarded children (mean IQ = 56.4; mean CA = 13 years, 7 months). Significant associations were found between two types of teacher measures of children's social competence, between measures made by teachers and children themselves, and among scores of social competence and the skills of role-taking and referential communication. The findings suggest ways of assessing social adaptation more directly, which may be extended into specific interventions.     

Personality factors and bronchial asthma: A study of South African Indian children

A group of South African Indian children (Asthmatics, Normals and Stammerers) were investigated by means of personality and intelligence tests, interviews and case-history records. The first aim of the study was to test the hypothesis that there is a unique personality type associated with bronchial asthma. The second aim was to evaluate the effectiveness of this particular type of research design, and the implications it might have for the understanding of bronchial asthma. (1) No evidence for a specific personality type peculiar to asthma emerged from the results, although symptoms of maladjustment and dependency traits were prominent attributes of the asthmatics and stammerers. (2) It is argued that the methodological limitations of the techniques used in this type of experimental design, are too great, and that the clinical implications are too few—to make the approach worthwhile.     

Evaluation of a school-based intervention programme for South African children of divorce

Objective: Parental divorce affects approximately 30 000 South African children annually. This pilot study aimed to evaluate the effectiveness of the Children of Divorce Intervention Programme (CODIP) at two South African schools. CODIP is a preventively oriented group programme which was developed to foster resilience by helping children cope more effectively with possible academic, behavioural, and emotional problems brought about by their parents’ divorce.

Method: Twenty-five 10- to 14-year-old boys from two primary schools were randomly assigned to 2 experimental groups and 1 delayed intervention control group. The experimental groups attended 12 one-hour weekly sessions; the control group received no intervention until after the study was completed. Children's understanding of divorce related events and social, emotional and behavioural adjustment was assessed one week before the intervention and three months thereafter using a battery of self-rated, teacher-rated and parent-rated questionnaires.

Results: One-way ANOVAs indicated no statistically significant decline in children's self-reported problematic beliefs about divorce or total difficulties. However, teachers’ and parents’ ratings indicated that compared to the control group, the combined experimental groups showed significant improvement in their general behavioural, emotional and social adjustment after programme participation.

Conclusions: The results suggest that South African children who experience parental divorce may benefit from participation in CODIP.     

Mental and physical health of out of school children in a South African township

BACKGROUND: Poor school attendance has negative consequences for the individual and society. We investigated physical and mental health correlates of school attendance amongst black children in Cape Town, South Africa. METHODS: We undertook a cross-sectional community study of children, aged 6-16 years, living in Khayelitsha township. Multistage sampling produced a sample of 499 children. They, and/or their parents, were interviewed using a Xhosa translation of the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3). Prevalence of mental and physical health problems of school attenders were compared with those of non-attenders. RESULTS: 23.6 % of children were not attending school. Young children from unserviced areas were at particular risk. Male school attenders suffered higher levels of chronic illness than non-attenders. No differences in the prevalences of psychiatric disorders were found. CONCLUSIONS: There is no significant excess of physical or mental health problems in out of school children. Poverty plays an important role in failure to attend school.     

Exposure to violence, coping resources, and psychological adjustment of South African children

The effects of exposure to direct and vicarious political, family, and community violence on the adjustment of 625 six-year-old black South African children was examined. Ambient community violence was most consistently related to children's psychosocial outcomes. Resources in the form of individual child resilience, maternal coping, and positive family relationships were found to mitigate the adverse impact in all the assessed domains of children's functioning.     

Health actions and health promotion among a sample of rural Black South African children

The purpose of this study was to investigate the daily activities that young South African children perceived as health related activities. The sample included 117 children (33, ages 5–7 years; 44, ages 8–10 years; and 40, ages 11–12 years) chosen by two-stage cluster sampling in a rural community of the central region of the Northern Province. Results indicated that the most important health actions around healthy eating were, 'washing hands'; around dressing, 'wearing warm clothes'; around keeping clean, 'washing body and hair'; going to sleep, 'washing body'; activity at school, 'read and write'; recess and leisure time, 'playing football or netball'. Personal hygiene (washing, brushing teeth, etc.) was the most common health action of the children around healthy eating, keeping clean and going to sleep. Some health actions were insufficiently mentioned, brushing teeth for example and some wrongly mentioned such as eating porridge before going to sleep. This study showed that children have insufficient knowledge and understanding about health related activities. Results suggest that health professionals and teachers should consider providing more information about health related activities for young children.     

Perceived social skills and social competence in maltreated children.

The relative effects of child maltreatment, perceived social support, and other risk factors on measures of peer relations were assessed at two points in time. Maltreatment was not found to be related to children's self-reports of social skills or social acceptance, but mothers of maltreated children rated their children as significantly less competent than did mothers of nonmaltreated children. Lower perceived support from peers consistently predicted poorer peer relationships on all measures of peer relations.     

Self-perceived interpersonal competence in older schizophrenia patients: the role of patient characteristics and psychosocial factors.

OBJECTIVE: This study compared older schizophrenia patients with normal subjects in terms of their perceived interpersonal competence. METHOD: A total of 95 middle-aged and elderly schizophrenia patients and 85 age-matched normal subjects completed the Interpersonal Competence Questionnaire. RESULTS: Patients scored significantly lower than normal subjects on initiation, provision of emotional support, and conflict management. Severity of psychiatric symptoms and other patient characteristics were examined as predictors of interpersonal competence among patients. Negative symptoms were inversely related to interpersonal competence, whereas emotional support from others and a positive appraisal coping style both yielded positive associations. CONCLUSION: These findings suggest the need for clinical interventions designed to enhance the interpersonal skills of older schizophrenia patients, particularly those with marked negative symptoms.     

Management of ADHD in children and adolescents: clinical audit in a South African setting

Objectives: Attention deficit hyperactivity disorder (ADHD) is common, yet under-recognised and undertreated, particularly in low socio-economic settings. Little is known about compliance to evidence- based guidelines in low- and middle-income countries, and no clinical audits have been published in Africa. We undertook to measure compliance in a South African setting using the National Institute for Clinical Excellence (NICE) guidelines for ADHD as the gold standard to compare compliance and socio-demographic characteristics between two treatment locations in Cape Town and to generate an audit checklist for standardising care.

Methods: The study used a sample of 100 randomly selected cases of school-age patients diagnosed with ADHD, at the Division of Child & Adolescent Psychiatry, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa. Fifty cases each from a central and a peripheral clinic location were reviewed retrospectively using audit tools, including 17 audit standards derived from NICE guidelines. We defined compliance as “good” with ≥80%, “fair” with 50–79%, and “poor” with <50% adherence.

Results: Compliance was low, with only four audit standards rated as “good”. Physical monitoring was especially poor. The central group received more treatment options and relatively safer monitoring.

Conclusions: We recommend introducing structured protocols followed by re-auditing to improve service delivery, and present a checklist for use in future audit cycles.