4 Steps To My Future (4STMF): protocol for a universal school-based pilot and feasibility study of a CBT-based psychoeducational intervention to support psychological well-being amongst young adolescents in the Western Cape, South Africa.

BACKGROUND: Mental health problems often emerge during middle childhood and adolescence. In South Africa, and in the context of high rates of poverty, violence, and adversity, many children are at a considerable risk for developing mental health problems. Access to and costs of mental health services preclude treatment for most. There is evidence that universal school-based prevention programmes are effective in well-resourced settings. However, little is known about the feasibility and acceptability of such programmes in low- and middle-income countries (LMICs), including South Africa. METHODS: This is a feasibility pilot study of 4 Steps To My Future (4STMF), a Cognitive Behaviour Therapy (CBT) school-based programme for young adolescents in the Western Cape, South Africa. This eight-session intervention will be delivered to children in grade 5 (aged 10-13 years approximately) attending two public government-run schools in the Western Cape, South Africa. We aim to enrol approximately 224 children in grade 5. We will randomise which school receives the intervention first and the other will be a delayed intervention group. We will train individuals with a post-graduate degree in psychology to facilitate the programme. We will collect demographic data on participants as well as data on primary (feasibility measures) and secondary outcomes (mental health and well-being measures). We will collect data at baseline, post-intervention, and at 1-month follow-up. DISCUSSION: This pilot study will provide data on the acceptability and feasibility of delivering a universal school-based prevention programme in South African schools. The study will provide preliminary data to inform the design of a full-scale randomised controlled trial (RCT) of a universal school-based mental health programme aimed at preventing mental health problems. TRIAL REGISTRATION: This trial is registered with the Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=10881 ) database, with unique identification number for the registry: PACTR202004803366609. Registered on 24 April 2020.

Cross-cultural adaptation of an anxiety measure in a disadvantaged South African community context: Methodological processes and findings.

An important challenge to enhancing community access to mental health interventions in marginalised, transcultural settings is the development of culturally relevant screening measures. Cross-cultural adaptation (CCA) and translation methods offer guidelines for the adaption of existing screening measures for use across cultures with the aim of preserving semantic and construct equivalence as well as validity. Yet, the application of CCA methods has been inconsistent and validation strategies have focused predominantly on expert review and quantitative validity testing. Additionally, potentially important context-specific interpretations of measure items have been lost in translation-heavy approaches. The missing link in the CCA of existing measures may be the addition of culturally sensitive, community-based evaluative methods. This paper presents a report of the application of a seven-step CCA method developed by the first author to address the issue of cultural relevance in the translation and cross-cultural adaptation of the Spence Child Anxiety Scale (SCAS) an anxiety measure for use in a specific South African community context. The findings emphasise the surprising context-specific interpretations of items in measures applied transculturally, which support the case for qualitative, community-based validation of translated, CCA screening measures used to explore the effectiveness of mental health interventions across cultural contexts.

Cognitive behaviour therapy-based early intervention and prevention programme for anxiety in South African children with visual impairments.

BACKGROUND: Anxiety is the most common psychological difficulty reported by youth worldwide and may also be a significant problem for children with visual impairments. Cognitive behaviour therapy (CBT) interventions have proven to be successful in treating childhood anxiety; however, mostly these are not suitable for children with visual impairments, as the materials used are not sufficiently accessible to this population. OBJECTIVES: The present study was motivated by the dearth of research on this topic and aimed to examine the effects of a specifically tailored, group-based, universally delivered, CBT intervention for anxiety in children with visual impairments and to examine the influence of three predictor variables (i.e. age, gender and level of visual impairment) on prevention effects. METHOD: A randomised wait-list control group design with pre-, post- and follow-up intervention measures was employed. The final sample of 52 children (aged 9-14) with varying degrees of visual impairment received the anxiety intervention. Participants were followed over a course of 10 months during which their anxiety symptoms were assessed quantitatively at four time points (T1-T4). RESULTS: The results indicated that the anxiety intervention did not significantly decrease symptoms of anxiety within the intervention groups. However, the intervention appeared beneficial for girls, younger children and legally blind participants. CONCLUSION: This study demonstrated how CBT interventions can be adapted for use in children with visual impairments. Results obtained provide a foundation upon which future updated anxiety intervention programmes can be built, meeting the need for further research in this area.

Students' self-reported fears and the perceived origins thereof.

The objective of this study was to explore the five most frequently reported fears in a sample of university students, and investigate the origins of these fears. The study employed a cross-sectional design with convenience sampling. Data were collected using a self-report questionnaire and analysed using a combination of descriptive statistics and content analysis. Participants consisted of 544 first-year psychology students. This study identified academic failure, animals, general failure, losing loved ones to death, and violence/crime as the top five fears among a sample of university students. 'Conditioning experiences' was one of the most prominent pathways in the acquisition of all these fears. 'Negative information transmission' was also a dominant pathway relating to the origin of fear such as academic failure and violence/crime. However, 'modelling experiences' was not identified as a prominent pathway in the present study. These findings contribute to identifying the origins of first-year students' self-reported fears by using the three pathways theory. These findings may contribute meaningfully to the development and implementation of prevention and intervention programmes at higher education institutions.

Research Protocol: Development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments.

BACKGROUND: Childhood anxiety presents a serious mental health problem, and it is one of the most common forms of psychological distress reported by youth worldwide. The prevalence of anxiety symptoms amongst South African youth is reported to be significantly higher than in other parts of the world. These high prevalence rates become even more significant when viewed in terms of children with visual impairments, as it is suggested that children with physical disabilities may be more prone, than their non-disabled peers, for the development of psychological difficulties. OBJECTIVES: The main aim of this study is to develop, implement and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments. METHOD: A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9-13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a randomised wait-list control group design with pre- post- and follow-up intervention measures, with two groups each receiving a 10 session anxiety intervention programme. The main outcome measure relates to the participants' symptoms of anxiety as indicated on the Revised Child Anxiety and Depression Scale. CONCLUSION: If the anxiety intervention programme is found to be effective in reducing symptoms of anxiety, this universal intervention will lay down the foundation upon which future contextually sensitive (South African) anxiety intervention programmes can be built.

Research protocol: development, implementation and evaluation of a cognitive behavioural therapy-based intervention programme for the management of anxiety symptoms in South African children with visual impairments

Background: Childhood anxiety presents a serious mental health problem, and it is one of the most common forms of psychological distress reported by youth worldwide. The prevalence of anxiety symptoms amongst South African youth is reported to be significantly higher than in other parts of the world. These high prevalence rates become even more significant when viewed in terms of children with visual impairments, as it is suggested that children with physical disabilities may be more prone, than their non-disabled peers, for the development of psychological difficulties. Objectives: The main aim of this study is to develop, implement and evaluate a specifically tailored anxiety intervention programme for use with South African children with visual impairments. Method: A specifically tailored cognitive-behavioural therapy-based anxiety intervention, for 9-13 year old South African children with visual impairments, will be evaluated in two special schools. The study will employ a randomised wait-list control group design with pre- postand follow-up intervention measures, with two groups each receiving a 10 session anxiety intervention programme. The main outcome measure relates to the participants' symptoms of anxiety as indicated on the Revised Child Anxiety and Depression Scale. Conclusion: If the anxiety intervention programme is found to be effective in reducing symptoms of anxiety, this universal intervention will lay down the foundation upon which future contextually sensitive (South African) anxiety intervention programmes can be built

Construction and validation of the South African version of the Fear Survey Schedule for Children: an exploratory factor analysis.

The Fear Survey Schedule for Children-Revised (Ollendick, 1983) is an 80-item self-report instrument that has been used internationally to asses the number of fears and general level of fearfulness among children. Despite its widespread use, this instrument has not been adapted to the South African context. The present study addressed this gap by means of a 2-phase investigation aimed at developing a South African version of the instrument. In Phase 1, semistructured interviews were conducted with 40 children (7 to 13 years of age). Qualitative data obtained from these interviews were used to construct additional items for inclusion in the South African Fear Survey Schedule for Children-Revised. The modified scale, consisting of 97 items, was then administered to a sample of 646 children between the ages of 7 and 13 years. Further psychometric considerations resulted in the final version of the scale consisting of 74 items with high internal consistency (α=.97). The factor structure was explored by means of principal component analysis with varimax rotation and a 5-factor solution was found to provide the best conceptual fit. The factors identified were as follows: Fear of Death and Danger; Fear of the Unknown; Fear of Small Animals and Minor Threats to Self; Large Animal Fears; and Situational Fears. Differences between the South African version and the original Fear Survey Schedule for Children-Revised are noted and implications for the study of fear in South Africa and other countries are discussed.

Fears of South African children affected by HIV/AIDS.

Although fears are part of normal development, the living environment of HIV/AIDS affected children is conducive to the development of particular fears. This study examined the fears of 39 South African children (7-13 years) living in a low socioeconomic community with a high prevalence of HIV/AIDS. The aim was to consider if these children were a special population with regard to their fears. The Free Option Method was used to identify the children's fears. Data were analyzed by means of a priori thematic analysis, followed by a qualitative analysis. The expressed fears could be described with fear categories previously reported by normative samples. The wild animal category and specifically snake fears were reported most. The second analysis revealed a substantial minority of fears reflecting life in the South African HIV/AIDS affected context. It was concluded that the children represented a normative population who experienced particular fears due to their special circumstances. Further investigation of HIV/AIDS affected children's fears and related psychological issues is recommended.

Young children's self-reports of coping with fears and perceived effectiveness of coping strategies in the South African context.

This descriptive study attempted to explore the coping strategies and perceived effectiveness of these strategies in response to self-reported fears among a sample of young South African children: 72 girls and 80 boys (mean age six years, two months, SD = 5.32 months, range; 5-7 years). Differences in children's coping strategies and the perceived effectiveness of these strategies with respect to socio-economic (SE) status were also assessed. Self-report data on coping strategies and the perceived effectiveness of these strategies were collected by means of individual semi-structured interviews in conjunction with children's drawings of feared objects. Social/spiritual support was perceived to be the most effective, and the most frequently utilized coping strategy in relation to self-reported fears by the children. Differences that were found with respect to young children's coping strategies in terms of SE background, points out the need for further research in this regard.

Monsters in the dark and other scary things: preschoolers' self-reports.

OBJECTIVE: This study attempted to obtain normative data regarding the content and frequency of expressed fears of a culturally diverse group of 152 South African preschool children (aged 5-7 years). METHOD: The study employed four measuring instruments: a biographical questionnaire, the Goodenough-Harris Drawing Test, and individual drawings of feared objects by participants in conjunction with semi-structured interviews. The data analysis included descriptive statistics based on the themes that emerged from the children's drawings and interviews. RESULTS: Fear of animals was the most commonly expressed fear. Other high-frequency fear categories that emerged were fear of the dark, night and bad dreams; fantasy people; real people; and physical harm. For the group as a whole, the results largely support the existing body of literature. Participants expressed between one and nine fears (f = 429; mean = 2.8). CONCLUSIONS: This study contributed to a better understanding of both an under-researched psychological phenomenon, fear, and of an under-researched target group of young children. This knowledge is important in order for significant others, such as parents and caregivers, to understand and effectively mediate potentially stressful experiences of young children in their respective capacities.

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.

Fears, coping and perceived efficacy of coping mechanisms among South African children living in children's homes.

BACKGROUND: The present study examined common childhood fears, coping strategies and perceived efficacy of coping mechanisms among 8- to 13-year-old South African children (n = 141) living in four children's homes. METHOD: Fears were assessed by means of the Fear List Method (FLM) and the Fear Survey Schedule for Children Revised (FSSC-R). For both measures, the content and number of fears were determined. The FSSC-R was also used to establish the levels of fearfulness, as well as the pattern of fears. Coping strategies and the perceived efficacy of these strategies were assessed by means of open-ended questions. RESULTS: The rank orders of fears as obtained with the FLM were quite different from those derived from the FSSC-R. Girls expressed more fears as well as higher levels of fears than boys. Secondary coping strategies (i.e. seeking social and/or spiritual support) were most often engaged in and were also perceived as most effective. CONCLUSIONS: A greater sensitivity to the emotional needs, especially with regard to fears, coping and perceived efficacy, of special populations is recommended.

Fears, coping and perceived efficacy of coping mechanisms among South African children living in childrens homes

Background: The present study examined common childhood fears, coping strategies and perceived efficacy of coping mechanisms among 8- to 13-year-old South African children (n = 141) living in four children's homes.Method: Fears were assessed by means of the Fear List Method (FLM) and the Fear Survey Schedule for Children Revised (FSSC-R). For both measures, the content and number of fears were determined. The FSSC-R was also used to establish the levels of fearfulness, as well as the pattern of fears. Coping strategies and the perceived efficacy of these strategies were assessed by means of open-ended questions.Results: The rank orders of fears as obtained with the FLM were quite different from those derived from the FSSC-R. Girls expressed more fears as well as higher levels of fears than boys. Secondary coping strategies (i.e. seeking social and/or spiritual support) were most often engaged in and were also perceived as most effective.Conclusions: A greater sensitivity to the emotional needs, especially with regard to fears, coping and perceived efficacy, of special populations is recommended

Screening of intellectual maturity: exploring South African preschoolers' scores on the Goodenough-Harris Drawing Test and teachers' assessment.

The present study explored the relationship between South African preschool children's intelligence scores achieved on the Goodenough-Harris Drawing Test (GHD), and the accuracy of teachers' ratings of the human-figure drawings and teachers' general perceptions of children's intellectual maturity. The GHD was administered individually to 30 boys and 30 girls between the ages of 4 and 6 years (M = 4.5. SD = 0.7) from a multicultural (Black, Colored, and White) preschool near the Cape, South Africa. The three class teachers of these preschoolers provided the ratings and perceptions of each child's intellectual maturity. Results indicated that the teachers' assessments of children's intellectual maturity were fairly similar to the formal measures of children's intellectual maturity using human figure drawings and their own perceptions. It appears that teacher ratings of drawings could be relied upon as a means of assessment. General perceptions of children's intellectual maturity should not be solely relied upon, but instead these perceptions should be used as an aid for enhancing the teachers' assessment of children's intellectual maturity in addition to the rating of human figure drawings.

DSM-defined anxiety disorders symptoms in South African youths: Their assessment and relationship with perceived parental rearing behaviors.

This study investigated DSM-defined anxiety symptoms in South African youths. Children and adolescents (N = 701) from various cultural groups completed the SCARED and a questionnaire measuring perceived parental rearing behaviors. Results indicated that the psychometric properties of the SCARED were satisfactory in the total sample of South African youths, and acceptable in colored and black children and adolescents. Further, colored and black youths displayed higher SCARED scores than white youths, and there were also differences in the perceived parental rearing behaviors of the cultural groups. White youths generally rated their parents' rearing behaviors as less anxious, overprotective, and rejective, but more emotionally warm than colored and black youths. Finally, positive correlations were found between anxious rearing, overprotection, and rejection and anxiety symptoms. The clinical and research implications of these findings are briefly discussed.

Correlations of scores on the developmental test of visual-motor integration and copying test in a South African multi-ethnic preschool sample.

This study assessed the intercorrelations of scores on the Developmental Test of Visual-Motor Integration, the locally standardized Copying Test, and teachers' ratings of scholastic skills in a South African multi-ethnic preschool sample. The study also investigated whether cultural and socioeconomic factors might influence test data. Participants were 71 Black, 101 Coloured, and 66 White children attending preschools in a semirural district. Participants' ages ranged from 4 yr., 9 mo. to 7yr., 0 mo. (M=5.8 yr., SD= 0.3 yr.). Analysis yielded a correlation of .75 between the test scores and supports the suitability of the widely used Developmental Test of Visual-Motor Integration in a multi-ethnic sample. Scores on the Copying Test correlated higher with teachers' ratings. However, significant differences in test performance among groups by race and socioeconomic status suggest the rate of perceptual-motor development may be related to cultural factors. Normative data are reported for groups by race and socioeconomic status.

Visual-motor integration functioning in a South African middle childhood sample.

Visual-motor integration functioning has been identified as playing an integral role in different aspects of a child's development. Sensory-motor development is not only foundational to the physical maturation process, but is also imperative for progress with formal learning activities. Deficits in visual-motor integration have been identified as precursors of later learning disabilities and other neurological conditions. The primary aim of this study was to determine the status of visual-motor integration functioning of a group of learners from a disadvantaged peri-urban South African community. Visual-motor integration functioning was assessed using the Developmental Test of Visual-Motor Integration (VMI) and the Goodenough-Harris Drawing Test (GHD). Three hundred and thirty-nine learners in grades 1-4 were assessed and results for the group relative to gender, chronological age and socioeconomic status are reported. For the group, the mean test age fell 16 months below the mean chronological age on the VMI. The mean GHD score for the group was about a half a standard deviation below the GHD's test norm. At school entry level, visual-motor integration was more than one standard deviation below the mean. Compared to female learners, male learners achieved significantly higher scores on the test age score of the VMI (mean difference = 8.69 months), and the intelligence coefficient score of the GHD (mean difference = 4.68). Scores on both measures increased as a function of socioeconomic status. The VMI and GHD scores were significantly correlated (r = 0.45; P < 0.01) suggesting that visual-motor integration is integral to intellectual functioning.