PLEASE NOTE: This page is NOT maintained. For up-to-date publications and research interests, see my personal website: https://www.markboyes.com/ Address: School of Psychology, Curtin University, Perth, Western Australia
Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-pr... more Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African sample. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior , discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.
Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting pro... more Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low-income and middle-income countries, on abuse and parenting practices.
Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.
Participants 552 families reporting conflict with their adolescents (aged 10–18).
Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.
Main outcome measures Primary outcomes: abuse and parenting practices at 1 and 5–9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5–9 months postintervention. Blinding was not possible.
Results At 5–9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P<0.001); corporal punishment (caregiver report IRR=0.55 (95% CI 0.37 to 0.83, P=0.004)); improved positive parenting (caregiver report d=0.25 (95% CI 0.03 to 0.47, P=0.024)), involved parenting (caregiver report d=0.86 (95% CI 0.64 to 1.08, P<0.001); adolescent report d=0.28 (95% CI 0.08 to 0.48, P=0.006)) and less poor supervision (caregiver report d=−0.50 (95% CI −0.70 to −0.29, P<0.001); adolescent report d=−0.34 (95% CI −0.55 to −0.12, P=0.002)), but not decreased neglect (caregiver report IRR 0.31 (95% CI 0.09 to 1.08, P=0.066); adolescent report IRR 1.46 (95% CI 0.75 to 2.85, P=0.264)), inconsistent discipline (caregiver report d=−0.14 (95% CI −0.36 to 0.09, P=0.229); adolescent report d=0.03 (95% CI −0.20 to 0.26, P=0.804)), or adolescent report of abuse IRR=0.90 (95% CI 0.66 to 1.24, P=0.508) and corporal punishment IRR=1.05 (95% CI 0.70 to 1.57, P=0.819). Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected.
Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.
Trial registration number Pan-African Clinical Trials Registry PACTR201507001119966.
Background
Models of non-suicidal self-injury (NSSI) typically focus on the role of emotion regu... more Background
Models of non-suicidal self-injury (NSSI) typically focus on the role of emotion regulation in NSSI, yet recent work supports a role for NSSI-related cognitions. NSSI outcome expectancies may offer important clues about who is at risk of NSSI, who is able to cease the behaviour, and who is at risk of relapse. Yet, so far, there is no reliable and valid means of assessing these cognitions. We developed, and reported on initial validation, of an NSSI Expectancy Questionnaire. Methods
A total of 49 statements reflecting possible outcomes of NSSI were administered to 496 undergraduate students. Results
Principal axis factoring revealed five factors (Affect Regulation, Negative Social Outcomes, Communication, Pain, Negative Self-Beliefs), which differentiated people with a history of NSSI from people with no NSSI history. Correlations with measures of self-efficacy, emotion regulation, and NSSI functions offer convergent and discriminant validity. Conclusions
The questionnaire appears to be a reliable and valid measure of NSSI outcome expectancies that could be a useful addition to the measurement toolkit when investigating cognitive variables related to NSSI.
Purpose: A small but growing body of literature indicates that children with dyslexia are at elev... more Purpose: A small but growing body of literature indicates that children with dyslexia are at elevated risk of internalising and externalising mental health problems. However, little research addresses why this might be the case, particularly from the point of view of the children or their parents. This study therefore aimed to explore the lived experiences of children with dyslexia, and their parents. Method: Drawing on a phenomenological approach, 13 children with dyslexia and 21 parents were interviewed. The semi-structured interviews were analysed thematically. Result: Dyslexia was seen to impact at the individual, family and community level. Children’s accounts of their experiences were ecologically situated at both the micro and mesosystem levels of Bronfenbrenner’s ecological model, while parent’s accounts extended to include the exosystem. Both also reflected on “difference”, a theme related to cultural and attitudinal views at the level of the macrosystem. Conclusion: Presentation of the themes contrasts the experiences of children and parents, illustrating that the experience of dyslexia is indicative of broader challenges associated with societal values and attitudes that privilege perceived ability and shame difference. This study provides information that could be used to inform and educate families and teachers about the impact of living with dyslexia.
Objective: Children with reading difficulties are at elevated risk for externalising (e.g., condu... more Objective: Children with reading difficulties are at elevated risk for externalising (e.g., conduct disorder) and internalising (e.g., anxiety and depression) mental health problems. Reading ability is also negatively associated with self-esteem, a consistent predictor of child and adolescent mental health more broadly. This study examined whether self-esteem moderated and/or mediated relationships between reading ability and mental health. Method: One hundred and seventeen children (7–12 years) completed standardised reading assessments (Castles and Coltheart Test 2; CC2) and self-report measures of mental health (Strengths and Difficulties Questionnaire; SDQ) and self-esteem (Coopersmith Self-esteem Inventory). Non-verbal intelligence (IQ) was measured using the block design and matrix reasoning subscales of the Wechsler Abbreviated Scale of Intelligence, and was controlled for in all multivariate analyses. Results: Reading ability was negatively associated with internalising symptoms. This relationship was not moderated by self-esteem. Poor readers also reported more total difficulties and externalising symptoms, but only at low levels of self-esteem. There was no evidence that self-esteem mediated relationships between reading ability and mental health. Conclusions: Poor reading was associated with internalising symptoms. Self-esteem moderated the impact of reading ability on total difficulties and externalising symptoms, with high self-esteem buffering against negative impacts of poor reading. However, the reliability of the self-esteem scale used in the study was poor and findings need replication using a reliable and valid self-esteem measure, as well as other measures of child mental health. If replicated, future research should examine whether interventions aiming to improve self-esteem can reduce the risk of externalising problems in children with reading difficulties.
This study examined prospective associations between poverty, gender, and school dropout in a lar... more This study examined prospective associations between poverty, gender, and school dropout in a large community sample of South African adolescents (baseline: n = 3515, follow-up: n = 3401, 57% female, age range at baseline: 10–17 years, mean age at baseline = 13.45). School dropout was defined as being enrolled in school at baseline assessment but no longer enrolled in school at follow-up assessment. Poverty was measured at baseline assessment using an index of access to the eight highest socially perceived necessities for South African children and adolescents. Demographic characteristics including child gender and age, province, and urban versus rural location were recorded at baseline assessment and controlled for in the analysis. As predicted, higher poverty scores (AOR = 2.01, p < .001) were associated with increased odds of school dropout 1 year later. Gender was not a significant predictor of school dropout (AOR = 1.56, p = .07) but did interact with poverty (AOR = 0.66, p = .04) in predicting school dropout. However, our initial hypothesis that the impact of poverty on school dropout would be stronger for girls than boys was not supported. Instead, results indicated that while girls were at elevated risk of school dropout at low and mean levels of poverty, at high levels of poverty this gender difference was no longer evident. Findings suggest that vulnerable boys should not be neglected in policies to improve retention in education in contexts of extreme poverty.
This chapter reflects some of the key ethical quandaries that emerged from two longitudinal South... more This chapter reflects some of the key ethical quandaries that emerged from two longitudinal South African studies of the impacts of parental HIV/AIDS on children. The first was a four-year study of 1025 AIDS-orphaned, other-orphaned and non-orphaned children to identify long-term impacts of orphanhood. In 2005 all children lived in the Cape Flats or on the streets of Cape Town, but by 2009 we followed them up into three provinces, and interviewed them in prisons and hospitals. The second study was a one-year national longitudinal study of 6000 children and 2600 of their primary caregivers – comparing children orphaned, living with sick parents and in healthy families to understand the impacts not just of death but also of parental illness on children's health, psychological, sexual and educational outcomes. In 2009-10 this involved random systematic sampling of census enumeration areas in the Western Cape, KwaZulu-Natal and Mpumalanga, and in 2011-12 children were followed up in six provinces (Eastern Cape, Western Cape, Gauteng, Mpumalanga, Limpopo, Free State and North West), and also into Mozambique and Swaziland. The studies are explicitly aimed at helping to inform evidence-based policy-making, and are conducted in collaboration with the South African National Departments of Social Development, Health and Basic Education, with UNICEF, USAID, Save the Children and the National Action Committee for Children Affected by AIDS, and with the Universities of Oxford, KwaZulu-Natal, Cape Town and Witwatersrand. As the Principal Investigator of both studies, I was responsible for the studies overall, including the overarching ethical planning and conduct, and the day-today ethical decisions made by the project's fifty fieldworkers, fifteen data capturers, ten managers and seven volunteers.
Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence am... more Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine 'cash/cash-in-kind' and 'care' provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33–0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33–0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25–0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amongst girls: without any provisions 49 % reported unprotected sex; with 1–2 provisions 13–38 %; and with all provisions 9 %. Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls. Resumen La protección social puede reducir los com-portamientos de riesgo asociados al VIH en los adoles-centes en general, siendo los datos limitados en cuanto a adolescentes VIH-positivo se refiere. Este estudio se evalúa cuantitativamente si la protección social está asociada con la reducción de relaciones sexuales sin protección en una muestra de 1060 adolescentes elegibles para el tratamiento antirretroviral, en 53 instalaciones gubernamentales en Sudáfrica. En este estudio la protección social se midió usando nueve tipos de medidas de protección incluyendo efectivo, pago en especie y servicios de atención a la salud. Los efectos interactivos y aditivos de estas medidas se analizaron usando regresiones logísticas y modelos de efectos marginales, controlando por covariables. El 18 % de todos los adolescentes VIH positivo y el 28 % de las chicas adolescentes declararon haber tenido relaciones sexuales sin protección. Menores tasas de relaciones sexuales sin protección estuvieron asociadas con el acceso a la escuela (OR 0.52 95 % CI 0.33–0.82 p = 0.005), la supervisión parental (OR 0.54 95 % CI 0.33–0.90 p = 0.019), y la atención clínica adecuada a las necesida-des de los adolescentes (OR 0.43 95 % CI 0.25–0.73 p = 0.
Background: Theoretically, two types of emotional responding could underlie individual difference... more Background: Theoretically, two types of emotional responding could underlie individual differences in trait affect: 1) a disposition reflecting increased probability of experiencing positive or negative emotions (emotional reactivity), and 2) a disposition to experience prolonged emotional reactions once elicited (emotional perseveration). We developed a measure of these dimensions and investigated whether emotional reactivity and perseveration 1) account for unique variance in trait affect, and 2) are differentially associated with symptoms of psychological distress. Method: In Study 1, participants (T1: n = 90; T2: n = 51) completed the Positive and Negative Affect Schedule (PANAS) and the Emotional Reactivity and Perseveration Scale (ERPS, adapted from the PANAS). In study 2, participants (n = 228) completed the PANAS, ERPS, and Depression Anxiety Stress Scales. Results: Study 1 established the basic psychometric properties of the ERPS and demonstrated that emotional reactivity and perseveration accounted for unique variance in trait positive and negative affect. Study 2 confirmed these findings and established that emotional reactivity and perseveration are differentially associated with depression, anxiety, and stress scores. Conclusion: Emotional reactivity and perseveration represent independent dimensions of trait affect. Considering these dimension in future research could further the understanding of both normal emotional responding and emotional vulnerability.
A growing literature indicates children with reading difficulties are at elevated risk for mental... more A growing literature indicates children with reading difficulties are at elevated risk for mental health problems; however, little attention has been given to why this might be the case. Associations between reading difficulties and mental health differ substantially across studies, raising the possibility that these relationships may be ameliorated or exacerbated by risk or resilience-promoting factors. Using socio-ecological theory as a conceptual framework, we outline four potential lines of research that could shed light on why children with reading difficulties are at risk of mental health problems and identify potential targets for intervention.
An important characteristic of a screening tool is its discriminant ability or the measure’s accu... more An important characteristic of a screening tool is its discriminant ability or the measure’s accuracy to distinguish between those with and without mental health problems. The current study examined the inter-rater agreement and screening concordance of the parent and teacher versions of SDQ at scale, subscale and item-levels, with the view of identifying the items that have the most informant discrepancies; and determining whether the concordance between parent and teacher reports on some items has the potential to influence decision making. Cross-sectional data from parent and teacher reports of the mental health functioning of a community sample of 299 students with and without disabilities from 75 different primary schools in Perth, Western Australia were analysed. The study found that: a) Intraclass correlations between parent and teacher ratings of children’s mental health using the SDQ at person level was fair on individual child level; b) The SDQ only demonstrated clinical utility when there was agreement between teacher and parent reports using the possible or 90% dichotomisation system; and c) Three individual items had positive likelihood ratio scores indicating clinical utility. Of note was the finding that the negative likelihood ratio or likelihood of disregarding the absence of a condition when both parents and teachers rate the item as absent was not significant. Taken together, these findings suggest that the SDQ is not optimised for use in community samples and that further psychometric evaluation of the SDQ in this context is clearly warranted.
Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-pr... more Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African sample. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior , discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.
Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting pro... more Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low-income and middle-income countries, on abuse and parenting practices.
Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.
Participants 552 families reporting conflict with their adolescents (aged 10–18).
Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.
Main outcome measures Primary outcomes: abuse and parenting practices at 1 and 5–9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5–9 months postintervention. Blinding was not possible.
Results At 5–9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P<0.001); corporal punishment (caregiver report IRR=0.55 (95% CI 0.37 to 0.83, P=0.004)); improved positive parenting (caregiver report d=0.25 (95% CI 0.03 to 0.47, P=0.024)), involved parenting (caregiver report d=0.86 (95% CI 0.64 to 1.08, P<0.001); adolescent report d=0.28 (95% CI 0.08 to 0.48, P=0.006)) and less poor supervision (caregiver report d=−0.50 (95% CI −0.70 to −0.29, P<0.001); adolescent report d=−0.34 (95% CI −0.55 to −0.12, P=0.002)), but not decreased neglect (caregiver report IRR 0.31 (95% CI 0.09 to 1.08, P=0.066); adolescent report IRR 1.46 (95% CI 0.75 to 2.85, P=0.264)), inconsistent discipline (caregiver report d=−0.14 (95% CI −0.36 to 0.09, P=0.229); adolescent report d=0.03 (95% CI −0.20 to 0.26, P=0.804)), or adolescent report of abuse IRR=0.90 (95% CI 0.66 to 1.24, P=0.508) and corporal punishment IRR=1.05 (95% CI 0.70 to 1.57, P=0.819). Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected.
Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.
Trial registration number Pan-African Clinical Trials Registry PACTR201507001119966.
Background
Models of non-suicidal self-injury (NSSI) typically focus on the role of emotion regu... more Background
Models of non-suicidal self-injury (NSSI) typically focus on the role of emotion regulation in NSSI, yet recent work supports a role for NSSI-related cognitions. NSSI outcome expectancies may offer important clues about who is at risk of NSSI, who is able to cease the behaviour, and who is at risk of relapse. Yet, so far, there is no reliable and valid means of assessing these cognitions. We developed, and reported on initial validation, of an NSSI Expectancy Questionnaire. Methods
A total of 49 statements reflecting possible outcomes of NSSI were administered to 496 undergraduate students. Results
Principal axis factoring revealed five factors (Affect Regulation, Negative Social Outcomes, Communication, Pain, Negative Self-Beliefs), which differentiated people with a history of NSSI from people with no NSSI history. Correlations with measures of self-efficacy, emotion regulation, and NSSI functions offer convergent and discriminant validity. Conclusions
The questionnaire appears to be a reliable and valid measure of NSSI outcome expectancies that could be a useful addition to the measurement toolkit when investigating cognitive variables related to NSSI.
Purpose: A small but growing body of literature indicates that children with dyslexia are at elev... more Purpose: A small but growing body of literature indicates that children with dyslexia are at elevated risk of internalising and externalising mental health problems. However, little research addresses why this might be the case, particularly from the point of view of the children or their parents. This study therefore aimed to explore the lived experiences of children with dyslexia, and their parents. Method: Drawing on a phenomenological approach, 13 children with dyslexia and 21 parents were interviewed. The semi-structured interviews were analysed thematically. Result: Dyslexia was seen to impact at the individual, family and community level. Children’s accounts of their experiences were ecologically situated at both the micro and mesosystem levels of Bronfenbrenner’s ecological model, while parent’s accounts extended to include the exosystem. Both also reflected on “difference”, a theme related to cultural and attitudinal views at the level of the macrosystem. Conclusion: Presentation of the themes contrasts the experiences of children and parents, illustrating that the experience of dyslexia is indicative of broader challenges associated with societal values and attitudes that privilege perceived ability and shame difference. This study provides information that could be used to inform and educate families and teachers about the impact of living with dyslexia.
Objective: Children with reading difficulties are at elevated risk for externalising (e.g., condu... more Objective: Children with reading difficulties are at elevated risk for externalising (e.g., conduct disorder) and internalising (e.g., anxiety and depression) mental health problems. Reading ability is also negatively associated with self-esteem, a consistent predictor of child and adolescent mental health more broadly. This study examined whether self-esteem moderated and/or mediated relationships between reading ability and mental health. Method: One hundred and seventeen children (7–12 years) completed standardised reading assessments (Castles and Coltheart Test 2; CC2) and self-report measures of mental health (Strengths and Difficulties Questionnaire; SDQ) and self-esteem (Coopersmith Self-esteem Inventory). Non-verbal intelligence (IQ) was measured using the block design and matrix reasoning subscales of the Wechsler Abbreviated Scale of Intelligence, and was controlled for in all multivariate analyses. Results: Reading ability was negatively associated with internalising symptoms. This relationship was not moderated by self-esteem. Poor readers also reported more total difficulties and externalising symptoms, but only at low levels of self-esteem. There was no evidence that self-esteem mediated relationships between reading ability and mental health. Conclusions: Poor reading was associated with internalising symptoms. Self-esteem moderated the impact of reading ability on total difficulties and externalising symptoms, with high self-esteem buffering against negative impacts of poor reading. However, the reliability of the self-esteem scale used in the study was poor and findings need replication using a reliable and valid self-esteem measure, as well as other measures of child mental health. If replicated, future research should examine whether interventions aiming to improve self-esteem can reduce the risk of externalising problems in children with reading difficulties.
This study examined prospective associations between poverty, gender, and school dropout in a lar... more This study examined prospective associations between poverty, gender, and school dropout in a large community sample of South African adolescents (baseline: n = 3515, follow-up: n = 3401, 57% female, age range at baseline: 10–17 years, mean age at baseline = 13.45). School dropout was defined as being enrolled in school at baseline assessment but no longer enrolled in school at follow-up assessment. Poverty was measured at baseline assessment using an index of access to the eight highest socially perceived necessities for South African children and adolescents. Demographic characteristics including child gender and age, province, and urban versus rural location were recorded at baseline assessment and controlled for in the analysis. As predicted, higher poverty scores (AOR = 2.01, p < .001) were associated with increased odds of school dropout 1 year later. Gender was not a significant predictor of school dropout (AOR = 1.56, p = .07) but did interact with poverty (AOR = 0.66, p = .04) in predicting school dropout. However, our initial hypothesis that the impact of poverty on school dropout would be stronger for girls than boys was not supported. Instead, results indicated that while girls were at elevated risk of school dropout at low and mean levels of poverty, at high levels of poverty this gender difference was no longer evident. Findings suggest that vulnerable boys should not be neglected in policies to improve retention in education in contexts of extreme poverty.
This chapter reflects some of the key ethical quandaries that emerged from two longitudinal South... more This chapter reflects some of the key ethical quandaries that emerged from two longitudinal South African studies of the impacts of parental HIV/AIDS on children. The first was a four-year study of 1025 AIDS-orphaned, other-orphaned and non-orphaned children to identify long-term impacts of orphanhood. In 2005 all children lived in the Cape Flats or on the streets of Cape Town, but by 2009 we followed them up into three provinces, and interviewed them in prisons and hospitals. The second study was a one-year national longitudinal study of 6000 children and 2600 of their primary caregivers – comparing children orphaned, living with sick parents and in healthy families to understand the impacts not just of death but also of parental illness on children's health, psychological, sexual and educational outcomes. In 2009-10 this involved random systematic sampling of census enumeration areas in the Western Cape, KwaZulu-Natal and Mpumalanga, and in 2011-12 children were followed up in six provinces (Eastern Cape, Western Cape, Gauteng, Mpumalanga, Limpopo, Free State and North West), and also into Mozambique and Swaziland. The studies are explicitly aimed at helping to inform evidence-based policy-making, and are conducted in collaboration with the South African National Departments of Social Development, Health and Basic Education, with UNICEF, USAID, Save the Children and the National Action Committee for Children Affected by AIDS, and with the Universities of Oxford, KwaZulu-Natal, Cape Town and Witwatersrand. As the Principal Investigator of both studies, I was responsible for the studies overall, including the overarching ethical planning and conduct, and the day-today ethical decisions made by the project's fifty fieldworkers, fifteen data capturers, ten managers and seven volunteers.
Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence am... more Social protection can reduce HIV-risk behavior in general adolescent populations, but evidence among HIV-positive adolescents is limited. This study quantitatively tests whether social protection is associated with reduced unprotected sex among 1060 ART-eligible adolescents from 53 government facilities in South Africa. Potential social protection included nine 'cash/cash-in-kind' and 'care' provisions. Analyses tested interactive/additive effects using logistic regressions and marginal effects models, controlling for covariates. 18 % of all HIV-positive adolescents and 28 % of girls reported unprotected sex. Lower rates of unprotected sex were associated with access to school (OR 0.52 95 % CI 0.33–0.82 p = 0.005), parental supervision (OR 0.54 95 % CI 0.33–0.90 p = 0.019), and adolescent-sensitive clinic care (OR 0.43 95 % CI 0.25–0.73 p = 0.002). Gender moderated the effect of adolescent-sensitive clinic care. Combination social protection had additive effects amongst girls: without any provisions 49 % reported unprotected sex; with 1–2 provisions 13–38 %; and with all provisions 9 %. Combination social protection has the potential to promote safer sex among HIV-positive adolescents, particularly girls. Resumen La protección social puede reducir los com-portamientos de riesgo asociados al VIH en los adoles-centes en general, siendo los datos limitados en cuanto a adolescentes VIH-positivo se refiere. Este estudio se evalúa cuantitativamente si la protección social está asociada con la reducción de relaciones sexuales sin protección en una muestra de 1060 adolescentes elegibles para el tratamiento antirretroviral, en 53 instalaciones gubernamentales en Sudáfrica. En este estudio la protección social se midió usando nueve tipos de medidas de protección incluyendo efectivo, pago en especie y servicios de atención a la salud. Los efectos interactivos y aditivos de estas medidas se analizaron usando regresiones logísticas y modelos de efectos marginales, controlando por covariables. El 18 % de todos los adolescentes VIH positivo y el 28 % de las chicas adolescentes declararon haber tenido relaciones sexuales sin protección. Menores tasas de relaciones sexuales sin protección estuvieron asociadas con el acceso a la escuela (OR 0.52 95 % CI 0.33–0.82 p = 0.005), la supervisión parental (OR 0.54 95 % CI 0.33–0.90 p = 0.019), y la atención clínica adecuada a las necesida-des de los adolescentes (OR 0.43 95 % CI 0.25–0.73 p = 0.
Background: Theoretically, two types of emotional responding could underlie individual difference... more Background: Theoretically, two types of emotional responding could underlie individual differences in trait affect: 1) a disposition reflecting increased probability of experiencing positive or negative emotions (emotional reactivity), and 2) a disposition to experience prolonged emotional reactions once elicited (emotional perseveration). We developed a measure of these dimensions and investigated whether emotional reactivity and perseveration 1) account for unique variance in trait affect, and 2) are differentially associated with symptoms of psychological distress. Method: In Study 1, participants (T1: n = 90; T2: n = 51) completed the Positive and Negative Affect Schedule (PANAS) and the Emotional Reactivity and Perseveration Scale (ERPS, adapted from the PANAS). In study 2, participants (n = 228) completed the PANAS, ERPS, and Depression Anxiety Stress Scales. Results: Study 1 established the basic psychometric properties of the ERPS and demonstrated that emotional reactivity and perseveration accounted for unique variance in trait positive and negative affect. Study 2 confirmed these findings and established that emotional reactivity and perseveration are differentially associated with depression, anxiety, and stress scores. Conclusion: Emotional reactivity and perseveration represent independent dimensions of trait affect. Considering these dimension in future research could further the understanding of both normal emotional responding and emotional vulnerability.
A growing literature indicates children with reading difficulties are at elevated risk for mental... more A growing literature indicates children with reading difficulties are at elevated risk for mental health problems; however, little attention has been given to why this might be the case. Associations between reading difficulties and mental health differ substantially across studies, raising the possibility that these relationships may be ameliorated or exacerbated by risk or resilience-promoting factors. Using socio-ecological theory as a conceptual framework, we outline four potential lines of research that could shed light on why children with reading difficulties are at risk of mental health problems and identify potential targets for intervention.
An important characteristic of a screening tool is its discriminant ability or the measure’s accu... more An important characteristic of a screening tool is its discriminant ability or the measure’s accuracy to distinguish between those with and without mental health problems. The current study examined the inter-rater agreement and screening concordance of the parent and teacher versions of SDQ at scale, subscale and item-levels, with the view of identifying the items that have the most informant discrepancies; and determining whether the concordance between parent and teacher reports on some items has the potential to influence decision making. Cross-sectional data from parent and teacher reports of the mental health functioning of a community sample of 299 students with and without disabilities from 75 different primary schools in Perth, Western Australia were analysed. The study found that: a) Intraclass correlations between parent and teacher ratings of children’s mental health using the SDQ at person level was fair on individual child level; b) The SDQ only demonstrated clinical utility when there was agreement between teacher and parent reports using the possible or 90% dichotomisation system; and c) Three individual items had positive likelihood ratio scores indicating clinical utility. Of note was the finding that the negative likelihood ratio or likelihood of disregarding the absence of a condition when both parents and teachers rate the item as absent was not significant. Taken together, these findings suggest that the SDQ is not optimised for use in community samples and that further psychometric evaluation of the SDQ in this context is clearly warranted.
This chapter reflects some of the key ethical quandaries that emerged from two longitudinal South... more This chapter reflects some of the key ethical quandaries that emerged from two longitudinal South African studies of the impacts of parental HIV/AIDS on children. The first was a four-year study of 1025 AIDS-orphaned, other-orphaned and non-orphaned children to identify long-term impacts of orphanhood. In 2005 all children lived in the Cape Flats or on the streets of Cape Town, but by 2009 we followed them up into three provinces, and interviewed them in prisons and hospitals. The second study was a one-year national longitudinal study of 6000 children and 2600 of their primary caregivers – comparing children orphaned, living with sick parents and in healthy families to understand the impacts not just of death but also of parental illness on children’s health, psychological, sexual and educational outcomes. In 2009-10 this involved random systematic sampling of census enumeration areas in the Western Cape, KwaZulu-Natal and Mpumalanga, and in 2011-12 children were followed up in six provinces (Eastern Cape, Western Cape, Gauteng, Mpumalanga, Limpopo, Free State and North West), and also into Mozambique and Swaziland. The studies are explicitly aimed at helping to inform evidence-based policy-making, and are conducted in collaboration with the South African National Departments of Social Development, Health and Basic Education, with UNICEF, USAID, Save the Children and the National Action Committee for Children Affected by AIDS, and with the Universities of Oxford, KwaZulu-Natal, Cape Town and Witwatersrand. As the Principal Investigator of both studies, I was responsible for the studies overall, including the overarching ethical planning and conduct, and the day-to-day ethical decisions made by the project’s fifty fieldworkers, fifteen data capturers, ten managers and seven volunteers.
Child psychology and mental health: Cultural and ethno-racial perspectives: Volume 1: International perspectives: Development and context (pp. 65-87), 2011
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Design Pragmatic cluster randomised controlled trial.
Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.
Participants 552 families reporting conflict with their adolescents (aged 10–18).
Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.
Main outcome measures Primary outcomes: abuse and parenting practices at 1 and 5–9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5–9 months postintervention. Blinding was not possible.
Results At 5–9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P<0.001); corporal punishment (caregiver report IRR=0.55 (95% CI 0.37 to 0.83, P=0.004)); improved positive parenting (caregiver report d=0.25 (95% CI 0.03 to 0.47, P=0.024)), involved parenting (caregiver report d=0.86 (95% CI 0.64 to 1.08, P<0.001); adolescent report d=0.28 (95% CI 0.08 to 0.48, P=0.006)) and less poor supervision (caregiver report d=−0.50 (95% CI −0.70 to −0.29, P<0.001); adolescent report d=−0.34 (95% CI −0.55 to −0.12, P=0.002)), but not decreased neglect (caregiver report IRR 0.31 (95% CI 0.09 to 1.08, P=0.066); adolescent report IRR 1.46 (95% CI 0.75 to 2.85, P=0.264)), inconsistent discipline (caregiver report d=−0.14 (95% CI −0.36 to 0.09, P=0.229); adolescent report d=0.03 (95% CI −0.20 to 0.26, P=0.804)), or adolescent report of abuse IRR=0.90 (95% CI 0.66 to 1.24, P=0.508) and corporal punishment IRR=1.05 (95% CI 0.70 to 1.57, P=0.819). Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected.
Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.
Trial registration number Pan-African Clinical Trials Registry PACTR201507001119966.
Models of non-suicidal self-injury (NSSI) typically focus on the role of emotion regulation in NSSI, yet recent work supports a role for NSSI-related cognitions. NSSI outcome expectancies may offer important clues about who is at risk of NSSI, who is able to cease the behaviour, and who is at risk of relapse. Yet, so far, there is no reliable and valid means of assessing these cognitions. We developed, and reported on initial validation, of an NSSI Expectancy Questionnaire.
Methods
A total of 49 statements reflecting possible outcomes of NSSI were administered to 496 undergraduate students.
Results
Principal axis factoring revealed five factors (Affect Regulation, Negative Social Outcomes, Communication, Pain, Negative Self-Beliefs), which differentiated people with a history of NSSI from people with no NSSI history. Correlations with measures of self-efficacy, emotion regulation, and NSSI functions offer convergent and discriminant validity.
Conclusions
The questionnaire appears to be a reliable and valid measure of NSSI outcome expectancies that could be a useful addition to the measurement toolkit when investigating cognitive variables related to NSSI.
Method: Drawing on a phenomenological approach, 13 children with dyslexia and 21 parents were interviewed. The semi-structured interviews were analysed thematically.
Result: Dyslexia was seen to impact at the individual, family and community level. Children’s accounts of their experiences were ecologically situated at both the micro and mesosystem levels of Bronfenbrenner’s ecological model, while parent’s accounts extended to include the exosystem. Both also reflected on “difference”, a theme related to cultural and attitudinal views at the level of the macrosystem.
Conclusion: Presentation of the themes contrasts the experiences of children and parents, illustrating that the experience of dyslexia is indicative of broader challenges associated with societal values and attitudes that privilege perceived ability and shame difference. This study provides information that could be used to inform and educate families and teachers about the impact of living with dyslexia.
Method: One hundred and seventeen children (7–12 years) completed standardised reading assessments (Castles and Coltheart Test 2; CC2) and self-report measures of mental health (Strengths and Difficulties Questionnaire; SDQ) and self-esteem (Coopersmith Self-esteem Inventory). Non-verbal intelligence (IQ) was measured using the block design and matrix reasoning subscales of the Wechsler Abbreviated Scale of Intelligence, and was controlled for in all multivariate analyses.
Results: Reading ability was negatively associated with internalising symptoms. This relationship was not moderated by self-esteem. Poor readers also reported more total difficulties and externalising symptoms, but only at low levels of self-esteem. There was no evidence that self-esteem mediated relationships between reading ability and mental health.
Conclusions: Poor reading was associated with internalising symptoms. Self-esteem moderated the impact of reading ability on total difficulties and externalising symptoms, with high self-esteem buffering against negative impacts of poor reading. However, the reliability of the self-esteem scale used in the study was poor and findings need replication using a reliable and valid self-esteem measure, as well as other measures of child mental health. If replicated, future research should examine whether interventions aiming to improve self-esteem can reduce the risk of externalising problems in children with reading difficulties.
Design Pragmatic cluster randomised controlled trial.
Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa.
Participants 552 families reporting conflict with their adolescents (aged 10–18).
Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme.
Main outcome measures Primary outcomes: abuse and parenting practices at 1 and 5–9 months postintervention. Secondary outcomes: caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence and family financial well-being at 5–9 months postintervention. Blinding was not possible.
Results At 5–9 months postintervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, P<0.001); corporal punishment (caregiver report IRR=0.55 (95% CI 0.37 to 0.83, P=0.004)); improved positive parenting (caregiver report d=0.25 (95% CI 0.03 to 0.47, P=0.024)), involved parenting (caregiver report d=0.86 (95% CI 0.64 to 1.08, P<0.001); adolescent report d=0.28 (95% CI 0.08 to 0.48, P=0.006)) and less poor supervision (caregiver report d=−0.50 (95% CI −0.70 to −0.29, P<0.001); adolescent report d=−0.34 (95% CI −0.55 to −0.12, P=0.002)), but not decreased neglect (caregiver report IRR 0.31 (95% CI 0.09 to 1.08, P=0.066); adolescent report IRR 1.46 (95% CI 0.75 to 2.85, P=0.264)), inconsistent discipline (caregiver report d=−0.14 (95% CI −0.36 to 0.09, P=0.229); adolescent report d=0.03 (95% CI −0.20 to 0.26, P=0.804)), or adolescent report of abuse IRR=0.90 (95% CI 0.66 to 1.24, P=0.508) and corporal punishment IRR=1.05 (95% CI 0.70 to 1.57, P=0.819). Secondary outcomes showed reductions in caregiver corporal punishment endorsement, mental health problems, parenting stress, substance use and increased social support (all caregiver report). Intervention adolescents reported no differences in mental health, behaviour or community violence, but had lower substance use (all adolescent report). Intervention families had improved economic welfare, financial management and more violence avoidance planning (in caregiver and adolescent report). No adverse effects were detected.
Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.
Trial registration number Pan-African Clinical Trials Registry PACTR201507001119966.
Models of non-suicidal self-injury (NSSI) typically focus on the role of emotion regulation in NSSI, yet recent work supports a role for NSSI-related cognitions. NSSI outcome expectancies may offer important clues about who is at risk of NSSI, who is able to cease the behaviour, and who is at risk of relapse. Yet, so far, there is no reliable and valid means of assessing these cognitions. We developed, and reported on initial validation, of an NSSI Expectancy Questionnaire.
Methods
A total of 49 statements reflecting possible outcomes of NSSI were administered to 496 undergraduate students.
Results
Principal axis factoring revealed five factors (Affect Regulation, Negative Social Outcomes, Communication, Pain, Negative Self-Beliefs), which differentiated people with a history of NSSI from people with no NSSI history. Correlations with measures of self-efficacy, emotion regulation, and NSSI functions offer convergent and discriminant validity.
Conclusions
The questionnaire appears to be a reliable and valid measure of NSSI outcome expectancies that could be a useful addition to the measurement toolkit when investigating cognitive variables related to NSSI.
Method: Drawing on a phenomenological approach, 13 children with dyslexia and 21 parents were interviewed. The semi-structured interviews were analysed thematically.
Result: Dyslexia was seen to impact at the individual, family and community level. Children’s accounts of their experiences were ecologically situated at both the micro and mesosystem levels of Bronfenbrenner’s ecological model, while parent’s accounts extended to include the exosystem. Both also reflected on “difference”, a theme related to cultural and attitudinal views at the level of the macrosystem.
Conclusion: Presentation of the themes contrasts the experiences of children and parents, illustrating that the experience of dyslexia is indicative of broader challenges associated with societal values and attitudes that privilege perceived ability and shame difference. This study provides information that could be used to inform and educate families and teachers about the impact of living with dyslexia.
Method: One hundred and seventeen children (7–12 years) completed standardised reading assessments (Castles and Coltheart Test 2; CC2) and self-report measures of mental health (Strengths and Difficulties Questionnaire; SDQ) and self-esteem (Coopersmith Self-esteem Inventory). Non-verbal intelligence (IQ) was measured using the block design and matrix reasoning subscales of the Wechsler Abbreviated Scale of Intelligence, and was controlled for in all multivariate analyses.
Results: Reading ability was negatively associated with internalising symptoms. This relationship was not moderated by self-esteem. Poor readers also reported more total difficulties and externalising symptoms, but only at low levels of self-esteem. There was no evidence that self-esteem mediated relationships between reading ability and mental health.
Conclusions: Poor reading was associated with internalising symptoms. Self-esteem moderated the impact of reading ability on total difficulties and externalising symptoms, with high self-esteem buffering against negative impacts of poor reading. However, the reliability of the self-esteem scale used in the study was poor and findings need replication using a reliable and valid self-esteem measure, as well as other measures of child mental health. If replicated, future research should examine whether interventions aiming to improve self-esteem can reduce the risk of externalising problems in children with reading difficulties.