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de Vries PJ. Editorial perspective: Transforming child and adolescent mental health services and systems (CAMHSS) around the globe - the importance of diversity, inclusion and equity in CAMHSS research. Child Adolesc Ment Health 2024; 29:194-196. [PMID: 38634297 DOI: 10.1111/camh.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
Children and adolescents around the globe have mental health and neurodevelopmental needs. However, no country or region of the world has found good solutions to meet these needs, which are often long-term and complex. Most child and adolescent mental health research comes from high-income, mostly English-speaking, contexts even though 95% of the world's children and adolescents live in low- and middle-income countries (LMIC), where there is vast cultural, linguistic, and socio-economic diversity, with limited services and systems for child and adolescent mental health (CAMH). There is therefore both a 'knowledge gap' (more than 90% of all research represents less than 10% of the global population) and an 'identification and treatment gap' (fewer than 1 in 10 children in LMIC ever receive a diagnosis or any kind of treatment). The purpose of this editorial perspective was to consider the challenges of diversity, inclusion and equity in CAMH research around the globe, and to present some practical things we can all do to close these gaps and transform the global CAMH research agenda.
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Affiliation(s)
- Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Pillay S, Duncan M, de Vries PJ. 'We wait and we wait'-caregiver perspectives on autism spectrum disorder services in the Western Cape Province of South Africa. Child Adolesc Ment Health 2024; 29:145-153. [PMID: 38533770 DOI: 10.1111/camh.12704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Caregivers of children with autism face significant challenges in navigating health, education and other systems of care to ensure appropriate services for their children. In South Africa, for example, many children with autism are reported to be out of schools and waiting long periods for specialist school placements thus adding to the burden of care for caregivers and raising many questions about equity, diversity and inclusion. METHODS Here we performed a qualitative study using focus groups to collect data on the perspectives of caregivers of children with autism waiting for school placement in the Western Cape Province of South Africa. We asked families about their experiences of current autism services and for suggestions to improve service delivery. RESULTS The main theme that emerged was 'We wait and we wait'. Caregivers expressed high levels of frustration with existing autism educational and other services. Perspectives about services were captured under three categories. The first category, 'The costs of waiting' describes the socioemotional, financial and time costs associated with having a child with autism wait for educational services. The second category 'Barriers while waiting' describes the attitudinal, structural, process and communication barriers experienced by caregivers while seeking services for their children. The final category 'Expecting action' describes attitudinal, service and policy expectations that caregivers felt could improve service delivery. Caregivers provided 10 recommendations for autism service improvements. CONCLUSION Caregivers of children with autism waiting for educational services in the Western Cape Province of South Africa expressed dissatisfaction with existing services. Efforts to find solutions to providing services and support to children with autism waiting for educational services and their caregivers should be prioritized.
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Affiliation(s)
- Sarosha Pillay
- Department of Health and Rehabilitation Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Madeleine Duncan
- Department of Health and Rehabilitation Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Franz L, Viljoen M, Askew S, Brown M, Dawson G, Di Martino JM, Sapiro G, Sebolai K, Seris N, Shabalala N, Stahmer A, Turner EL, de Vries PJ. Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial. PLoS One 2024; 19:e0291883. [PMID: 38215154 PMCID: PMC10786379 DOI: 10.1371/journal.pone.0291883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. OBJECTIVES First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. METHODS This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. RESULTS Participant enrolment started in April 2023. Estimated primary completion date is March 2027. CONCLUSION The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators. TRIAL REGISTRATION NCT05551728 in Clinical Trial Registry (https://clinicaltrials.gov).
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Musaddiqah Brown
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Katlego Sebolai
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Aubyn Stahmer
- Center for Excellence in Developmental Disabilities, MIND Institute, University of California, Davis, Davis, California, United States of America
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
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Pillay S, Duncan M, de Vries PJ. 'We are doing damage control': Government stakeholder perspectives of educational and other services for children with autism spectrum disorder in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:73-83. [PMID: 36510832 PMCID: PMC10771016 DOI: 10.1177/13623613221142111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
LAY ABSTRACT Autism spectrum disorder is a growing public health concern in low- and middle-income countries like South Africa where there are no plans or policies in place for autism spectrum disorder management. Many children with autism spectrum disorder in South Africa are out of schools and waiting for school placement to become available. This study explored the perspectives of key government stakeholders on educational and other services for children with autism spectrum disorder in the Western Cape Province of South Africa and their suggestion for improving services for these children and their families. Semi-structured interviews were conducted with government stakeholders from the Western Cape Department of Education, Department of Health and the Department of Social development. The main theme that emerged was 'We are doing damage control'. Government stakeholders acknowledged that autism spectrum disorder services were being overlooked because of other demands on government resources. Finding from this study highlighted the need for government departments to work together to develop a strategy for autism spectrum disorder management. Engagement between government and civil society to break down barriers, strengthen systems and develop solutions to improving access to services for children with autism spectrum disorder and their families is recommended.
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Franz L, Viljoen M, Askew S, Brown M, Dawson G, Di Martino JM, Sapiro G, Sebolai K, Seris N, Shabalala N, Stahmer A, Turner EL, de Vries PJ. Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.10.23295331. [PMID: 37745535 PMCID: PMC10516098 DOI: 10.1101/2023.09.10.23295331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. Objectives First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. Methods This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. Results Participant enrolment started in April 2023. Estimated primary completion date is March 2027. Conclusion The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators.
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Musaddiqah Brown
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Katlego Sebolai
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Aubyn Stahmer
- Center for Excellence in Developmental Disabilities, MIND Institute, University of California Davis, California, USA
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
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Rieder AD, Viljoen M, Seris N, Shabalala N, Ndlovu M, Turner EL, Simmons R, de Vries PJ, Franz L. Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa. Child Adolesc Psychiatry Ment Health 2023; 17:64. [PMID: 37210513 PMCID: PMC10199438 DOI: 10.1186/s13034-023-00611-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Despite the high number of children living with neurodevelopmental disabilities in sub-Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI-whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes. METHODS We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2. RESULTS Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication-9/10 improved, Foundations of Learning-10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication-9/10 improved, Socialization-6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers. CONCLUSIONS This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.
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Affiliation(s)
- Amber D Rieder
- Division of Child and Family Mental Health & Community Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa.
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
| | - Minkateko Ndlovu
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Ryan Simmons
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
| | - Lauren Franz
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, South Africa
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA
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Guler J, Stewart KA, de Vries PJ, Seris N, Shabalala N, Franz L. Conducting caregiver focus groups on autism in the context of an international research collaboration: Logistical and methodological lessons learned in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:751-761. [PMID: 35999698 PMCID: PMC9947186 DOI: 10.1177/13623613221117012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Most of the autism research to date has been conducted in high-income countries, with children and families typically from White, upper-middle-income backgrounds. However, we know there are significant inequalities that exist which influence how autistic individuals from diverse, underserved communities can access services they need. As many of these individuals have not been included in the majority of autism research to date, there is much we do not know about these individuals' life experiences, which are critically needed to better inform the development and implementation of care for families from historically underrepresented groups. In this article, we describe the research process we took to conduct focus group discussions with 22 caregivers of young autistic children living in Cape Town, South Africa. We specifically describe the lessons we learned in implementing these focus groups and provide recommendations aimed at how to best reduce logistical and methodological challenges moving forward to improve research conducted in similar low-resource contexts.
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Affiliation(s)
- Jessy Guler
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | | | - Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Noleen Seris
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lauren Franz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Rieder AD, Viljoen M, Seris N, Shabalala N, Ndlovu M, Turner EL, Simmons R, Vries PJ, Franz L. Improving access to early intervention for autism - findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa. RESEARCH SQUARE 2023:rs.3.rs-2624968. [PMID: 36909555 PMCID: PMC10002833 DOI: 10.21203/rs.3.rs-2624968/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background Despite the high number of children living with neurodevelopmental disabilities in sub-Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI - whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes. Methods We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2. Results Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication - 9/10 improved, Foundations of Learning - 10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication - 9/10 improved, Socialization - 6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers. Conclusions This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.
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Affiliation(s)
- Amber D Rieder
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Marisa Viljoen
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Noleen Seris
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Minkateko Ndlovu
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | | | - Ryan Simmons
- Department of Biostatistics and Bioinformatics, Duke University
| | - Petrus J Vries
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town
| | - Lauren Franz
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University
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Abstract
Whereas traditional teaching environments encourage lively and engaged interaction and reward extrovert qualities, introverts, and others with symptoms that make social engagement difficult, such as autism spectrum disorder (ASD), are often disadvantaged. This population is often more engaged in quieter, low-key learning environments and often does not speak up and answer questions in traditional lecture-style classes. These individuals are often passed over in school and later in their careers for not speaking up and are assumed to not be as competent as their gregarious and outgoing colleagues. With the rise of the metaverse and democratization of virtual reality (VR) technology, post-secondary education is especially poised to capitalize on the immersive learning environments social VR provides and prepare students for the future of work, where virtual collaboration will be key. This study seeks to reconsider the role of VR and the metaverse for introverts and those with ASD. The metaverse has the potential to continue the social and workplace changes already accelerated by the pandemic and open new avenues for communication and collaboration for a more inclusive audience and tomorrow.
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