Fears and Fearfulness in South-African Children

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.

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.

The association between car accident fatalities and children's fears: A study in seven EU countries

Children's fear of a car accident occurring to parents or themselves has been used as a concrete example to illustrate one of the symptoms of anxiety disorders such as separation anxiety and generalized anxiety. However, its usage across countries may be questionable where the prevalence of this specific type of injury differs. This cross-sectional study compares samples from seven diverse European countries (Bulgaria, Germany, Italy, Lithuania, Netherlands, Romania, Turkey) to see if an environmental exposure, car accident death rate per 100,000 people (country-wide from WHO data), is associated with children's self-report of car accident fears. In this study, 6-11 year-old children were surveyed by a diagnostic instrument (Dominic Interactive) about several situations and asked if they believed they were similar to a fictional child depicted in said situations. Mothers were surveyed for additional sociodemographic information. Multivariable logistic regression was used to adjust for covariates including mother's age, mother's education, single parenting, and mother's professional inactivity. We report a monotonic relationship between higher car accident death rates and the prevalence of children reporting fear of parent's or own accident. Relative to a reference of 3.9 deaths per 100,000 people, children's odds of reporting fear of parent's accident ranged from 1.99 (95% CI 1.51-2.61) times to 4.84 (95% CI 3.68-6.37) times as the risk of death by car accident increased across countries. A similar result arose from fear of child's own accident, with significant ORs ranging from 1.91 (95% CI 1.53-2.40) to 2.68 (95% CI 2.07-3.47) alongside increased death rates. Given that reporting of these fears accompanies correspondingly high accident death rates, the pertinence of using fear of car accidents as an illustration for some diagnostic item for mental disorders cross-nationally appears to be an issue.

Towards a comprehensive test specification for normative adolescent fears: a conservation of resources perspective

OBJECTIVE

This study assessed the extent to which the primary tenets of Conservation of Resources theory provide an adequate basis for categorising and conceptualising normative adolescent fears.

METHOD

Initial descriptive research, using data obtained from a sample of South African adolescents (n = 163), used systematic emergent content analysis to develop a test specification (i.e., content domains and manifestations of content domains) relevant to measures of normative adolescent fears, with subsequent a priori content analyses being used to explore the content validity of the test specification with respect to the item-content of selected normative childhood and adolescent fear schedules.

RESULTS

Analyses suggest that content domains proposed by Conservation of Resources theory provide an adequate (exhaustive and mutually exclusive) basis for reliably conceptualising and categorising normative adolescent fears and for predicting the valence of specific adolescent fears.

CONCLUSIONS

A Conservation of Resources perspective was found to be of heuristic value in exploring content domains relevant to normative adolescent fears, and would appear to hold promise as a useful conceptual framework for future research in the field.

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.

What Made Sahar Scared?: Imaginary and Realistic Causes in Palestinian and American Children’s Concept for Fear

Young children associate fear with monsters, ghosts, and other imaginary creatures more than with real threats to safety, such as robbers or bullies – at least in Western societies. Cross-cultural studies are rare, are limited to older children, and have not asked if the role of the imagination extends to emotions other than fear. In this study, young Palestinian and American children (60 in each group, 3–7 years, age- and sex-matched) were asked to tell stories in which they generated a cause for fear as well as happiness, sadness, anger and surprise. Imaginary creatures were rarely cited as the cause of any emotion other than fear, but were cited frequently for fear by both Palestinians and Americans. There was also a cultural difference: Palestinians generated significantly fewer imaginary and more realistic causes for fear than did Americans. Thus, imaginary causes are a part of Palestinian children’s fear concept, but imaginary causes are not primary as they are for American children; for Palestinian children, realistic causes are primary in their fear concept.

The short form of the fear survey schedule for children-revised (FSSC-R-SF): an efficient, reliable, and valid scale for measuring fear in children and adolescents

The present study examined the psychometric properties of the Short Form of the Fear Survey Schedule for Children-Revised (FSSC-R-SF) in non-clinical and clinically referred children and adolescents from the Netherlands and the United States. Exploratory as well as confirmatory factor analyses of the FSSC-R-SF yielded support for the hypothesized five-factor structure representing fears in the domains of (1) failure and criticism, (2) the unknown, (3) animals, (4) danger and death, and (5) medical affairs. The FSSC-R-SF showed satisfactory reliability and was capable of assessing gender and age differences in youths' fears and fearfulness that have been documented in previous research. Further, the convergent validity of the scale was good as shown by substantial and meaningful correlations with the full-length FSSC-R and alternative childhood anxiety measures. Finally, support was found for the discriminant validity of the scale. That is, clinically referred children and adolescents exhibited higher scores on the FSSC-R-SF total scale and most subscales as compared to their non-clinical counterparts. Moreover, within the clinical sample, children and adolescents with a major anxiety disorder generally displayed higher FSSC-R-SF scores than youths without such a diagnosis. Altogether, these findings indicate that the FSSC-R-SF is a brief, reliable, and valid scale for assessing fear sensitivities in children and adolescents.

Child-friendly procedures and accommodations for the use of a self-report fear survey with children who have visual impairments: Reflections on a South African case study

Although the experience of childhood fear has been deemed a common phenomenon, in some cases, children’s fears can become excessive and interfere with daily functioning and activities, and may thus warrant clinical attention. It is in cases such as these that reliable and valid methods to assess childhood fears are required. Although normative fear literature describes many effective modes of assessment, these methods are not accessible to all children, and certain accommodations are necessary when assessing the fears of children with visual impairments. This article provides a reflection on a case study where the fears of 67 South African children with varying degrees of visual impairment were assessed using the South African version of the Fear Survey Schedule for Children (FSSC-SA). Aspects relating to child-friendly procedure and accommodations are discussed.

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.

Exploring the Effectiveness of the FRIENDS Program in Reducing Anxiety Symptoms Among South African Children

The prevalence of anxiety symptoms among South African children is reported to be significantly higher than in other parts of the world. The need for an effective anxiety prevention and early intervention program for use with South African children is urgently needed. The aim of the present study was therefore to determine whether the Australian FRIENDS program could effectively reduce the anxiety symptoms, as measured by the Spence Children's Anxiety scale (SCAS), among a sample of South African children from low socioeconomic background. The program evaluation employed a quasi-experimental, nonequivalent control group design that followed participants (N = 46) over a course of 10 months. Within group effects and between group effects revealed that the FRIENDS program had little statistically significant postintervention effect on the anxiety symptoms of this sample, but had significant effects in the longer term, at 4 months and 6 months follow-up. The implications of these results for the South African context 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.

The Fear Survey Schedule for Children-Revised: Normative Developmental Data in Italy

The aim of the study was to explore children's fear content. Using the Italian Fear Survey Schedule for Children, an Italian-language version of Ollendick's Fear Survey Schedule for Children–Revised (1983), the study assessed the reliability of the survey and reported intensity, prevalence, and content of fears in children aged six to 10 years, using this questionnaire. 1,845 school children (931 girls, 914 boys; M age = 8.3 yr., SD = 1.4) were asked to complete the survey, indicating what they thought were their fears, and the intensity of those fears. Sex and age differences were also examined. Girls endorsed significantly higher fearfulness than did boys. Few age differences were found, with seven-year-olds appearing more fearful than 10- to 11-year-old children. Results were interpreted in relation to developmental changes. Cross-national comparisons were discussed.

Children's fears: a survey of Italian children ages 6 to 10 years

The aim of this study was to explore children's fears. The article reports on average factor scores of a study carried out in Italy using the Fear Survey Schedule for Children (here, the "Fear Survey"; Ollendick, 1983) with normal 6- to 10-yr.-old children (931 girls, 914 boys). Participants were 1,845 children, recruited in mainstream classrooms. Respondents were asked to complete the schedule indicating their fears and the intensity of such fears. A principal components analysis yielded a four-factor structure (1: Death and Danger, 2: Injury and Animals, 3: Failure and Criticism, 4: Fear of the Unknown). Average factor scores showed significant differences across the factors and according to sex and age. Girls reported significantly higher fearfulness than boys. Age differences were found on some factors.

Exploratory and confirmatory factor analysis of the Multidimensional Anxiety Scale for Children among adolescents in the Cape Town metropole of South Africa

There are no published data on the factor structure of the Multidimensional Anxiety Scale for Children (MASC) among adolescents in the Cape Town metropole of South Africa. The objectives of this study were (i) to establish the exploratory factor structure of the MASC using a principal components exploratory factor analysis (EFA); (ii) to confirm the derived factor structure using confirmatory factor analysis (CFA); and (iii) to examine gender, age, and race effects among adolescents in the Western Cape of South Africa. A convenience sample of 1,051 adolescents was selected from nine different schools in the Cape Town metropole of South Africa. An EFA yielded a four-factor structure congruent to the factor structure established previously in other samples. Furthermore, the CFA showed that the four-factor structure fit the data well. Black participants reported significantly higher levels of Harm Avoidance than other racial groups, and Black and Coloured (mixed race) participants reported significantly higher levels of Anxious Coping than White and Asian participants. Black and Coloured participants reported significantly higher levels of Separation/Panic than White participants, and Black participants reported higher levels than Asian and Coloured participants. Finally, there were no significant age effects, but females scored significantly higher overall and on all MASC subscales. The MASC seems to be a useful tool for assessing and distinguishing anxiety symptoms among adolescents in the Cape Town metropole of South Africa.

Origins of common fears in South African children

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

DSM-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.

Weekly problems scales: instruments for sexually abused youth and their nonoffending parents in treatment

This study's purpose was to determine if efficient measures could be created to assess multiple problematic behaviors identified in youth who were sexually abused and in treatment. Because of the lack of easily administered brief instruments that assess multiple domains of interest in this population, complementary parent and child assessment measures were developed. The Weekly Problems Scale-Child Version (WPSC) and the Weekly Problems Scale-Parent Version (WPS-P) were created to monitor the weekly progress of the child and family in treatment and focus specifically on common areas of difficulties in this population. Exploratory factor analysis was conducted to assist in identifying the number of underlying dimensions in the scales. Results indicate that the WPS-C and WPS-P demonstrate adequate internal consistency, temporal stability, and construct validity. The WPS-C and WPSP display significant promise as research and clinical assessment tools for use with youth who are sexually abused and their nonoffending parents in treatment.