Family-based activity settings of children in a low-income African context

IsiZulu-speaking caregivers' perceptions of child language stimulation

BACKGROUND

 South African children from low-income households are at higher risk of cognitive-linguistic difficulties because of multiple risk factors. Early language stimulation minimises the effects of risk factors and prepares children for literacy and learning. Understanding caregivers' perceptions of language stimulation is important because perceptions shape practices, which determine child language outcomes.

OBJECTIVES

 This study explored the existing perceptions of language stimulation among 15 isiZulu-speaking caregivers from KwaDabeka township.

METHOD

 A qualitative, descriptive research design was adopted and the caregivers were interviewed using a semi-structured interview schedule. The NVivo software programme supported the inductive, thematic analysis of the data.

RESULTS

 Although the caregivers held positive perceptions of language stimulation, their perceptions of benefit focussed on meeting children's basic physiological needs with less reference to the long-term benefits for literacy, employment and social integration. Providing language models, watching television, singing songs, and reading books were perceived to be examples of language-stimulating activities and techniques. The caregivers expressed a need to improve their knowledge of language stimulation and queried how they could be supported to achieve this outcome.

CONCLUSION

 This group of caregivers needed support to increase their awareness of the long-term benefits of language stimulation and their knowledge and use of evidence-based activities, stimuli and facilitation techniques.Contribution: Caregivers' existing perceptions could serve as a barrier to the effective language stimulation of children from low-income households in South Africa.

Caregivers' perspectives of early developmental tele-assessments in challenging circumstances

BACKGROUND

 Outbreaks, such as the COVID-19 pandemic in 2020, exacerbate barriers to accessing early childhood developmental care. Tele-assessment may serve as an innovative approach to developmental monitoring to overcome service delivery amidst challenging circumstances. It is vital to collect caregivers' perspectives of this potential service delivery method to inform clinical decision making.

OBJECTIVES

 This study aimed to determine caregivers' perspectives of interview-based early developmental tele-assessment in a South African context.

METHOD

 Thirty caregivers of children (aged birth - 36 months) completed a caregiver-report developmental assessment via a telecommunications platform, as well as an online questionnaire probing their perspectives on the tele-assessment.

RESULTS

 Most participants (96.7%, n = 29 out of 30) rated their overall experience of the tele-assessment as positive; however, 53.8% (n = 14 out of 26 that answered the question) indicated that they would additionally still prefer in-person assessment.

CONCLUSION

 Tele-assessment appears to be a viable approach for caregivers to access developmental care during circumstances such as COVID-19.Contribution: This study provided valuable insight into a novel approach using interview-based early developmental tele-assessment and the perspectives of caregivers thereof.

The contributions of grandparents to preadolescent grandchildren's social skills in rural Malaysia

This study aimed to generate localized knowledge by investigating the perceptions and experiences of preadolescent grandchildren and grandparents regarding grandparenting and intergenerational interactions and how these processes were related to the social skills of preadolescents from three ethnic groups in Malaysia. Using a concurrent quantitative-qualitative mixed method research design, Chinese, Malay, and Indian preadolescents (N = 465; ages 9-12 years old; M = 10.27 years; SD = 1.03) from rural areas in Malaysia completed a self-administered quantitative survey; furthermore, 25 grandparents participated in one-on-one interviews. Survey findings showed that preadolescent grandchildren who reported higher grandparental warmth and support had greater social skills, mediated by positive grandparent-grandchildren (GP-GC) relationships. The GP-GC relationship and preadolescent social skills association was stronger for skipped generation compared to three-generation households. Interview findings revealed that grandparents expressed unconditional love and autonomy support in their grandparenting roles by guiding and encouraging their preadolescent grandchildren to make decisions. The GP-GC interactions served as a dynamic force in promoting preadolescents' social skills. By employing a decolonized approach and drawing on the lived experiences of grandparents from three ethnic backgrounds in rural Malaysia, the study provided an understanding of grandparenting practices and their general implications across the three ethnic groups. The interview responses highlighted both commonalities and specificities in grandparenting practices and relationship dynamics shaped by religious, class, and sociocultural dimensions in rural Malaysia.

Parental perspectives on the impact of screen time on the language skills of typically developing Indian children

PURPOSE

The overuse of screen-based devices results in developmental problems in children. Parents are an integral part of the children's language development. The present study explores the parental perspectives on the impact of screen time on the language skills of typically developing school-going children using a developed questionnaire.

METHODS

192 parents of typically developing children between 6 and 10 years of age participated in the study. Phase 1 of the study included the development of a questionnaire targeting the impact of screen devices on language development. The questionnaire was converted into an online survey and was circulated among the parents in Phase 2. Descriptive statistics were performed on the retrieved data and a chi-square test was done to determine the association between the use of screen devices across all language parameters.

RESULTS

Parents reported television and smartphones to be the most used type of device, with a large proportion of children using screen-based devices for 1-2 hours per day. Most parents reported children prefer watching screens mainly for entertainment purposes, occasionally under supervision, without depending on them as potential rewards. The impact of screen-based devices on language skills has been discussed under the semantics, syntax, and pragmatic aspects of language.

CONCLUSION

The findings of this study will help identify the existing trends in the usage of screen-based devices by children, thereby identifying potential contributing factors towards language delays. This information will also benefit in parental counselling during the interventional planning of children with language delays.

Infant screen media and child development: A prospective community study

The current study examined longitudinal associations between early screen media exposure (assessed at 6, 12, and 24 months) and the child's motor and language/communication development at the ages of 24 and 36 months. We also aimed to study whether these associations varied by socioeconomic status (SES). Participants were 179 parent-infant dyads, recruited from well-baby clinic services during routine visits. Child development measures included standardized measures of developmental milestones as assessed by professionals and referral data to child developmental centers. Both measures were retrieved from the official health maintenance organization records by an expert in child development. Results indicated that screen exposure at 6 and 12 months was associated with a higher risk for language/communication deficits at 36 months in children with moderate or high SES but not in children with low SES. Our findings are consistent with existing literature demonstrating cross-sectional and longitudinal associations between early screen exposure and language development deficits. Given that media use practices and motivations vary among families from different backgrounds, further investigation of the interaction between SES and screen exposure is needed.

Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines

BACKGROUND

 Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT's fit or what adaptations might be needed to improve its applicability within a resource-constrained setting.

OBJECTIVES

 To explore stakeholders' perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT's contextual fit.

METHOD

 We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components.

RESULTS

 Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families' available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa.

CONCLUSION

 Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.

The Relationship between Language and Technology: How Screen Time Affects Language Development in Early Life-A Systematic Review

Screen time refers to the amount of time a child is exposed to a screen, that is, television, computer, smartphone, or any other digital medium. Prolonged screen time in the first years of life may affect a child's cognitive abilities, especially language acquisition. A systematic review was conducted, following the PRISMA-P guidelines, with the aim to explore the available literature relating to the impact of screen time on children's language development. This review identified 18 articles. The articles reviewed showed that prolonged screen time and exposure to screens in the first 2 years of life can negatively affect language development and communication skills, in terms of comprehension and vocabulary range. In addition, overexposure to screens in the early years can affect overall cognitive development, especially attention to environmental stimuli, social experiences, problem solving, and communication with others, e.g., the alternance of rhythms and roles in a conversation. In conclusion, our systematic review supports the idea that preschool screen time has negative effects on children's cognitive and language development. Television seems to be the medium most detrimental to children's skills, as it is used in a passive manner and is often characterised by language and content that do not suit the child's processing mode. Future studies should increasingly focus on the digital media that children possess at an early age, such as mobile phones and tablets, and on how children relate to the online world, such as social networks.

Resilience to depression: the role of benevolent childhood experiences in a South African sample

Background

Studies elsewhere show that benevolent childhood experiences (BCEs) have protective mental health value. However, this protective value has never been investigated in an African context. Given the need to better understand what might support mental health resilience among African young people, this study explores the relationship between BCEs and depressive symptoms among a South African sample of young adults living in a community dependent on the economically volatile oil and gas industry.

Methods

A sample of young adults in an oil and gas community in South Africa (N = 313, mean age 20.3 years, SD = 1.83, range from 18 to 26; majority Black African) completed self-report questionnaires to assess BCEs and depressive symptoms (Beck Depression Inventory-II). The analysis controlled for socio-demographics and experience of family adversity. Multinomial logistic regressions were used to examine the association of BCEs with depressive symptoms using STATA 17.

Results

The majority (86.4% of the sample) reported all 10 BCEs. Of the 10 BCEs, having at least one good friend was the most reported (94%) compared to 75% of the sample reporting having a predictable home routine, such as regular meals and a regular bedtime. The unadjusted multinomial logistic regression analysis indicated that having at least one good friend, comforting beliefs, and being comfortable with self were associated with lower odds of moderate depression. The adjusted results showed no association between BCEs and the depression of young adults in this sample.

Conclusion

In this South African sample, our results do not show protective associations between BCEs and depression. This could be as a result of the homogeneity in our sample. It is also possible that the BCEs explored could not counteract the effect of chronic risk factors in the lives of the young people in this study context. Further research is needed to understand this complexity.

mHealth developmental screening for preschool children in low-income communities

Children are often only identified with a developmental delay when they enter primary school due to developmental delays hindering academic progress. Detection of at-risk children in low-income communities is typically unavailable due to several challenges. This study validated an mHealth-based developmental screening tool as a potential time- and cost-effective way of delivering services for preschool children. This cross-sectional within-subject study screened 276 preschool children from low-income communities using the mHealth Parents' Evaluation of Developmental Status (PEDS) tools. The mHealth PEDS tools' performance was then evaluated by comparing caregiver concerns according to the PEDS tools with results obtained using a reference standard assessment tool, the Vineland-3. The mHealth PEDS tools identified 237 (85.9%) of children at risk of developmental delay compared to 80.1% (n = 221) of children identified with a developmental delay using the Vineland-3. Sensitivity of the PEDS tools was high (92.6%) with low specificity (22.5%) using US standardised criteria. Literacy skills were found to be most delayed, according to the PEDS: DM (89.3%; n = 142) and Vineland-3 (87.1%; n = 134). Low specificity of the prescribed criteria may require the implementation of adapted referral criteria within low socio-economic status (SES) settings. The mHealth PEDS tools may still be valuable for preschool developmental surveillance of children within low SES settings. It is recommended, however, that children who are identified with a developmental concern undergo a second screen to reduce false positives.

A model for cross-cultural translation and adaptation of speech-language pathology assessment measures: Application to the Focus on the Outcomes of Communication Under Six (FOCUS©)

PURPOSE

In the absence of a gold standard, this study illustrates the process involved in the cross-cultural translation and adaptation of the FOCUS^© and its shortened version, FOCUS-34^© (the Parent Form and Instruction Sheet, as well as the Clinician Form and Instruction Sheet), while also determining the social validity and clinical applicability of the translated measure. The target language used as example was Afrikaans, one of the 11 official languages of South Africa.

METHOD

A two-phase cross-cultural translation model was employed in which Phase 1 (comprising a six-step blind back-translation procedure) was sequentially followed by Phase 2 (social validation and clinical applicability of the measure, using focus groups with stakeholders).

RESULT

The extensive process followed in Phase 1 resulted in a clear and appropriate translation acceptable to both stakeholder groups (parents and speech-language pathologists). Both groups questioned the meaning of certain concepts, explored cultural differences and requested the extension of some items. Parents also shared their emotional reactions towards assessment, while therapists focussed on editorial changes to the measures.

CONCLUSION

A framework is proposed for cross-cultural translation and adaptation of assessment measures with suitability in the speech-language pathology discipline.