A case of effective single-session treatment for attention deficit and learning problems in a routine clinical practice : the value of a transdiagnostic approach to case formulation

This article reports a systematic clinical case study of the psychological assessment and treatment of Daniel (9), a coloured South African boy with a diagnosis of attention deficit hyperactivity disorder (ADHD) (inattentive type). The case is of scientific interest because: (1) there was only a single treatment session, in which contingency management training was delivered to Daniel’s parents and teacher; (2) there was evidence for the effectiveness of the intervention immediately and at two-year follow-up; (3) it documents the transportability to a South African context of an intervention developed by overseas research; (4) it documents the central role of case formulation in the delivery of effective psychological interventions; and (5) although Daniel met the criteria for ADHD, he also displayed symptoms of depression and social anxiety and the case supports the use of a transdiagnostic approach to case formulation. The conscientiousness with which his parents and teachers applied the programme was a major factor in the effectiveness of the intervention, and such rapid impact would not be possible where parents and teachers are unavailable or not co-operative. The publication of systematic case studies such as this one is important for the development of a local evidence-based practice in South Africa

Cerebral damage in diving: Taking the cue from sports concussion medicine

Within the compressed gas diving arena there is a risk of cerebral damage with deleterious neuropsychological sequelae in association with decompression illness (DCI), hypoxia, gas toxicity, as well as the cumulative subclinical effect of ‘silent’ paradoxical gas embolisms, the last being an area of growing concern. However, within diving medicine there is little evidence of the regular use of neuropsychological evaluation to monitor brain-related sequelae of frequent diving activity. In contrast, in recent years there has been an explosion of interest in the management of sports concussive injury, including emphasis on the pivotal role ofneuropsychological evaluation within that context. Taking the cue from sports concussion medicine, it is proposed that there is an urgent need to incorporate neurocognitive baseline and follow-up screening as a core component in the medical management of those involved in intensive commercial and recreational compressed air diving activities. The objective would be to facilitate (i) accurate neurodiagnostic follow-up of frank DCI or an identifiable hypoxic or toxic incident; (ii) timeous identification of cumulative deleterious effects of repetitive subclinical hypoxic/toxic incidents and/or ‘silent’ paradoxical gas embolisms that might affect them in later life; and (iii) disability assessment following any such eventsor the combination thereof for rehabilitation and compensation purposes

Effects of digital chatbot on gender attitudes and exposure to intimate partner violence among young women in South Africa

Background South Africa has among the highest rates of intimate partner violence (IPV) globally, with young women at heightened risk due to inequitable gender roles, limited relationship skills, and inadequate social support. Despite an urgent need for violence prevention in low- and middle-income settings, most efficacious approaches are time-intensive and costly to deliver. Digital, interactive chatbots may help young women navigate safer relationships and develop healthier gender beliefs and skills Methods Young women (18–24 years old) across South Africa were recruited via Facebook for participation in an individually randomised controlled trial (n = 19,643) during the period of June 2021-September 2021. Users were randomly allocated, using a pipeline algorithm, to one of four trial arms: Pure Control (PC) had no user engagement outside of study measures; Attention Treatment (T0) provided didactic information about sexual health through a text-based chatbot; Gamified Treatment (T1) was a behaviourally-informed gamified text-based chatbot; Narrative Treatment (T2) was a behaviourally-informed drama delivered through pre-recorded voice notes. All chatbots were delivered in WhatsApp, through which users were invited to complete brief “quizzes” comprising adapted versions of validated scales. Primary outcomes were short-form adaptations of scales for gender attitudes (Gender Relations Scale) and past-month IPV (WHO Multi-country Study Instrument). Secondary outcomes were identification of unhealthy relationship behaviours (Intimate Partner Violence Attitudes Scale) and brief screener for depressive symptoms (Patient Health Questionnaire). A direct chat link to a trained counsellor was a safety measure (accessed by 4.5% of the sample). We estimated treatment effects using ordinary least squares and heteroskedasticity robust standard errors Findings The trial retained 11,630 (59.2%) to the primary endpoint of gender attitudes. Compared to control, all treatments led to moderate and significant changes in attitudes towards greater gender equity (Cohen’s D = 0.10, 0.29, 0.20 for T0, T1, and T2, respectively). The gamified chatbot (T1) had modest but significant effects on IPV: 56% of young women reported past-month IPV, compared to 62% among those without treatment (marginal effects = -0.07, 95%CI = -0.09to-0.05). The narrative treatment (T2) had no effect on IPV exposure. T1 increased identification of unhealthy relationship behaviours at a moderate and significant level (Cohen’s D = 0.25). Neither T1 nor T2 had a measurable effect on depressive symptoms as measured by the brief screener. Interpretation: A behaviourally-informed, gamified chatbot increased gender equitable attitudes and was protective for IPV exposure among young women in South Africa. These effects, while modest in magnitude, could represent a meaningful impact given potential to scale the low-cost intervention

Effects of digital chatbot on gender attitudes and exposure to intimate partner violence among young women in South Africa.

BackgroundSouth Africa has among the highest rates of intimate partner violence (IPV) globally, with young women at heightened risk due to inequitable gender roles, limited relationship skills, and inadequate social support. Despite an urgent need for violence prevention in low- and middle-income settings, most efficacious approaches are time-intensive and costly to deliver. Digital, interactive chatbots may help young women navigate safer relationships and develop healthier gender beliefs and skills.MethodsYoung women (18-24 years old) across South Africa were recruited via Facebook for participation in an individually randomised controlled trial (n = 19,643) during the period of June 2021-September 2021. Users were randomly allocated, using a pipeline algorithm, to one of four trial arms: Pure Control (PC) had no user engagement outside of study measures; Attention Treatment (T0) provided didactic information about sexual health through a text-based chatbot; Gamified Treatment (T1) was a behaviourally-informed gamified text-based chatbot; Narrative Treatment (T2) was a behaviourally-informed drama delivered through pre-recorded voice notes. All chatbots were delivered in WhatsApp, through which users were invited to complete brief "quizzes" comprising adapted versions of validated scales. Primary outcomes were short-form adaptations of scales for gender attitudes (Gender Relations Scale) and past-month IPV (WHO Multi-country Study Instrument). Secondary outcomes were identification of unhealthy relationship behaviours (Intimate Partner Violence Attitudes Scale) and brief screener for depressive symptoms (Patient Health Questionnaire). A direct chat link to a trained counsellor was a safety measure (accessed by 4.5% of the sample). We estimated treatment effects using ordinary least squares and heteroskedasticity robust standard errors.FindingsThe trial retained 11,630 (59.2%) to the primary endpoint of gender attitudes. Compared to control, all treatments led to moderate and significant changes in attitudes towards greater gender equity (Cohen's D = 0.10, 0.29, 0.20 for T0, T1, and T2, respectively). The gamified chatbot (T1) had modest but significant effects on IPV: 56% of young women reported past-month IPV, compared to 62% among those without treatment (marginal effects = -0.07, 95%CI = -0.09to-0.05). The narrative treatment (T2) had no effect on IPV exposure. T1 increased identification of unhealthy relationship behaviours at a moderate and significant level (Cohen's D = 0.25). Neither T1 nor T2 had a measurable effect on depressive symptoms as measured by the brief screener. Interpretation: A behaviourally-informed, gamified chatbot increased gender equitable attitudes and was protective for IPV exposure among young women in South Africa. These effects, while modest in magnitude, could represent a meaningful impact given potential to scale the low-cost intervention

Does positive behaviour facilitate self-concept or does positive self-concept facilitate behaviour?

The study examines whether students’ prior behaviour influences subsequent academic self-concept or prior self-concept influences subsequent behaviour at school. Students (N=774) from primary (3rd to 6th grades) and secondary students (7th to 10th grades) were asked to respond to survey items at two time points, 10 months apart. Two behaviour-related factors were Knowledge (knowing school rules) and Behaviour (following school rules). Two self-concept factors were Competence (sense of competence in schoolwork) and Affect (liking schoolwork). Confirmatory factor analysis supported an 8-factor model with the same four factors measured at two time points (T1, T2). Structural equation modelling found that in the light of strong association between parallel factors across time points, the paths from T1 Affect had noteworthy additional influences on T2 factors, although the paths were stronger for primary than secondary students. For primary students, T1 Knowledge had additional influences on T2 Competence, but this path was not significant for secondary students. It seems that both knowledge of rules and academic self-concept tend to be mutually reinforcing each other in primary education, such that both behaviour and self-concept should be attended to for primary students’ benefit. For secondary students, given the consistently stronger association between parallel factors across T1 and T2, it seems that positive gains in both behaviour and self-concept are harder to obtain. For both primary and secondary students, the consistently strong paths from T1 Affect to both behaviour and self-concept factors at T2 indicate that enabling students to enjoy schooling may be the key to success in facilitating both behaviour and self-concept

Positive behavior interventions : The issue of sustainability of positive effects

During the last decade, positive behavior interventions have resulted in improvement of school behavior and academic gains in a range of school settings worldwide. Recent studies identify sustainability of current positive behavior intervention programs as a major concern. The purpose of this article is to identify future direction for effective implementation of positive behavior interventions based on a comprehensive review of the current status of positive behavior interventions in terms of sustainability. The review will also examine implementation fidelity, as a factor that impacts upon sustainability. Literature reviewed in this study demonstrates that administrator support and professional development were the most frequently cited influential factors in previous research on sustainability of positive behavior interventions. In particular, the review highlights the significance of implementation fidelity at the classroom level for sustaining positive outcomes of positive behavior interventions over time. It is argued that in order to sustain positive effects of positive behavior intervention, future implementation efforts need to emphasize administrator support for the school team, ongoing high-quality professional development, and technical assistance. Moreover, a focus on coaching classroom-level implementation fidelity is of significant importance, as is the development and validation of evaluation tools for sustainability based on large-scale longitudinal international studies and more in-depth qualitative investigations