April 15, 2014
Researchers Identify Children With Emotional Behavior Difficulties
Diagnostic tool easily accessible and administered by lay people in South Africa
Research on children orphaned by HIV/AIDS in South Africa may provide insight on how to identify and help children with emotional behavior issues in other areas of the world, which may have limited access to healthcare and further research that could lead to successful interventions.A report on the global AIDS epidemic published by the United Nations mentions that due to the HIV/AIDS pandemic, which has left 12 million children orphaned in Sub-Saharan African, children are at an increased risk for mental health problems.
"There has been a big push to understand what we can do to help these kids, but also how to identify these children in the community," said Carla Sharp, a native of South Africa and an associate professor of clinical psychology and director of the Developmental Psychopathology Lab at the University of Houston.
"Part of the challenge is that there are four psychologists per 100,000 people in South Africa and .03 psychiatrists per 100,000 people. Individuals that are typically trained to help with mental health needs in the community are not available, and the few people who are available are often not culturally aware."
Sharp serves as principal investigator for a $951,147 grant funded by the National Institutes of Health (NIH), titled, "Emotional-behavior disorders in South African children affected by AIDS." The goal of the research study is to develop a reliable and valid diagnostic tool for the early detection of psychiatric disorder as a first step toward successful intervention.
The three-year cross-sectional study adapted two measures for the South African context, a clinical diagnostic interview and questionnaire using multiple informants (caregiver, teacher and self-report), to collect 750 interviews from children, ages 7 to 11 years old, which included 250 children orphaned by AIDS, 250 orphaned by other means and 250 non-orphaned.
"We wanted to look at a few factors, such as accessibility and feasibility of using the diagnostic measure in an educational context, substance use among caregivers and poverty among the three (orphaned) groups to see if there's anything special to being a child orphaned by AIDS – because they're lots of things going on like desertion, or parents dying in accidents or violence, " said Sharp.
Sharp notes the findings of the research study indicated poverty may wash out any of the effects between the children, "…so it almost doesn't matter if the children are orphaned by AIDS, they are going to be at risk for emotional and behavioral problems anyway because they are so poor."
What Sharp found through the study was the diagnostic tool to identify children with emotional behavior disorders that she thought would be used by teachers in schools for intervention was too complicated to work in the educational system.
"A more strategic point of intervention is to work with community-based organizations (CBO), often run by women in the community who themselves may be HIV-positive, poor, uneducated, mostly. But these organizations take these orphans in after school because of their problems at home, and they come and get a meal at the CBO," said Sharp. "We discovered these CBOs are highly motivated to work with us for intervention purposes, but beyond giving them a meal they don't know what to do with them."
The follow-up study Sharp plans to conduct is an intervention to help CBO care workers develop skills to respond to the emotional and cognitive needs of the children.
"Now, there is a validated population-based screen and an interview-based measure that can be done to help identify children," said Sharp. "What's lacking is the translation into actually using the research findings. I think there will need to be further research to see what are the barriers stopping people from using these assessment tools in all these settings they work in," said Sharp.
"The other problem that exists in South Africa, as well as here, is that once you've identified children with emotional behavior problems, then what do you do with them? That's the next step. It's all good and well if you are identifying them. That's what we are looking at now, but I don't think CBOs and church-based organizations always know how to intervene with kids if they were able to identify them."
She is currently working on and researching interventions that can be adapted for community-based interventions and address the needs of identified children.
The research team included professor Lochner Marais, the Centre for Development Support at the University of Free State, in conjunction with Donald Skinner, director of the Research on Health and Society at the University of Stellenbosch. Marais and Molefi Lenka led a team of four fieldworkers in South Africa.
Sharp earned her Ph.D. from the University of Cambridge and has received early career awards, including a National Alliance for Research on Schizophrenia and Depression's Young Investigator Award and the University of Houston Research Excellence Award. She has received research grants for her work on psychological disorders in children and adolescents from the National Institutes of Health and various agencies.
She is a prolific writer, having extensively published papers and book chapters. She is lead editor of "Social Cognition and Developmental Psychopathology" and co-author of "Midbrain Mutiny: The Picoeconomics and Neureconomics of Disordered Gambling" and the upcoming "Handbook of Borderline Personality Disorder in Children and Adolescents" (May 31, 2014).
She also serves as director of research for The Menninger Clinic's Adolescent Treatment Program and principal investigator of The Menninger's adolescent outcomes project.
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