Faculty of Health Sciences
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Item The adolescent HIV executive function and drumming (AHEAD) study, afeasibility trial of a group drumming intervention amongst adolescents with HIV(2023-04-11) Kirsten Rowe; Julia Ruiz Pozuelo; Alecia Nickless; Absolum David Nkosi; Andeline Dos Santos; Kathleen Kahn; Stephen Tollman; Ryan G Wagner; Gaia Scerif; Alan SteinAHEAD feasibility trial assessed the feasibility and acceptability of an 8-session group drummingprogramme aiming to improve executive function, depression and anxiety symptoms, andperceived social support in adolescents living with HIV in a rural low-income South Africansetting. Sixty-eight 12- to 19-year-old adolescents participated. They were individuallyrandomised. The intervention arm (n= 34) received weekly hour-long group drumming sessions.Controls (n= 34) received no intervention. Feasibility and acceptability were assessed usingrates of: enrolment; retention; attendance; logistical problems; adolescent-reportedacceptability. Secondary measures included:five Oxford Cognitive Screen-Executive Function(OCS-EF) tasks; two Rapid Assessment of Cognitive and Emotional Regulation (RACER) tasks; theSelf-Reporting Questionnaire-20 (SRQ-20) measuring depression and anxiety symptoms; theMultidimensional Scale of Perceived Social Support (MSPSS). All feasibility criteria were withingreen progression limits. Enrolment, retention, and acceptability were high. There was a positiveeffect on adolescent depressed mood with signal for a working memory effect. There were nosignificant effects on executive function or socio-emotional scales. Qualitativefindingssuggested socio-emotional benefits including: group belonging; decreased internalised stigma;improved mood; decreased anxiety. Group drumming is a feasible and acceptable interventionamongst adolescents living with HIV in rural South Africa. A full-scale trial is recommended.Item Executive function and pre-academic skills in preschoolers from South Africa(2023-08-25) Caylee J. Cook; Steven Howard; Gaia Scerif; Rhian Twine; Kathleen Kahn; Shane Norris; Catherine DraperBackground: While there is now considerable evidence in support of a relationship between executive function (EF) and academic success, these findings almost uniformly derive from Western and high-income countries. Yet, recent findings from low- to middle-income countries have suggested that patterns of EF and academic skills differ in these contexts, but there is little clarity on the extent, direction and nature of their association. Aim: This study aimed to investigate the contribution of EF to pre-academic skills in a sample of preschool children (N = 124; Mage = 50.91 months; 45% female). Setting: Two preschools were recruited from an urban setting in a community with both formal and informal housing, overcrowding, high levels of crime and violence, and poor service delivery. Three preschools were recruited from rural communities with household plots, a slow rate of infrastructure development, reliance on open fires for cooking, limited access to running water and rudimentary sanitation. Methods: Pre-academic skills were assessed using the Herbst Early Childhood Development Criteria test, and EF was assessed using the Early Years Toolbox. Results: Although EF scores appeared high and pre-academic skills were low (in norm comparisons), EF inhibition (ß = 0.23, p = 0.001) and working memory (ß = 0.25, p < 0.001) nevertheless showed strong prediction of pre-academic skills while shifting was not significant. Conclusion: While EF is an important predictor of pre-academic skills even in this low- and middle-income country context, factors in addition to EF may be equally important targets to foster school readiness in these settings. Contribution: The current study represents a first step towards an understanding of the current strengths that can be leveraged, and opportunities for additional development, in the service of preparing all children for the demands of schoolItem Executive function and pre-academic skills in preschoolers from South Africa(2023-08-25) Caylee J. Cook; Steven Howard; Gaia Scerif; Rhian Twine; Kathleen Kahn; Shane Norris; Catherine DraperBackground: While there is now considerable evidence in support of a relationship between executive function (EF) and academic success, these findings almost uniformly derive from Western and high-income countries. Yet, recent findings from low- to middle- income countries have suggested that patterns of EF and academic skills differ in these contexts, but there is little clarity on the extent, direction and nature of their association. Aim: This study aimed to investigate the contribution of EF to pre-academic skills in a sample of preschool children (N = 124; Mage = 50.91 months; 45% female). Setting: Two preschools were recruited from an urban setting in a community with both formal and informal housing, overcrowding, high levels of crime and violence, and poor service delivery. Three preschools were recruited from rural communities with household plots, a slow rate of infrastructure development, reliance on open fires for cooking, limited access to running water and rudimentary sanitation. Methods: Pre-academic skills were assessed using the Herbst Early Childhood Development Criteria test, and EF was assessed using the Early Years Toolbox. Results: Although EF scores appeared high and pre-academic skills were low (in norm comparisons), EF inhibition (ß = 0.23, p = 0.001) and working memory (ß = 0.25, p < 0.001) nevertheless showed strong prediction of pre-academic skills while shifting was not significant. Conclusion: While EF is an important predictor of pre-academic skills even in this low- and middle-income country context, factors in addition to EF may be equally important targets to foster school readiness in these settings. Contribution: The current study represents a first step towards an understanding of the current strengths that can be leveraged, and opportunities for additional development, in the service of preparing all children for the demands of school.Item Validation of Oxford Cognitive Screen: Executive Function (OCS-EF), a tablet-based executive function assessment tool amongst adolescent females in rural South Africa(2021) Kirsten Rowe; Mihaela Duta; Nele Demeyere; Ryan G. Wagner; Audrey Pettifor; Kathleen Kahn; Stephen Tollman; Gaia Scerif; Alan SteinShort, reliable, easily administered executive function (EF) assessment tools are needed to measure EF in low- and middle-income countries, particularly in sub-Saharan Africa given the prevalence of human immunodeficiency virus (HIV)-associated neurocognitive disorder. We administered Oxford Cognitive Screen—Executive Function (OCS-EF) to 932 rural South African females (mean age 19.7 years). OCS-EF includes seven tasks: two hot inhibition tasks (a modified Iowa Gambling Task, emotional go/no-go) and five cool EF tasks, two switching tasks (visuospatial rule-finding, geometric trails) and three working memory tasks (digit recall, selection and figure drawing). We performed confirmatory factor analysis testing whether a three-factor, two-factor hot-cool, two-factor working memory and inhibition/switching, or one-factor EF model fitted the data better. The three-factor (switching, inhibition and working memory) model had the best local and global fit (χ2 (11) 24.21, p = 0.012; RMSEA 0.036; CFI 0.920; CD 0.617). We demonstrated the feasibility of OCS-EF administration by trained laypeople, the tripartite structure of EF amongst adolescent females and the factorial validity of OCS-EF in this population and context. OCS-EF tablet-based cognitive assessment tool can be administered by trained laypeople and is a valid tool for assessing cognition at scale amongst adolescents in rural South Africa and similar environments.