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Background: Intellectual Disability (ID) is important and has a major impact on life, quality of life, mental illness, economic and educational well-being. Little research has taken place in Africa about ID. One of the key challenges is to identify appropriate, useful, and free screening tools that might identify those at risk of ID both for clinical purposes and for prevalence studies. One tool that has been used to investigate the broad category of 'disability' (which includes ID) is the Ten Questions Questionnaire (TQQ). The TQQ has given some rates of 'disability' in lowand middle-income countries (LMICS) in the order of 10-25%. However, no further dissection of ID within the broader category of 'disability' has been performed given that the TQQ was not developed with ID in mind. The Wessex Behavioural Schedule (WBS) is a UK screening tool for functional ability for adults with ID, and therefore seemed an appropriate candidate instrument to evaluate for potential use in Africa. However no psychometric data for the tool were available and no clinical cut-off scores for ID had ever been developed. A broader project using the WBS in Khayelitsha, a township area in Cape Town, South Africa, generated a prevalence rate of 19% 'disability'. The purpose of this study was to explore the psychometric properties of WBS to determine its suitability for use in children and adolescents in a South African setting, and to generate clinical cut-offs to define ID. Methods: The study consisted of a secondary analysis of the data from the broader Khayelitsha prevalence study, which was a cluster randomized door-to-door household survey in Khayelitsha using the WBS. Firstly, data were used to evaluate the internal consistency and to perform factor analysis of the WBS. Secondly, the Minimal Difference Perceived 75% of time (MDP75) approach was used on a subset of 100 randomly selected participants to generate an intellectual disability cut-off score for the WBS. Results: Data were available on 452 children and adolescents aged 5-18 years. The mean age was 10.3 (SD 3.9), 54% were female, over 90% were in school, and 53% had a mother as primary carer. The WBS had good internal consistency (alpha = 0.80) and all items appeared to be worthy of retention. Exploratory factor analysis suggested the WBS to be a multidimensional scale composed of four subscales: conceptual abilities, practical skills, sensory abilities and continence. Even though four expert raters were used for the MDP75 calculation, inter-rater reliability was low-58% (Fleiss kappa = 0.08). It was therefore not deemed appropriate to proceed to further analysis to determine the MDP75 and cut-off values for the WBS. Possible reasons for low inter-rater reliability suggested by the raters included age-based expectations, inclusion of physical disabilities, limited information to make a diagnosis of ID contained in the WBS, and the need to take environmental factors into consideration. Conclusion: The good internal consistency and factor analysis structure of the WBS was encouraging, but the low inter-rater reliability brought into question the usefulness of the WBS in a child and adolescent age group. Whilst the WBS may remain useful in an adult age range, we recommend that a more developmentally-sensitive measure be sought or developed as a screening tool for ID. Keywords: Wessex Behavioural Schedule, children and adolescents, intellectual disability, Khayelitsha

Background: Adults who have an intellectual disability (ID) often continue to live with their parents long after their siblings have left home. While an increasing body of research has described positive parental experiences, research has also found that parents of adults who have ID and behavioural difficulties are more vulnerable to develop parental stress and depression. Aggression is one of the most difficult forms of problem behaviours to manage and could have a negative impact on the parent-child relationship, the child's social inclusivity and the psychological well-being of parents. Method: A case-based psychotherapy design was used to explore maternal experiences among mothers of adults with ID and aggression who access a specialised mental health service in Cape Town. Psychotherapy was used with six participants to attempt to reduce parental stress and other negative psychological states. In an area of research that has received scant attention in South Africa, the study extensively describes the psychotherapy process and the role of contextual factors in the lives of the participating mothers. The study used a mixed methods design which included psychometric measurements that were conducted at various intervals of intervention. Thematic analysis was used in all the case studies and interviews were scheduled before and after completing psychotherapy. External credibility was enhanced through the use of different qualitative strategies that included peer supervision and reflexivity. Findings: Besides elevated parental stress, the majority of participants presented with symptoms of depression and other mental health problems that varied according to their individual profiles. Although parental stress showed a discernible relationship with the child's behavioural difficulties, other significant life stressors contributed to maternal stress and depressive symptoms. Psychotherapy produced only modest improvement of parental stress among some of the participants. However, therapeutic input appeared to be more effective in reducing depressive symptoms among the majority of mothers. Critical reflection and discussion are centred on the clinical implications and meaning of findings on a psychological level.

Includes abstract., Includes bibliographical references., The Autism Spectrum Disorders(ASD) are a group of neurobiological conditions of growing prevalence for which there is no known cure. International prevalence studies have determined that children and adolescents with ASD are a highly medicated population. This comes to light in the context of a paucity of data around the efficacy of commonly prescribed medications. There is no data around the prevalence of medication use in the ASD population in South Africa. The aim of this study is to determine the prevelance and patterns of medication use in children and adolescents with ASD in the Western Cape and to determine the relationship between demographic variables and behaviours and medication use.

The aims of this study were i) to evaluate the domains of language production, comprehension and naming in children with moderate or heavy prenatal exposure to alcohol, and ii) to determine if these domains are a specific weakness in these children. The study compared 25 children with FASD to 25 typically developing non-alcohol exposed controls on four language measures; (1) the Clinical Evaluation of Language Fundamentals Revised; (2) the Test of Reception of Grammar- Version II; (3) the Cookie Jar Theft Picture test and; (4) the Boston Naming test.

Includes bibliographical references (leaves 54-59)., Central nervous system involvement contributes significantly to the morbidity and mortality of paediatric HIV infection. The spectrum of CNS morbidity varies from minor developmental disabilities to severe, progressive encephalopathy. Therefore regular developmental evaluation should be regarded as an essential component of the overall care of HIV-infected children. Antiretroviral therapy may arrest or even reverse neurocognitive and motor deficits associated with HIV infection.

In the past two decades major focus has been placed on child's rights, survival and development. This has occurred both on an international level and, since the inception of the Government of National Unity (GNU) in South Africa, nationally, provincially and locally through various development programmes. Development in a child concerns the sequential acquisition of cognitive, motor and social skills. Adverse biological and environmental factors will have a major negative impact on a child's development. It is therefore crucial that children affected by these adverse factors are identified as early as possible, to prevent disability or facilitate intervention to ensure that they reach their maximum developmental potential. The global prevalence for developmental disability (DD) is 7-10% of the population. The national prevalence for South African children is not known but a recent Disability Survey by the Department of Health in 1998 quotes 5. 7% - 6.1 % for the overall population. Developmental disability is therefore an important priority to be addressed, especially at the primary health care level. This has been highlighted in the White Paper on Integrated National Disability Strategy of the GNU in 1997. The efficacy of intervention for developmental disabilities is debated. Scientifically this efficacy has not been proven unequivocally but there is consensus from parents, professionals and advocacy groups that early intervention is beneficial. Taken that early identification is essential, screening is the ideal method in the South African context for detection of developmental disability. There are numerous screening tools used for this purpose which need to fulfil certain criteria to ensure effectiveness. Important issues around existing developmental screening tools have been: time taken to administer the test; reliability, validity and sensitivity; measurement methods; ease of administering; and applicable age range. Questions which record parents' or caregivers' observations of their child's developmental skills have been used as effective screening tools for developmental disability. A large study which assessed prevalence of disability using a "Ten Question" format has been used extensively in Bangladesh and found to be effective. A 10-question tool was developed to screen for developmental disabilities in 9-month-old infants, the age of attendance at clinics for measles immunisation. The questions focused on the four areas traditionally tested in developmental assessments, namely speech and hearing, gross and fine motor, vision and personal/social functions. Other factors such as weight, head circumference, dysmorphic features and chronic illness were documented concurrently. The 9-month screening tool in this study was tested at Site B Clinic (Khayelitsha) and Eastridge Clinic (Mitchells Plain) and extended to high risk clinics such as the Neonatal Elevated Risk, Cerebral Palsy and Developmental Clinics of Red Cross War Memorial Children's Hospital. This was a prospective observational study. 235 9-month-old infants were seen between the period September 1996 to January 1997. The interviews were conducted in Xhosa (53%), Afrikaans (28%) and English (19%). The questionnaire was administered to the parent or caregiver of each infant. This was followed by an examination and neurodevelopmental assessment of the infant. On assessment 192 infants (82%) had no disability, 39 (16%) had developmental disability and 4 (2%) were at risk for motor disability. A further analysis of the 39 infants with developmental disability revealed that 25 (64%) were language impaired only, 2 (5%) were motor disabled and 12 (31%) were globally disabled (i.e. in both language and motor areas). Males and females were equally affected. The results showed that the 9-month screening questionnaire is a valid tool for the screening for developmental disability. The overall sensitivity of the questionnaire was 97.7% (95% Confidence interval [CI] of 95.8 - 99.6) and specificity 88.5% (95% CI of 84.4 - 92.6). The positive predictive value was 65.6% and negative predictive value 99.4%. Only one infant who was at risk for motor disability was missed by the questionnaire. On evaluation of the questions in specific areas (i.e. speech, hearing, motor, vision, squint), the numbers assessed were too small for meaningful analysis. As personal and social development involves motor, language and hearing skills, this area was not used on its own in the overall assessment of the infant, but those questions were incorporated into other areas of the screen. Of concern was that a number of infants screened positive for DD on certain questions (e.g. language), but on assessment were found to have disability i n a different developmental area (e.g. motor). In these cases, the questionnaire identified the children with disability - but for the incorrect reason. Certain issues would need to be addressed prior to implementation of the screening tool to ensure an adequate, appropriate screening procedure and prevention of falsely raising the expectations of parents. This involves personnel training, monitoring of screening, referral mechanisms, intervention once DD is identified and involvement of the family as a partner in the process.