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This study explores the cognitive development of children born to adolescent mothers within South Africa compared to existing reference data, and explores development by child age bands to examine relative levels of development. Cross-sectional analyses present data from 954 adolescents (10-19 years) and their first-born children (0-68 months). All adolescents completed questionnaires relating to themselves and their children, and standardized child cognitive assessments (Mullen Scales of Early Learning) were undertaken. Cognitive development scores of the sample were lower than USA reference population scores and relative performance compared to the reference population was found to decline with increasing child age. When compared to children born to adult mothers in the sub-Saharan African region, children born to adolescent mothers (human immunodeficiency virus [HIV] unexposed; n = 724) were found to have lower cognitive development scores. Findings identify critical periods of development where intervention may be required to bolster outcomes for children born to adolescent mothers.

This study evaluated the impact of a parenting intervention on children's cognitive and socioemotional development in a group of caregivers and their 21-to-28-month-old children in a low-income South African township. A randomized controlled trial compared an experimental group (n = 70) receiving training in dialogic book-sharing (8 weekly group sessions) with a wait-list control group (n = 70). They were assessed before the intervention, immediately following it, and at a six month follow-up. The intervention had positive effects on child language and attention, but not behavior problems, prosocial behavior, or theory of mind. Intervention caregivers were less verbally and psychologically harsh, showed more sensitivity and reciprocity and more complex cognitive talk. This program benefitted parenting and child development and holds promise for low-income contexts.

Author(s): Mark Tomlinson 1,2,*, Marguerite Marlow 1 In the early months of the Coronavirus Disease 2019 (COVID-19) pandemic, data were mixed on the pandemic's impact on mental health. Globally, suicide [...]

Adolescents living in low- and-middle incomeand middle-income countries are at a particular risk of poor mental health. Caregiver mental health plays a crucial role in a child's emotional and behavioural development and may directly impact a child's risk for future development of mental health problems. Data collected as part of a two-decade longitudinal multiphase research project were used. Participants, originally women in their third trimester of pregnancy (n = 449), were recruited from a peri-urban impoverished community outside of Cape Town, South Africa, and assessed at several time-points over subsequent years. Data collected during the three phases of the research were used to assess the effects of early and current caregiver depression on adolescent internalising and externalising behaviour. Analyses of Covariance models were used to explore the effect of caregiver depression on adolescent internalising and externalising behaviour, while controlling for multiple covariates. We analysed data for 313 adolescent participants and their primary caregivers. Caregiver depression patterns had a significant main effect on externalising behaviour, F(3,305) = 4.10 (p = 0.007), but not on internalising behaviour, F(3,305) = 2.71 (p = 0.09). Post-hoc analysis showed that those adolescents exposed to early and current caregiver depression scored on average 3.83 points (95% CI [0.99; 6.66]) higher in externalising behaviour than those exposed to no caregiver depression. Also, adolescents who experienced a change in caregiver, compared to those whose biological mother were still their primary caregiver, reported significantly higher levels of externalising behaviour F(1,305) = 5.10, p = 0.03. The study findings provide crucial insight into critical periods of risk, as well as opportunities for prevention. Preventive interventions should ideally target caregivers and adolescents to prevent or reduce behavioural problems and disrupt intergenerational cycles of mental disorders or behavioural problems. [ABSTRACT FROM AUTHOR]

Childhood and adolescence are key developmental periods in the life course for addressing mental health, and there is ample evidence to support significant, increased investment in mental health promotion for this group. However, there are gaps in evidence to inform how best to implement mental health promotion interventions at scale. In this review, we examined psychosocial interventions implemented with children (aged 5–10 years) and adolescents (aged 10–19 years), drawing on evidence from WHO guidelines. Most psychosocial interventions promoting mental health have been implemented in school settings, with some in family and community settings, by a range of delivery personnel. Mental health promotion interventions for younger ages have prioritised key social and emotional skills development, including selfregulation and coping; for older ages, additional skills include problem-solving and interpersonal skills. Overall, fewer interventions have been implemented in low- and middle-income countries. We identify cross-cutting areas affecting child and adolescent mental health promotion: understanding the problem scope; understanding which components work; understanding how and for whom interventions work in practice; and ensuring supportive infrastructure and political will. Additional evidence, including from participatory approaches, is required to tailor mental health promotive interventions to diverse groups’ needs and support healthy life course trajectories for children and adolescents everywhere. [ABSTRACT FROM AUTHOR]

Background: Child cognitive development is often compromised in contexts of poverty and adversity, and these deficits tend to endure and affect the child across the life course. In the conditions of poverty and violence that characterise many low‐ and middle‐income countries (LMIC), the capacity of parents to provide the kind of care that promotes good child development may be severely compromised, especially where caregivers suffer from depression. One avenue of early intervention focuses on the quality of the early mother–infant relationship. The aim of this study was to examine the long‐term impact of an early intervention to improve the mother–infant relationship quality on child cognitive outcomes at 13 years of age. We also estimated the current costs to replicate the intervention. Method: We re‐recruited 333 children from an early childhood maternal–infant attachment intervention, 'Thula Sana', when the children were 13 years old, to assess whether there were impacts of the intervention on child cognitive outcomes, and maternal mood. We used the Kaufman Assessment Battery to assess the child cognitive development and the Patient Health Questionnaire (PHQ‐9) and the Self‐Reporting Questionnaire (SRQ‐20) to assess maternal mental health. Results: Effect estimates indicated a pattern of null findings for the impact of the intervention on child cognitive development. However, the intervention had an effect on caregiver psychological distress (PHQ‐9, ES = −0.17 [CI: −1.95, 0.05] and SRQ‐20, ES = −0.30 [CI: −2.41, −0.19]), but not anxiety. The annual cost per mother–child pair to replicate the Thula Sana intervention in 2019 was estimated at ZAR13,365 ($780). Conclusion: In a socio‐economically deprived peri‐urban settlement in South Africa, a home visiting intervention, delivered by community workers to mothers in pregnancy and the first six postpartum months, had no overall effect on child cognitive development at 13 years of age. However, those caregivers who were part of the original intervention showed lasting improvements in depressed mood. Despite the fact that there was no intervention effect on long‐term child outcomes, the improvements in maternal mood are important. [ABSTRACT FROM AUTHOR]

Globally, randomised controlled trials (RCTs) are increasingly seen as the gold standard of programme evaluation, representing the best way to determine whether new interventions are effective - but they are not without limitations. In this article, we discuss the phases of scientific discovery and the research standards that are necessary before scaling up interventions. We also outline the core characteristics of RCTs, such as randomisation, efficacy and effectiveness, and discuss the benefits of using the RCT as the standard of intervention evaluation. We discuss how 'realist' evaluation contributes to what policymakers need to know in order to make a decision about an evaluation and alternatives to the RCT, such as stepped wedge, regression discontinuity, non-randomised cohort, and time series designs. [ABSTRACT FROM AUTHOR]