Browsing by Author "Hoogenhout, Michelle"

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    Autism screening in children: using the social communication questionnaire in a Western Cape population
    (2013) Bozalek, Faye; Malcolm-Smith, Susan; Hoogenhout, Michelle
    Autism spectrum disorder (ASD) has a global prevalence of approximately one percent of all new births. There is a lack of literature on autism in South Africa. South African children are waiting years for diagnoses, despite the fact that early diagnosis and subsequent intervention appear to have a positive effect on the outcomes of the intervention. A screening device to detect ASD could be used to speed up the diagnostic process. This study tested the viability of using the Social Communication Questionnaire (SCQ) in a Western Cape state-funded hospital. This thesis describes Phase 1 of a larger study. The 40 item SCQ was adapted and translated into Afrikaans and isiXhosa. The English, Afrikaans and isiXhosa versions of the SCQ were administered to parents of very young children attending the Red Cross Children?s Hospital?s developmental clinic (N = 228, age range of children = 3.00-5.97 years). Positive results were that no relationship was found between age and SCQ score, or between SCQ language version and SCQ score were found. However there was a relationship between SCQ score and socioeconomic status, indicating a possible bias in the SCQ. Internal reliability of the SCQ versions was analysed and was satisfactory. The factor structure of the English SCQ was examined. Two and four factor solutions were explored, with the two factor solution proving the best fit with good internal reliability. This two factor solution reflected the recent changes to the Diagnostic and Statistical Manual of Mental Disorders, as well as previous findings on the SCQ and the ADI-R, the diagnostic instrument on which the SCQ was based. Preliminary results of Phase 2 of the larger study were analysed. Eighteen children received an Autism Diagnostic Observation Schedule (ADOS) assessment;; the current gold standard for diagnosing ASD. SCQ scores proved to be a good predictor of ASD diagnosis, predicting 17 out of 18 individuals correctly. Further research on isiXhosa and Afrikaans versions of the SCQ as well as the predictive power, sensitivity and specificity and cut-off scores for the SCQ is recommended.
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    Evaluating the Psychometric Properties of Neurodevelopmental Assessment Tools in a South African Context
    (2021) Zieff, Michal R; Donald, Kirsten; Hoogenhout, Michelle
    Neurodevelopmental and behavioural tools, used to assess children's cognitive and psychological development, play important supportive roles in clinical decision-making processes. It is therefore important that inferences made based on the information generated by these tools are valid and reliable. Because validity and reliability are inextricably tied to the context in which the tool is administered, it is critical that tools, including established “gold standard” tools, undergo ongoing psychometric evaluation. This is particularly important when tools are used in contexts different to that in which the original tool was developed. The use of poorly performing measures in clinical settings may result in a higher risk of misinterpretation of results or misdiagnosis, carrying serious implications for provision of interventions. This dissertation explored the psychometric properties of two frequently used behavioural tools in a South African context. The first aim of the dissertation was to investigate the use, cultural appropriateness, and psychometric soundness of Achenbach System of Empirically Based Assessment (ASEBA) forms in sub-Saharan Africa. The ASEBA forms are used worldwide to screen children and adolescents for behavioural and emotional problems. To achieve this aim, I conducted a systematic review of the psychometric properties of the ASEBA forms in sub-Saharan Africa. The second aim was to evaluate the structural and construct validity of a commonly used measure of AttentionDeficit/Hyperactivity Disorder (ADHD), the Swanson, Nolan, and Pelham ADHD Rating Scale (SNAP-IV), in a sample of South African children with neurodevelopmental disorders (NDDs), including Autism Spectrum Disorder and Intellectual Disability. The systematic review identified 58 studies with sub-Saharan African participants that reported measurement properties of the ASEBA forms. Most studies came from Southern (n = 29, 50%) or East African (n = 25, 43%) countries. Forty-nine studies (84%) used translated versions of the tool, but details regarding the translation process, if available, were often sparse. Most studies (n = 47, 81%) only reported internal consistency (using coefficient alpha) for one or more subscales. The methodological quality of the psychometric evaluations varied considerably across all measurement properties, except for internal consistency. There is limited good quality psychometric evidence available for the ASEBA forms in sub-Saharan Africa. Recommendations include implementing a standardised procedure for conducting and reporting translation processes and conducting more comprehensive psychometric evaluations of the translated versions of the tools. Parents of 109 children with one or more diagnosed NDDs completed the SNAP-IV. A subset of parents (n = 79) also completed the ASEBA Child Behaviour Checklist (CBCL/6-18). We conducted a confirmatory factor analysis to inspect the two-factor structure of the SNAP-IV (Inattention + Hyperactivity-Impulsivity). We also calculated ordinal coefficient alpha (α) to estimate internal consistency. Finally, we correlated scores of SNAP-IV and CBCL/6-18 subscales to estimate concurrent, convergent (ADHD + externalizing behaviour), and discriminant (ADHD + internalizing behaviour) validity respectively. The two-factor model performed acceptably (χ2 (134) = 249.82, p < 0.001, TLI = 0.868, RMSEA = 0.089, p < 0.001). The model fit improved after removing three problematic items, two of which were dependent on the child's level of spoken language (χ2 (89) = 135.17, p < 0.01, TLI = 0.942, RMSEA = 0.069, p = 0.096). The revised SNAP-IV subscales had acceptable internal consistencies (α = 0.85-0.86). Correlation coefficients between the SNAP-IV and ADHD-related CBCL/6-18 subscales were significant (r = 0.53- 0.62, p < 0.001). Correlations between ADHD and externalizing behaviours (r = 0.45, p < 0.001) and internalizing behaviours (r = 0.38, p < 0.001) respectively were not significantly different (z = 0.97, p = 0.165). The findings tentatively support the use of the SNAP-IV in this group of children. However, there are limitations to its performance in this population likely related to the presence of NDDs. Taken together, the findings of these two studies highlight the need for clinicians and researchers to conduct ongoing psychometric testing of behavioural tools for use with linguistically and culturally diverse sub-Saharan African populations. The data also reveal important insights regarding problems associated with using standard behavioural tools in children with complex clinical presentations.
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    Examining empathy in Autism Spectrum Disorders: cognitive, subjective and physiological correlates of the perception of pain
    (2017) Hoogenhout, Michelle; Malcolm-Smith, Susan; Weyers, Peter; Schulz, Stefan
    Social-communication impairments in autism spectrum disorder (ASD) are often ascribed to deficits in empathy. I argue that social-communicative deficits in ASD stem from impairments in specific aspects of empathy, rather than a general empathy impairment. Empathy is defined as the sharing of another's emotion (affective empathy), understanding others' mental states (cognitive empathy), and regulation of one's own emotional state (self-regulation). Empathy can also lead to muscle mimicry and empathic concern for another's wellbeing. I argue that empathy should be measured on multiple levels: cognitive, subjective and physiological. Particularly, measurement of autonomic regulation can contribute to characterising the empathy profile in ASD. Furthermore, confounding factors such as lack of understanding of one's own emotions, or alexithymia, must be accounted for when measuring empathy. I measured subjective trait empathy ratings in people with varying levels of autism traits (N₁ = 519 & N₂ = 98, ages 14 - 45). I also investigated the association between physiological arousal, trait empathy, and empathic concern for (1) sensory pain and (2) facial pain expressions, controlling for alexithymia (N = 98); and examined the evidence for atypical autonomic arousal at rest and during empathy-induction in individuals with ASD. Autism traits were negatively correlated with cognitive empathy and self-regulation, but were not associated with atypical affective empathy per se. However, individuals with poor self-regulation showed heightened subjective affective states, whereas alexithymic individuals showed reduced affective empathy to facial pain expressions. Regarding the autonomic regulation of empathy, there was a significant association between autonomic arousal and affect regulation: Low sympathetic arousal and concurrent high parasympathetic arousal at rest predicted smaller changes in personal distress during pain observation than did autonomic co-inhibition. However, resting state arousal did not predict absolute affective state levels or dispositional empathy, and was not associated with amount of autism traits. In conclusion, the findings do not support the hypothesis of global empathy deficits in ASD. The results suggest that interventions focusing on own-emotion identification and self-regulation skills are important, but caution against the over-hasty adoption of interventions targeting resting state autonomic arousal, which was not related to either ASD or dispositional empathy.