Browsing by Author "Schrieff, Leigh"

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    A systematic review on the neurological and psychopathological correlates of pica
    (2025) Fourie, Lauren; Schrieff, Leigh
    Pica, the consumption of non-nutritive substances for longer than 30 days, has had several aetiologies reported. These include micronutrient deficiency, psychological and developmental disorders, and neurological and neurochemical pathologies, with a predominant focus in literature on micronutrient deficiency. Thus, a thorough exploration of the possible neurological (i.e., diagnosed conditions, neuroanatomical regions, neuropsychological profiles, neurodevelopmental disorders, neurotransmitter systems) and psychopathological (i.e., diagnosed conditions, psychological mechanism) correlates is needed. Although a recent review on the topic exists, it has not been reported on systematically. The aim of this systematic review (SR) is to firstly, provide a comprehensive overview of the existing research pertaining to neurological and psychopathological correlates of pica. Secondly, to provide a deeper understanding of pica onset and progression and to inform comorbid diagnosis and treatment of pica. Methodology of the review followed the PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Science Direct, EbscoHost (Academic Search Premier, CINAHL, Health Source: Nursing/Academic Edition, APA PsycArticles, APA PsycInfo, Medline). Methodological evaluation of studies was conducted using the Joanna Briggs Institute (JBI) Critical Appraisal Tool. An adapted JBI checklist was used for each of the study designs including case reports, case series, case control, and cross-sectional designs. 5468 journal articles were identified, 1102 articles were checked using eligibility criteria, and 15 articles were included in the review. Findings showed that the most prevalent neurological conditions correlated to pica included neurodegenerative diseases (Fronto-temporal dementia; Alzheimer's disease and Multi-infarct Dementia), acquired brain injury and stroke. The neuroanatomical regions most associated with pica included the frontal and temporal cortex as well as limbic system structures. Neuropsychological profiles of individuals with pica were in keeping with the neuroanatomical regions described and included semantic memory deficit, aphasia (Transcortical Sensory and Wernicke's) as well as cognitive difficulties following left temporal (verbal learning, memory, and reasoning) and right frontal (cognitive switching) damage. The most prevalent neurodevelopmental disorders associated with pica were Intellectual Disability and Autism-Spectrum Disorder. Successful treatment of pica mainly included serotonin inhibitors or antagonists, indicating a possible correlation between the dysregulation of serotonin neurotransmitters and pica. In addition, the most prevalent psychopathological correlates of pica included OCD, schizophrenia, and depression, with the relief of anxiety being the most prominently reported reason for engaging in pica behaviour. Furthermore, even though these findings prove to be promising, the studies included were predominantly case report or case series, therefore a recommendation for larger scaled studies is warranted.
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    A systematic review on the neurological and psychopathological correlates of pica
    (2025) Fourie, Lauren; Schrieff, Leigh
    Pica, the consumption of non-nutritive substances for longer than 30 days, has had several aetiologies reported. These include micronutrient deficiency, psychological and developmental disorders, and neurological and neurochemical pathologies, with a predominant focus in literature on micronutrient deficiency. Thus, a thorough exploration of the possible neurological (i.e., diagnosed conditions, neuroanatomical regions, neuropsychological profiles, neurodevelopmental disorders, neurotransmitter systems) and psychopathological (i.e., diagnosed conditions, psychological mechanism) correlates is needed. Although a recent review on the topic exists, it has not been reported on systematically. The aim of this systematic review (SR) is to firstly, provide a comprehensive overview of the existing research pertaining to neurological and psychopathological correlates of pica. Secondly, to provide a deeper understanding of pica onset and progression and to inform comorbid diagnosis and treatment of pica. Methodology of the review followed the PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Science Direct, EbscoHost (Academic Search Premier, CINAHL, Health Source: Nursing/Academic Edition, APA PsycArticles, APA PsycInfo, Medline). Methodological evaluation of studies was conducted using the Joanna Briggs Institute (JBI) Critical Appraisal Tool. An adapted JBI checklist was used for each of the study designs including case reports, case series, case control, and cross-sectional designs. 5468 journal articles were identified, 1102 articles were checked using eligibility criteria, and 15 articles were included in the review. Findings showed that the most prevalent neurological conditions correlated to pica included neurodegenerative diseases (Fronto-temporal dementia; Alzheimer's disease and Multi-infarct Dementia), acquired brain injury and stroke. The neuroanatomical regions most associated with pica included the frontal and temporal cortex as well as limbic system structures. Neuropsychological profiles of individuals with pica were in keeping with the neuroanatomical regions described and included semantic memory deficit, aphasia (Transcortical Sensory and Wernicke's) as well as cognitive difficulties following left temporal (verbal learning, memory, and reasoning) and right frontal (cognitive switching) damage. The most prevalent neurodevelopmental disorders associated with pica were Intellectual Disability and Autism-Spectrum Disorder. Successful treatment of pica mainly included serotonin inhibitors or antagonists, indicating a possible correlation between the dysregulation of serotonin neurotransmitters and pica. In addition, the most prevalent psychopathological correlates of pica included OCD, schizophrenia, and depression, with the relief of anxiety being the most prominently reported reason for engaging in pica behaviour. Furthermore, even though these findings prove to be promising, the studies included were predominantly case report or case series, therefore a recommendation for larger scaled studies is warranted.
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    Attention Training following Moderate to Severe Traumatic Brain Injury in Adults: A Systematic Review
    (2023) Soule, Alexa; Schrieff, Leigh
    Traumatic brain injury (TBI) is a significant contributor to trauma-related mortality and morbidity globally. The high burden of disease for TBI is not only attributable to high incidence rates, but also due to the extensive and often severe post-TBI multi-domain sequelae, of which attentional deficits are particularly prevalent and persistent. Such deficits have far-reaching consequences, given the gateway function of this domain. The high prevalence rate of post-TBI attentional deficits holds true particularly for moderate to severe TBI populations, as more severe injuries are associated with poorer outcomes. Thus exists a clear need from a personal and economic perspective to establish reliable and valid rehabilitation efforts to aid in the recovery of those directly affected by TBI and their families, especially for deficits in attention. The current study aimed to determine the extent and efficacy of attentional training as a form of neuropsychological rehabilitation to ameliorate such deficits following moderate to severe TBI in adults, through a systematic review of relevant literature in this area. Methodology was based on PRISMA guidelines. Databases searched included CINAHL, Cochrane Library, PubMed, PsycINFO, Scopus, and Web of Science. Eligible studies included a combination of RCTs, observational studies and single case designs. All final included studies were assessed for methodological quality and analysed in accordance with the objectives of this review. A total of 7 314 articles were retrieved and of those, 4 845 articles were screened for eligibility. 21 articles met eligibility criteria and were included in this review. Findings of this review suggest that attentional gains can be made in a moderate to severe adult TBI sample, irrespective of time since injury, age, and injury severity. A growing interest in investigating the role that technology (e.g., computerised training) plays in this rehabilitation setting is ever present and needs to be further explored. Further, while findings from this review are suggestive that attentional gains are seen across techniques, it is unclear whether these gains are reflective in the patients' daily life or maintained over time. As such, it is recommended that future research adopts a more holistic assessment approach in which aspects like self-report questionnaires in conjunction with standardised neuropsychological assessments are administered with longer term follow-up assessments. Keywords: attention, cognitive rehabilitation, neuropsychology, TBI
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    Demographic and neuropsychological profile of HIV-positive children referred for an assessment at a local clinic over a 5-year period
    (2025) Mokoena, Limpho; Schrieff, Leigh
    Individuals in low- and middle-income countries (LMICs) are disproportionately affected by the human immunodeficiency virus (HIV) relative to high-income countries (HICs). Children are particularly vulnerable given the impact of HIV on brain development. Neuropsychology is still in its infancy in South Africa and there are limited services dedicated to addressing neuropsychological difficulties, including the assessment of children living with HIV. At the pediatric neuropsychology clinic (PNC) at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town, South Africa, free services related to neuropsychological assessments are available to those referred by health professionals, an offering that is rare in South Africa. Considering the impact of HIV on the brain, the PNC offers services and resources to support the study of the effect of HIV (and other pathologies that result in neuropsychological impairments) on the developing brain and its influence on children more broadly in the South African context. Given how limited such services of this nature are in this context and the related opportunity for research and knowledge based on such services, I aimed to the describe the demographic, medical, developmental, and neuropsychological profiles of children referred to RXH PNC over a 5-year period (with an in depth focus on those who are HIV-positive). I investigated a series of neuropsychological reports from the PNC, retrospectively from the year 2012 to 2016, using qualitative and quantitative methods. I report on all the children referred to the clinic within this period (N= 158) and then specifically report in depth on the proportion of children who were HIV-positive (n= 73, 45%) and describe their demographic profiles. I then compared the neuropsychological outcomes of the HIV-Positive Subsample to a separate demographically matched typically developing Control Group (n=41) recruited from local communities. Overall, there were no significant differences in the demographic profile between the HIV- Positive Subsample and the Control Group. However, in the neuropsychological profile there were significant differences found between these two groups in all of the neuropsychological domains except visual memory. The evidence from this study supported the association between cognitive deficits found in children with HIV often discussed in literature. Given the dearth of specialist neuropsychological assessment facilities that are accessible to the public, this highlights the importance of clinics such as the PNC. More specifically the PNC is at the forefront of providing pediatric neuropsychology services in South Africa. The benefits of the PNC include a hub for data of cognitive fall out seen at the clinic which can inform research and other collaborative projects with clinicians and universities. Further, having detailed neuropsychological and demographic profiles/data of children living with HIV can inform intervention-based studies. Intervention-based studies can include a practical component in assisting HIV-positive children attaining a better quality of life considering their neuropsychological difficulties.
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    Does the learner profiler successfully screen for neurodiversity and predict neuropsychological outcomes in high school learners?
    (2024) Antvorskov, Khayreyah; Schrieff, Leigh
    There has been a push for improved inclusive education for learners with learning difficulties and disabilities in SA due to the long-lasting detrimental consequences learning difficulties and disabilities have on learners' academic achievement and future outcomes. The importance of the screening and identification of learning difficulties and disabilities has been highlighted as the current screening policy in SA presents several issues and formal neuropsychological tests are time-consuming, costly, require expertise in administration, and lack language diversity. Therefore, computerized assessments, such as the Learner Profiler, have been put forward as a useful supportive tool to aid the screening for, and identification of, learning difficulties and disabilities. The current study investigated if the Learner Profiler, a computerized assessment tool, could successfully predict working memory, numeracy and literacy outcomes from formal neuropsychological pen and paper tests in a sample of high school learners. Participants were recruited from English-medium Cape Town high schools (N= 51). Participants first completed the Learner Profiler working memory, literacy and numeracy modules (stage 1) and then were later administered the KTEA-3 and the Working Memory Index from the WISC-IV (stage 2). It was found that the working memory outcomes from the Learner Profiler significantly predicted the overall Working Memory Index outcomes (p < .001) but not outcomes from the Digit Span Backwards and Letter-number Sequencing individual subtests (p > .05). The numeracy outcomes from the Learner Profiler did not significantly predict the outcomes from the numeracy neuropsychological pen and paper tests (p > .05). However, excluding one reading subtest (p >.05), the literacy outcomes from the Learner Profiler significantly predicted the literacy outcomes from the KTEA-3 (p
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    Exploring Knowledge of Neurodisabilities and Access to Education in Custody at a Young Offender Centre in Cape Town, South Africa
    (2023) Nkoana, Winnie; Schrieff, Leigh
    Neurodisabilities are highly prevalent in the young offender population. However, there is a dearth of literature on neurodisabilities (including LDs and TBI) and access to education among young offenders in South Africa (SA). Young offenders in custody have needs across different areas, such as education, health, social and emotional. Amongst other efforts, rehabilitation approaches in prisons often include vocational training and education. The latter is especially important for youth in prison, who are still minors. Research that focuses on education for youth in custody is therefore emerging. The current study aimed to explore awareness, understanding and knowledge of neurodisabilities amongst the prison stakeholders, as well as screening tools used to screen for and identify neurodisabilities in young offenders. Furthermore, the study aimed to explore access to education in custody, by investigating how prison stakeholders make meaning of young offenders' access to education. Using qualitative semi-structured interviews, I interviewed (n=9) prison stakeholders at a youth correctional centre in Cape Town, SA. Thematic analysis, using inductive approach was the method of data analysis in the current study. The findings of the study highlight that although prison stakeholders had exposure to some neurodisabilities (e.g., LDs and FASD), they were not aware of others, such as TBI. This was largely compounded by a lack of comprehensive and validated screening tools. In keeping with previous studies prison stakeholders also reported that they are not qualified nor trained to deal with young offenders with neurodisabilities and that they are not “experts”. Although there is provision of education in custody for young offenders, there are factors that impact on their access to education in custody mainly: offender factors (high risk offenders, disruptive offenders: displaying problematic behaviors, young offenders' motivation to engage in education and presence of neurodisabilities and cognitive difficulties, which further makes it difficult for them to navigate the CJS, and systemic factors (prison overpopulation, lack of educators, attitudes of prison stakeholders and gang-related activities). The results of this study may be used to inform policy implementation in terms of rehabilitation and the use of proper screening and assessment tools to screen for various neurodisabilities in SA young offender population, as well as providing training and support for prison stakeholders, to work effectively with young offenders who may present with neurodisabilities. Additionally, the schooling structures in youth offender institutions may be reformed, to better accommodate for educational needs of young offenders, including those with neurodisabilities.
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    Families of children with traumatic brain injuries : stressors and needs in the South African context
    (2010) Oosthuizen, Deirdre; Thomas, Kevin; Schrieff, Leigh
    [Background] The effects of a traumatic brain injury (TBI) can be devastating not only for the child that sustains the injury but also for his or her family. A TBI can negatively affect a child cognitively, emotionally, and behaviourally. In developing countries such as South Africa these negative effects of TBI are often compounded by the impact of other health crises such as HIV / AIDS, as well as by the existence of relatively few economic resources and a lack of rehabilitation services. Injury-related consequences, further compounded by developing world contexts, seem to suggest that families of children with TBI have many stressors and strains that need to be addressed. Aims. The current study sought to explore the needs and stressors of caregivers of children with TBI, and how local contextual factors contribute to those needs and stressors. [Methods] The sample consisted of four groups (n = 18 caregivers in each). These four groups included parents/caregivers who cared for a child with either a mild head injury, a moderate/severe head injury, or an orthopaedic injury, and a control group of caregivers with healthy children. The Parenting Stress Index, Family Burden of Injury Interview, and Family Needs Questionnaire were administered to each participant. [Results] South African caregivers of children with TBIs are critically stressed. Much of their stress is related to the child's behaviour and ways of relating to their caregiver. Caregivers in the Moderate/Severe TBI group reported experiencing particular difficulty with their own reactions to the injury, and reported feeling depressed and incompetent, as well as isolated and restricted by their role as parent. Caregivers also reported experiencing a need for health information, professional support, community support, involvement in the child's care, and emotional support. They reported, however, that few of these needs were being met. Results also showed that South African caregivers of children with TBI displayed more stressors and needs than similar samples in developed countries. [Conclusions] We suggest that a better understanding of the experience of families of children with TBIs is needed amongst TBI service providers. It is hoped that this study's results will aid that understanding, and that they will provide information for policy makers who can set into motion a sequence of services that more adequately aid both the child with TBI and his/her family.
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    Investigating an Executive Function Intervention Using Goal Management Training in HIV+ Adolescents in South Africa
    (2021) Harwood, Angela; Schrieff, Leigh; Thomas, Kevin
    Advances in pharmacological treatment and medical management of HIV have resulted in decreases in HIV-associated mortality and morbidity for people living with HIV worldwide. However, many HIV+ individuals continue to experience some degree of neurocognitive impairment, particularly in the domain of executive functioning. HIV-related executive deficits are particularly pertinent in the adolescent population as individuals transition into adulthood and assume greater responsibility for their daily functioning. Despite the high prevalence of HIV in South African adolescents, neuropsychological rehabilitation interventions are largely absent. Currently, metacognitive approaches such as Goal Management Training (GMT) demonstrate the best evidence base for improving executive functions. The main aim of this study was to evaluate the effectiveness of a pGMT intervention for HIV+ adolescents in South Africa. A secondary objective was to provide commentary on the feasibility of conducting cognitive rehabilitation interventions in low resourced settings such as those commonly found in South Africa. This quantitative study used a pre-test post-test quasi experimental research design to investigate the effectiveness of a 7-week pGMT intervention in HIV+ adolescents in South Africa. Participants included 18 HIV+ adolescent (aged 14-17) first language Xhosa speakers from low socio-economic backgrounds. Participants formed two groups: a pGMT intervention (n = 10), and a Control (n = 8) group. A neuropsychological test battery was administered pre- and post- intervention to assess executive functions. Neuropsychological test scores were sorted into four executive function composite domains. To assess the efficacy of the pGMT intervention, these executive function domains were analysed using a mixed-design ANOVA and Mann-Whitney U analysis of difference scores. No significant effects were detected, suggesting that the pGMT intervention demonstrated limited efficacy in the study sample. However, the successful implementation of the intervention supports the use of the GMT protocol in low-resourced settings such as those commonly found in LMICs like South Africa. Findings of the current study contribute valuable insights into the limitations and opportunities relevant not only to research in this field, but also more broadly to the implementation of cognitive rehabilitation interventions in LMICs such as South Africa.
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    Investigating Cognitive Functioning in a Sample of Spinal Cord Injury Inpatients, in Relation to the Cognitive Demands of their Specialized Rehabilitation Program: A Pilot Exploratory Study
    (2023) Gray, Emma-Louise; Schrieff, Leigh
    Spinal Cord Injury (SCI) rehabilitation programs have significant and specific cognitive demands, requiring patients to acquire knowledge and new skills while adjusting to their profoundly altered physiology. Existing research from high income countries (HIC) has shown that SCI is associated with cognitive dysfunction, which is in turn linked to poorer rehabilitation outcomes and ultimately increased costs of care. The aetiology of SCI in South Africa is distinct from HICs, which implies differences in associated risks and mediators for cognitive pathology (e.g., focal traumatic injuries, HIV-associated non-traumatic injuries), which render questionable the local generalizability of existing research evidence. There are no South African studies on cognitive dysfunction related to SCI, and research in this area from other developing world countries is sparse. Therefore, this study aimed to address the evidence gap by investigating the cognitive profile of a sample of SCI rehabilitation inpatients in relation to the cognitive demands of their SCI rehabilitation programme, at a specialized public neurorehabilitation hospital in Cape Town. This exploratory pilot study used quantitative methodology to describe the cognitive profile of a sample of new SCI rehabilitation inpatients shortly after their admission. Twentynine participants aged 18-65, who were predominantly male and from lower socioeconomic backgrounds were included in the study. All participants completed a battery of neuropsychological tests, where the assessment tools chosen measured cognitive domains identified as essential for engagement with a specialized SCI rehabilitation program. Participants also completed selected questionnaires screening for common psychological, behavioural and somatic comorbidities, with established links to cognitive dysfunction. Interpretation of the cognitive test results was undertaken through comparison with internationally and locally normed results, in conjunction with an exploration of the presence of comorbidities with known risk to cognitive function. In comparison to international data, the sample's cognitive performance was indicative of dysfunction across all domains assessed, while performance was relatively better in certain cognitive domains, relative to available South African normative data. Considering all available normative data and local trends, learning and memory, attention and certain executive functions emerged as possible areas of cognitive deficit. The potential mismatch between SCI rehabilitation programme cognitive demands and the sample's cognitive profile was evident, while their profile of comorbidities placed them at risk for cognitive dysfunction in multiple domains. This pilot study provided evidence to suggest that, despite their distinct epidemiology and lower rates of comorbid TBI, local SCI rehabilitation inpatients are at risk of cognitive dysfunction, where cognitive domains potentially affected are integral to their specialized SCI rehabilitation programme. As a pilot study conducted in the context of a pandemic, multiple areas for further investigation with altered methodology were identified. Nonetheless it was clear that additional in-depth research in this area would benefit the SCI rehabilitation community at large. Future studies should include a well-matched control group, where COVID-19 clinical research disruptions precluded this design in the current study.
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    Investigating Exposure to Community Violence and Associated Internalizing and Externalising Behaviours in a Sample of South African Male Youth
    (2022) Goolam Nabi, Zayaan; Schrieff, Leigh
    Exposure to community violence has been acknowledged as a public health problem, affecting individuals' mental well-being and health. Community violence refers to incidents of violence which take place within an individual's community or outside an individual's home. Research exploring the behavioural and emotional outcomes of exposure to community violence has suggested that youth with high levels of exposure to community violence may exhibit adverse emotional and behavioural outcomes. Although there is a large body of literature exploring exposure to community violence, there is a dearth of South African (SA) literature looking at exposure to community violence in terms of being a victim, witness or perpetrator of community violence and the associated outcomes. Existing research does not consider the impact of community violence on all three levels (and especially so with regards to perpetration of violence) in relation to internalizing and externalizing behaviours and callous-unemotional traits in male youth, thus presenting an area for research inquiry. Using a cross-sectional, quantitative design, the current study investigated exposure to community violence and its three subcategories, namely, witness, victim or perpetrator and the associated callous-unemotional traits, internalising and externalising behaviours in a sample of SA male youth (N =108) through a range of self-report measures (Alcohol Use Disorders Identification Test; Alcohol, Smoking, and Substance Involvement Screening Test; Beck Depression Inventory-Second Edition; Child Behaviour Checklist Youth Self-Report; Child Exposure to Community Violence Checklist; Inventory of Callous-Unemotional Traits; Maudsley Addiction Profile and Reactive-Proactive Aggression Questionnaire). Results indicated that not all three subcategories of exposure to community violence were significant predictors of the outcome variables. The results of the regression analyses showed: exposure to community violence and its three subcategories as significant predictors of the externalizing behaviour syndrome grouping, and of depressive symptoms and withdrawn/depressed symptoms in terms of internalising behaviours; exposure to community violence and being a witness and victim of violence as significant predictors of the internalizing behaviour syndrome grouping, and anxious/depressed symptoms and somatic complaints within this grouping; exposure to community violence and being a victim and perpetrator of violence as significant predictors of aggression and reactive aggression (externalising behaviours); exposure to community violence as a perpetrator as a significant predictor of proactive aggression (externalising behaviour); and exposure to community violence and being a witness and perpetrator of violence as significant predictors of rule breaking behaviour (externalising behaviour), with significance rates ranging from p < .05 to p < .001. Notably, callous-unemotional traits were not significantly correlated to any study variables. The current study is largely aligned with existing research and how both internalizing and externalizing behaviours may co-occur in relation to the three levels of exposure to community violence. Further research on callous-unemotional traits in relation to community violence is needed. As community violence occurs in various contexts understanding the associated adverse outcomes at all three levels of exposure may assist the development of interventions and policy initiatives which can prevent further experiences of victimization and perpetration of community violence by male youth.
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    Investigating severe pediatric traumatic brain injury in South Africa : a demographic profile of admissions, brain oxygenation and neuropsychological outcomes and an attention-training intervention
    (2013) Schrieff, Leigh; Thomas, Kevin
    The aim of this dissertation was to investigate severe pediatric traumatic brain injury (pTBI) in South Africa. To that end, I conducted three studies, each examining a different aspect of severe pTBI. Study 1 presents a demographic profile of trends in severe pTBI admissions to the Red Cross War Memorial Children's Hospital (RXH) from June 2006 to April 2011. Study 2 examines the associations between secondary injury, as manifest by low brain oxygenation (PbtO2), and neuropsychological outcomes in severe pTBI. Study 3 evaluates the efficacy of an attention-training intervention for severe pTBI, and discusses the implementation of that intervention in the context of a low- and middle-income country. All three studies were cross-sectional and quantitative.
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    Investigating the effects of acute intracranial pressure and brain oxygenation on neuropsychological outcomes 12 months after severe pediatric traumatic brain injury
    (2019) Dodge, Lydia; Schrieff, Leigh; Figaji, Anthony
    Traumatic brain injury (TBI) is one of the major causes of mortality and morbidity among children and adolescents all over the world and studies suggest a higher incidence of pediatric TBI (pTBI), as well as poorer post-TBI outcomes, in countries with extreme levels of socioeconomic inequality such as South Africa. pTBI leads to a multitude of long-term adverse outcomes in a wide range of domains and in general, a dose-response pattern is evident. Multiple acute and post-acute stage predictors of outcome have been investigated, however acute stage neurological and neurosurgical variables are relatively absent from this knowledge base. This study was conducted to better understand the heterogeneity in outcomes of pTBI: it aimed to investigate the nature and severity of neuropsychological deficits in pTBI patients one year after injury and to investigate the association between acute stage physiological changes in intracranial pressure (ICP) and brain tissue oxygenation (PbtO2) and neuropsychological outcomes one year after pTBI. Results of the study indicated that children who sustained TBI performed significantly poorer than healthy, matched controls on multiple cognitive, behavioural and quality of life domains, however, neither acute ICP nor PbtO2 reliably predicted within-TBI group performance. The results of the study emphasise the poor relationship of ICP and PbtO2, and the complexity of the relationship between acute physiological variables and outcomes after pTBI. Further studies of this kind should be done on large sample sizes and include multiple physiological variables.
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    Investigating the effects of psychoeducation interventions in improving misconceptions of traumatic brain injury (TBI) among undergraduate university students.
    (2021) Padayachy, Preanka; Schrieff, Leigh; Jan, Paul B
    There exists a substantial number of studies exploring the misconceptions of TBI and concussion in various geographical regions, but an insufficient number of studies have focused on why this may be the case and what can be done to improve the knowledge amongst different populations. The current study attempted to explore low cost psychoeducation interventions around misconceptions, which can hinder TBI-related prevention, help-seeking behaviours, and recovery. This study includes both quantitative and qualitative components. The study is divided into three parts: Part A: the pre-test component, which seeks to measure TBI knowledge and misconceptions through survey format. Part B: the implementation of different types of psychoeducation interventions delivered through a lecture, video or pamphlet. It also includes the re-administration of the survey (post-test). Part C: an online survey exploring the participants' experiences with the various interventions. All undergraduate students enrolled in the first year psychology PSY1005/7S course at the University of Cape Town (UCT) were invited to participate through the use of convenience sampling and the Student Research Participation Program (SRPP). Statistical analyses included descriptive statistics, one-way and repeated measures ANOVAs, and thematic analyses, related to parts A-C of the study, respectively. The results of the study suggested the positive impact of all three interventions. Each intervention was shown to increase knowledge gain in both TBI and concussion knowledge, at least descriptively. A between-groups analysis showed a significance of p = 0.01 where the lecture intervention yielded the greatest results followed by the video and pamphlet intervention respectively. Adequate awareness, knowledge and understanding of TBI are paramount to the prevention and recovery of trauma-related brain injuries, which is particularly relevant in countries with (probable) high rates of TBI, such as South Africa.
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    Investigating the executive functioning and patterns of adherence to antiretroviral therapy among adolescents living with HIV in South Africa
    (2020) Gama, Lungile Vakele; Schrieff, Leigh; Atujuna, Millicent
    Given the pathophysiology associated with the Human Immunodeficiency Virus (HIV) and the reported predilection for frontal circuitries and deep white matter, one might expect that executive dysfunction forms part of the neurocognitive profile of people living with HIV. However, such deficits have mainly been reported for adults living with HIV. Adolescence is a period where significant growth and refinement of executive functioning occurs and therefore specific research focused on HIV-positive adolescents is needed. Adolescence is also a developmental period where poor adherence to Antiretroviral Therapy (ART) persists despite marked increases in the national roll out of ART in South Africa, which has significantly decreased HIV-related morbidity and mortality rates. Poor adherence is not only a threat to the efficacy of ART but is also linked to the emergence of drug-resistant HIV strains and identified as a key contributor in the persistence of some cognitive impairments among people living with HIV. Studies show that executive dysfunction can undermine adherence to ART particularly in adolescents, whose frontal lobes are still developing. The first aim of this study was to compare the executive function profile of a group of HIV positive adolescents with that of a matched HIV negative control group. Using P. Anderson's (2002) model, executive functions were considered along the four subdomains: attentional control, processing speed, cognitive flexibility and goal setting. A second aim of the study was to investigate the relationship between executive function and levels of adherence to ART amongst the HIV positive adolescents in the sample. This cross sectional, between-groups study used a comprehensive neuropsychology test battery which was sorted into composite domains to investigate differences in executive functioning between the two study groups of adolescents aged between 14 to 16 (n = 22 in each group) using t-tests. Correlation coefficients were further computed to establish association between adherence and executive functioning. Apart from processing speed (p = 0.42, after the removal of outliers), there were no significant between-group differences in executive functioning outcomes that emerged between the HIV-positive and HIV-negative groups. The neuropsychological test scores for both groups were largely in the borderline range. Correlations between adherence and executive functioning outcomes did not yield any significant associations for each of the executive function domains. The lack of significant between-group differences may be explained by the mitigating effects of ART in the CNS in the HIV-positive group. However, consideration should be given to social factors as these may be important mediators of cognition and may therefore confound neuropsychological performance outcomes for both groups. Although the findings in the current study did not conclusively provide evidence for the role of executive functions in adherence, given the noted limitations, further studies with larger samples should confirm such outcomes.
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    Investigating the prevalence of traumatic brain injury and post-traumatic stress disorder in a sample of South African women who have experienced intimate partner violence
    (2025) Haniff, Khadija; Schrieff, Leigh; Boonzaier, Floretta
    Intimate partner violence (IPV) is widely recognized as a significant public health concern, resulting in substantial physical and psychological harm, particularly among women. IPV refers to abuse occurring within intimate relationships and is linked to a range of neurological injuries, such as traumatic brain injuries (TBIs), as well as adverse mental health outcomes like post-traumatic stress disorder (PTSD). Although IPV and its effects have been extensively studied, there remains a gap in research both globally and within South Africa exploring the overlap between IPV, general and IPV-specific TBIs, and PTSD outcomes. Specifically, the literature lacks a thorough understanding of the prevalence of, and mechanisms for IPV-related TBIs, their severity and their link to PTSD. This study employed a cross-sectional, quantitative approach to examine IPV exposure, TBIs (both general and IPV-specific) and PTSD outcomes in a sample of South African women (N = 81) using self-report measures, including a Demographic Questionnaire and Asset Index, Primary Care PTSD Screen for DSM-5, Life Events Checklist for DSM-5, Women Abuse Screening Tool, and Brain Injury Screening Questionnaire. The results demonstrated a high prevalence of IPV within the sample, with physical and emotional abuse being the most frequently co-occurring forms thereof. IPV-related TBIs were also commonly reported. Simple regression analyses indicated that IPV-related TBIs were a significant predictor (p = 0.009) of PTSD outcomes, highlighting the important role of these injuries in psychological distress. However, multiple regression analyses indicated that, collectively, no single variable stood out as the strongest predictor of PTSD outcomes. The findings of this study are largely aligned with existing research regarding the prevalence and effects of IPV. However, there is a clear need for further research to enhance the understanding of the intersection between IPV, TBIs and PTSD. Given the widespread and debilitating nature of IPV, examining its neurological and psychological effects is essential for informing trauma-sensitive interventions, practices, and policies to better support survivors experiencing IPV-related TBIs and associated mental health challenges.
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    Myths and Misconceptions of Traumatic Brain Injuries Among High School Learners and University Students in South Africa
    (2021) Moodley, Miranda; Schrieff, Leigh; Jantz, Paul
    Traumatic Brain Injury (TBI) is a major cause of disability and death around the world with an annual worldwide prevalence rate ranging from 369 per 100 000 people (James et al., 2019). TBI is specifically more concerning in adolescents and young adults as rates of injuries acquired during this period are similar to adult rates, but with more far-reaching effects, especially in low and middle-income countries (Dewan et al., 2016). TBI has significant long-term effects (e.g., cognitive, behavioural, social) on adolescents and young adults, which are compounded in low and middle income countries (LMICs) like South Africa. However, myths and misconceptions regarding TBI and associated outcomes often cloud the understanding thereof and contribute to poor help-seeking behaviours post-TBI. Poor help-seeking behaviours post-TBI can impact TBI recovery and result in even worse impairments if appropriate help is not sought. This study aimed to describe and compare myths and misconceptions about head injuries or traumatic brain injuries (HI/TBI), including concussions, for high school learners (with/without HI/TBI) and university students (with/without HI/TBI). In terms of misconceptions, students (n=393) scored significantly higher on HI/TBI and concussion knowledge, compared to learners (n=80). Regression analyses showed that adolescence (learners) vs young adulthood (students) was a significant predictor of myths and misconceptions regarding TBI/HI; F (44, 369) = 3.32, p < .001; but not for concussion knowledge and attitudes; F (44, 369) = 1.10, p =.31 and F (44, 369) = .725, p =.904. Understanding what high school learners know and how this differs from university students' knowledge about TBI will help inform interventions tailored to adolescents and young adults – which is needed as they are a vulnerable population group.
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    The neuropsychological and behavioural profiles of HIV-infected asymptomatic HAART-naïve children : a cross sectional and follow-up study
    (2011) Webster, Victoria; Schrieff, Leigh
    One of the most serious consequences of pediatric HIV infection is its impact on the central nervous system (CNS). Children born with HIV may present with cognitive abnormalities within a few months or years of birth. However, there is a group of children known as ‘slow progressors’ or asymptomatic children who do not exhibit typical symptoms of HIV and are consequently not put onto Highly Active Antiretroviral Therapy (HAART). The study sought to explore the cognitive and behavioural profiles of asymptomatic HAART-naïve children in comparison to a matched HIV-negative control group. Results suggest that Asymptomatic HAART-naïve children do experience some underlying CNS impairments and behavioural difficulties that need to be taken into account so that the appropriate services can be made available for their proper care and management.
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    Neuropsychological and Neuroimaging Outcomes Following Moderate to Severe Paediatric Traumatic Brain Injury in South Africa
    (2022) Mc Fie-Schwartz, Sarah; Schrieff, Leigh; Figaji, Anthony
    Paediatric traumatic brain injury (pTBI) is a leading cause of mortality and disability. South Africa is predicted to have a high pTBI rate and an adverse socioeconomic environment for recovery. Despite this, few studies have investigated the neuropsychological and/or neuroimaging outcomes of pTBI in South Africa. The study was designed as a capacity-building exercise to demonstrate the successful collection of data from different sites involved in a developing international collaboration. The aims were therefore to 1) provide a detailed description of the premorbid factors and neuropsychological and neuroimaging outcomes of a sample of South African children with moderate to severe pTBI, and 2) investigate the barriers to the successful implementation of neuropsychological and neuroimaging research in this population. Five patients with severe pTBI were enrolled during the 6-month recruitment window. These participants presented with 6-month post-TBI outcomes that ranged from mild neuropsychological deficits and no visible abnormalities on neuroimaging to severe neuropsychological deficits and evidence of multifocal pathology on imaging. There was a relatively high occurrence of adverse developmental, socioeconomic, and neuropsychological histories, which will need to be considered when selecting an appropriate control group or combining with other populations in a potential future multicentre study. Additional strategies will also be required to improve recruitment and increase the rate of successful imaging. Changes may need to be made to the neuropsychology assessment so as not to disadvantage this population, for example avoiding tests that are reliant on sequencing the alphabet. In conclusion, the study's findings will help to improve the likelihood of the much-needed large-scale research in this at-risk and understudied South African population.
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    Patterns of racial segregation in residence dining halls
    (2005) Schrieff, Leigh; Tredoux, Colin; Dixon, John; Finchilescu, Gillian
    Social psychologists have long been interested in the effects of ‘contact’ between racial groups. The conditions under which this contact can manifest have usually been experimentally manipulated in order to determine optimal combinations. A shortcoming of this approach is that it constructs contact situations that are unnatural and contrived. Some researchers have proposed an approach that examines contact as a natural phenomenon (Dixon & Durrheim, 2003). The present research adopts this approach, and reports on a naturalistic, observational study of ‘contact’ between students in university residence dining-halls. Seating patterns of students were observed for one month and analysed along dimensions of spatial variation. The results show high levels of informal segregation and that the segregation manifests as a specifi c spatial confi guration. Such results, which occur despite the presence of apparently favourable conditions, illustrate how this approach may lead to different conclusions to those achieved through experimental manipulation.
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    Social Communication Intervention via Telehealth Following Traumatic Brain Injury in Adults: A Systematic Review
    (2022) Christie-Taylor, Taryn; Schrieff, Leigh
    Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability, affecting millions of individuals annually worldwide. Neuropsychological sequalae following TBI are multiple and heterogenous, with the combination of such deficits having a marked impact on individuals' ability to effectively communicate. Functional implications of impaired communicative competence are profound and long-lasting, therefore warranting intervention. Neurorehabilitation targeting social communication post-TBI has to date been dominated by social skills and communication partner training, with telehealth (TH) delivery thereof recently emerging as a promising avenue of intervention. Method: This systematic review of social communication intervention via TH following TBI, was structured according to PRISMA guidelines, involved searching six scientific databases and included four studies which were evaluated using Cicerone et al.'s (2009) and Tate et al.'s (2008) checklists for methodological quality. Results: In both a single-case experimental design and clinical trial of a TH intervention program, TBIconneCT, improvements in conversational skills and quality were recorded on independent observer and self-report measures. Results of participants receiving TH intervention appear comparable to that of in-person (IP) counterparts. Across studies the logistics of TH delivery did not seem to detract from the subjective experience of intervention with participants reporting high levels of acceptability, and feasibility. Conclusion: The current evidence base for TH options for social communication intervention post-TBI is scarce, yet findings of initial studies are promising. Given the potential of TH to expand the variety and reach of neurorehabilitation services, and the current global shift towards virtual functioning, further such research appears warranted.