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

Bibliography: leaves 106-112. / The primary aim of this dissertation was to gain an understanding of the psychopathology present in the perpetrator of Munchausen Syndrome by Proxy (MSP), exploring Jureidini's (1999) notion that this behaviour can be explained as the perpetrator engaging in a form of pathological play. A systematic literature review regarding MSP, with particular foci on psychopathology in perpetrators of MSP and the notion of pathological play was conducted. The notion that MSP is a form of pathological play was critically evaluated through the use of clinical case material. Two cases were selected, both of which met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnostic criteria for MSP, based on the assessment of a child psychiatrist with expertise in this area. The case material was analysed through the generation of common themes and identification of repetitive patterns which were then systematically analysed and compared with the findings cited in the literature review, with particular reference to MSP as a form of pathological play. Jureidini's (1999) theoretical statement was analysed in the light of the available evidence and the theoretical basis was then revised. Aspects explained by the theory were presented. Aspects not explained by the theory were rejected. Object Relations Theory was proposed as an alternative to understanding the psychopathology present in a perpetrator of MSP.

Includes abstract. Includes bibliographical references.

Includes bibliographical references. / This study documents hearing parents' experiences of the impact of deafness on raising their deaf children during the preschool years. It focuses on their experience of health services for their child. The study population of 20 children was drawn from parents with children under 6 years of age diagnosed with moderate to profound loss of hearing at the Developmental Ciinic, Red Cross Chiidren’s Hospital, Rondebosch; Cape Town. Data was collected from 2 sources, namely a semi-structured interview, which was analysed for themes, and a questionnaire, which measures parental stress, communication difficuities, and experience of professional support.

Includes abstract. Includes bibliographical references.

Includes abstract. Includes bibliographical references (leaves 334-373).

Bibliography: leaves 68-75.

Includes bibliographical references (leaves 273-287). / Over the last decade, sexual abuse committed by young sexual offenders has increasingly been reported in South Africa. Such offenders are often inappropriately managed by both mental health and related professionals and the justice system. This dissertation describes the process involved in the development and implementation of a diversion programme for young sexual offenders in the local setting by the use of action research. This is preceded by an overview of the concepts of diversion and the characteristics, assessment and management of young sexual offenders. The development and implementation process is presented in stepwise action cycles, highlighting the various action steps that were taken. These are evaluated in the 'observation' and 'reflection' sections of each cycle. Twelve action cycles, spanning a period of 6 years, are described, beginning with the identification that young sexual offenders and their management posed a problem, the development of a diversion programme and the initial pilot studies, through to the formation of SAYSTOP, a multidisciplinary umbrella organisation. Further steps describe the wider implementation of the programme, facilitator training and follow-up studies conducted on young sexual offenders. The multi-disciplinary role played by SAYSTOP in the management of young sexual offenders is discussed and the SAYSTOP diversion programme is compared to guidelines suggested in the literature. The strengths, weaknesses and limitations of both the process and the SAYSTOP diversion programme are discussed in the conclusion, followed by recommendations for future guidelines and policy decisions regarding young sexual offenders. Results indicate that sexual offences committed by youths in South Africa are common and that no intervention programmes exist that aim to rehabilitate these offenders. Professionals from various fields were able to combine their experience and develop a group intervention programme targeting these youths. Following successful administration of this programme to young sexual offenders a manual documenting both the content and objectives of group sessions was developed. Structured workshops with the aim of training future facilitators (probation officers) ensured that the diversion programme was implemented on a regional level in the Western and Eastern Cape. Follow-up studies on young sexual offenders and feedback from facilitators indicated that the core concepts of the programme were understood by participants although several areas were identified that needed to be addressed in more detail. The follow-up studies showed that none of the youths re-offended, although disappointingly only ± 30% of youths could be interviewed. A system whereby young sexual offenders could be managed and followed-up over a longer period within a continuum of care model could not be implemented. Insufficient resources and high staff turnover are identified as key factors that hampered both the development and implementation of the SAYSTOP diversion programme. Although the SAYSTOP diversion programme proved to be successful as a first line of intervention, further refinement of the programme content, development of a continuum of care model and a central management structure involving all role players is necessary for this form of diversion programme to be successful in the future.

Includes abstract. / Includes bibliographical references. / The Highly Active Antiretroviral Therapy (HAART) era in the mid-nineties signalled a dramatic change in the long-term outcome of Human Immunodeficiency Virus (HIV). Many children have shown significant neurologic benefit, and in particular, a decline in the incidence of HIV encephalopathy. As increasing numbers of children have survived into adolescence and early adulthood new challenges have arisen, such as the detection and characterization of milder forms of HIV-associated neurocognitive deficits in children previously thought to be asymptomatic...

The diagnosis of Schizophrenia in children has historically been the source of much psychiatric controversy, especially with regard to classification, treatment and prognosis. This was further complicated by the broad category for the diagnosis of psychotic disorders in childhood in the Diagnostic and Statistical Manual of Mental Disorders (DSM 11).This included Schizophrenia in childhood, autism, and other psychotic conditions. The work of Kolvin (1971 a-f) and Rutter (1972), have been instrumental in separating autism and Schizophrenia into distinct categories. This review is not aimed at being an exhaustive coverage of all the literature on Schizophrenia in childhood, but is focused on classification, phenomenology, epidemiology, differential diagnosis, etiology, course, cross-cultural factors, and treatment. The adult literature has been referred to, when there is no appropriate reference in the literature on children with Schizophrenia, in certain focused areas. Specific research questions will be discussed in depth in the appropriate sections. These are: 1) Is Schizophrenia with childhood onset a discretely homogenous entity or is the condition on a continuum with adult Schizophrenia? 2) Are the current classification systems diagnostically valid in children with Schizophrenia? 3) Do phenomenological descriptions of the condition assist the clinician diagnostically, given the financial constraints limiting the extent of special investigations, in the South African context? 4) The evidence concerning the etiology of Schizophrenia in childhood will be critically evaluated. 5) Do current treatment models have any relevance to clinical practice in South Africa, especially with regard to the need for cost-effective solutions? 6) Two cases obtained from the in-patient Unit of the Red Cross Hospital's Child and Family Unit will also be examined, in the light of the literature. As much of the literature prior to DSM III generally did not clearly differentiate between childhood Schizophrenia, autism and other heterogeneous conditions (Rutter, 1972), they have not been included, except for seminal papers. In addition the age groups in the papers do not always mention the pubertal status of the children, thus for the purpose of the review, primarily studies focusing on samples with onset prior to 13 years are included. These have lately been characterized in the literature as 'VEOS' (Very Early Onset Schizophrenia). In one of the few longitudinal studies of children with Schizophrenia, Werry, McClellan and Chard (1991), reported that more than half the sample (55%) which had been diagnosed as schizophrenic at first presentation, was found to have Bipolar Disorder at follow-up. It is possible that the papers reviewed may also reflect this once longitudinal follow-up has been completed. The results of longitudinal studies are awaited.