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Prenatal indoor air pollution and maternal psychosocial factors have been associated with adverse psychopathology. We used environmental-exposure mixture methodology to investigate joint effects of both exposure classes on child behavior trajectories. For 360 children from the South African Drakenstein Child Health Study, we created trajectories of Child Behavior Checklist scores (at 24, 42, and 60 months) using latent-class linear mixed effects models. Indoor air pollutants and psychosocial factors were measured during pregnancy (second trimester). After adjusting for confounding, single-exposure effects (per natural log-1 unit increase) were assessed using polytomous logistic regression models, joint effects using self-organizing maps, and principal component analysis. Three trajectories were chosen for both internalizing and externalizing problems, with "high" (externalizing) or "increasing" (internalizing) being the most adverse trajectories. High externalizing trajectory was associated with increased exposure to particulate matter of ≤ 10 microns in diameter (PM10) (odds ratio [OR] = 1.25; 95% CI, 1.01-1.55) and self-organizing maps exposure profile most associated with smoking (OR = 2.67; 95% CI, 1.14-6.27). Medium internalizing trajectory was associated with increased emotional intimate partner violence (OR = 2.66; 95% CI, 1.17-5.57), increasing trajectory with increased benzene (OR = 1.24; 95% CI, 1.02-1.51) and toluene (1.21; 95% CI, 1.02-1.44) and the principal component most correlated with benzene and toluene (OR = 1.25; 95% CI, 1.02-1.54). Prenatal exposure to environmental pollutants and psychosocial factors was associated with internalizing and externalizing child behavior trajectories. Understanding joint effects of adverse exposure mixtures will facilitate targeted interventions to prevent childhood psychopathology. This article is part of a Special Collection on Mental Health., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.)

Little is known about the relationship between violence exposure and mental health in preschoolers living in low- and middle-income countries (LMICs). Multiple regression analyses investigated associations between violence exposure and mental health in the Drakenstein Child Health Study (N = 978), a South African birth cohort. Lifetime violence exposure was assessed at age 4.5 years using the parent-report Child Exposure to Community Violence Checklist (CECV). Mental health was assessed at age 5 years using the Child Behaviour Checklist (CBCL 1.5-5). Eighty-three percent of the children were exposed to some form of violence. Internalising and externalising behaviours were positively associated with overall violence exposure (β per one unit change in the overall score = 0.55 [0.16, 0.94] and β = 0.53 [0.23, 0.84], respectively), domestic victimisation (β per one unit change in the subscore = 1.28 [0.28, 2.27]; β = 1.14 [0.37, 1.90]) and witnessing community violence (β = 0.77 [0.15, 1.39]; β = 0.68 [0.19, 1.18]). There was a positive association between polyvictimisation and externalising (β = 1.02 [0.30, 1.73]) but not internalising (β = 0.87 [-0.06, 1.80]) behaviour problems. Evidence for an association of witnessing domestic violence with internalising (β = 0.63 [-0.97, 2.24]) or externalising (β = 1.23 [-0.04, 2.50]) behaviours was less robust. There was no association between community victimisation and internalising or externalising behaviours (β = 0.72 [-1.52, 2.97; β = 0.68 [ -1.06, 2.41]). Observations highlight the risk for mental health problems among preschoolers living in high-violence contexts and emphasize the need for early interventions., (© 2024. The Author(s).)

It is hypothesized that air pollution and stress impact the central nervous system through neuroinflammatory pathways Despite this, the association between prenatal exposure to indoor air pollution and psychosocial factors on inflammatory markers in infancy has been underexplored in epidemiology studies. This study investigates the individual and joint effects of prenatal exposure to indoor air pollution and psychosocial factors on early life inflammation (interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)). We analyzed data from the South African Drakenstein Child Health Study (N = 225). Indoor air pollution and psychosocial factor measurements were taken in the 2nd trimester of pregnancy. Circulating inflammatory markers (IL-1β, Il-6, and TNF-α) were measured in serum in the infants at 6 weeks postnatal. Linear regression models were used to investigate associations between individual exposures and inflammatory markers. To investigate joint effects of environmental and psychosocial factors, Self-Organizing Maps (SOM) were used to create exposure profile clusters. These clusters were added to linear regression models to investigate the associations between exposure profiles and inflammatory markers. All models were adjusted for maternal age, maternal HIV status, and ancestry to control for confounding. Most indoor air pollutants were positively associated with inflammatory markers, particularly benzene and TNF-α in single pollutant models. No consistent patterns were found for psychosocial factors in single-exposure linear regression models. In joint effects analyses, the SOM profile with high indoor air pollution, low SES, and high maternal depressive symptoms were associated with higher inflammation. Indoor air pollutants were consistently associated with increased inflammation in both individual and joint effects models, particularly in combination with low SES and maternal depressive symptoms. The trend for individual psychosocial factors was not as clear, with mainly null associations. As we have observed pro- and anti-inflammatory effects, future research should investigate joint effects of these exposures on inflammation and their health effects., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dan Stein reports a relationship with Discovery Vitality that includes: consulting or advisory. Dan Stein reports a relationship with Johnson & Johnson that includes: consulting or advisory. Dan Stein reports a relationship with Kanna that includes: consulting or advisory. Dan Stein reports a relationship with L'Oreal that includes: consulting or advisory. Dan Stein reports a relationship with Orion that includes: consulting or advisory. Dan Stein reports a relationship with Sanofi that includes: consulting or advisory. Dan Stein reports a relationship with Servier that includes: consulting or advisory. Dan Stein reports a relationship with Takeda that includes: consulting or advisory. Dan Stein reports a relationship with Vistagen that includes: consulting or advisory. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Empathy is a key factor to examine in development, because of its predictive associations with both aggression and successful prosocial behaviour. However, established measures of empathy for Low-to-Middle Income Countries, including South Africa, are lacking. In children, parent-report measures are key. However, a local study examining empathy and aggression (Malcolm-Smith et al ., 2015) found poor psychometric performance for a widely used parent-report measure of dispositional empathy, the Griffith Empathy Measure (GEM). We thus investigated which of two questionnaires measuring dispositional cognitive and affective empathy perform better in this context., Method: We contrasted internal consistency reliability of a simplified version of the GEM (SGEM; n = 160) and a parent-report version of the Questionnaire of Cognitive and Affective Empathy (QCAE; n = 440) in a low-mid socio-economic status sample. Convergence between the measures and factor structure were also assessed., Results: The parent-report version of the QCAE performed well as a measure of child dispositional cognitive and affective empathy, with good reliability (overall α = 0.90 vs. SGEM α = .63), and confirmatory factor analysis supporting the two-factor structure. The SGEM's reliability and failure to correlate with QCAE indicated poor psychometric performance., Conclusion: This is the first psychometric evaluation of the QCAE as a parent-report measure, and our results indicate that it should prove useful for future assessments of dispositional empathy in children across a variety of contexts.

Objective: Evidence shows that dialogic book-sharing improves language development in young children in low-middle income countries (LMICs), particularly receptive and expressive language. It is unclear whether this intervention also boosts development of other neurocognitive and socio-emotional domains in children. Using a randomized controlled trial (RCT) nested in the Drakenstein Child Health Study (DCHS), a book-sharing intervention was implemented in caregivers of 3.5-year-old preschool children living in low-income South African communities., Methods: 122 Caregivers and their children (mean age 3.5 years) were randomly assigned to an intervention group (n = 61) or waitlist control group (n = 61). A neurocognitive battery determined baseline receptive and expressive language, executive function, theory of mind, and behavior scores., Results: No differences were observed between intervention and control groups on receptive and expressive language, or any of the neurocognitive or socio-emotional measures from baseline (3.5 years) to 4 months post-intervention administration (4 years)., Conclusion: The benefits noted in prior literature of book-sharing in infants did not appear to be demonstrated at 4 months post-intervention, in children from 3.5 to 4 years of age. This suggests the importance of early intervention and emphasizes the need for further research on adaptation of book-sharing for older participants in a South African context., Trial Registration: retrospectively registered on 03/04/2022 PACTR202204697674974., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background : Research has highlighted high rates of exposure to violence among South African youth. However, work to date has been largely cross-sectional, focused on violence exposure during the adolescence period, and has been limited to specific types of violence exposure. We examined violence exposure in South African preschool children between 3 and 6 years of age, capturing both direct and indirect forms of violence, and tested for potential sex differences across the several types of exposures. Methods : Lifetime direct and indirect exposure to domestic and community violence was measured by parental report when children were 3.5 years (N = 530), 4.5 years (N = 749) and 6 years of age (N= 417) in a South African birth cohort located in a peri-urban community. Results : There are three main findings. First, a large proportion of children (72%-75%) were reported as having been exposed to some form of direct or indirect violent experience in their homes or communities from a young age. Second, there was significant polyvictimization,  with 49% of the children being exposed to more than one type of violence by age 6. Third, by 4.5 years of age, there was evidence that boys were more likely than girls to be exposed to domestic victimisation (28% vs. 17%) and polyvictimization (38% vs. 28%). Conclusions : These findings highlight the high levels of violence exposure in young South African children, particularly among boys, and the need for prevention at both the community and individual levels., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Tsunga L et al.)

Mental health problems often begin in early childhood. However, the associations of various individual and contextual risk factors with mental health in the preschool period are incompletely understood, particularly in low- to middle-income countries (LMICs) where multiple risk factors co-exist. To address this gap, we prospectively followed 981 children in a South African birth cohort, the Drakenstein Child Health Study, assessing pre-and postnatal exposures and risk factors. The predictive value of these factors for child mental health (assessed by the Child Behavior Checklist) was modeled using structural equation modeling. We identified two key pathways to greater externalizing behavior: (1) prenatal exposure to substances (alcohol and smoking) directly predicted increased externalizing behavior (β = 0.24, p < 0.001); this relationship was partially mediated by an aspect of infant temperament (negative emotionality; β = 0.05, p = 0.016); (2) lower socioeconomic status and associated maternal prenatal depression predicted more coercive parenting, which in turn predicted increased externalizing behavior (β = 0.18, p = 0.001). Findings in this high-risk LMIC cohort cohere with research from higher income contexts, and indicate the need to introduce integrated screening and intervention strategies for maternal prenatal substance use and depression, and promoting positive parenting across the preschool period.

Background: The number of children living with HIV (CLWHIV) has been increasing, reflected by lower mortality. However, this change is coupled with higher rates of morbidity, where CLWHIV face considerable challenges, including neurocognitive delays and mental health and behavioral functioning challenges. Despite Sub-Sahara accounting for the highest number of CLWHIV, there is still limited research on the effects of HIV on child mental health and adaptive functioning., Method: Mental health and adaptive functioning were assessed in 120 children. The sample included 62 CLWHIV and 58 demographically-matched HIV-uninfected children aged 6-12 years. Mental health was assessed using the Connors, while adaptive functioning was assessed using the Vineland Adaptive Behavioral Scale (VABS)., Results: Scores obtained were within average ranges for mental health (T-score 40-59) and adaptive functioning standard scores (70-115). However, CLWHIV had significantly higher mental health problems than uninfected children in executive functioning and aggressiveness ( p < 0.05). CLWHIV had lower adaptive functioning scores on the VABS Communication domain although these differences were not significant. In the Daily Living Skills domain, CLWHIV had significantly higher scores than the HIV-uninfected children ( p < 0.05). There were no significant differences in the Socialization subdomain. Furthermore, CLWHIV had significantly higher scores on the Maladaptive Behavior scales of the VABS' internalizing and externalizing subdomains., Conclusion: Challenges to mental health and adaptive functioning are still pervasive among CLWHIV. These findings support the need to develop support mechanisms for CLWHIV to help address mental health and adaptive functioning problems, especially as they progress into adolescence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kalungwana, Malcolm-Smith and Schrieff.)

Background: The ability to identify and interpret facial emotions plays a critical role in effective social functioning, which may be impaired in individuals with fetal alcohol spectrum disorders (FASD). We previously reported deficits in children with fetal alcohol syndrome (FAS) and partial FAS (PFAS) on the "Reading the Mind in the Eyes" (RME) test, which assesses the interpretation of facial emotion. This follow-up study in adolescents was designed to determine whether this impairment persists or represents a developmental delay; to classify the RME stimuli by valence (positive, negative, or neutral) and determine whether RME deficits differ by affective valence; and to explore how components of executive function mediate these associations., Methods: The RME stimuli were rated and grouped according to valence. Sixty-two participants who had been administered the RME in late childhood (mean ± SD = 11.0 ± 0.4 years) were re-administered this test during adolescence (17.2 ± 0.6 years). Overall and valence-specific RME accuracy was examined in relation to prenatal alcohol exposure (PAE) and FASD diagnosis., Results: Children with FAS (n = 8) and PFAS (n = 15) performed more poorly on the RME than non-syndromal heavily exposed (HE; n = 19) and control individuals (n = 20). By adolescence, the PFAS group performed similarly to HE and controls, whereas the FAS group continued to perform more poorly. No deficits were seen for positively valenced items in any of the groups. For negative and neutral items, in late childhood individuals with FAS and PFAS performed more poorly than HE and controls, but by adolescence only the FAS group continued to perform more poorly. Test-retest reliability was moderate across the two ages. At both timepoints, the effects in the FAS group were partially mediated by Verbal Fluency but not by other aspects of executive function., Conclusions: Individuals with full FAS have greater difficulty interpreting facial emotions than those with non-syndromal HE and healthy controls in both childhood and adolescence. By contrast, RME deficits in individuals with PFAS in childhood represent developmental delay., (© 2022 The Authors. Alcoholism: Clinical & Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcoholism.)

Social impairment in Autism Spectrum Disorder (ASD) has been linked to Theory of Mind (ToM) deficits. However, little research has investigated the relationship between ToM and moral decision-making in children with ASD. This study compared moral decision-making and ToM between aggregate-matched ASD and neurotypical boys (n = 38 per group; aged 6-12). In a third-party resource allocation task manipulating recipient merit, wealth, and health, neurotypical children allocated significantly more resources to the morally deserving recipient, suggesting equitable allocation. A comparatively larger portion of the ASD group allocated equally. ToM emerged as a predictor of moral decision-making. We suggest that ToM (cognitive empathy) deficits may underly atypical moral decision-making in ASD by limiting the integration of empathic arousal (affective empathy) with moral information., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Maternal responses to infant facial expressions were examined in two socioeconomically diverse samples of South African mothers (Study I, N = 111; and Study II, N = 214; age: 17-44 years) using pupil and gaze tracking. Study I showed increased pupil response to infant distress expressions in groups recruited from private as compared to public maternity clinics, possibly reflecting underlying differences in socioeconomic status (SES) across the groups. Study II, sampling uniformly low-SES neighborhoods, found increased pupil dilation and faster orientation to expressions of infant distress, but only in the highest income group. These results are consistent with maternal physiological and attentional sensitivity to infant distress cues but challenge the universality of this sensitivity across socioeconomic diversity., (© 2020 Society for Research in Child Development.)

Recent research has identified a leftward cradling bias in males, although males are much less lateralised than females. It has been suggested that on an individual level this leftward bias is strengthened as males acquire caregiving experience. Furthermore, recent explanations propose that leftward cradling bias is facilitated by right-hemispheric specialisation for processing facial emotions. Some have suggested that it is specifically facilitated by right-hemispheric specialisation for basic social-affective processes that underlie our capacity to relate to others. The present study investigated male cradling bias in relation to these three factors. Ninety-eight right-handed males aged 18-56 years were observed across four separate trials of an imaginary cradling scenario. Caregiving experience, attachment style, hemispheric lateralisation for processing facial emotion, and autistic traits were measured. A leftward cradling bias was observed in 72.4% of participants and was not contingent on caregiving experience. Regression analyses revealed that right-hemispheric lateralisation for processing facial emotions and autistic traits were both significant predictors of leftward cradling, while attachment style did not predict leftward cradling. Overall, our findings indicate that the leftward cradling bias in males is not contingent on previous caregiving experience and provide further support for right-hemispheric specialisation and basic social-affective processing explanations., (Copyright © 2020. Published by Elsevier Inc.)

Background: Although deficits in the interpretation of affective facial expressions have been described clinically and in behavioral studies of fetal alcohol spectrum disorders (FASD), effects of prenatal alcohol exposure on the neural networks that mediate affective appraisal have not previously been examined., Methods: We administered a nonverbal event-related fMRI affective appraisal paradigm to 64 children (mean age = 12.5 years; 18 with fetal alcohol syndrome (FAS) or partial FAS (PFAS), 18 nonsyndromal heavily exposed (HE), and 28 controls). Happy, sad, angry, fearful, and neutral faces and pixelated control images were presented sequentially in a randomized order. The child indicated whether the currently displayed face showed the same or different affect as the previous one., Results: Data from whole-brain analyses showed that all groups activated the appropriate face processing neural networks. Region of interest analyses indicated that, compared to HE and control children, the FAS/PFAS group exhibited greater blood oxygenation level-dependent (BOLD) signal changes when processing neutral faces than pixelated images in 2 regions that form part of the visual sensory social brain network, which plays an important role in the initial processing of facial affect. By contrast, BOLD signal when processing angry faces was weaker for the FAS/PFAS group in a region involved in the processing of facial identity and facial expressions and in a region involved in the recognition and selection of behavioral responses to aggressive behavior., Conclusions: These findings of greater BOLD signal in the FAS/PFAS group in response to neutral faces suggest less efficient neural processing of more difficult to interpret emotions, and the weaker BOLD response to angry faces suggests altered processing of angry stimuli. Although behavioral performance did not differ in this relatively simple affective appraisal task, these data suggest that in children with FAS and PFAS, the appraisal of neutral affect and anger is likely to be more effortful in more challenging and dynamic social contexts., (© 2020 by the Research Society on Alcoholism.)

Objective: Leftward cradling bias is thought to facilitate optimal interaction between mother and infant. There is mixed evidence indicating this bias may be disrupted by depression. This study investigated the relationship between depressive symptoms and preferred cradling side (i.e., cradling bias) in nulliparous women. Method: Six hundred and nineteen females, aged 18 to 25 years, were asked to imagine cradling an infant to soothe it. This instruction was given on four separate occasions. Participants also completed the Beck Depression Inventory-II. All data were collected via an online survey. Results: As the number of depressive symptoms increased, leftward cradling decreased. Although this relationship was not statistically significant, a pattern emerged: As depressive symptoms increased, so too did the likelihood of cradling to the right. Furthermore, those scoring highest on depressive symptoms were more likely to cradle inconsistently to the left, consistently to the right, or show no bias, when compared to those scoring lower on depressive symptoms. Conclusions: Theory suggests that leftward cradling is facilitated by right hemisphere processes involved in relating to others. A relationship between affective symptoms such as depressive symptoms and reduced leftward cradling bias supports this argument. It is argued that leftward cradling facilitates optimal interactions between cradler and infant. Consequently, disruptions of leftward cradling have implications for child development.

Humans are social beings, and acts of prosocial behavior may be influenced by social comparisons. To study the development of prosociality and the impact of social comparisons on sharing, we conducted experiments with nearly 2500 children aged 3-12 years across 12 countries across five continents. Children participated in a dictator game where they had the opportunity to share up to 10 of their stickers with another anonymous child. Then, children were randomized to one of two treatments. In the "shared a little" treatment children were told that another child from their school had shared 1 sticker, whereas in the "shared a lot" treatment children were told that another child from their school had shared 6 stickers in the same game. There was a strong increase in baseline sharing with age in all countries and in both treatments. The "shared a lot" treatment had a positive treatment effect in increasing sharing overall, which varied across countries. However, cross-cultural comparisons did not yield expected significant differences between collectivist and individualist countries. Our results provide interesting evidence for the development of sharing behavior by age across the world and show that social information about the sharing of peers is important for children's decision making., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To investigate the association of prenatal alcohol exposure (PAE) and early neurodevelopment in the first 2 years of life, adjusting for maternal socio-demographic and psychosocial factors, in the Drakenstein Child Health Study (DCHS), a South African birth cohort study., Methods: The DCHS comprises a population-based birth cohort of 1143 children, of which a subsample completed the Bayley Scales of Infant Development-III (BSID-III) at 6 (n = 260) and 24 months of age (n = 734). A subset of alcohol-exposed and -unexposed children was included in this analysis at age 6 (n = 52 exposed; n = 104 unexposed) and 24 months (n = 92 exposed; n = 184 unexposed). Multiple hierarchical regression was used to explore the associations of PAE with motor and language development., Results: PAE was significantly associated with decreased gross motor [odds ratio (OR) = 0.16, 95% confidence interval (CI) = 0.06-0.44, p = 0.001] or fine motor (OR = 0.16, 95% CI = 0.06-0.46, p = 0.001) functioning after adjusting for maternal socio-demographic and psychosocial factors at 6 months of age only. No significant effects were found in either receptive or expressive communication and cognitive outcomes at either time points., Conclusion: PAE has potentially important consequences for motor development in the first 2 years of life, a period during which the most rapid growth and maturation occur. These findings highlight the importance of identifying high-risk families in order to provide preventive interventions, particularly in antenatal clinics and early intervention services.

Objective: The aim of this paper was to provide a systematic review and update on the available longitudinal studies on the impact of prenatal alcohol exposure (PAE) on language, speech and communication development, as well as associated potential environmental confounders during the preschool period., Methods: A literature search was restricted to English, full-text, peer-reviewed, longitudinal studies in from 1970 until present: PUBMed, Scopus, Web of Science {C-e Collection, Biological Abstracts, KCI-Kean Journal Database, Russian Science Citation Index, SciELO Citation Index, Zoological Rec-d}, Academic Search Premier (Africa-Wide Information, CINAHL, MEDLINE, PsycINFO. Keywords included: prenatal alcohol exposure (PAE); speech or language or communication outcomes; neurocognitive or neurodevelopment or neurobehavioral or neurobehavioural; infant or baby or toddler or preschooler; longitudinal or follow-up. The inclusion criteria included (i) longitudinal cohorts with at least 2 time-points; (ii) association of light, moderate or heavy PAE on language, speech or communication delay, development or disorder; (iii) environmental confounders; (iv) infants up to preschool age., Results: Six studies satisfied the threshold for inclusion. Three studies reported that PAE was significantly associated with receptive or expressive delay. These studies demonstrated lower scores on either receptive or expressive communication in the alcohol group in comparison to the non-alcohol group, even after controlling for environmental factors up to 36 months., Conclusion: Evidence from the longitudinal studies reviewed suggest that PAE influenced delays in receptive and expressive communication up to 36 months. Contextual risk factors played a significant role in language development over time and especially as children approached school age.

A concern for fairness is a fundamental and universal element of morality. To examine the extent to which cultural norms are integrated into fairness cognitions and influence social preferences regarding equality and equity, a large sample of children (N 2,163) aged 4-11 were tested in 13 diverse countries. Children participated in three versions of a third-party, contextualized distributive justice game between two hypothetical recipients differing in terms of wealth, merit, and empathy. Social decision-making in these games revealed universal age-related shifts from equality-based to equity-based distribution motivations across cultures. However, differences in levels of individualism and collectivism between the 13 countries predicted the age and extent to which children favor equity in each condition. Children from the most individualistic cultures endorsed equitable distributions to a greater degree than children from more collectivist cultures when recipients differed in regards to wealth and merit. However, in an empathy context where recipients differed in injury, children from the most collectivist cultures exhibited greater preferences to distribute resource equitably compared to children from more individualistic cultures. Children from the more individualistic cultures also favored equitable distributions at an earlier age than children from more collectivist cultures overall. These results demonstrate aspects of both cross-cultural similarity and divergence in the development of fairness preferences., (© 2018 John Wiley & Sons Ltd.)

Introduction: There is growing awareness that psychosocial risk and resilience factors in early life play a key role in influencing later health. Most work has been done in high-income settings, rather than low-income and middle-income countries (LMICs), where the majority of the global childhood population resides. The few studies with well-defined cohorts in LMICs have employed various methods and measures, making comparisons across studies challenging. This presentation describes the methodology for infant and child developmental measures used in the Drakenstein Child Health Study (DCHS), a multidisciplinary longitudinal birth cohort study in South Africa., Methods and Analysis: We outline a multilevel approach combining a range of measures including parental reports, behaviour observations, clinician-administered scales and brain imaging. Using this approach, we aim at a longitudinal perspective of developmental, cognitive, socioemotional and neurophysiological outcomes in a birth cohort of children in an LMIC., Ethics and Dissemination: The study was approved by the faculty of Health Sciences, Human Research Ethics Committee, University of Cape Town (401/2009), Stellenbosch University (N12/02/0002) and the Western Cape Provincial Health Research committee (2011RP45)., Discussion: Children in the DCHS develop in a context typical of many communities in South Africa and other LMICs. There is a critical need for research in LMICs to elucidate underlying factors that inform risk for, and resilience to, poor developmental outcomes in infants born into high-risk communities. Such work may inform effective intervention strategies appropriate to this context., Competing Interests: Competing interests: None declared.

Autism Diagnostic Observation Schedule-2 is the 'gold standard' autism spectrum disorder observational assessment, and it is increasingly used in South Africa. However, its use is limited to English speakers, as it has not been translated into the country's other 10 official languages. Moreover, the cultural appropriateness of this tool has not been explored in South Africa. The Autism Diagnostic Observation Schedule-2 was translated into Afrikaans and assessed for cultural appropriateness to the 'coloured' population from low-middle socioeconomic status backgrounds in the Western Cape Province. Using a mixed-methods approach, three components associated with method bias in the Autism Diagnostic Observation Schedule-2 were investigated: language used, social interactions and activities, and materials. An ethnographic investigation of play, social interaction and social activities was conducted in a community sample ( n = 40), and the Afrikaans Autism Diagnostic Observation Schedule-2 was pre-piloted in a clinical sample ( n = 7). Results highlighted unique aspects of the language ('Kaaps') that need to be considered during Autism Diagnostic Observation Schedule-2 administration. The social interaction demands of the Autism Diagnostic Observation Schedule-2 appeared appropriate, and sufficient familiarity with Autism Diagnostic Observation Schedule-2 materials and activities was found to support the use of the Autism Diagnostic Observation Schedule-2. Guidelines for administration of the Autism Diagnostic Observation Schedule-2 to this population were generated to improve cultural sensitivity and cultural appropriateness and to reduce method bias.

Morality is an evolved aspect of human nature, yet is heavily influenced by cultural environment. This developmental study adopted an integrative approach by combining measures of socioeconomic status (SES), executive function, affective sharing, empathic concern, theory of mind, and moral judgment in predicting sharing behavior in children (N = 999) from the age of 5 to 12 in five large-scale societies: Canada, China, Turkey, South Africa, and the USA. Results demonstrate that age, gender, SES, culture, and social cognitive mechanisms explain over 20% of the variance worldwide in children's resource allocation. These findings are discussed in reference to standard cultural comparisons (individualist/collectivist), as well as the degree of market integration, and highlight continuities and discontinuities in children's generosity across urban contexts., (© 2016 John Wiley & Sons Ltd.)

The ability to adaptively increase cognitive control in response to cognitive challenges is crucial for goal-directed behavior. Recent findings suggest that aversive arousal triggers adaptive increases of control, but the neurochemical mechanisms underlying these effects remain unclear. Given the known contributions of the opioid system to hedonic states, we investigated whether blocking this system increases adaptive control modulations. To do so, we conducted a double-blind, placebo-controlled psychopharmacological study (n=52 females) involving a Stroop-like task. Specifically, we assessed the effect of naltrexone, an opioid blocker most selective to the mu-opioid system, on two measures of adaptive control that are thought to depend differentially on aversive arousal: post-error slowing and conflict adaptation. Consistent with our hypothesis, relative to placebo, naltrexone increased post-error slowing without influencing conflict adaptation. This finding not only supports the view that aversive arousal triggers adaptive control but also reveals a novel role for the opioid system in modulating such effects., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

We investigated whether theory of mind skills can indicate autism spectrum disorder severity. In all, 62 children with autism spectrum disorder completed a developmentally sensitive theory of mind battery. We used intelligence quotient, Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis and level of support needed as indicators of severity level. Using hierarchical cluster analysis, we found three distinct clusters of theory of mind ability: early-developing theory of mind (Cluster 1), false-belief reasoning (Cluster 2) and sophisticated theory of mind understanding (Cluster 3). The clusters corresponded to severe, moderate and mild autism spectrum disorder. As an indicator of level of support needed, cluster grouping predicted the type of school children attended. All Cluster 1 children attended autism-specific schools; Cluster 2 was divided between autism-specific and special needs schools and nearly all Cluster 3 children attended general special needs and mainstream schools. Assessing theory of mind skills can reliably discriminate severity levels within autism spectrum disorder.

Positive social cues, like happy facial expressions, activate the brain's reward system and indicate interest in social affiliation. Facial mimicry of emotions, which is the predominantly automatic and unconscious imitation of another person's facial expression, has been shown to promote social affiliation. It has been demonstrated repeatedly that the opioid system is vital to social affiliation in rodents, but there is less evidence in humans. We investigated whether a 50mg administration of naltrexone, an opioid antagonist with highest affinity for the mu-opioid system, modulates emotional mimicry. A passive viewing task with dynamic facial expressions was used in a randomized placebo controlled between-subjects design. Mimicry was measured with electromyography (EMG) on three facial muscles, the corrugator supercilii and the depressor jaw muscle, associated with negatively-valenced emotions, and the zygomaticus major, which is activated during smiling. The results demonstrate an increase of negatively-valenced facial responses (corrugator and depressor) to happy facial expressions after naltrexone compared to placebo, consistent with lowered interest in social interaction or affiliation. Our findings provide evidence for a role of the opioid system in modulating automatic behavioral responses to cues of reward and social interaction, and translate to rodent models of the mu-opioid system and social affiliation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: This paper systematically reviews the literature on the effects of prenatal alcohol exposure (PAE) on episodic memory. Specifically, the review focuses on recurring questions of whether memory deficits are consistent across memory domains, whether the impairments are consistent across the stages of episodic memory, and whether the impairments are primary episodic memory impairments or secondary to a global performance deficit or a higher order deficit., Method: In total, 33 relevant studies were identified through searches on electronic databases. Journal articles were limited to those that included human subjects and that were published in English-language journals., Results: The vast majority of reviewed studies examined memory in school-aged children and adolescents. Twenty-three studies examined verbal memory and 19 studies examined visual-spatial memory. Although all of the reviewed studies examined encoding of new material, only 10 studies examined retention of the learned material over time. Ten studies controlled for IQ, either statistically or with matched controls, when analyzing memory task performance., Conclusion: In general, studies show that PAE results in impaired verbal and visual-spatial episodic memory performance in affected individuals and these impairments are unlikely to be secondary to a global impairment. However, impairments on some memory tests are specific to the encoding stage, whereas retention is relatively spared; suggesting that the episodic memory deficit might be influenced, at least in part, by higher order cognitive processes., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Autism Spectrum Disorder (ASD) is characterised by poor social competence; and since Theory of Mind (ToM) is a building block for social-communicative skills and successful social integration, these skills are important to assess when preparing and monitoring educational and therapeutic plans. ToM is a complex skill requiring the ability to form mental concepts, to represent complex constructs verbally, to inhibit some mental states in favour of others, and to consider and compare multiple perspectives. It is critical to consider cognitive influences on the ability to develop and convey ToM skills to ensure that deficits in other cognitive domains do not falsely present as ToM deficits. This consideration is particularly vital in ASD populations with known difficulties not only in ToM, but also in intellectual functioning, language, and executive functioning. This article reviews the influence of intellectual ability, language, working memory, and inhibition skills on the presentation of ToM; with particular focus on ToM in ASD. We discuss practical suggestions based on clinical experience in neuropsychological practice and research in South Africa for the successful assessment of ToM ability.

There is an ongoing debate about the graded or dichotomous form of visual consciousness. Studies involved in the disagreement have typically employed subjective awareness ratings in psychophysical experiments. Variations in scale length have made comparisons across studies difficult and have even been suspected of influencing conclusions about the form of consciousness. We tested the proposal that a 21-point awareness scale produces dichotomous awareness state reports. The experiment described in this article randomly assigned participants to use one of four scale lengths used in previous studies in a backward masking task. Our findings suggest that all scales indicate the presence of graded awareness states, but that the resulting proportion of degraded state reports differed across the scales. Consequently, we argue that the decision of whether the form of consciousness observed in a given study is dichotomous or graded is dependent on an interpretation of the relative degree of degradation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Theory of mind (ToM) refers to the ability to understand and make inferences about other people's intentions, feelings, and beliefs. Although children with fetal alcohol spectrum disorders (FASD) are known to have deficits in social-cognitive function, little is known about ToM in FASD., Methods: ToM ability was assessed using a developmentally sensitive ToM battery, including the reading the mind in the eyes (RME) test, a measure of mental inferential ability that has been found to be impaired in other clinical populations. IQ and executive function (EF) were assessed as potential mediating variables. The battery was administered to 63 children (aged 9 to 11 years) from Cape Town, South Africa, whose mothers had been prospectively recruited during pregnancy. Children with fetal alcohol syndrome (FAS; n = 8) and partial FAS (PFAS; n = 19), as well as nonsyndromal heavily exposed children (n = 17), were compared to children born to abstaining or light drinkers (n = 19) from the same community., Results: No FASD group differences were found on the less challenging ToM tasks. By contrast, children with FAS and PFAS performed more poorly than controls on a more challenging ToM task, the RME test. A continuous measure of prenatal alcohol exposure (PAE) was more sensitive than FASD diagnosis in that it was related to 4 higher-order ToM measures, particularly the ability to attribute mental states assessed on RME. IQ only partially mediated the effect of exposure on RME performance, and these effects were not mediated by EF. Hence, the data suggest that these ToM measures tap into a specific alcohol-related social-cognitive deficit that does not merely reflect poorer EF. FASD diagnosis and PAE were each also related to RME after control for attention deficit/hyperactivity disorder., Conclusions: These findings suggest that deficits in higher-order ToM function may play a significant role in the social-cognitive behavioral impairment in FASD., (Copyright © 2016 by the Research Society on Alcoholism.)

Background. A subgroup of MS patients present with "euphoria." Classical authors describe this symptom as the predominant mood state of these patients, while contemporary authors regard it as rare. Objective. This study aimed to address these discrepancies and investigate the contributions made by varying operational definitions and measurement instruments. Methods. One hundred MS patients and 100 matched controls completed the classical interview of Cottrell and Wilson and the modern Neuropsychiatric Inventory in a once-off interview. Results. The MS group demonstrated high frequencies of euphoria using the classical measure but low frequencies using the contemporary measure and definition. The matched control group demonstrated significantly higher rates than the MS group using the classical measure and lower rates than the MS group using the contemporary measure. Conclusion. The discrepancies in incidence rates of euphoria noted in the literature do not reflect a change in the incidence of euphoria in MS, but rather in the definition and operationalisation of "euphoria." Furthermore, these results highlight the importance of characterising what represents pathological euphoria as well as the need for better definitions and instruments of measure.

Prosocial behaviors are ubiquitous across societies. They emerge early in ontogeny and are shaped by interactions between genes and culture. Over the course of middle childhood, sharing approaches equality in distribution. Since 5.8 billion humans, representing 84% of the worldwide population, identify as religious, religion is arguably one prevalent facet of culture that influences the development and expression of prosociality. While it is generally accepted that religion contours people's moral judgments and prosocial behavior, the relation between religiosity and morality is a contentious one. Here, we assessed altruism and third-party evaluation of scenarios depicting interpersonal harm in 1,170 children aged between 5 and 12 years in six countries (Canada, China, Jordan, Turkey, USA, and South Africa), the religiousness of their household, and parent-reported child empathy and sensitivity to justice. Across all countries, parents in religious households reported that their children expressed more empathy and sensitivity for justice in everyday life than non-religious parents. However, religiousness was inversely predictive of children's altruism and positively correlated with their punitive tendencies. Together these results reveal the similarity across countries in how religion negatively influences children's altruism, challenging the view that religiosity facilitates prosocial behavior., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

A recent interest in euphoria in multiple sclerosis (MS) has resulted in a wealth of literature on this topic. However, a marked change in the definition of this symptom appears to have taken place since its first descriptions in the mid-19(th) century. This short report will demonstrate that the 'euphoria' being studied today may not be the same state as that originally observed and described in MS patients and some implications of this possibility are discussed., (© The Author(s), 2014.)

In rodents, there is abundant evidence for the involvement of the opioid system in the processing of reward cues, but this system has remained understudied in humans. In humans, the happy facial expression is a pivotal reward cue. Happy facial expressions activate the brain's reward system and are disregarded by subjects scoring high on depressive mood who are low in reward drive. We investigated whether a single 0.2mg administration of the mixed mu-opioid agonist/kappa-antagonist, buprenorphine, would influence short-term memory for happy, angry or fearful expressions relative to neutral faces. Healthy human subjects (n38) participated in a randomized placebo-controlled within-subject design, and performed an emotional face relocation task after administration of buprenorphine and placebo. We show that, compared to placebo, buprenorphine administration results in a significant improvement of memory for happy faces. Our data demonstrate that acute manipulation of the opioid system by buprenorphine increases short-term memory for social reward cues., (Copyright © 2015. Published by Elsevier Ltd.)

Objective: In a context of disturbing rates of violent crime, this pilot study initiated examination of the association between empathy and aggressive behaviour in young Western Cape children. Establishing which empathy measures are appropriate for our context was a primary concern., Method: To capture various aspects of empathy in young children we adopted a multi-method approach. We examined empathy scores in 65 lower middle socio-economic status (SES) English-speaking Grade 1 pupils (6.0-8.0 years old) and their association with aggressive externalising behaviour., Results: Parent report measures of callous-unemotional traits and aggression performed well, however, the Griffith Empathy Measure, a well-established parent report scale, proved problematic. Empathy scores, particularly those for callous-unemotional traits, were associated with aggression. We also found several associations between aspects of empathy, consistent with the international literature. Cognitive empathy, as measured by first-order false belief reasoning, was not well established, suggesting that other more complex social cognitive tasks were inappropriate for this age group in our context., Conclusion: The association between empathy and aggression warrants further investigation in this context. Appropriate measures for the South African context must be utilised.

Previous studies suggest that leftward cradling bias may facilitate mother-infant relationships, as it preferentially locates the infant in the mother's left hemi-space, which is specialized for several social-affective processes. If leftward cradling bias is mediated by social-affective attachment processes, it should be reduced in humans who are deficient in such processes. Individuals diagnosed with Autism Spectrum Disorders (ASDs) constitute a population with known deficits in social and emotional relating. A pilot study confirmed reduced bias in this group, and in the present study, we elaborated methods to assess also the impact of higher cognitive processes on cradling bias. Direct systematic observation was used to investigate the occurrence of cradling bias in ASD, non-ASD intellectually disabled children and typically developing children. Ninety-three participants aged 5-15 years cradled a life-like doll on four separate occasions. Intelligence and executive functions were assessed. Regression analyses revealed that ASD diagnosis was the only significant predictor of atypical cradling preference. While intellectually disabled and typically developing children clearly preferred to cradle to the left, no preference was evident in the ASD group. Results support the hypothesis that leftward cradling bias is associated with basic social-affective capacities.

In rodents, the endogenous opioid system has been implicated in emotion regulation, and in the reduction of fear in particular. In humans, while there is evidence that the opioid antagonist naloxone acutely enhances the acquisition of conditioned fear, there are no corresponding data on the effect of opioid agonists in moderating responses to fear. We investigated whether a single 0.2mg administration of the mu-opioid agonist buprenorphine would decrease fear sensitivity with an emotion-recognition paradigm. Healthy human subjects participated in a randomized placebo-controlled within-subject design, in which they performed a dynamic emotion recognition task 120min after administration of buprenorphine and placebo. In the recognition task, basic emotional expressions were morphed between their full expression and neutral in 2% steps, and presented as dynamic video-clips with final frames of different emotional intensity for each trial, which allows for a fine-grained measurement of emotion sensitivity. Additionally, visual analog scales were used to investigate acute effects of buprenorphine on mood. Compared to placebo, buprenorphine resulted in a significant reduction in the sensitivity for recognizing fearful facial expressions exclusively. Our data demonstrate, for the first time in humans, that acute up-regulation of the opioid system reduces fear recognition sensitivity. Moreover, the absence of an effect of buprenorphine on mood provides evidence of a direct influence of opioids upon the core fear system in the human brain., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: This study investigated relations among empathy and cradling bias in children diagnosed with autism spectrum disorders (ASDs)., Method: Twenty children with ASDs and 20 typically developing (TD) children, aged 5-15 years old, cradled a doll as if it were an infant s/he was putting to sleep on three separate occasions. We recorded side preference on each occasion., Results: Children with ASDs showed no preference for cradling side whereas TD children showed a strong left-sided preference. To the best of our knowledge, children with ASDs are the only population that does not exhibit cradling bias., Conclusion: An absence of cradling bias and empathy deficits in ASD may be related. If so, these data support the hypothesis that leftward cradling is a characteristic of enhanced quality of caregiver-infant interaction and bonding.

Moral emotions are critically important in guiding appropriate social conduct. Empirical investigation of these emotions remains a challenge, however, because of the difficulty in eliciting them reliably in controlled settings. Here we describe a novel prejudice paradigm that aimed to elicit both negatively and positively valenced moral emotions in real-time. Low-prejudice females (N = 46) who met highly specific demographic and personality-based screening criteria completed a series of Implicit Association Tests (IATs). Feedback following these IATs was pre-programmed to either endorse participants' non-prejudiced self-standards (positive condition), or to contradict their self-standards (negative condition), in response to sensitive social topics. Neutral condition IATs reflected participants' attitudes toward non-sensitive social topics. Results demonstrated that the IATs were successful in eliciting moral-positive emotions (satisfaction and pride) and moral-negative emotions (primarily guilt). In addition, participants high in self-reported punishment sensitivity, as assessed by the Behavioral Inhibition System (BIS) scale, reported greater guilt.

The influential threat simulation theory (TST) asserts that dreaming yields adaptive advantage by providing a virtual environment in which threat-avoidance may be safely rehearsed. We have previously found the incidence of biologically threatening dreams to be around 20%, with successful threat avoidance occurring in approximately one-fifth of such dreams. TST asserts that threat avoidance is over-represented relative to other possible dream contents. To begin assessing this issue, we contrasted the incidence of 'avoidance' dreams with that of their opposite: 'approach' dreams. Because TST states that the threat-avoidance function is only fully activated in ecologically valid (biologically threatening) contexts, we also performed this contrast for populations living in both high- and low-threat environments. We find that 'approach' dreams are significantly more prevalent across both contexts. We suggest these results are more consistent with the view that dreaming is generated by reward-seeking systems than by fear-conditioning systems, although reward-seeking is clearly not the only factor determining the content of dreams., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Revonsuo's influential Threat Simulation Theory (TST) predicts that people exposed to survival threats will have more threat dreams, and evince enhanced responses to dream threats, compared to those living in relatively safe conditions. Participants in a high crime area (South Africa: n=208) differed significantly from participants in a low crime area (Wales, UK: n=116) in having greater recent exposure to a life-threatening event (chi([1,N=186])(2)=14.84, p<.00012). Contrary to TST's predictions, the SA participants reported significantly fewer threat dreams (chi([1,N=287])(2)=6.11, p<.0134), and did not differ from the Welsh participants in responses to dream threats (Fisher's Exact test, p=.2478). Overall, the incidence of threat in dreams was extremely low-less than 20% of dreams featured realistic survival threats. Escape from dream threats occurred in less than 2% of dreams. We conclude that this evidence contradicts key aspects of TST.