South Africa School Intervention Project (Supplement)
Despite ongoing efforts to prevent maternal drinking during pregnancy, prenatal alcohol exposure continues to be the leading non-genetic cause of mental retardation. As the result of ongoing epidemiological studies in South Africa since 1999, the prevalence of fetal alcohol syndrome (FAS) in the Western Cape Region of South Africa has been found to range from 46 per 1000 to 75 per thousand among school children ages 5 to 9 years. These are the highest recorded rates in any general community in the world and are many times higher than prevalence estimates for the United States. Even though the need for developing intervention programs for alcohol-affected children has long been recognized, no systematic outcome studies of such intervention programs exist.
Therefore, the current project aims to test the efficacy of three intervention methods in the remediation of specific behavioral and learning problems in alcohol-affected children in the Western Cape Province of South Africa. The specific aims of the multi-method study are: 1) To determine the degree to which cognitive control therapy improves academic skills and behavior in alcohol-exposed children; 2) To determine the degree to which family interventions improve academic skills and behavior of alcohol-exposed children; 3) To determine the degree to which specific linguistic and literacy training programs improve academic skills and behavior of alcohol-exposed children; 4) To determine the degree to which environmental modifications in the classroom (e.g. limited class size and structured teaching) improve academic skills and behavior in alcohol-exposed children; 5) To determine the degree to which combinations of above methods improve academic skills and behavior in alcohol-exposed children; 6) To assess the effects of 3 mediating variables (self-efficacy, attention, meta-cognitive skills) and 3 moderating variables (child's IQ, life stress, maternal education) on therapeutic outcomes.
One hundred and twenty children, ages 7 to 9 will be recruited through an epidemiological study currently being conducted in the Western Region of South Africa. Twenty children will be randomly assigned to one of six groups, four treatment groups (cognitive control therapy, family support, classroom modification, and linguistic and literacy training) and one alcohol-exposed control group and one typically developing control group. During the first phase of the project, all treatment and control-group children will be administered a comprehensive battery of tests consisting of a neuropsychological test battery, tests of academic achievement, selected speech/language tests, and a functional behavior assessment. The pre-testing will serve the following two distinct purposes: 1) to provide pretest data for each child in the research cohort and, 2) to identify current educational and behavioral issues for each child in the study. Following the pre-testing, each of the three proposed intervention methods will be administered once a week with children in each study group over a period of 18 months. In addition, each child in the study will be observed by a blinded observer 4 times in the prescribed time of intervention. After the 18- month intervention trial, the same testing battery will be administered as post-intervention measures. The pre-test and post-test performance of the children will be analyzed.