A Year-long Caregiver Training Program to Improve Neurocognition in Preschool Ugandan HIV-exposed Children

Abstract

Objective Mediational intervention for sensitizing caregivers (MISC) is a structured program enabling caregivers to enhance their child’s cognitive and emotional development through daily interactions. The principal aim was to evaluate if a year-long MISC caregiver training program produced greater improvement in child cognitive and emotional development compared with a control program. Methods 119 uninfected HIV-exposed preschool children and their caregivers were randomly assigned to one of two treatment arms: biweekly MISC training alternating between home and clinic for one year or a health and nutrition curriculum. All children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales, Color-Object Association Test (COAT) for memory, and Achenbach Child Behavior Checklist (CBCL) for psychiatric symptoms. Caregivers were evaluated on the same schedule with the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. Results The treatment arms were compared using repeated-measures ANCOVA with child age, gender, weight, SES, caregiving quality, caregiver anxiety, and caregiver education as covariates. The MISC children had significantly greater gains compared to controls on the Mullen Receptive and Expressive Language development, and on the Mullen composite score of cognitive ability. COAT total memory for MISC children was marginally better than controls. No CBCL differences between the groups were noted. Caldwell HOME scores and observed mediational interaction scores from videotapes measuring caregiving quality also improved significantly more for the MISC group. Conclusion MISC enhanced cognitive performance, especially in language development. These benefits were possibly mediated by improved caregiving and positive emotional benefit to the caregiver.

Parenting Skills and Emotional Availability: An RCT

“…8,9 Inclusion of responsive care and responsive feeding messages in the RS intervention and responsive feeding in the EN intervention benefited both interventions, which may explain in part some benefits to feeding practices as a result of RS exposure. Caregivers in the EN group did not receive responsive care advice using the same behavioral change technique, which was guided by the developmental literature (ie, rehearsal and feedback on interaction during play and daily care activities), as the RS group received; however, application of this technique for responsive feeding is worth exploring in future research to strengthen the impact of nutrition counseling on responsive parenting behaviors.…”

“…8,9 Inclusion of responsive care and responsive feeding messages in the RS intervention and responsive feeding in the EN intervention benefited both interventions, which may explain in part some benefits to feeding practices as a result of RS exposure. The group-based delivery strategy and behavior change techniques (eg, problem solving and social support) were intended to support mothers and contribute to the reduction in maternal depressive symptoms.…”

“…Responsive parenting (the ability to be aware of a child's signals and provide a timely and developmentally appropriate response) 7 is a fundamental parenting skill to support children's survival and development. Promoting responsive caregiving behaviors through training 8,9 or using contexts such as shared book reading 10 or play 6 have demonstrated improvements in children's development, 6 maternal mood, 9 secure infant attachment, 9 and quality of mother-child interactions. [8][9][10] Responsive feeding has shown improvements in maternal verbal responsiveness, 11,12 child's acceptance of foods, 12 mouthfuls eaten, 11 and dietary intake.…”

Reducing neurodevelopmental disorders and disability through research and interventions

“…A child dies from malaria every minute, and one in four survivors present with significant neurodevelopmental impairment 6,7 . However, cognitive rehabilitation, speech and physical therapy, and carer-training interventions can improve cognitive performance and behaviour of treated mother-child pairs 8,9 . As rehabilitation approaches are evaluated, there is mounting evidence of the neurocognitive benefits of computerized cognitive rehabilitation training (CCRT) in African children with a brain injury as a result of severe malaria and in those with HIV-related brain injury 10 .…”

A Randomized Controlled Trial to Evaluate if Computerized Cognitive Rehabilitation Improves Neurocognition in Ugandan Children with HIV

“…33 It has been previously used by our group in pediatric HIV research in Uganda. 35,36 Although the CBCL can provide a wide array of DSM-V and Syndrome scale scores, our principal outcomes were Internalizing, Externalizing, and Total symptoms.…”