Validity of Neuropsychological Testing in Young African Children Affected by HIV

Abstract

Introduction Western-constructed neuropsychological tests have been used in low and middle income countries to assess the impact of HIV/AIDS and other chronic illnesses. We explore using such instruments cross-culturally in a sub-Saharan Africa setting. Methods IMPAACT P1104S was a two-year observational study carried out at six clinical sites (South Africa- 3 sites, Malawi, Uganda and Zimbabwe) to assess and compare neuropsychological outcomes in three cohorts of children 5–11 years of age: HIV-infected (HIV), HIV-exposed but uninfected (HEU) and HIV unexposed and uninfected (HU). Descriptive statistics compared socio-demographic characteristics among children at sites. Instruments included the KABC-II cognitive ability, TOVA attention/impulsivity, BOT-2 motor proficiency tests, and BRIEF executive function problems. Test characteristics were assessed using intraclass and Spearman non-parametric correlations, linear regression and principal factor analyses. Results Of the 611 participants, 50% were male and mean age ranged from 6.6 to 8 years. In Malawi, Uganda and Zimbabwe, substantial proportions of families lived in rural settings in contrast to the South African sites. Intraclass correlation coefficients between weeks 0 and 48 were highest for the KABC scores, ranging between 0.42 to 0.71.Correlations among similar test domains were low to moderate but significant, with positive correlation between KABC Sequential and TOVA scores and negative correlation between BRIEF and KABC scores. TOVA response time scores correlated negatively with the BOT-2 Total points score. Strong and significant associations between individual measures of growth, disability and development with all test scores were observed. Performance-based measures were markedly lower for HIV compared to HEU and HU participants, even after controlling for age, sex and site. Factor analyses confirmed the underlying theoretical structure of the KABC scaled item scores. Conclusion The KABC, TOVA, BRIEF and BOT-2 were valid and reliable tools for assessing the neuropsychological impact of HIV in four sub-Saharan African countries.

Reliability and Validity of an Adapted and Translated Version of the Mullen Scales of Early Learning (AT‐MSEL) in Rural Guatemala

“…Current results supported the reliability and validity the AT-MSEL (Connery, Colbert, et al, 2019) in rural Guatemala. This project lends further support to an emerging literature suggesting tests developed in high-income countries can be used to assess children in low resource settings when measures are carefully translated, adapted, and applied Bornman et al, 2018;Chernoff et al, 2018;Heckman, 2008;Holding et al, 2018;Mitchell et al, 2017).…”

“…An alternative approach is to adapt existing measures. A growing body of literature supports the use of tests developed in high-income countries to assess children in low resource settings when carefully translated, adapted, and applied Bornman et al, 2018;Chernoff et al, 2018;Heckman, 2008;Holding et al, 2018;Mitchell et al, 2017). Several resources are available to guide the process of the selection, translation, adaptation and use of measures (Erkut, 2010;Geisinger, 1994;Gudmundsson, 2009;Hambleton, 2004;Hambleton & Patsula, 1999;ITC, 2017;Van De Vijver & Poortinga, 2004), as well for establishing reliability and validity in a new cultural context (Hambleton & Swaminathan, 1987;Milfont & Fischer, 2010;Pena, 2013;Reise, Widaman, & Pugh, 1993;Sireci, 2004).…”

Growth, clinical and neurodevelopmental outcomes at school age are similar for children who received 1-year lamivudine or lopinavir/ritonavir HIV prophylaxis in early life

“…The Kaufman Assessment Battery for children, second edition (KABC-II) 8 , 9 , Luria model was used which measures cognitive abilities in three domains at the ages under study : (1) sequential processing, (2) simultaneous processing, (3) learning. A global score of mental processing index (MPI) was also obtained.…”

Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin

“…The final score identifying Attention Deficit and Hyperactivity Disorder (ADHD) is calculated based on response times, variability of response times, and rate of deterioration of responses to computerized stimuli appearing on a screen in front of children during the test. Based on United States norms, scores below -1.80 are considered suggestive of ADHD, with higher scores indicating normal attention rates [ 37 ]. The TOVA and BOT-2 were not validated for use in this population; however, they have been validated within other populations of children in SSA countries [ 37 ].…”

“…Based on United States norms, scores below -1.80 are considered suggestive of ADHD, with higher scores indicating normal attention rates [ 37 ]. The TOVA and BOT-2 were not validated for use in this population; however, they have been validated within other populations of children in SSA countries [ 37 ]. For the purposes of our analyses, results within our population were not compared to Western norms and instead analyses focused solely on internal comparisons of scores among children.…”