A year-long caregiver training program to improve neurocognition in preschool Ugandan HIV-exposed children.

Published on May 1, 2013in Journal of Developmental and Behavioral Pediatrics2.056
· DOI :10.1097/DBP.0B013E318285FBA9
Michael J. Boivin37
Estimated H-index: 37
(MSU: Michigan State University),
Paul Bangirana23
Estimated H-index: 23
(MUK: Makerere University)
+ 6 AuthorsPnina S. Klein18
Estimated H-index: 18
(BIU: Bar-Ilan University)
OBJECTIVE: Mediational intervention for sensitizing caregivers (MISC) is a structured program enabling caregivers to enhance their childs 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: One hundred and nineteen uninfected HIV-exposed preschool children and their caregivers were randomly assigned to 1 of 2 treatment arms: biweekly MISC training alternating between home and clinic for 1 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 for memory and Achenbach Child Behavior Checklist for psychiatric symptoms. Caregivers were evaluated on the same schedule with the Hopkins Symptoms Checklist-25 for depression and anxiety. RESULTS: The treatment arms were compared using repeated-measures analysis of covariance with child age gender weight socioeconomic status 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. Color-Object Association Test total memory for MISC children was marginally better than controls. No Achenbach Child Behavior Checklist differences between the groups were noted. Caldwell Home Observation for Measurement of the Environment scores and observed mediational interaction scores from videotapes measuring caregiving quality also improved significantly more for the MISC group. CONCLUSIONS: The MISC enhanced cognitive performance especially in language development. These benefits were possibly mediated by improved caregiving and positive emotional benefit to the caregiver.
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