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: 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.

Figure 1

depicts the adjusted group mean score across the three time points (baseline, 6 months, 1 yr for the MISC (blue) and control (green) caregiver training intervention groups. The means are adjusted according to the RM-ANCOVA model presented in Table 2. Each Mullen Early Learning Scale (MELS) is presented and the MELS composite score for the four cognitive scales (Fine Motor, Expressive Language, Receptive Language, Visual Reception).

Figure 2

depicts the adjusted group mean score across the three time points (baseline, 6 months, 1 year) for the MISC (blue) and Control (green) caregiver training intervention groups. The means are adjusted according to the RM-ANCOVA model presented in Table 3. Both Color-Object Association Test (COAT) scores are presented: Immediate Recall (memory) and Total Recall (learning).

Figure 3

depicts the adjusted group mean score across the three time points (baseline, 6 months, 1 year) for the MISC (blue) and Control (green) caregiver training intervention groups. The means are adjusted according to the RM-ANCOVA model presented in Table 5. Both quality-of-caregiving outcome measures are presented: Caldwell Home Observation for Measurement of the Environment (HOME) total and Observed Mediated Interactions (OMI) total score from the 15 minute video evaluation of the caregiver s feeding, bathing, and working with the child.

Figure 4

depicts the adjusted group mean score for the Hopkins Symptoms Checklist, 25 item questionnaire (HSCL-25) across the three time points (baseline, 6 months, 1 year) for the MISC (blue) and Control (green) caregiver training intervention groups. The means are adjusted according to the RM-ANCOVA model presented in Table 4.