title: 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.
authors.affiliation: Department of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, MI 48824 48824, USA. boivin@msu.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Boivin
authors.forename: Paul
authors.initials: P
authors.lastname: Bangirana
authors.forename: Noeline
authors.initials: N
authors.lastname: Nakasujja
authors.forename: Connie F
authors.initials: CF
authors.lastname: Page
authors.forename: Cilly
authors.initials: C
authors.lastname: Shohet
authors.forename: Deborah
authors.initials: D
authors.lastname: Givon
authors.forename: Judith K
authors.initials: JK
authors.lastname: Bass
authors.forename: Robert O
authors.initials: RO
authors.lastname: Opoka
authors.forename: Pnina S
authors.initials: PS
authors.lastname: Klein
mesh_terms: D001007:Anxiety / Q000523:psychology; D017028:Caregivers / Q000193:education* / Q000523:psychology; D002657:Child Development; D016241:Child of Impaired Parents / Q000523:psychology; D002675:Child, Preschool; D003071:Cognition; D003863:Depression / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D014454:Uganda
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