Improving early childhood development of children of AIDS patients

A simple in-home training program for caregivers can give children of AIDS patients a better shot at prosperity by improving their early-childhood development, according to a study led by a Michigan State University researcher.

Michael Boivin, MSU associate professor in the departments of Psychiatry, and of Neurology and Ophthalmology, conducted the research in Uganda, where about one million children have lost at least one parent to AIDS -- an unlucky club that adds another member every 14 seconds.

With deceased or gravely ill parents who often work long hours in the fields to provide food, these kids miss out on the affection and regular interaction that are crucial for their early physical, social and cognitive development, Boivin noted.

"They face hardship even in the best of circumstances, because most are in impoverished environments," he said. "Their poverty is compounded by the fact that their parents are infected with HIV. They face tremendous challenges to their development."

Funded by the National Institutes of Health and published in the Journal of Developmental and Behavioral Pediatrics, the study was designed to see if children whose parents have HIV or AIDS could benefit from a training program called Mediational Intervention for Sensitizing Caregivers, or MISC. The program has helped caregivers in other countries and circumstances use day-to-day interaction at home to develop children's social skills, language and cognitive ability.

"MISC is about training mothers or other caregivers on ways they can be sensitive to their child's natural tendencies to learn, and to direct those tendencies in everyday life to enrich the child's development," said Boivin.

To test the approach, the researchers recruited 120 uninfected preschool-aged children whose mothers had HIV. The children's caregivers -- their infected mothers, in most cases -- were randomly assigned to receive childcare training through MISC or through an education program focused on improving children's health and nutrition.

After a year, the children whose caregivers received the MISC training showed significantly more developmental progress than the others, with particularly strong gains in language learning. They also developed better memory and overall cognitive skills.

The training didn't just help the children. Caregivers in both groups showed decreased symptoms of depression and anxiety, which Boivin said may be due to the social support provided through the biweekly training sessions.

Boivin and colleagues are doing similar research involving children who are HIV-infected, and early evidence suggests MISC can actually extend their lives by improving the care they receive.

The training program -- developed by study collaborator Pnina Klein of Bar Ilan University in Israel -- can be used in nearly any setting where poverty, disease and other factors threaten early-childhood development, Boivin said, since it involves no special tools or expensive equipment.

"MISC is sustainable in resource-limited settings because it doesn't require outside materials," he said. "It has the potential to alter the caregiving culture in a community once it takes hold."