A year-long caregiver training program improves cognition in preschool Ugandan children with human immunodeficiency virus.

OBJECTIVE: To evaluate mediational intervention for sensitizing caregivers (MISC). MISC biweekly caregiver training significantly enhanced child development compared with biweekly training on health and nutrition (active control) and to evaluate whether MISC training improved the emotional well-being of the caregivers compared with controls. STUDY DESIGN: Sixty of 120 rural Ugandan preschool child/caregiver dyads with HIV were assigned by randomized clusters to biweekly MISC training, alternating between home and clinic for 1 year. Control dyads received a health and nutrition curriculum. Children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales and the Color-Object Association Test for memory. Caldwell Home Observation for Measurement of the Environment and videotaped child/caregiver MISC interactions also were evaluated. Caregivers were evaluated for depression and anxiety with the Hopkins Symptoms Checklist. RESULTS: Between-group repeated-measures ANCOVA comparisons were made with age, sex, CD4 levels, viral load, material socioeconomic status, physical development, and highly active anti-retroviral therapy treatment status as covariates. The children given MISC had significantly greater gains compared with controls on the Mullen Visual Reception scale (visual-spatial memory) and on Color-Object Association Test memory. MISC caregivers significantly improved on Caldwell Home Observation for Measurement of the Environment scale and total frequency of MISC videotaped interactions. MISC caregivers also were less depressed. Mortality was less for children given MISC compared with controls during the training year. CONCLUSIONS: MISC was effective in teaching Ugandan caregivers to enhance their children's cognitive development through practical and sustainable techniques applied during daily interactions in the home.

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

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.

Effects of MISC intervention on cognition, autonomy, and behavioral functioning of adult consumers with severe intellectual disability.

This study examined the effects of a yearlong Mediational Intervention for Sensitizing Caregivers (MISC; Klein, 1992) on: (a) the quality of interactions between rehabilitation day center paraprofessional staff (n=10) and their adult consumers (n=19) with severe intellectual disability (ID) and (b) the consumers' cognition, autonomy, and behavioral functioning, versus a consumers' control group (n=13). Regarding the staff-consumer interactions, more mediation of meaning (choice-making), expansion, and competence with explanation and less mediation of physical assistance were observed in the intervention group than in the control group following intervention. On a battery of cognitive measures (n=17), consumers in the MISC group improved their arithmetic skills, temporal concepts, and sequential memory of two digits. Behavioral observations indicated that the MISC group revealed increased positive behaviors, autonomy, and duration of work and decreased verbal and maladaptive behaviors.

Enhancing mothers' interactions with toddlers who have sensory-processing disorders.

The objective of the current study was to examine the effects of a brief Mediational Intervention for Sensitizing Caregivers (the MISC-SP) designed to enhance the quality of mothers' interaction with their toddlers who have sensory processing disorders (SPD). The basic assumption was that quality parent-child interactions can serve as a protective factor moderating the potential negative effects of toddlers' sensory processing and regulation difficulties on their development. The effects of the intervention were compared to those of another intervention designed to enhance children's sensory functioning (the SI group) and to a control group receiving no intervention. Participants were 86 toddlers (12-18 months old) with SPD and their mothers, who were randomly assigned to the aforementioned three research groups. Following the intervention period, mothers in the MISC-SP group showed more sensitive behavior, supported their toddlers' communication behavior better, and used teaching behaviors more appropriately than did mothers in the two other groups.

Relations between parenting quality and cognitive performance of children experiencing varying amounts of childcare.

Associations between parenting quality and 3-year-olds' school readiness, receptive, and expressive language were examined in relation to the amount of time they spent in childcare, based on data from the NICHD Study of Early Child Care and Youth Development (N = 1,364). Associations for school readiness and receptive language were stronger among children who experienced medium amounts of childcare than among children who experienced high amounts of childcare, and they were not weaker than among children who experienced primarily maternal care. Contrary to expectations, the association between parenting quality and school readiness among children who experienced medium amounts of childcare was significantly stronger than among children who experienced predominantly maternal care.

Toddlers' self-regulated compliance to mothers, caregivers, and fathers: implications for theories of socialization.

To compare children's socialized behavior to parents and nonparental agents, this study examined self-regulated compliance to mothers and caregivers--an early form of internalization--in 90 toddlers, half of whom were also observed with fathers. Adults were observed in play, teaching, and discipline sessions with the child and were interviewed on child-rearing philosophies. Child cognition and emotion regulation were assessed, and naturalistic observations were conducted at child-care locations. Mean-level and rank-order stability were found in child compliance to the 3 adults. Child emotion regulation and adult warm control in a discipline situation were related to self-regulated compliance to the mother, caregiver, and father. Compliance to parents correlated with parental sensitivity and philosophies, and compliance to the caregiver correlated with child cognition and social involvement when child-care quality was controlled. Maternal sensitivity and warm control discipline predicted compliance to the caregiver but not vice versa. Results are consistent with theoretical positions on the generalization of socialization from the mother to nonmaternal agents.