Mary Carlson

Promoting child and adolescent mental health in the context of the HIV/AIDS pandemic with a focus on sub-Saharan Africa

BACKGROUND The pandemic of HIV/AIDS is actually a composite of many regional and national-level epidemics. The progress made in many parts of the developed and developing world is tempered by the continued devastating consequences of HIV infection in sub-Saharan Africa (SSA). This review focuses on the ways in which children and adolescents are impacted by the epidemic, giving particular attention to their mental health. METHODS A health promotion framework is adopted to guide analysis. Three issues are covered: prevention of HIV infection, care and treatment of children infected with HIV, and care of children whose caregivers are ill or have died of AIDS. Existing reviews and literature search engines were used to review the scientific literature, focusing on the past five years. RESULTS Preventive interventions continue to manifest limited benefits in behavioral changes. More complex causal models and improved behavioral measures are needed. In the African context, the time has come to view pediatric AIDS as a chronic disease in which the mental health of caregivers and children influences important aspects of disease prevention and management. Increasingly sophisticated studies support earlier findings that social and psychological functioning, educational achievement and economic well-being of children who lose parents to AIDS are worse than that of other children. CONCLUSIONS Important changes are taking place in SSA in increased access to HIV testing and antiretroviral therapies. To be effective in promoting mental health of children and adolescents, interventions require a more fundamental understanding of how to build HIV competence at personal and community levels. A key recommendation calls for the design and execution of population-based studies that include both multilevel and longitudinal features. Such rigorous conceptual and empirical investigations that assess the capacities of children are required to mobilize children, families and communities in comprehensive actions plans for prevention, treatment and care in response to the enduring HIV/AIDS pandemic.

Neighborhood Characteristics, and Child Care Type and Quality

Research Findings: Using data from the Project on Human Development in Chicago Neighborhoods, this article relates neighborhood characteristics to the type of child care used in families with toddlers and preschoolers (N = 1,121; representative of children in Chicago in 1996–1998). Neighborhood structural disadvantage was assessed via U.S. Census data, and neighborhood processes (i.e., density of social networks, collective efficacy, and level of participation in neighborhood organizations) were accessed with a community survey. Child care decisions (i.e., whether they chose care in centers; child care homes by non-relative, by relatives, and exclusively by parents) and the quality of center child care (Early Childhood Environment Rating Scale–Revised) were assessed in a longitudinal sample. After controlling for family characteristics, various neighborhood characteristics were related to child care characteristics. In communities with denser social networks, children were less likely to experience care in child care homes by unrelated adults. Children were more likely to be in child care homes and less likely to cared for by parents exclusively or by relatives when collective efficacy was higher. Center care quality was lower in disadvantaged neighborhoods and higher for publicly funded programs. Further, neighborhood structural disadvantage was more negatively related to quality when mothers had less education. Practice or Policy: These findings provide further evidence that public programs such as Head Start and public pre-kindergarten programs may be especially important to ensure that children living in poverty in disadvantaged neighborhoods have access to the types of child care that promote school readiness.

Enhancing adolescent self-efficacy and collective efficacy through public engagement around HIV/AIDS competence: A multilevel, cluster randomized-controlled trial

The potential capacity of children to confront the HIV/AIDS pandemic is rarely considered. Interventions to address the impact of the pandemic on children and adolescents commonly target only their vulnerabilities. We evaluated the Young Citizens Program, an adolescent-centered health promotion curriculum designed to increase self- and collective efficacy through public education and community mobilization across a municipality in the Kilimanjaro Region of Tanzania. The theoretical framework for the program integrates aspects of human capability, communicative action, social ecology and social cognition. The design consists of a cluster randomized-controlled trial (CRCT). Fifteen pairs of matched geopolitically defined neighborhoods of roughly 2000-4000 residents were randomly allocated to treatment and control arms. Within each neighborhood cluster, 24 randomly selected adolescents, ages 9-14, deliberated on topics of social ecology, citizenship, community health and HIV/AIDS competence. Building on their acquired understanding and confidence, they dramatized the scientific basis and social context of HIV infection, testing and treatment in their communities over a 28-week period. The curriculum comprised 5 modules: Group Formation, Understanding our Community, Health and our Community, Making Assessments and Taking Action in our Community and Inter-Acting in our Community. Adolescent participants and adult residents representative of their neighborhoods were surveyed before and after the intervention; data were analyzed using multilevel modeling. In treatment neighborhoods, adolescents increased their deliberative and communicative efficacy and adults showed higher collective efficacy for children. Following the CRCT assessments, the control group received the same curriculum. In the Kilimanjaro Region, the Young Citizens Program is becoming recognized as a structural, health promotion approach through which adolescent self-efficacy and child collective efficacy are generated in the context of civil society and local government.

Development of tactile discrimination capacity in Macaca mulatta. I. Normal infants.

Infant macaques between the ages of 7 and 25 weeks of age were trained on a series of manual tactile discrimination tasks. Tactile discrimination capacity, as measured by the most difficult level of size and texture discrimination tasks mastered, was the same for all ages of infants and did not differ from that of adults. Infants as young as 10 weeks of age were found to have a discrimination capacity similar to that of adult macaques, although an adult level of manual motor control had not been achieved by this early age. During the acquisition of size tasks, older animals made fewer errors than did younger animals, suggesting an improved efficiency in size discrimination capacity over the first 6 months of life. By contrast, the efficiency with which the younger animals mastered texture discrimination was superior to that of the older infants. The possible contributions of sensory experience or manual motor control to the maturation of sensory capacity were examined by applying 16 weeks of sensory restriction in one infant and a unilateral motor cortex lesion in another infant, respectively. Only transient impairment was found in either case suggesting that neither tactile experience nor motor control contribute significantly to the maturation of tactile discrimination capacity in infant macaques.

Effects of Monocular Exposure to Oriented Lines on Monkey Striate Cortex

This study examines the extent to which the restriction of visual experience to lines of a single orientation influences the organization of the striate cortex in infant monkeys (Macaca mulatta). Previous studies of kittens raised with monocular exposure to a single line orientation have consistently shown the response preference of cells driven by that eye to be biased towards the experienced orientation. Studies of binocular exposure to restricted orientations have been equivocal. In the infant monkey cortex responses to oriented lines have virtually all the specificity of responses seen in the adult animal. In an effort to clarify the phenomenon and the mechanism by which orientation bias might be obtained, we examined the effects of monocular exposure to a restricted orientation in infant macaques. Three monkeys were used. Each monkey was raised with one open eye exposed to lines of a single orientation and one eye occluded by lid suture. As in other cases of monocular deprivation in either cat or monkey, few binocularly driven cells were recorded and the majority of cells were dominated by the open eye. Cells driven by the open eye had normal representation of all orientation preferences and there was no overall increase in the number of cells preferring the orientation to which the eye had been exposed. The cells dominated by the occluded eye, however, showed a lack of cells responding to orientations to which the open eye had been exposed. These findings suggest that a competitive mechanism operates between the two eyes to provide an orientation selective advantage to the open eye.

Development of tactile discrimination capacity in Macaca mulatta. III. Effects of total removal of primary somatic sensory cortex (SmI) in infants and juveniles

Four infant macaques between the ages of 3.0 and 5.1 weeks and three juvenile macaques between the ages of 79.9 and 109.3 weeks received unilateral lesions of all cytoarchitectural fields (Brodmanns areas 3, 1 and 2) in the hand area of the postcentral gyrus. These total SmI-lesioned infants acquired the size and texture tasks within the same time period and with the same efficiency as normal infants. On some size- and texture-ALL tasks they actually performed significantly better than partial SmI-lesioned or normal infants. The normal acquisition and ALL performance of the infants with total SmI lesions contrasts with that of the juveniles with comparable lesions. On size acquisition and ALL tasks, with the contralateral hand, total SmI-lesioned juveniles were significantly inferior to normal and total SmI-lesioned infants and to partial SmI-lesioned juveniles. During texture acquisition with the contralateral hand, the total SmI-lesioned juveniles made significantly more errors than normal and total SmI-lesioned infants. The capacity to recover from partial SmI lesions extends into the second year of life and is a gradual process which may be mediated by remaining SmI subdivisions. By contrast, the capacity to recover from total SmI lesions is restricted to infants and is a rapid process which must depend on other areas within the damaged, or possibly the intact, hemisphere.

The Role of Somatic Sensory Cortex in Tactile Discrimination in Primates

Research on cerebral cortex function during the 50-year period referred to in the above quote was conducted by clinicians before the development of the neuroanatomical and electrophysiological methods that have dominated research on cortical sensory areas over the last 75 years. As these new experimental techniques gained in prominence in research on nonhuman species (and perhaps occupied the “acutest intellects in medicine”), interest in sensory phenomena and skills associated with sensory areas declined. Many of the same theoretical issues raised in the early clinical studies of tactile function following disease, injury, or surgical removal of parietal cortex remain the topic of contemporary research in the somatic sensory system. Review of the earlier experimental studies of tactile deficits following surgical lesions in nonhuman primates points to several important methodological issues, such as the significance of the age and species of experimental subject, of types of tasks used to assess tactile skills, and the basis for specification of the specific cortical area(s) involved in a particular skill, which may account for some of the differences in findings between past and current studies. Recent and ongoing studies from my laboratory on a variety of Old and New World primates are summarized to present both a comparative and a developmental perspective on the role of somatic sensory cortex in tactile discrimination capacity. In these studies, physiological mapping and selective cortical lesions were done, in conjunction with tactile discrimination testing, to determine how normal cortical organization and/or surgical intervention in cortical areas related to tactile capacity. Finally, theories that address the relationship between ontogenetic and phylogenetic changes in brain and behavior will be discussed to bring together the findings on development and evolution of the somatic sensory system and tactile capacities in primates.

The Somatic Sensory Cortex

Although this quote from The Antecedents of Man refers to the origins of the human species, it has the same relevance to the current topic—the evolution of more elaborately organized somatic sensory cortex (Sm I) of Old and New World simians from the simpler forms, the ancestral prosimians. Contemporary prosimians are the living descendents of the earliest group of primates and are believed to have separated from a common mammalian ancestor over 70 million years ago (57). Whereas living prosimians are found only in the Old World, early prosimians diversified into many forms and spread through Africa, Asia and Europe as well as North and South America. Fossil remains of many extinct genera indicate a close resemblance in cortical features between these earlier forms and some living prosimians. Examination of cerebral cortical organization in both fossil and living prosimians can be expected to facilitate our understanding of the more complex simian and anthropoid forms and to suggest evolutionary changes occurring in the primate brains derived from prosimian patterns of organization.

Adolescents as Deliberative Citizens: Building Health Competence in Local Communities

Given the host of tragic events that children experience, it is often compelling for well-intended adults to respond in a protective and charitable fashion. The child rights approach asks for more. Building on their collective experiences in the developmental and social sciences, the authors present in roughly chronological fashion a synopsis of the theoretical explorations and scientific evaluation that completes a framework to advance the status of children as citizens. The recognition of the agency and capability of a child and the dynamic and enduring source of socialization from and social integration within the community are fundamental to this project. The participatory rights enshrined in the Convention on the Rights of the Child serve as an impetus and inspiration to this project, the Young Citizens Program. What began with small-scale deliberative groups in Chicago matured into a cluster randomized controlled trial in northern Tanzania.

The Evolution of Child Rights Councils in Brazil

If it is true that a child rights framework alters our views and actions towards improving children’s lives, it is also true that the breadth of the concept makes concrete implementation difficult. In this paper the expansiveness of the concept is addressed by focusing attention on a community-based model of child-care derived from the Child Rights Legislation in Brazil. Departing from a general view of the child related policies in Brazil, the child rights monitoring system currently in place in that country is described. The potential contribution of this structure to child well-being is considered, taking account of the fact that the system is still scaling up. It is recommended that key aspects of the structure be systematically evaluated to place it on the most secure operational platform in Brazil. Such an effort will advance the generalizability of the Brazilian experience to other countries and guide applications of this model, particularly in democratically developing societies.