Pamela J. Bachanas

Family Experiences with Pediatric Antiretroviral Therapy: Responsibilities, Barriers, and Strategies for Remembering Medications

This study examines the relationship between adherence to pediatric HIV regimens and three family experience factors: (1) regimen responsibility; (2) barriers to adherence; and (3) strategies for remembering to give medications. Caregivers of 127 children ages 2-15 years in the PACTS-HOPE multisite study were interviewed. Seventy-six percent of caregivers reported that their children were adherent (taking > or = 90% of prescribed doses within the prior 6 months). Most caregivers reported taking primary responsibility for medication-related activities (72%-95% across activities); caregivers with primary responsibility for calling to obtain refills (95%) were more likely to have adherent children. More than half of caregivers reported experiencing one or more adherence barriers (59%). Caregivers who reported more barriers were also more likely to report having non-adherent children. Individual barriers associated with nonadherence included forgetting, changes in routine, being too busy, and child refusal. Most reported using one or more memory strategies (86%). Strategy use was not associated with adherence. Using more strategies was associated with a greater likelihood of reporting that forgetting was a barrier. For some families with adherence-related organizational or motivational difficulties, using numerous memory strategies may be insufficient for mastering adherence. More intensive interventions, such as home-based nurse-administered dosing, may be necessary.

Depressive and conduct disorder symptoms in youth living with HIV: The independent and interactive roles of coping and neuropsychological functioning

Abstract Emerging research suggests the importance of psychosocial characteristics (e.g., coping and social support) for positive adaptation among youth with behaviorally acquired HIV. However, little is known about how these traits interact with cognitive abilities to impact emotional and behavioral adjustment. This study examined whether coping skills and executive functioning interact in their association with psychological adjustment in HIV-positive youth. Data from Project Adolescents Living with HIV/AIDS (ALPHA), a study to examine psychosocial, behavioral and neuropsychological functioning of youth with behaviorally acquired HIV, were used. Fifty-nine participants, aged 14–23, diagnosed with HIV prior to age 20 and receiving care in one of two HIV clinics in Atlanta or New York City, were recruited, consented and enrolled. Participants completed measures of depressive symptoms (Beck Depression Inventory), conduct disorder (Adolescent Symptom Index), and use of positive and negative coping strategies (Kidcope). The Wisconsin Card Sorting Test (WCST) assessed abstract reasoning (categories completed) and cognitive inflexibility (perseverative errors). In this sample of HIV-positive youth, depressive symptoms were best predicted by an interactive combination of negative coping skills and poor neuropsychological functioning. Neuropsychological functioning (cognitive inflexibility) and negative coping skills were directly associated with conduct disorder symptoms. Results highlight the importance of including neuropsychological assessment in the evaluation of HIV-positive youth, particularly those with emotional or behavioral problems.

Cognitive behavioral interventions with persons affected by HIV/AIDS

The AIDS epidemic continues to have devastating physical and psychosocial effects worldwide. Through their involvement in health psychology and empirically based techniques, cognitive behavior therapists are in unique positions to help HIV-affected populations significantly. To date, most of this involvement has been through risk reduction interventions, but increasingly, therapists are called upon to offer more traditional mental health care to adults, children, adolescents, and families affected by HIV/AIDS. HIV disease is conceptualized as a chronic medical condition with unique life-threatening illnesses and psychosocial stresses that affect ones ability to cope, effective daily functioning, and quality of life. This paper describes such factors and suggests approaches for intervention from individual adult, child, and family perspectives. Although many strategies may be adapted from work with other populations and from basic fields of cognitive and behavioral research, there are unique challenges facing persons with HIV/AIDS that affect the context in which services may be delivered effectively. Recommended readings are also offered for more detailed discussions of selected topics.

Prediction of Cognitive, Adaptive,and Behavioral Functioning in Preschool and School-Age Children With HIV

This study describes and predicts cognitive, adaptive, and behavioral functioning in children with HIV utilizing a risk factor model. Sixty-seven perinatally infected children 3 to 16 years of age were administered standardized measures of cognitive, adaptive, and behavioral functioning. Mean group performance fell below the normative samples on cognitive and adaptive skills and above normative samples for behavior. Hierarchical regression equations found a relationship between socioeconomic status and cognitive functioning that was mediated by the ratio of children to adults in the home. Treatment type and the child-to-adult ratio in the home were predictive of adaptive behavior. The risk factor model failed to predict behavior problems. Implications for future research and clinical work with children with HIV are discussed.