Caregiver -Child attachment and drug adherence among HIV positive children: The effect of behavioral and emotional proclivities on adherence
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Purpose/Aim of study: Assessing emotional and behavioral function in children and adolescents who are HIV+ may help predict and explaining adherence in future. The aim of the study was to investigate the relationship between caregiver-child attachment classification styles and adherence to medication among HIV positive children. Sample: The sample consisted of 22 HIV positive children aged 3-5 years old. Procedure: Informed consent (caregiver) was obtained and screening for eligibility. Eligible subjects responded to the adherence questionnaire and interview, the Beck depression scale, the Self Efficacy questionnaire. Social provision Scale, Ages and Stages Questionnaire (all to caregiver). Anthropometric measurements were taken and children completed the Attachment Story Completion Task (ASCT). Observations (EAS) were made of the child-caregiver interacting during "complete a dot task and during medication administration. Results: The Chi-Square analysis on adherence and attachment was significant. ANOVA yielded a significant effect of depression on adherence, and a significant effect of education on adherence. There was significant positive correlation between adherence and the 5 dimensions of the EAS; parental sensitivity, parental nonhostility parental nonintrusiveness, child responsiveness and child involving, but a low nonsignificant correlation between adherence and parental structuring. There was a negative moderate correlation between self efficacy to manage mood and adherence but low correlations between tlie 5 other domains (guidance, assurance of worth, social integration, opportunity to nurturance, attachment) of social support and adherence. BMI fall between 5th and 95th percentile. 59% of children had deficits in problem solving, 32% had deficits in gross motor and 41% in fine motor respectively. Conclusions and Implications: Emotional and behavioral proclivities are important in pediatric health; particularly the nature of the bond between the caregiver and the child which seem to increase the resilience of young children to the damaging effects of illnesses and diseases. Counseling should be dedicated to parents and children's well-being and social support. High rate of developmental delays in HIV infected children underscores the need for screening, prevention and calls for access to early interventions, nutritional and care programs for these vulnerable children.