Objective Early childhood development (ECD) programs typically combine healthy nutrition and cognitive stimulation in an integrated model. We separately delivered these two components in a cluster randomized controlled trial (RCT) to evaluate their comparative effectiveness in promoting healthy child development and caregiver mental health. This is the first study to do so for HIV-affected children and their infected mothers,. Methods 221 HIV-exposed but uninfected (HEU) child (2 to 3 years old) and caregiver dyads in 18 geographic clusters in Eastern Uganda were randomized by cluster to receive biweekly individualized sessions of either 1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation, or 2) Uganda Community Based Association for Child Welfare program that delivered (UCOBAC) health and nutrition training. Children were evaluated at baseline, six months, one year (training conclusion), and one-year post-training with the Mullen Scales of Early Learning (MSEL), the Color-Object Association Test (COAT) for memory, the Early Childhood Vigilance Test (ECVT) of attention, and the Behavior Rating Inventory of Executive Function (BRIEF-parent). The Caldwell HOME was completed by observers to gauge caregiving quality after training. Caregiver depression/anxiety (Hopkins Symptom Checklist-25) and functionality (list of activities of daily living) were also evaluated. Data collectors were blinded to trial arm assignment. Results MISC resulted in significantly better quality of caregiving compared to UCOBAC mid-intervention with an adjusted mean difference (MadjDiff ) of 2.34 (95% CI: 1.54, 3.15, p<0.01), post intervention (MadjDiff=2.43, 95% CI: 1.61, 3.25, p<0.01) and at one year follow-up (MadjDiff=2.07, 95% CI: 1.23, 2.90, p<0.01). MISC caregivers reported more problems on the BRIEF for their child at one-year post-training only (p<0.01). Caregiving quality (HOME) was significantly correlated with MSEL composite performance one-year post training for both the MISC and the UCOBAC trial arms. Likewise, physical growth was significantly related to child development outcomes even though it did not differ between trial arms. Conclusions Even though MISC demonstrated an advantage of improving caregiving quality, it did not produce better child cognitive outcomes compared to health and nutrition training.

Objective Tobii eye tracking was compared to webcam-based observer scoring on an animation viewing measure of attention (ECVT) to evaluate the feasibility of automating measurement and scoring. Outcomes from both scoring approaches were compared to the Mullen Scales of Early Learning (MSEL), Color-Object Association Test (COAT), and Behavior Rating Inventory of Executive Function for preschool children (BRIEF-P). Method 44 children 44 to 65 months of age were evaluated with the ECVT, COAT, MSEL, and BRIEF-P. Tobii X2-30 portable infrared cameras were programmed to monitor pupil direction during the ECVT 6-minute animation, and compared to observer-based PROCODER webcam scoring. Results Children watched 78% of the cartoon (Tobii) compared to 67% (webcam scoring), although the two measures were highly correlated (r=0.90,P=0.001). It is possible for two such measures to be highly correlated even if one is consistently higher than the other (Bergemann et al., 2012). Both ECVT Tobii and webcam ECVT measures significantly correlated with COAT immediate recall (r=0.37,P=0.02 versus r=0.38,P=0.01 respectively) and total recall (r=0.33,P=0.06 versus r=0.42,P=0.005) measures. However, neither the Tobii eye tracking nor PROCODER webcam ECVT measures of attention correlated with MSEL composite cognitive performance or BRIEF-P global executive composite. Conclusion ECVT scoring using Tobii eye tracking is feasible with at-risk very young African children and consistent with webcam-based scoring approaches in their correspondence to one another and other neurocognitive performance-based measures. By automating measurement and scoring, eye tracking technologies can improve the efficiency and help better standardize ECVT testing of attention in younger children. This holds promise for other neurodevelopmental tests where eye movements, tracking, and gaze length can provide important behavioral markers of neuropsychological and neurodevelopmental processes associated with such tests.

Both intervention conditions resulted in improvements in the study children over time. MISC showed additional impacts on child language and caregiver well-being. Future directions that include assessing the extent enhanced language development resulting from improved caregiving may better prepare impoverished children for school.

Objective: Evaluate a computerized-based attention test in early infancy in predicting neurocognitive schoolage performance in human immunodeficiency virus (HIV)-exposed uninfected children. Method: Thirty-eight Ugandan HIV-exposed/uninfected children (17 boys, 21 girls) were evaluated with the Early Childhood Vigilance Test (ECVT) of attention between 3 and 5 years of age, which is a 6-min 44 s animation with colorful animals that greet the child and move across the screen. Attention was proportion of total animation time viewing a computer screen, as well as the proportion of time tracking the moving animal using eye tracking. These children were then again tested at least 2 years later (between 5 and 9 years of age) with the Kaufman Assessment Battery for Children, 2nd Edition (KABC-II) and the visual computerized Tests of Variables of Attention (TOVA). Results: Irrespective of whether scored by webcam video scoring or using automated eye tracking to compute proportion of time viewing the animation, ECVT attention was significantly correlated with all TOVA outcomes for vigilance attention. This was still the case when the correlation was adjusted for type of caregiver training for the mother, child gender, socioeconomic status (SES), and quality of Home Observational Measurement Evaluation (HOME) environment-especially for the TOVA response time variability to signal ( p = .03). None of the ECVT attention performance measures correlated significantly with any of the KABC-II cognitive ability outcomes. Conclusion: Attention assessment in early childhood is predictive of school-age computer-based measures of attention and can be used to gauge the effects of factors of early risk and resilience in brain/behavior development in African children affected by HIV.

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