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Article Excerpt
Abstract
HIV in children has presented substantial challenges to those that plan for and provide educational and social services. In addition to complications associated with immunologic compromise, developmental disabilities are feared consequences of congenital HIV in children. The high frequency of HIV and AIDS related neurodevelopment problems in children has also posed special dilemmas to those who provide services to children with developmental disabilities. Because early intervention and education are the major concerns for children with HIV, early intervention service providers and educators have a very important role to play. In what follows, we will discuss HIV and developmental delays, federal laws pertinent to the rights of persons with disabilities, the importance of interdisciplinary services, and psychosocial implications for children infected with and families affected by HIV. We will conclude with practical implications for early intervention service providers and educators.
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Although it was known by other names for several years, Acquired Immunodeficiency Syndrome (AIDS) was first described in the early 1980s. In its short history, this disease, caused by the human immunodeficiency virus (HIV), has become a pandemic. In the United States, it initially appeared to affect primarily gay men; however, it is now known to occur worldwide, among all populations, with an increasing incidence among women and, secondarily, their newborns. Although the last two decades have witnessed major advances in treatment, HIV infection remains an ultimately fatal disease. Among children, it is often associated with developmental disabilities (Rutstein, Conlon, & Batshaw, 1997).
The majority of children with HIV are born to women with HIV infection as a result of injecting drug use or heterosexual transmission of HIV. Pediatric HIV infection is especially widespread in this country among children of African-American and Hispanic heritage (Francois-Xavier Bagnoud Center, 1997-2000). In an effort to provide a broader meaning to issues associated with HIV infection among children, this paper discusses HIV and developmental delays, federal laws pertinent to the rights of persons with disabilities, the importance of interdisciplinary services, and psychosocial implications for children infected with and families affected by HIV. We will conclude with practical implications for early intervention service providers and educators.
HIV and Developmental Delay
HIV can have a profound physiological impact on children. Unless early intervention service providers and educators are aware of the disease manifestations in children with HIV, all efforts will be futile. Two major areas of concern are developmental disabilities and neurodevelopmental effects of HIV. Developmental disabilities are feared consequences of congenital HIV in children, and such complications are associated with immunologic compromise. From the outset of the pediatric AIDS epidemic, reports in the medical literature have linked congenital HIV to neurologic dysfunction (Crocker, Cohen & Kastner, 1992).
Many children with HIV infection do not gain weight or grow normally. HIV-positive children frequently are slow to reach important milestones in motor skills and mental development such as crawling, walking and speaking. As the disease progresses, many children develop neurological problems that may result in difficulty walking, poor school performance, seizures, mental retardation and cerebral palsy. Like adults who are HIV-positive, children with HIV may develop life-threatening opportunistic infections (OIs), although the incidence of various OIs differs in adults and children. Also, as children with HIV become sicker, they may suffer from chronic diarrhea due to opportunistic pathogens. Children with HIV suffer the usual childhood bacterial infections--only more frequently and more severely than uninfected children. These bacterial infections can cause seizures, fever, pneumonia, recurrent colds, diarrhea, dehydration and other problems that often result in extended hospital stays and nutritional problems (Crocker & Cohen, 1990). HIV-positive children frequently have severe candidiasis, a yeast infection that can cause unrelenting diaper rash and infections in the mouth and throat that make eating extremely difficult and painful.
Most of school going children have normal cognitive functioning. When a child develops HIV infection, a decrease in cognitive function can result because of central nervous system (CNS) dysfunction resulting in decline in academic performance (Gay, Armstrong, Cohen, 1995; Nozyce, Hittelman, Muenz, Durako, Fischer, Willonghby, 1994; Chase, Vibbert, Pelton et al, 1995 & Tardieu, Mayaux, Seibel, et al. 1995). The trials of...
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