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psychosocial adjustment (or psychoeducational performance) and have attempted to identify mechanisms that may explain these associations (e.g., predominant coping strategies, caregiver attitudes and practices, caregiver emotional distress). In an attempt to encourage further research on these mechanisms, this commentary will focus on factors identified by the four investigations that may hold promise for future intervention research. The findings of Coscia et al. are particularly noteworthy in that they identify both a mediating and a moderating mechanism in the relationship between HIV infection and cognitive functioning in children. As highlighted by the authors, the literature has identified a variety of central nervous system (CNS) outcomes associated with pediatric HIV infection. These outcomes include both changes in the structural integrity of the infected CNS (Campbell, 1997), as well as changes in neurochemical processes within the CNS of infected individuals (Kraiselburd, 1995). Yet, despite these biological differences, reports in the literature on the cognitive functioning of children with HIV/AIDS are varied (e.g., Bisiacchi, Suppiej, & Laverda, 2000; Fishkin et al., 2000; Loveland et al., 2000). Perhaps contributing to the explanation of the varied findings, Coscia et al. have identified home environment as a mediator between HIV infection and neurocognitive outcomes. These results suggest a need for prevention efforts (i.e., prior to significant disease progression), as well as specialized intervention for families once the child’s illness has progressed. A number of issues resulting from this finding will require further investigation, including whether, how, and when Journal of Pediatric Psychology, Vol. 26, No. 6, 2001, pp. 363–366

Commentary: HIV Infection and Family Processes: Toward the Next Generation of Research