Home Improvement: Evaluating Secular Changes in NLSY HOME-Cognitive Stimulation and Emotional Support Scores

This study evaluated changes over time in the quality of children's home environment, using the Home Observation Measurement of the Environment (HOME). Longitudinal increases in HOME scores were predicted by both theory and past empirical results. Analysis of the National Longitudinal Survey of Youth Children data (N = 5715, aged 0-14) suggested that HOME scores have been increasing, and that the increase is a family-level phenomenon. The data were a sample of children born to mothers who were approximately representative of the United States in 1979. An increase in HOME scores occurred primarily for the three age categories younger than ten. Effect sizes were of approximately the same magnitude as the Flynn effect for intelligence. These results have implications for policy and future research regarding the home environment.

Measuring atopic eczema symptoms in clinical practice: The first consensus statement from the Harmonising Outcome Measures for Eczema in clinical practice initiative

BACKGROUND

Measuring patient-centered outcomes in clinical practice is valuable for monitoring patients and advancing real-world research. A new initiative from the Harmonising Outcome Measures for Eczema (HOME) group aims to recommend what might be recorded for atopic eczema patients in routine clinical care.

OBJECTIVES

Prioritize outcome domains to measure atopic eczema in clinical practice and select valid and practical outcome measurement instruments for the highest-priority domain.

METHODS

An online survey of HOME members identified and ranked 21 possible health domains. Suitable instruments were then selected for the top-prioritized domain at the HOME VI meeting, using established consensus processes informed by systematic reviews of instrument quality.

RESULTS

Patient-reported symptoms was the top-prioritized domain. In accordance with psychometric properties and feasibility, there was consensus that the recommended instruments to measure atopic eczema symptoms in clinical practice are the POEM, the PO-SCORAD index, or both. The numeric rating scale for itch received support pending definition and validation in atopic eczema.

CONCLUSION

Following the first step of the HOME Clinical Practice initiative, we endorse using the POEM, the PO-SCORAD index, or both for measuring atopic eczema symptoms in clinical practice. Additional high-priority domains for clinical practice will be assessed at subsequent HOME meetings.

The Home Observation Measure of the Environment is associated with symptoms of ADHD and oppositionality in a CAMHS sample

BACKGROUND

Severe early deprivation has a causal role in attention-deficit/hyperactivity disorder (ADHD). Adversity in the home is associated with increased ADHD and oppositional symptoms in children with ADHD. We aimed to replicate this in an independent clinic sample.

METHODS

A total of 247 sequential families with a child referred to child and adolescent mental health services (CAMHS) were invited to participate; 100 families completed the study. The Home Observation Measure of the Environment (HOME) assessment was completed in the family home; parents completed the Conners' Rating Scale.

RESULTS

A less supportive home was associated with more symptoms of inattention ( r = .33, p = .001), hyperactivity/impulsivity ( r = -.22, p = .028) and oppositionality ( r = -.48, significant at p < .000001).

CONCLUSION

The HOME correlates with ADHD and oppositional symptom severity in a clinic sample; more research is required to ascertain whether this is a causal association and the direction of causation. If causal, then the modification of the home environment may be a treatment strategy for ADHD.

A year-long caregiver training program improves cognition in preschool Ugandan children with human immunodeficiency virus

OBJECTIVE

To evaluate mediational intervention for sensitizing caregivers (MISC). MISC biweekly caregiver training significantly enhanced child development compared with biweekly training on health and nutrition (active control) and to evaluate whether MISC training improved the emotional well-being of the caregivers compared with controls.

STUDY DESIGN

Sixty of 120 rural Ugandan preschool child/caregiver dyads with HIV were assigned by randomized clusters to biweekly MISC training, alternating between home and clinic for 1 year. Control dyads received a health and nutrition curriculum. Children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales and the Color-Object Association Test for memory. Caldwell Home Observation for Measurement of the Environment and videotaped child/caregiver MISC interactions also were evaluated. Caregivers were evaluated for depression and anxiety with the Hopkins Symptoms Checklist.

RESULTS

Between-group repeated-measures ANCOVA comparisons were made with age, sex, CD4 levels, viral load, material socioeconomic status, physical development, and highly active anti-retroviral therapy treatment status as covariates. The children given MISC had significantly greater gains compared with controls on the Mullen Visual Reception scale (visual-spatial memory) and on Color-Object Association Test memory. MISC caregivers significantly improved on Caldwell Home Observation for Measurement of the Environment scale and total frequency of MISC videotaped interactions. MISC caregivers also were less depressed. Mortality was less for children given MISC compared with controls during the training year.

CONCLUSIONS

MISC was effective in teaching Ugandan caregivers to enhance their children's cognitive development through practical and sustainable techniques applied during daily interactions in the home.

Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation

BACKGROUND

Clinical signs are a core outcome domain for atopic dermatitis (AD) trials. The current lack of standardization of outcome measures in AD trials hampers evidence-based communication.

OBJECTIVE

We sought to provide evidence-based recommendations for the measurement of clinical signs in AD trials and to inform the Harmonising Outcome Measures for Atopic Dermatitis Initiative.

METHODS

We conducted a systematic review on measurement properties of outcome measurements for clinical signs of AD. We systematically searched MEDLINE and Embase (until October 1, 2012) for validation studies on instruments measuring the clinical signs of AD. Grading of the truth, discrimination, and feasibility of scales; methodological study quality; and recommendations were based on predefined criteria.

RESULTS

Sixteen eligible instruments were identified, of which 2 were best validated. The Eczema Area and Severity Index has adequate validity, responsiveness, internal consistency, intraobserver reliability, and intermediate interobserver reliability but unclear interpretability and feasibility. The Severity Scoring of Atopic Dermatitis Index (SCORAD) has adequate validity, responsiveness, interobserver reliability, and interpretability and unclear intraobserver reliability. Only the objective SCORAD (ie, the clinical signs domain of the SCORAD) is internally consistent. The Six Area, Six Sign Atopic Dermatitis Index severity score and Three Item Severity Score fulfill some quality criteria, but the performance in other required measurement properties is unclear. The Patient-oriented Eczema Measure is reliable and responsive but has inadequate content validity to assess clinical signs of AD. The remaining 11 scales have either (almost) not been validated or performed inadequately.

CONCLUSIONS

The Eczema Area and Severity Index and SCORAD are the best instruments to assess the clinical signs of AD. The other 14 instruments identified are (currently) not recommended because of unclear or inadequate measurement properties.

Blood lead concentrations < 10 microg/dL and child intelligence at 6 years of age

BACKGROUND

Few studies provide data directly relevant to the question of whether blood lead concentrations < 10 microg/dL adversely affect children's cognitive function.

OBJECTIVE

We examined the association between blood lead concentrations assessed throughout early childhood and children's IQ at 6 years of age.

METHODS

Children were followed from 6 months to 6 years of age, with determination of blood lead concentrations at 6, 12, 18, and 24 months, and 3, 4, 5, and 6 years of age. At 6 years of age, intelligence was assessed in 194 children using the Wechsler Preschool and Primary Scale of Intelligence-Revised. We used general linear and semiparametic models to estimate and test the association between blood lead concentration and IQ.

RESULTS

After adjustment for maternal IQ, HOME scale scores, and other potential confounding factors, lifetime average blood lead concentration (mean = 7.2 microg/dL; median = 6.2 microg/dL) was inversely associated with Full-Scale IQ (p = 0.006) and Performance IQ scores (p = 0.002). Compared with children who had lifetime average blood lead concentrations < 5 microg/dL, children with lifetime average concentrations between 5 and 9.9 microg/dL scored 4.9 points lower on Full-Scale IQ (91.3 vs. 86.4, p = 0.03). Nonlinear modeling of the peak blood lead concentration revealed an inverse association (p = 0.003) between peak blood lead levels and Full-Scale IQ down to 2.1 microg/dL, the lowest observed peak blood lead concentration in our study.

CONCLUSIONS

Evidence from this cohort indicates that children's intellectual functioning at 6 years of age is impaired by blood lead concentrations well below 10 microg/dL, the Centers for Disease Control and Prevention definition of an elevated blood lead level.

The Home Observation for Measurement of the Environment Revisited

This review describes the Home Observation for Measurement of the Environment (HOME). After describing the structure of the instrument, it shows how it has been used successfully in studies on normally developing children and on samples drawn from high-risk populations. These are followed by studies showing how the HOME has been used to evaluate interventions. Although most interventions are not designed primarily on the basis of the HOME outcomes, the instrument has been used as a measure of the effectiveness of the intervention schedule. HOME has been used extensively in research to reveal relationships between several aspects of the home environment and children's developmental outcomes. The very good relationship between HOME scores and children's measures of developmental competence has also been found in non-normative populations and research has attempted to identify the specific aspects of the home environment, as indexed by the HOME subscales that reveal the strengths or the weaknesses of homes of at-risk populations.