The Color Object Association Test (COAT): the development of a new measure of declarative memory for 18- to 36-month-old toddlers.

Few methods exist to measure declarative (explicit) memory in children during the toddler and preschool stages of development. We report the development and psychometric properties of a new measure of declarative memory for this age group, the Color Object Association Test (COAT). In pilot testing and large scale application of the test, the COAT was demonstrated to be a reliable and a valid measure of declarative memory for healthy children ages 18-36 months, living in a disadvantaged community. The test shows a linear developmental trajectory, which allows longitudinal examination of the development of declarative memory in children.

Messages from moms: barriers to and facilitators of behavior change in a lead poisoning preventive education project.

Qualitative focus group data from participants of an intensive, culture-specific, lead poisoning preventive education research project were analyzed to assess success of communication strategies, and, specifically, to identify barriers to and facilitators of adopting behavior changes encouraged in the project. Effectiveness of education in preventing lead poisoning is addressed elsewhere. Education focused on housecleaning, hygiene, water, and nutrition. Ninety-five participants (89% of 107 eligible) of six ethnicities agreed to participate in focus groups. Seventy-eight (82%) actually attended. Barriers to behavior change included the effort required or unpleasantness of a prevention strategy, presentation of familiar information, denial of the problem, busyness, perceived lack of control, lack of social support, cultural traditions, and misunderstandings. Requiring one-time behavior changes; teaching simple, easy strategies; making less appealing tasks fun; demonstrating concepts; and presenting novel material that piques interest were features of the education that facilitated behavior change. Factors internal to the participant, such as love of the child or cultural practices, also served to motivate the participant to change behavior or to facilitate adoption of a prevention strategy. We offer recommendations to assist others in designing effective health education and risk communication prevention or intervention programs.

Recommendations from lead poisoning prevention program participants: best practices.

We present a program evaluation of the Phillips Lead Project, a 5-year study of the effectiveness of culture-specific, peer education in maintaining low blood lead levels of children in an inner-city neighborhood. We conducted focus groups to understand how project participants felt about the various strategies employed by the Lead Project. The purpose of this article is to describe their reactions to the project and make recommendations concerning appropriate educational strategies for lead poisoning prevention projects being undertaken in similar communities. Although this project was a research study, many of its methods, and participants' reactions to those methods, are relevant to non-research prevention programs and may be generalizable to other health issues besides lead poisoning.

A randomized trial of education to prevent lead burden in children at high risk for lead exposure: efficacy as measured by blood lead monitoring.

In this article we report on the effectiveness of a community-based, culture-specific, controlled trial of intensive peer education aimed at preventing lead burden in children 0-36 months of age within a neighborhood with high risk for lead exposure. Mothers (n = 594) were randomly assigned to control or intervention groups. Offspring blood lead levels were assessed every 4 months. All participants received brochures on basic lead prevention strategies. Intervention participants were offered 20 bi-weekly educational sessions by same-ethnicity peer educators over the course of 1 year, and quarterly booster sessions for 2 years afterward. The intervention group's educational curriculum included information on lead sources (e.g., paint, dust, water, soil, and risks from home repairs and remodeling), health consequences of lead burden, and strategies to reduce lead exposure, including household cleaning, hygiene, safe use of water, and nutritional recommendations. Results indicated that of the 378 children contributing sufficient blood data for analysis, 23% had blood lead levels > 10 micro g/dL before 3 years of age. Intervention participants were more likely to maintain blood lead levels < 10 micro g/dL than were controls (81% vs. 73%; p = 0.08). Multivariate analyses demonstrated that the intervention reduced the risk of blood lead levels > 10 micro g/dL by approximately 34%. We conclude that although intensive education resulted in a lower proportion of children with elevated lead levels, education alone cannot be relied upon to prevent lead burden.

Two sets of twins with selective mutism: neuropsychological findings.

Neuropsychological data are reviewed from two sets of dizygotic twins presenting with selective mutism characterized by situation specific anxiety, extreme passive behavior, lack of responsivity, lack of peer interaction, and a chronic course of selective mutism. Both sets of twins had a history of prematurity and delayed speech development. One set of twins presented with normal intelligence and normal receptive language skills but with expressive language and oral motor sequencing difficulties. The second set of twins presented with Verbal IQ deficits and significant receptive and expressive language deficits. A summary of current conceptualizations regarding etiology and treatment of selective mutism is provided.