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The Childhood Atopic Dermatitis Impact Scale: CADIS Comes of Age

This subjective parental assessment tool yielded results that were comparable to and more easily obtained than SCORAD system assessments.

Atopic dermatitis (AD) is the number-one cause of chronic skin problems in children, and moderate-to-severe AD profoundly affects quality of life (QOL) for patients and their families. To measure the effect of AD, researchers designed the Childhood Atopic Dermatitis Impact Scale (CADIS) for parents of patients younger than 6 years. The 45-item questionnaire includes questions about the child’s eczema during the last 4-week period, itch intensity, sleep loss, overall skin condition, and QOL. Parents provide answers ranging from "never" to "all the time" in response to five categories of questions:

• Symptoms (My child scratches or rubs her skin.)
  
• Limitations on activity (I limit my child’s outdoor activities, such as playing at beaches and parks.)
  
• Family/social interactions (Children seem to avoid touching or playing with my child because of his skin condition.)
  
• Parental sleep (I am bothered by my child sleeping in my bed.)
  
• Parental emotions (I am angry that my child has this skin condition.)
  

The researchers performed a prospective, longitudinal study to determine whether CADIS accurately reflects AD severity (as shown by the SCORAD score) and clinical improvement after AD treatment. Parents of 301 children with AD (age, <6 years) were asked to fill out the questionnaire; 90% completed it at enrollment, and 84% completed it after 4 weeks of AD therapy. A pediatric dermatologist assigned SCORAD values at each time point.

The CADIS scores correlated well with SCORAD values (e.g., more-severe AD correlated with worse quality of life). In addition, CADIS administered after treatment reflected improved QOL in patients whose disease improved. Because treatment improved AD in all patients, whether CADIS scores would accurately reflect worsening disease could not be determined.

Comment: Learning how to calculate a SCORAD score requires a tutorial, a deck of comparison photos, and a calculator. By contrast, CADIS — a simple QOL questionnaire — requires only a pencil for the parent, yet its value correlates well with the SCORAD value. CADIS obviates the interpretive problems encountered in determining a SCORAD score. Use of subjective parental assessments to generate a disease-severity measurement is an elegant innovation, and CADIS will undoubtedly prove helpful in future AD research.

— Mary Wu Chang, MD

Published in Journal Watch Dermatology July 13, 2007

Citation(s):

Chamlin SL et al. Childhood Atopic Dermatitis Impact Scale: Reliability, discriminative and concurrent validity, and responsiveness. Arch Dermatol 2007 Jun; 143:768-72.

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