Transcript Mental health in early childhood: What do we know and

Using the Brief-ITSEA
(BITSEA) in Primary Care
CTAIMH Workshop
Margaret Briggs-Gowan, Ph.D.
University of Connecticut Health Center,
Dept. of Psychiatry
April 30th, 2007
Acknowledgements
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All research has been in
collaboration with Alice S. Carter,
Ph.D., University of Massachusetts,
Boston.
Special thanks also to Darcy Lowell,
Carol Weitzman, and Michelle White
for their ongoing insights about real
world implementation and
interpretation.
Funding and Disclosures
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Grants from the National Institutes of
Mental Health.
A grant from the Astra Foundation.
Fellowship support from ZEROTOTHREE.
Disclosure: The ITSEA and BITSEA are
published by Psychological Corporation
of Harcourt Assessment.
Presentation Goals
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Present the Brief-ITSEA (BITSEA)
Discuss how to use the BITSEA
Brief-ITSEA (BITSEA)©
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Screener for 12- to 36-month-olds
Problems and delays in competence
Autism/Pervasive Developmental Delay
Developmentally salient items
42 questions
5 to 7 minutes to complete
Easy to hand score
Multiple informants (parent, childcare)
Many settings (pediatrics, early intervention,
childcare)
Reliable and valid
BITSEA Scores
The BITSEA yields two scores…
Problems
Competence
Measurement Development
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Reviewed relevant literatures
Included symptoms described in
DC 0-3 and relevant DSM diagnoses
Expert panel review to ensure ageappropriateness, coverage of intended
domains, and face validity
Problem behaviors
Two types of problem behaviors:
(1) Behaviors that have normal
manifestations but are problematic when
they are of extreme intensity or
frequency (e.g., tantrums) or when
they present as part of a cluster of
problem behaviors.
(2) Unusual or atypical behaviors (e.g.,
autism spectrum behaviors).
Areas Addressed
Externalizing
Internalizing
Aggression
Overactivity
Defiance
Oppositional behavior
Temper tantrums
Shyness
Anxiety
Separation distress
Behavioral Inhibition
Fear of unfamiliar situations
Fear of unfamiliar people
Specific fears
Depression
Social withdrawal
Areas Addressed
Dysregulation
Atypical
Maladaptive
Sleep problems
Eating problems
Emotionally reactive (upset easily)
Difficulty regulating emotions
Difficulty recovering from distress
Sensory sensitivities
Behaviors related to unusual
disorders (e.g., autism spectrum,
Tourette Disorder), abuse, neglect,
and trauma.
Competencies
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Social and emotional competencies
expected to emerge in early
childhood.
Areas Addressed
Social-emotional
Competence
Age-appropriate…
* Symbolic and imitative play
* Play with peers
* Cooperation
* Compliance with adult requests
* Curiosity, interest in new things
* Mastery motivation (tries even when challenged)
* Awareness of others’ feelings (early forms of empathy)
* Attention skills (listens to a book for a few minutes)
* Social relatedness (responds when name called,
interested in babies, looks for parent when upset)
BITSEA identifies children
at-risk for persistent problems
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59% of toddlers with problems
continued to have problems one
year later
Toddlers with high BITSEA scores
were 4 to 5 times more likely
than other children to have
significant problems in elementary
school
Administration
Please refer to cheat sheet included in your
packets for administration details about how
to introduce it, self-report versus interview,
etc.
Hand-Scoring Walk Thru
What does Possible Deficit or
Delay in Competence mean?
o The child’s score is in the lowest 10-15%
for the child’s age group and sex
o May indicate social-emotional delays
o May indicate autism spectrum disorders
Note that some children with scores in this
range may have cognitive or language
delays. However, the BITSEA is not
intended as a screen for these types of
delays.
What does Possible Problem
mean?
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The child’s score occurs in 25% or fewer of
children of the same age and sex
The child may be having social-emotional
problems
Eye of the beholder
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It is important to recognize that as a
parent-report measure, scores on the
BITSEA are the perception of the parent.
Scores may be influenced by factors, such
as knowledge about child development,
parental depression or anxiety, stress in
the family, and difficulties in the parentchild relationship.
BITSEA scores should never be considered
“diagnostic.”
Therefore, follow-up is always important.
How to follow-up?
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Review with the parent
Assess further
Refer
Monitor
Follow-up…
Determine whether parent is concerned or
worried about any specific behaviors.
Explore frequency, intensity, duration,
pervasiveness and impairment.
Be aware that cultural differences may
influence whether or not behaviors are
viewed as problematic.
Considerations for follow-up
Cluster: Is there a pattern of similar behaviors
that seem to go together?
Frequency: How often does the behavior occur?
Intensity: How strongly is it expressed?
Duration: How long does it last?
Triggers: What, if anything, causes behavior?
Pervasiveness across relationships
Pervasiveness across settings
Impairment
Forms of Impairment
• Limit
learning opportunities
• Limit acquisition of age-appropriate
social-emotional skills
• Interfere with development of peer
relationships
• Interfere with child/parent functioning
• Cause marked distress
• Prevent child from attending childcare
or preschool program, expulsion
• Strain the parent-child relationship
Example with separation distress:
You told me that Louis “often”
Cries or hangs onto you when you try to leave.
How often does this happen?
Does this happen every time you leave him
or just some of the time?
Who does this happen with? …new people?
…even people he knows well?
How long does he stay upset?
How upset is he – what does he do?
Do you avoid leaving him with others
because of this?
Example with night-waking:
You said that Louis “Often” Wakes up
at night and needs help to fall
asleep again.
How often does this happen? Most nights? A few times
a week?...How many times a night?...Does he ever
sleep through the night?
How long is Louis awake?
You said he needs your help to fall asleep again –
what do you do to help him?
When to assess further or refer:
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Cluster of problems
Frequent occurrence
Intense
Pervasive
Interfere with age-appropriate
activities/cause impairment
Multiple behaviors associated with
autism spectrum disorders are
reported/observed
Questions and Discussion