Presentation on theme: "Using the Brief-ITSEA (BITSEA) in Primary Care CTAIMH Workshop"— Presentation transcript:
1 Using the Brief-ITSEA (BITSEA) in Primary Care CTAIMH Workshop Margaret Briggs-Gowan, Ph.D.University of Connecticut Health Center, Dept. of PsychiatryApril 30th, 2007
2 AcknowledgementsAll 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.
3 Funding and Disclosures 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.
4 Presentation Goals Present the Brief-ITSEA (BITSEA) Discuss how to use the BITSEA
6 BITSEA ScoresThe BITSEA yields two scores…ProblemsCompetence
7 Measurement Development Reviewed relevant literaturesIncluded symptoms described in DC 0-3 and relevant DSM diagnosesExpert panel review to ensure age-appropriateness, coverage of intended domains, and face validity
8 Problem behaviors Two types of problem behaviors: 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.Unusual or atypical behaviors (e.g., autism spectrum behaviors).
9 Areas Addressed Externalizing Internalizing Aggression Overactivity Defiance Oppositional behaviorTemper tantrumsShyness Anxiety Separation distressBehavioral InhibitionFear of unfamiliar situationsFear of unfamiliar people Specific fears DepressionSocial withdrawalInternalizing
10 Areas Addressed Dysregulation Atypical Maladaptive Sleep problems Eating problems Emotionally reactive (upset easily) Difficulty regulating emotions Difficulty recovering from distressSensory sensitivitiesAtypical MaladaptiveBehaviors related to unusual disorders (e.g., autism spectrum,Tourette Disorder), abuse, neglect, and trauma.
11 CompetenciesSocial and emotional competencies expected to emerge in early childhood.
12 Social-emotional Competence Areas AddressedAge-appropriate… * Symbolic and imitative play* Play with peers* Cooperation* Compliance with adult requestsSocial-emotional Competence* 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)
13 BITSEA identifies children at-risk for persistent problems 59% of toddlers with problems continued to have problems one year laterToddlers with high BITSEA scores were 4 to 5 times more likely than other children to have significant problems in elementary school
14 AdministrationPlease refer to cheat sheet included in your packets for administration details about how to introduce it, self-report versus interview, etc.
16 What does Possible Deficit or Delay in Competence mean? The child’s score is in the lowest 10-15% for the child’s age group and sexMay indicate social-emotional delaysMay indicate autism spectrum disordersNote 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.
17 What does Possible Problem mean? The child’s score occurs in 25% or fewer of children of the same age and sexThe child may be having social-emotional problems
18 Eye of the beholderIt 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 parent-child relationship.BITSEA scores should never be considered “diagnostic.”Therefore, follow-up is always important.
19 How to follow-up?Review with the parentAssess furtherReferMonitor
20 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.
21 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 relationshipsPervasiveness across settingsImpairmentFrequency: How often does this occur? Does this happen every day, a few times a week, once a month…?Intensity: Is the quality extreme/unusual?How long does behavior last? Can child calm/settle herself on own?Duration/Onset:How long has this been going on? Environmental triggers?What brings the behavior on? What precipitates the behavior? What happens before the behavior starts? What is child trying to accomplish or what is the purpose for the child?Pervasiveness across people: With whom does this happen? (Look for one parent, both parents, other caregivers)Pervasiveness across settings: Does this happen in many settings or only at home, childcare, play group, doctor’s office, etc.?
22 Forms of Impairment Limit learning opportunities Limit acquisition of age-appropriate social-emotional skillsInterfere with development of peer relationshipsInterfere with child/parent functioningCause marked distressPrevent child from attending childcare or preschool program, expulsionStrain the parent-child relationship
23 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?
24 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?
25 When to assess further or refer: Cluster of problemsFrequent occurrenceIntensePervasiveInterfere with age-appropriate activities/cause impairmentMultiple behaviors associated with autism spectrum disorders are reported/observed