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Using the Brief-ITSEA (BITSEA) in Primary Care CTAIMH Workshop Margaret Briggs-Gowan, Ph.D. University of Connecticut Health Center, Dept. of Psychiatry.

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Presentation on theme: "Using the Brief-ITSEA (BITSEA) in Primary Care CTAIMH Workshop Margaret Briggs-Gowan, Ph.D. University of Connecticut Health Center, Dept. of Psychiatry."— 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 Psychiatry April 30th, 2007

2 Acknowledgements  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.

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

5 Brief-ITSEA (BITSEA) © oScreener for 12- to 36-month-olds oProblems and delays in competence oAutism/Pervasive Developmental Delay oDevelopmentally salient items o42 questions o5 to 7 minutes to complete oEasy to hand score  Multiple informants (parent, childcare)  Many settings (pediatrics, early intervention, childcare)  Reliable and valid

6 BITSEA Scores CompetenceProblems The BITSEA yields two scores…

7 Measurement Development  Reviewed relevant literatures  Included symptoms described in DC 0-3 and relevant DSM diagnoses  Expert panel review to ensure age- appropriateness, coverage of intended domains, and face validity

8 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).

9 Areas Addressed Externalizing Aggression Overactivity Defiance Oppositional behavior Temper tantrums Internalizing Shyness Anxiety Separation distress Behavioral Inhibition Fear of unfamiliar situations Fear of unfamiliar people Specific fears Depression Social withdrawal

10 Areas Addressed Dysregulation Sleep problems Eating problems Emotionally reactive (upset easily) Difficulty regulating emotions Difficulty recovering from distress Sensory sensitivities Atypical Maladaptive Behaviors related to unusual disorders (e.g., autism spectrum, Tourette Disorder), abuse, neglect, and trauma.

11 Competencies  Social and emotional competencies expected to emerge in early childhood.

12 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)

13 BITSEA identifies children at-risk for persistent problems  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

14 Administration Please refer to cheat sheet included in your packets for administration details about how to introduce it, self-report versus interview, etc.

15 Hand-Scoring Walk Thru

16 What does Possible Deficit or Delay in Competence mean? oThe child’s score is in the lowest 10-15% for the child’s age group and sex oMay indicate social-emotional delays oMay 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.

17 What does Possible Problem mean?  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

18 Eye of the beholder  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 parent- child relationship.  BITSEA scores should never be considered “diagnostic.”  Therefore, follow-up is always important.

19 How to follow-up?  Review with the parent  Assess further  Refer  Monitor

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 relationships Pervasiveness across settings Impairment

22 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

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 problems  Frequent occurrence  Intense  Pervasive  Interfere with age-appropriate activities/cause impairment  Multiple behaviors associated with autism spectrum disorders are reported/observed

26 Questions and Discussion


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