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

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.

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.

Presentation Goals

Present the Brief-ITSEA (BITSEA) Discuss how to use the BITSEA

Brief-ITSEA (BITSEA)©

oScreener for 12- to 36-month-oldsoProblems and delays in competenceoAutism/Pervasive Developmental DelayoDevelopmentally salient itemso42 questionso5 to 7 minutes to completeoEasy to hand score

Multiple informants (parent, childcare) Many settings (pediatrics, early intervention,

childcare)

Reliable and valid

BITSEA Scores

CompetenceProblems

The BITSEA yields two scores…

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

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

AggressionOveractivityDefianceOppositional behaviorTemper tantrums

Internalizing

ShynessAnxietySeparation distressBehavioral Inhibition Fear of unfamiliar situationsFear of unfamiliar peopleSpecific fearsDepressionSocial withdrawal

Areas Addressed

Dysregulation

Sleep problemsEating problems Emotionally reactive (upset easily)Difficulty regulating emotionsDifficulty recovering from distressSensory sensitivities

AtypicalMaladaptive

Behaviors related to unusualdisorders (e.g., autism spectrum, Tourette Disorder), abuse, neglect,and trauma.

Competencies

Social and emotional competencies expected to emerge in early childhood.

Areas Addressed

Social-emotionalCompetence

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

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?

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

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.

How to follow-up?

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 relationshipsPervasiveness across settingsImpairment

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:

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